Iran - Andrew Burke [352]
Standards of dental care are variable and there is an increased risk of hepatitis B transmission via poorly sterilised equipment. Travel insurance usually only covers emergency dental treatment.
For minor illnesses such as diarrhoea, pharmacists can often provide advice and sell over-the-counter medication. They can also advise when more specialised help is needed.
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INFECTIOUS DISEASES
Diphtheria
Diphtheria is spread through close respiratory contact. It causes a high temperature and severe sore throat. Sometimes a membrane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years.
Hepatitis A
Hepatitis A is spread through contaminated food (particularly shellfish) and water. It causes jaundice and, although it is rarely fatal, can cause prolonged lethargy and delayed recovery. Symptoms include dark urine, a yellow colour to the whites of the eyes, fever and abdominal pain. Hepatitis A vaccine (Avaxim, VAQTA, Havrix) is given as an injection: a single dose will give protection for up to a year while a booster 12 months later will provide a subsequent 10 years of protection. Hepatitis A and typhoid vaccines can also be given as a single dose vaccine, hepatyrix or viatim.
Hepatitis B
Infected blood, contaminated needles and sexual intercourse can all transmit hepatitis B. It can cause jaundice, and affects the liver, occasionally causing liver failure. All travellers should make this a routine vaccination. (Many countries now give hepatitis B vaccination as part of routine childhood vaccination.) The vaccine is given singly, or at the same time as the hepatitis A vaccine (hepatyrix). A course will give protection for at least five years. It can be given over four weeks, or six months.
HIV
HIV remains mercifully rare in Iran but the growing use of prostitutes and, more problematically, the large number of intravenous drug users, means the HIV rate is rising. For some visa types Iran requires a negative HIV test.
Leishmaniasis
Spread through the bite of an infected sand fly, leishmaniasis can cause a slowly growing skin lump or ulcer. It may develop into a serious life-threatening fever usually accompanied with anaemia and weight loss. Infected dogs are also carriers of the infection. Sand-fly bites should be avoided whenever possible.
Malaria
There is very little malaria in Iran. Still, it’s worth knowing that malaria almost always starts with shivering, fever and sweating. Muscle pains, headache and vomiting are common. Symptoms may occur anywhere from a few days to three weeks after the infected mosquito bite. The illness can start while you are taking preventative tablets if they are not fully effective, and may also occur after you have finished taking your tablets.
Poliomyelitis
Generally poliomyelitis is spread through contaminated food and water. It is one of the vaccines given in childhood and should be boosted every 10 years, either orally (a drop on the tongue), or as an injection. Polio may be carried asymptomatically, although it can cause a transient fever and, in rare cases, potentially permanent muscle weakness or paralysis.
Rabies
Spread through bites or licks on broken skin from an infected animal, rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. Three injections are needed over a month. If you have not been vaccinated you will need a course of five injections starting within 24 hours or as soon as possible after the injury. Vaccination does not provide you with immunity; it merely