Iran - Andrew Burke [353]
Tuberculosis
Tuberculosis (TB) is found in Iran, especially in the southeast. TB is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population. It is more important for those planning on a long stay or mixing closely with local people. TB can be asymptomatic, although symptoms can include cough, weight loss or fever months or even years after exposure. An X-ray is the best way to confirm if you have TB. BCG gives a moderate degree of protection against TB. It causes a small permanent scar at the site of injection, and is usually only given in specialised chest clinics. As it’s a live vaccine it should not be given to pregnant women or immunocompromised individuals. The BCG vaccine is not available in all countries.
Typhoid
This is spread through food or water that has been contaminated by infected human faeces. The first symptom is usually fever or a pink rash on the abdomen. Septicaemia (blood poisoning) may also occur. Typhoid vaccine (typhim Vi, typherix) will give protection for three years. In some countries, the oral vaccine Vivotif is also available.
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TRAVELLER’S DIARRHOEA
While water is safe to drink almost everywhere in Iran, avoiding tap water unless it has been boiled, filtered or chemically disinfected can help you avoid diarrhoea. Eat only fresh fruits or vegetables if cooked and avoid dairy products that might contain unpasteurised milk. Freshly prepared meals are best; while pre-prepared dishes like khoresht should be avoided by anyone with a fragile stomach.
If you develop diarrhoea, be sure to drink plenty of fluids, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as loperamide). If diarrhoea is bloody, persists for more than 72 hours, is accompanied by fever, shaking, chills or severe abdominal pain you should seek medical attention.
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ENVIRONMENTAL HAZARDS
Heat Illness
Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt, and travellers will be especially susceptible during Iran’s oven-hot summers, particularly if you are engaging in a greater level of exercise than you usually would. Be especially careful on desert treks out of places like Yazd.
Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty – aim to drink sufficient water such that you produce pale, diluted urine. The treatment of heat exhaustion consists of fluid replacement with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt loss component consists of salty fluids as in soup or broth, and adding a little more table salt to foods than usual. Electrolyte replacement sachets are the easiest and fastest way to treat dehydration.
Heatstroke is much more serious. This occurs when the body’s heat-regulating mechanism breaks down. An excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Insect Bites & Stings
Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitoes also spread dengue fever.
Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar.
Scorpions are frequently found in arid or dry climates. They can cause a painful