Middle East - Anthony Ham [560]
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, and can be given over four weeks or six months.
HIV
Countries in the Middle East covered by this book that require a negative HIV test as a visa requirement for some categories of visas (not tourist visas) include Egypt, Jordan and Lebanon.
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 by anaemia and weight loss. Sand fly bites should be avoided whenever possible. Infected dogs are also carriers. Leishmaniasis is present in Iraq, Israel and the Palestinian Territories, Jordan, Lebanon, Syria and Turkey.
Leptospirosis
Leptospirosis is spread through the excreta of infected rodents, especially rats. It can cause hepatitis and renal failure that may be fatal. It is unusual for travellers to be affected unless living in poor sanitary conditions; the greatest risk is in Turkey. The disease causes a fever and jaundice.
Malaria
The prevalence of malaria varies throughout the Middle East. Many areas are considered to be malaria free, while others have seasonal risks. The risk of malaria is minimal in most cities; however, check with your doctor if you are considering travelling to any rural areas. It is important to take antimalarial tablets if the risk is significant. For up-to-date information about the risk of contracting malaria in a specific country, contact your local travel health clinic.
Anyone who has travelled in a country where malaria is present should be aware of the symptoms of malaria. It is possible to contract malaria from a single bite from an infected mosquito. Malaria almost always starts with marked 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 spread through contaminated food and water, polio is present, though rare, throughout the Middle East. 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 (present in all countries of the Middle East) is fatal. Animal handlers should be