Middle East - Anthony Ham [561]
Rift Valley Fever
This haemorrhagic fever, which is found in Egypt, is spread through blood or blood products, including those from infected animals. It causes a ‘flu-like’ illness with fever, joint pains and occasionally more serious complications. Complete recovery is possible.
Schistosomiasis
Otherwise known as bilharzia, this is spread through the freshwater snail. It causes infection of the bowel and bladder, often with bleeding. It is caused by a fluke and is contracted through the skin from water contaminated with human urine or faeces. Paddling or swimming in suspect freshwater lakes or slow-running rivers should be avoided. There may be no symptoms. Possible symptoms include a transient fever and rash, and advanced cases of bilharzia may cause blood in the stool or in the urine. A blood test can detect antibodies if you have been exposed and treatment is then possible in specialist travel or infectious-
disease clinics. Be especially careful in Egypt, Iraq and Syria.
Tuberculosis (TB)
Tuberculosis 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 visiting family or planning on a long stay, and those employed as teachers and health-care workers. TB can be asymptomatic, although symptoms can include coughing, 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
Typhoid 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.
Yellow Fever
Yellow fever vaccination is not required for any areas of the Middle East. However, the mosquito that spreads yellow fever has been known to be present in some parts of the region. It is important to consult your local travel health clinic as part of your predeparture plans for the latest details. For this reason, any travellers from a yellow fever endemic area (eg parts of sub-Saharan Africa) will need to show proof of vaccination against yellow fever before entry. This normally means if arriving directly from an infected country or if the traveller has been in an infected country during the last 10 days. We would recommend, however, that travellers carry a certificate if they have been in an infected country during the previous month to avoid any possible difficulties with immigration. There is always the possibility that a traveller without an up-to-date certificate will be vaccinated and detained in isolation at the port of arrival for up to 10 days, or even repatriated. The yellow fever vaccination must be given at a designated clinic, and is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers.
TRAVELLER’S DIARRHOEA
To prevent diarrhoea, avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine tablets). Eat only fresh fruits or vegetables if cooked or if you have peeled them yourself, and avoid dairy products that may contain unpasteurised