Common travel-related illnesses

By Dr Martie Conradie, MBChB (UP), Diploma in Child Health (SA), Diploma in HIV Management (SA)

Getting ill while travelling

Nobody wants to have their travels cut short by illness or for it to be remembered as a terrible trip. Many studies have been done to investigate travel related illnesses and it has been found that about 22-87% of people experience some type of illness or affliction that is travel-related, with the highest risk of getting ill if you travel to a developing country.

Illnesses and afflictions

Traveller’s diarrhoea

Diarrhoea is NOT something you want to experience while travelling. But always be prepared, since nearly 50% of international travellers experience it during or after a trip.

Consuming contaminated food or drinks are the most common culprits, but even washing hands with contaminated water can result in an infection. Symptoms include diarrhoea, stomach cramps, fever and dehydration.

Always remember that the most important part of management is staying hydrated. Increase your fluid intake of clean water or rehydration solutions and look out for warning signs such as having a very dry mouth or feeling very weak. If these signs are present, visit a doctor to treat you with intravenous fluids and antibiotics or other medication to kill the suspected organism.

Jet lag

This is not really an illness, but not managing it properly can affect the quality of your stay. It makes you feel drained and tired because of the disruption of your normal sleep-wake cycle. Spending time in the sun and pacing your meals to fall into the local routine may help. Read up before your travels and visit your GP to discuss possibly using medication if it is a trip where you cannot afford to be jet lagged but be aware that using sleep aids or taking naps after landing might delay the adjustment to the local time.

Respiratory tract infections, including influenza

This is the most common complaint of travellers. Sometimes you will only have a slightly runny nose, but you may also become severely ill. Most often the cause of an infection is viral, but bacterial or fungal infections may occur. Aeroplanes, public facilities and places where high numbers of people gather are often where you become infected.

Nowadays, COVID-19 is a major concern, and you have likely been well educated about all the preventive steps to take. Fortunately, by following these steps, you actually reduce your chances of getting any of the other respiratory tract infections. It is therefore worth the effort to stick to the rules of wearing a mask and following good hygienic practices.

Getting an annual influenza vaccine before you travel is advised. It takes a few weeks to build your immunity, so plan it ahead of time. Pack some over-the-counter treatment to manage flu-like symptoms when they start and drink plenty of fluids.

Immediately seek help if you become short of breath or experience any of the warning signs of COVID-19 (such as loss of taste or smell, fever or fatigue).

Motion sickness

What a horrible feeling! I suffer from this and inevitably experience my stomach turning every time we go over the breathtakingly beautiful Outeniqua or Long Tom Passes.

Basically, what happens is that your inner ears and other senses detect motion, but your eyes don’t. This then mixes up the signals reaching the brain and it triggers nausea, vomiting and dizziness.

Over-the-counter medicines are available and if you plan to go on a boat cruise for the first time, it is a really good idea to be prepared.

Sunburn

Ouch…you know the feeling when your skin screams that you have neglected it while being in the sun! It burns like crazy, chafes where clothes touch it, starts blistering or peeling a few days later and some of you might even obtain a few more freckles. Unfortunately, these are not the only problems associated with sunburn. You can even develop sunstroke or heat exhaustion which might lead to feeling really bad for several days and you might end up in hospital. With every episode of sunburn, you also increase your risk of developing skin cancer.

Use sunscreen, wear a hat and be extra careful with kids since their skin is less resistant to sun damage. If you do get sun burnt, treat your skin with a good after sun product, drink plenty of fluids and stay out of the sun until your skin is healed.

Animal or insect bites or stings

Other than burning or itchy bites, some insects can cause serious illnesses. A tiny mosquito can cause malaria, West Nile virus or dengue fever, and a little tick’s bite can result in tick-bite fever or other rickettsial infections. Depending on what you do during your trip, you may also be exposed to bites or stings from other animals, such as jellyfish, snakes or spiders. Read up about the dangerous animals found in the places you travel to.

In South Africa, malaria and tick-bite fever are common.

Malaria

Malaria is mainly present in parts of three of nine South African provinces (Limpopo, Mpumalanga, and KwaZulu-Natal) with very little transmission in winter. It is a mosquito-borne disease and symptoms include headaches, dizziness, fever and even neurological symptoms such as hallucinations. It can have dire consequences and therefore the use of prophylactic medicine is advised when you travel to high-risk areas. If you are going to visit an endemic area, talk to your doctor for the correct anti-malaria drug to be prescribed. If possible, rather do not travel to high-risk areas if you are pregnant or have young children, since the infection can have especially bad consequences in these cases.

If you develop any of the symptoms described a week or up to a few months after travelling to high-risk areas, immediately visit your doctor and have a test done.

Tick-bite fever

Ticks can be carriers of dangerous bacteria such as Rickettsia africae, which is the bacteria often responsible for tick-bite fever in South Africa. If you plan to walk in areas where there may be ticks, wear protective clothing and frequently use DEET-based insect repellent. Also, occasionally check every part of your body. Ticks are often missed when they are in the areas between your toes or on the insides of your thighs.

People may be asymptomatic, only have mild symptoms or experience fever, headache, muscle pains, swollen lymph nodes or a rash. Doctors will look for an inoculation eschar, which is the blackish dead tissue around a bite site, and it is often pathognomonic of tick-bite fever.

West Nile Virus

This is another infection transmitted through the bites of mosquitoes. It is more common in tropical regions such as East Africa or the Caribbean. If you travelled to these regions and develop fever, fatigue, headache, nausea, swollen lymph gland or a rash, seek medical attention and tell the doctor where you’ve travelled to.

Dengue Fever

Dengue fever is one more illness caused by mosquitoes. It is common in India, Southern China and Africa. Symptoms include fever, weakness, nose bleeds and headaches. Prevention of mosquito bites is important.

Schistosomiasis (Bilharzia)

Schistosomiasis is endemic in large parts of South Africa. Even standing for a short while in contaminated water puts you at risk. There are different types, such as S. mansoni and S. japonicum. Their life cycle includes being present in various forms in snails, water and humans. They initially hatch from eggs, then penetrate the tissue of snails. Thereafter they are shed in water, from where they infect people when the larval form penetrates the skin. Inside the human host, maturity is reached, and eggs are laid. The eggs can be shed in stool or urine, which then contaminate fresh water again.

The symptoms in humans are due to the immunological reaction to the eggs that are trapped in tissues. The body tries to get rid of these foreign substances, but often ends up causing more damage without getting rid of everything.

A few days after becoming infected, a rash or itchy skin may occur. Within one to two months you may develop a fever, chills, cough or muscle aches. Blood in the urine may also be seen.

It is usually easily treated if it is diagnosed early, but unfortunately this condition is often missed and it can lead to chronic problems because of the damage that was caused to the tissues.

Travelling with pre-existing medical conditions

If you have an underlying condition, it is important to remember the following:

• Be well educated about your condition, e.g. know what to look out for as the indicators of a hypoglycaemic episode if you are a diabetic.
• Know what emergency numbers to use or which healthcare facilities will be nearby.
• Visit your doctor before departure to ensure you are fit for travel.

What treatment to take with you

The importance of a good first aid kit cannot be overemphasised. The following may be added to complete the “pharmacy” component of the kit:

• Chronic medicine and treatment you must use often for a specific condition – it is also good to take a copy of your script with you in case it needs to be reissued unexpectedly.
• Your malaria prophylaxis if you visit a malaria area.
• DEET-containing or other insect repellent – oil of lemon eucalyptus is also good at repelling insects and there is a product called Permethrin that can be used on clothes or shoes to repel insects.
• Antihistamine tablets – there are good over-the-counter preparations available for you and your kids and these are very handy when you suddenly realise you might be more allergic than you thought to the tree pollen while on your safari.
• Saline nasal spray – mucous membranes love saline and you will do yourself a favour using this nasal spray to reduce the risk of the membranes drying out during flights or in dry climates.
• Electrolyte containing rehydration preparations (e.g. Tasectan, Smecta or Rehydrate)
• Emulsifying ointment to moisturise skin.
• An analgesic for pain. Paracetamol is good and has very few interactions or side effects. An anti-inflammatory may also be packed.
• Hand sanitiser.
• Water purification tablets to make water safe for drinking.
• Sunblock (SPF 30 or higher) and after sun soothing gel.
• Unless you go to a very remote place or have a specific condition that you require it for, it is not advised to pack antibiotics. A visit to a doctor when you are sick enough to require antibiotics, is advised.

Getting ill while travelling or shortly after returning

Several of the illnesses described earlier can be managed by yourself and with some treatment from your medicines kit, but do not wait too long before seeking help. If symptoms do not seem to improve or if you develop any symptoms indicative of COVID, seek help. You can even have a virtual consultation with your usual GP.

Go to a doctor if you develop a fever, especially if you have travelled to a malaria-area or if you might have been bitten by ticks. Malaria and tick-bite fever are life-threatening conditions if not managed appropriately and they are easily misdiagnosed initially because their symptoms mimic a lot of other conditions.

Healthy travel habits

Not all travel illnesses are completely preventable, but there are a few things you can do to protect yourself:

• Make sure your vaccines are up to date – hepatitis A and B, influenza, yellow fever (if travelling to a high-risk country), measles, etc.
• Wash and sanitise your hands often.
• Drink plenty or clean water.
• Preferably eat hot food and avoid cold, raw or unpasteurised products, especially those from street vendors you are not familiar with. The CDC has a slogan ‘boil it, peel it, or forget it’ which might be a safe principle to use on travels.
• Sleep enough.
• Use an emollient to moisturise your skin.
• Keep insects at bay by wearing protective clothes and using good insect repellent.

May you all have a wonderful holiday and if you are travelling, may you stay healthy.