Foreign Travel (cont.)
Malaria, Meningococcal Meningitis, Plague, and Polio
Malaria: Malaria is a disease transmitted by the bite of an infected female Anopheles mosquito. Transmission occurs mostly in areas of Central and South America, Haiti, the Dominican Republic, Africa, Asia (including the Indian subcontinent, Southeast Asia, and the Middle East), Eastern Europe, and the South Pacific.
- Fever is the major symptom of malaria. The disease must always be suspected when fever occurs during or after travel to an infected area. In addition, flu-like symptoms can occur, including chills, headaches, muscle aches, and fatigue. The disease may also cause seizures, mental confusion, kidney failure, coma, and death.
- Travelers should observe mosquito precautions that include protective clothing, screened windows, mosquito netting, and insect repellants containing DEET. Currently no vaccine is available, but there are medications that can be taken before, during, and after exposure to prevent the disease. The CDC provides information both via the Internet and through a 24-hour hotline (1-877-FYI-TRIP, 1-877-394-8747) for detailed recommendations on proper medication for the destination and specific prevention tips.
- Several medications are available. The specific type of medication and length of treatment depends on several factors including the traveler's destination. The medicine does not stop the mosquito from biting or the organism from entering the bloodstream. The goal of taking the medication is to destroy the organisms before they have a chance to take hold. Thus, the medications must be continued after leaving the malaria-prone area.
Meningococcal meningitis: Meningococcal meningitis is a bacterial infection of the lining around the brain and spinal cord. The bacteria are transmitted from person to person through
respiratory secretions spread through coughing, sneezing, and oral secretions.
- The disease occurs sporadically in clusters throughout the world. However, the most significant outbreaks occur in sub-Saharan Africa, known as the "Meningitis Belt," extending from Senegal to Ethiopia and recently extending further south into the Great Lakes regions. Transmission is higher in the dry seasons. Those traveling to the meningitis belt during the dry season should be advised to receive the vaccine.
- During the Hajj, the annual pilgrimage to Mecca, Saudi Arabia hosts thousands of wayfarers from all over the world. Crowded conditions and arrivals from the infected zone of Africa combine to create the potential for an epidemic. Due to an outbreak associated with the 1987 Hajj, Saudi Arabia requires that Hajj and Umrah visitors have a certificate of vaccination before entering the country.
- Symptoms of meningitis include sudden onset of fever, intense headache, stiff neck, nausea, and vomiting. Other symptoms may include confusion or coma. This disease is potentially fatal and should be considered a medical emergency.
- Meningococcal meningitis can be treated with a number of effective antibiotics. Vaccination is not required for entry into any country except Saudi Arabia, for those traveling to Mecca during the annual Hajj and Umrah pilgrimage.
- The bacteria that cause meningococcal meningitis have developed into five slightly different strains, known as serotypes. Currently two vaccines are available. One has been available since 1981, and the other, thought to provide better and longer lasting protection, was licensed in 2005. The newer vaccine is also thought to be better at preventing the disease from spreading from person to person. Both vaccines can prevent four strains of the disease, including two of the three most common in the United States and one type that causes epidemics in Africa. Travelers should check to see if the vaccine is recommended for their destination and receive the vaccine at least one week before departure.
Plague: Plague is caused by a bacteria called Yersinia pestis and is
typically transmitted when people are bitten by fleas or rodents. It has gained attention in recent years as a potential weapon of bioterrorists. Transmission usually requires close contact with rodents in a rural area. Only a handful of cases have been reported in American travelers in the last century. Due to the very low risk of disease, plague is not a concern for the routine traveler. No vaccine is available. Travelers who will live or work in close contact with rodents, such as field biologists, may consider taking daily doxycycline to reduce the risk of disease.
Plague can rarely be spread via respiratory secretions when a person with plague pneumonia coughs. However, such infections are seen only in epidemic situations and are more of historical interest than posing a real threat to the modern traveler.
Polio: Although vaccination has eliminated naturally occurring polio in North and South America, rare cases continue to occur in developing countries of Africa, the Middle East,
Afghanistan, and Pakistan. The disease is caused by a virus that is spread when human waste is inadvertently swallowed. Symptoms include muscle aches and paralysis. Many infected people never have any symptoms. Travelers to infected areas should be immune to polio. For most adults who have already been vaccinated in the remote past, this means a single vaccine
booster dose of the injectable vaccine before travel.
Medically Reviewed by a Doctor on 8/3/2016
Mary D. Nettleman, MD, MS, MCAP
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