Foreign Travel (cont.)
Rabies, Typhoid Fever, and Yellow Fever
Rabies: Rabies is spread through contact with infected secretions, often from a bite wound from an infected animal. Infected saliva can spread disease into open cuts. In caves, disease may occur when bat guano is aerosolized and inhaled. Dogs, cats, skunks, raccoons, bats, cattle, and foxes are among animals that can transmit rabies.
- Rabies is caused by a virus that works its way into the brain over days to months. Once there, the virus causes coma and is virtually always fatal. Travelers at high risk include veterinarians, spelunkers (cave explorers), and those who will handle wild animals. Travelers should avoid petting, touching, or playing with animals in developing countries.
- Travelers to developing countries who will not have access to medical care for prolonged periods should consider vaccination.
- Bite wounds should be cleaned immediately with soap and water. Unless there is a way of ensuring that the animal is free of rabies, the bitten traveler should be evaluated by experienced medical personnel and will require vaccination to prevent rabies from occurring. Although the vaccine available in the United States is relatively safe, vaccines available in developing countries may cause significant side effects. Further, the cleanliness of needles used for injection may be a concern. In most cases, evacuation to a developed country for vaccination is recommended even if this would delay vaccination by a few days. Sometimes, an injection of rabies antibodies is also needed. Even travelers who have been vaccinated in the past need to be evaluated and often vaccinated after bite wounds.
Typhoid fever: Typhoid fever is a bacterial infection of the intestinal tract and blood stream. It is spread by contaminated food and water. The bacteria are passed in the feces and urine of those infected. Therefore, infection can occur by eating food handled by someone who has not washed their hands after using the bathroom or by drinking water directly contaminated by sewage containing the bacteria.
- Regions affected include the Indian subcontinent and other developing countries in Asia, Africa, the Caribbean, and Central and South America. There are approximately 22 million cases worldwide. Approximately
200-300 cases are reported annually in the United States, mostly among travelers.
- Fever is the hallmark of the disease. Headache, weakness, stomach pains, diarrhea, and loss of appetite can occur. Some people may develop a rash of flat, rose-colored spots that usually disappears in three or four days. Although most people clear the bacteria from their system, a few may appear to recover but still shed the bacteria in their stool. These carriers feel fine but can inadvertently spread the disease to others.
- Antibiotic therapy is the only effective treatment for typhoid fever. Supportive measures, including fluids, medications to bring down fevers, and appropriate nutrition are also important.
- Frequent hand washing is recommended, as are food and water precautions.
- Two new typhoid vaccines are available. One is a capsule by mouth requiring a booster every five years and the other is an injection with a booster recommended every two years. Both vaccines are safe and effective. Vaccines need to be completed at least one week before travel.
Yellow fever: Yellow fever is a viral infection that is spread by mosquitoes. The disease occurs in sub-Saharan Africa and South America. It has never been documented in Asia. The CDC provides current information about which countries and regions are affected.
- People who are infected get fatigued, become feverish, and their skin turns yellow. A small number die. The diagnosis can be confirmed by blood tests. No specific treatment is available for yellow fever.
- Those traveling to at-risk areas should take general precautions against exposure to mosquitoes. Wearing long-sleeved shirts and long pants, using insect repellents containing DEET on exposed skin and permethrin-containing repellents on clothing, and staying in screened-in and air-conditioned areas can reduce mosquito bites. However, the vaccination is the most important measure for protection, and therefore it is important to contact a health-care provider at least two weeks before travel to determine if the vaccination is recommended.
- The yellow fever vaccine is a safe and effective vaccine that can only be given at authorized yellow fever vaccination centers. Protection occurs in 95% of those who receive the vaccine and takes place within one week. After one dose, protection lasts for 10 years. Those traveling to areas at risk should talk to their health-care provider before receiving the vaccine. Vaccination is sometimes required before travelers are permitted to enter selected countries. Some countries require vaccination only if the traveler is coming from an infected area. The United States is not an infected area. An International Certificate of Vaccination, stamped by an official vaccinating center, affords proof of vaccination. In the United States, the CDC is responsible for licensing official vaccination centers. The official vaccination certificate is good for 10 years.
Medically Reviewed by a Doctor on 9/10/2014
Mary D. Nettleman, MD, MS, MCAP
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