type of infectious illness are second only to diarrhoea
as a cause of illness in travellers. Certain situations encountered
when travelling place travellers at an increased risk of acquiring
a respiratory infection.
Catching a cold at home is easy enough but travelling
will increase your susceptibility and expose you to new germs
to which you have no natural immunity.
Coughs, colds and sore throats
are very common in travellers but can be easily treated using
over the counter remedies which are available in pharmacies
and drug stores world-wide. Antibiotics can be purchased over
the counter in many countries but should be avoided in this
instance since they are totally ineffective against cold viruses.
majority of respiratory tract infections are viral and
are therefore not susceptible to antibiotic treatment. When
prescribed, antibiotics are often for secondary infections.
Many travellers spend long
periods of time in crowded conditions such as airports, hotels
etc. These places provide ideal conditions for spreading many
acute respiratory infections like common colds and influenza.
aircraft cabin atmospheres and smoking more than usual
(even passively), exposure to new allergens, dust and city
air pollution will all contribute to respiratory symptoms.
although not themselves infections of the respiratory tract
are also spread through the respiratory route and there have
been outbreaks in tourist resorts. Vaccination should be considered
for those at risk in endemic areas during outbreaks.
These infections are difficult
to prevent because of the ease with which they are spread
from person to person. Those liable to chest infections may
benefit from taking an 'emergency' course of antibiotics with
known as the flu, is a very contagious disease that is caused
by the influenza virus. It attacks the respiratory tract in
humans and is different from a cold. Influenza usually comes
on suddenly and may include the following symptoms:-
are known as the classic "flu-like" symptoms and
are not unlike the symptoms of other illnesses such as malaria.
Indeed many people have mistaken the onset of malaria for
a bout of flu and have not taken appropriate action with sometimes
Flu is most
common during the winter season, which in the southern
hemisphere is summer in the northern hemisphere and visa-versa.
It can occur year round in the tropics. Although Influenza
is a familiar illness, and is often fairly mild in many healthy
adults it is however, a serious and sometimes fatal illness
among frail and elderly persons. Vaccination should be considered
for those at risk.
viruses are spread is from person to person by "droplet
spread". This happens when droplets from a cough or sneeze
of an infected person are propelled through the air. The viruse
also can be spread when a person touches respiratory droplets
on another person (e.g. by shaking hands) and that person
then touches their own mouth or nose (or someone elses
mouth or nose) before washing their hands.
A person can start spreading the flu virus one day before
he or she feels sick and can continue to pass the flu virus
to others for another three to seven days after the symptoms
start. Symptoms start one to four days after the virus enters
the body. Some persons can be infected with the flu virus
but have no symptoms but they can still spread the virus to
can spread more easily amongst large groups of people living
in relatively close proximity to each other e.g. cruise ships.
Influenza is caused by a virus, so antibiotics don't work
to cure it. The best way to prevent the flu is to get an influenza
vaccine each autumn, before the flu season. If you do happen
to get it, then the following treatment should be undertaken:-
plenty of fluids
drinking alcohol and smoking tobacco
medication to relieve the symptoms
diphtheria is a bacterial infection that causes a moderately
sore throat with a greyish membrane over the infected area
(usually membranes of the tonsils, pharynx, or nose) with
low grade fever. In severe cases the neck tissue may become
passed from person to person by droplet transmission, usually
by breathing in diphtheria bacteria after an infected person
has coughed, sneezed or even laughed. It can also be spread
by handling used tissues or by drinking from a glass used
by an infected person.
countries the infection may occur as skin ulcers and is known
as cutaneous diphtheria which presents as infected skin lesions
which lack a characteristic appearance.
two to six weeks, the effects of toxins produced by the bacteria
become apparent with severe muscle weakness, mainly affecting
the muscles of the head and neck. Inflammation of the heart
muscle may cause heart failure. Myocarditis, polyneuritis,
and airway obstruction are common complications of respiratory
diphtheria; death occurs in 5%-10% of respiratory cases.
is usually by direct person to person contact. Avoid very
close contact with infected people particularly kissing and
sharing bottles or glasses. It spreads quickly amongst infected
people in crowded places. Cutaneous lesions are also important
remains endemic in developing countries and the countries
of the former Soviet Union have reported an epidemic which
began in 1990.
is specialised and requires medical supervision in hospital
where Diphtheria antitoxin is given as an intramuscular or
intravenous injection as soon as possible. The infection is
then treated with antibiotics, such as penicillin or erythromycin.
There is a vaccine for diphtheria. Most people in the UK receive
their first dose as a child in the form of a combined vaccine
called DTP (diphtheria-tetanus-pertussis).
Immunisation: is very effective but protective immunity is
not present longer than 10 years after the last vaccination,
so it is important for adults at risk to get a booster of
tetanus-diptheria (Td) vaccine every 10 years.
disease, a form of pneumonia
is a severe infection which is
caused by the bacterium Legionella Pneumophila. It
has been linked to contaminated
water used in water cooled air-conditioning systems and sometimes
is believed to occur worldwide.
Legionella organisms can be found in many types of water systems.
However, the bacteria reproduce to high numbers in warm, stagnant
water such as that found in certain plumbing systems and hot
water tanks, cooling towers and evaporative condensers of
large air-conditioning systems, and whirlpool spas.
of legionellosis have occurred after persons have breathed
mists that come from a water source (e.g., air conditioning
cooling towers, whirlpool spas, showers) contaminated with
Legionella bacteria. Persons may be exposed to these mists
in hotels, hospitals, or public places.
Legionaires' is not passed from person to person, and there
is no evidence of persons becoming infected from auto air
conditioners or household window air-conditioning units.
People of any age may get Legionnaires' disease, but the illness
most often affects middle-aged and older persons, particularly
those who smoke cigarettes or have chronic lung disease. The
time between the patient's exposure to the bacterium and the
onset of illness for Legionnaires' disease is 2 to 10 days.
There is a significant mortality rate particularly among the
Patients with Legionnaires' disease usually have fever, chills,
and a cough, which may be dry or may produce sputum. Some
patients also have muscle aches, headache, tiredness, loss
of appetite, and, occasionally, diarrhoea.
Erythromycin is the antibiotic currently recommended for treating
persons with Legionnaires' disease. In severe cases, a second
drug, rifampicin, may be used in addition. Other drugs are
available for patients unable to tolerate erythromycin.
tuberculosis is a contagious bacterial infection caused by
Mycobacterium tuberculosis (TB). The lungs are primarily involved
causing persistent cough with fever and sweating, but the
infection can spread to other organs. The disease
is slow to establish itself and general malaise, weakness
and weight loss are characteristic during this incubation
which may be up to twelve weeks. The disease is characterised
by the development of granulomas (granular tumours) in the
is much more common in some parts of the world than in the
UK. The risk to travellers is limited since transmission of
the disease usually requires prolonged close contact. Sometimes
the disease can be overwhelming; producing meningitis and
coma; this particularly dangerous form is usually found in
children and those who have not previously been vaccinated
or exposed to the disease. Recently, antibiotic-resistant
strains of tuberculosis have appeared.
can develop after inhaling droplets sprayed into the air from
a cough or sneeze from an infected person and it can also
spread through infected sputum and there is a form spread
through milk from infected cows. The risk of contracting TB
increases with the frequency of contact with people who have
the disease, and with crowded or unsanitary living conditions
and poor nutrition.
TB develops in the minority of people whose immune systems
do not successfully contain the primary infection. The disease
may occur within weeks after the primary infection, or it
may lie dormant for years before causing disease. The extent
of the disease can vary from minimal to massive involvement,
but without effective therapy, the disease becomes progressive.
the elderly, and individuals who are immunocompromised, those
undergoing transplant surgery who are taking anti rejection
medications are at higher risk for progression of the disease
or reactivation of dormant disease. Those who have not received
BCG immunisation are advised to do so and if for travel purposes,
at least six weeks before departure to ensure a protective
level of immunity.
with anti microbial drugs is effective but is prolonged and
requires medical supervision. It is also expensive and not
always available abroad. Incomplete treatment of TB infections
(such as failure to take medications for the prescribed length
of time) can contribute to the emergence of drug-resistant
strains of bacteria.
Avoid overcrowded places in endemic areas, particularly where
spitting is common. Never drink unpasteurised milk. If in
doubt, boil it before drinking. There is a vaccination (BCG)
which can give a valuable degree of protection, particularly
in children. Travellers who plan to spend more than a month
in an area with a high tuberculosis rate and who have not
been previously immunised should consider immunisation with
(Severe Acute Respiratory Syndrome)
a severe pneumonia that has been reported in China Hong Kong,
Vietnam, Singapore, Taiwan, Indonesia, the Philippines, Thailand
and Canada. It appears to have spread in a short period of
time and is now regarded by the World Health Organisation
as a worldwide threat.
Travellers to areas where SARS has been reported should be
aware of the symptoms and seek immediate medical advice should
they develop any symptoms within ten days of returning from
an infected region.
Since April 2nd (2003) the Department of Health has strongly
advised against travel to Hong Kong and Guangdong Province
in southern China where the disease appears to have its origins.
More recently they have added Beijing and Shanxi Province
in China and Toronto in Canada. Travellers are also advised
to ensure that they have adequate insurance to cover medical
care and unplanned extensions to their stay.
in the UK are most likely to occur in people returning from
an affected area, especially one where transmission is thought
to be continuing
such as Hong Kong or Guangdong Province. Recent data suggests
that transmission has slowed or stopped in certain areas i.e.
Canada, Singapore, Vietnam and Taiwan but caution is still
The infection is thought to be passed on by close contact
with an infected person, aerosol infection if it occurs is
rare. The initial signs are a flu like illness developing
within ten days of contact. Symptoms include rapid onset of
high fever followed by headache, muscle aches and respiratory
symptoms including cough, sore throat, shortness of breath
and difficulty breathing. There have been numerous fatalities.
organism responsible for SARS was originally thought to be
a paramyxo virus similar to the viruses responsible for causing
measles and mumps but It has now been identified as a member
of the coronavirus family never previously seen in humans.
Identification of the coronavirus means that scientists can
now move towards developing treatments for SARS and successfully
controlling the disease. At present there is no specific treatment.
such as the one in Toronto which affected family members and
health care workers are thought to have occurred early in
the epidemic when the significance of the condition was not
appreciated. Where infection control measures are applied,
outbreaks seem not to occur. Therefore, anyone thought to
be suffering from the illness should be isolated and nursed
using barrier techniques. Secondary infections can be controlled
with antibiotics and symptomatic treatment undertaken.
Type A influenza viruses can infect several
animal species, including birds, pigs & horses. Birds
are an especially important species because all known subtypes
of the virus circulate among wild birds, which are considered
the natural hosts for influenza A viruses and when they infect
birds they are known as "avian influenza viruses."
Avian influenza viruses do not usually directly infect humans
or circulate among humans.
influenza usually does not make wild birds sick, but can make
domesticated birds very sick and kill them. They do not usually
infect humans; however, several instances of human infections
and outbreaks have been reported since 1997. When such infections
occur, public health authorities monitor the situation closely
because of concerns about the potential for more widespread
infection in the human population.
reported symptoms of avian influenza in humans have ranged
from typical influenza-like symptoms (e.g., fever, cough,
sore throat and muscle aches) to eye infections, pneumonia,
acute respiratory distress, viral pneumonia, and other severe
and life-threatening complications.
there is no definitive evidence of human-to-human transmission
of avian influenza and no infections have been documented
among health-care workers. While it is unusual for people
to get influenza infections directly from animals, such transmission
has been documented several times in recent years and is under
investigation although most human cases have been linked to
direct contact with diseased birds.
World Health Organisation and other health authorities worldwide
are seriously concerned over the co-circulation of human and
highly pathogenic animal influenza viruses since an exchange
of genes between the two viruses might occur if individuals
were co-infected with both viruses which could give rise to
a new virus to which humans would have little or no immunity
and which could be transmitted from person to person.
recommended that travellers to countries experiencing outbreaks
of avian influenza in poultry should avoid areas with live
poultry, such as live animal markets and poultry farms. Large
amounts of the virus are known to be excreted in the droppings
from infected birds. Be sure to include a thermometer and
alcohol-based hand sanitiser for hand hygiene in your travel