Welcome to our April edition of the Travel Health Bulletin. In this month’s edition we look at Schistosomiasis (Bilharzia) and the latest Zika guidance for healthcare professionals
In terms of its impact Schistosomiasis is second to malaria as the most devastating parasitic infection affecting almost 240 million people worldwide. For travellers visiting endemic countries they could be at significant risk, but are we discussing the risk and prevention in our travel health consultations? Below we discuss some keys points to help inform our travellers of the risks.
Schistosomiasis is present in many countries, particularly in the African continent. Countries in Central and South America arte also affected as well as some countries in Asia including Laos and Cambodia. These are all popular destinations with travellers.
Most travel-associated cases of Schistosomiasis are contracted in sub-Saharan Africa. Infection is spread in rivers and water sources. High risk areas include: Lake Malawi, Lake Victoria, the Omo River (Ethiopia), the Zambezi River, and the River Nile.
Risk of infection includes swimming, bathing, wading and undertaking water sporting activities in contaminated freshwater (streams, lakes and rivers). Infection cannot be contracted in saltwater such as the sea. Showering in lodges close by infected lakes is also a potential source of infection as water is often drawn directly from lakes themselves. Wading through streams on walking safaris is also a hazard.
Symptoms include tingling skin, rash, fever, headache, muscle ache, bloody diarrhoea/urine, cough, tiredness, and abdominal pain. These symptoms will usually appear within a few days or weeks after being infected. Some will experience no symptoms at all. Left untreated, Schistosomiasis can cause chronic illness damaging the bladder, genital organs, kidneys, liver and spleen, heart, lungs and intestines. It can cause irreversible damage and cancer.
There is no vaccine or any drug available to prevent infection. Avoid all skin contact with fresh water in countries of risk and avoid engaging in activities in these waters including diving, sailing and windsurfing. Avoid drinking infected water and showering in nearby lodges. Wear waterproof footwear if possible. Even if the tour operator claim that the water is safe.
Lake Malawi is well known for its water sporting activities with people running them insisting that the water is safe. There are many cases of travellers experiencing severe Schistosomiasis infection.
Infection should be treated in a specialist infectious disease unit. Praziquantel is the only drug available that will destroy adult worms. A check up on return home is advised to travellers who may have put themselves at risk.
Zika virus – latest resources to help advise clients on Zika virus risks, infection and advice for pregnant women and those planning pregnancy and their partners
At Nomad, we have a lot of clients seeking further advice on the Zika virus including a lot of questions regarding pregnancy.
On Travelhealthpro.org you will find the following:
• An algorithm for ZIKV showing advice for pregnant women, those planning pregnancy and their partners. This can be downloaded as a PDF and put up in clinic - click here.
• Zika Virus country maps, showing areas with high risk of Zika transmission. These maps can be found on Travelhealthpro.org, country information pages in the ‘other risk’ section. To see an example - click here.