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Lack of oxygen at high altitudes (over 2500m) affects most people to some extent. The effect may be mild or severe and occurs because less oxygen reaches the muscles and the brain at high altitudes, requiring the heart and lungs to compensate by working harder. Symptoms of Acute Mountain Sickness (AMS) usually develop during the first 24 hours at altitude but may be delayed up to three weeks. Mild symptoms include headache, lethargy, dizziness, difficulty sleeping and loss of appetite. AMS may become more severe without warning and can be fatal. Severe symptoms include breathlessness, a dry, irritative cough (which may progress to the production of pink, frothy sputum), severe headache, lack of coordination and balance, confusion, irrational behaviour, vomiting, drowsiness and unconsciousness. There is no hard-and-fast rule as to what is too high: AMS has been fatal at 3000m, although 3500m to 4500m is the usual range.
Treat mild symptoms by resting at the same altitude until recovery, which usually takes a day or two. Paracetamol or aspirin can be taken for headaches. If symptoms persist or become worse, however, immediate descent is necessary; even 500m can help. Drug treatments should never be used to avoid descent or to enable further ascent.
Diamox (acetazolamide) reduces the headache of AMS and helps the body acclimatise to the lack of oxygen. It is only available on prescription and those who are allergic to the sulfonamide antibiotics may also be allergic to Diamox.
Heat exhaustion occurs following heavy sweating and excessive fluid loss with inadequate replacement of fluids and salt. This is particularly common in hot climates when taking unaccustomed exercise before full acclimatisation. Symptoms include headache, dizziness and tiredness. Dehydration is already happening by the time you feel thirsty - aim to drink sufficient water such that you produce pale, diluted urine. The treatment of heat exhaustion involves fluid replacement with water or fruit juice or both, and cooling by cold water and fans. The treatment of the salt loss component involves consuming salty fluids such as soup or broth, and adding a little more table salt to foods than usual.
Heat stroke is much more serious. This occurs when the body's heat-regulating mechanism breaks down. Excessive rise in body temperature leads to sweating ceasing, irrational and hyperactive behaviour and eventually loss of consciousness and death. Rapid cooling by spraying the body with water and fanning is an ideal treatment. Emergency fluid and electrolyte replacement by intravenous drip is usually also required.
Mosquitoes may not carry malaria but can cause irritation and infected bites. Using DEET-based insect repellents will prevent bites. Mosquitos also spread dengue fever.
Bees and wasps only cause real problems to those with a severe allergy (anaphylaxis). If you have a severe allergy to bee or wasp stings you should carry an adrenaline injection or similar. Sand flies are found around the Mediterranean beaches. They usually cause only a nasty, itchy bite but can carry a rare skin disorder called cutaneous leishmaniasis. Bites may be prevented by using DEET-based repellents.
Scorpions are frequently found in arid or dry climates. They can cause a painful bite which is rarely life threatening.
Bed bugs are often found in the hostels and cheaper hotels. They lead to very itchy lumpy bites. Spraying the mattress with an appropriate insect killer will do a good job of getting rid of them.
Scabies are also frequently found in cheap accommodation. These tiny mites live in the skin, particularly between the fingers. They cause an intensely itchy rash. Scabies is easily treated with lotion available from pharmacies; people who you come into contact with also need treating to avoid spreading scabies between asymptomatic carriers.
Do not walk barefoot or stick your hand into holes or cracks. Half of those bitten by venomous snakes are not actually injected with poison (envenomed). If bitten by a snake, do not panic. Immobilise the bitten limb with a splint (eg a stick) and apply a bandage over the site, using firm pressure, similar to a bandage over a sprain. Do not apply a tourniquet, or cut or suck the bite. Get the victim to medical help as soon as possible so that antivenin can be given if necessary.
Diphtheria is spread through close respiratory contact. It causes a high temperature and severe sore throat. Sometimes a membrane forms across the throat requiring a tracheostomy to prevent suffocation. Vaccination is recommended for those likely to be in close contact with the local population in infected areas. The vaccine is given as an injection alone, or with tetanus, and lasts 10 years.
Spread through the bite of an infected sand fly, leishmaniasis can cause a slowly growing skin lump or ulcer. It may develop into a serious life-threatening fever usually accompanied with anaemia and weight loss. Infected dogs are also carriers of the infection. Sand fly bites should be avoided whenever possible.
Several different viruses cause hepatitis; they differ in the way that they are transmitted. The symptoms in all forms of the illness include fever, chills, headache, fatigue, feelings of weakness and aches and pains, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes.
There are 6 known types of viral hepatitis:A, B, C, D, E and G. G is not dangerous. A and E are passed on by the fecal-oral route of transmission; there is a vaccine. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. A and E cause an acute illness, but you will recover fully from it.
B and D are passed on via blood, saliva, semen and vaginal fluids. They can be passed on by close contact, sexual contact, and blood-to-blood contact. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or a long-term carrier state. There is a vaccine.
Hepatitis C is only passed on from blood-to-blood contact. There is no vaccine.
HIV is spread via infected blood and blood products, sexual intercourse with an infected partner and from an infected mother to her newborn child. It can be spread through 'blood to blood' contacts such as contaminated instruments during medical, dental, acupuncture and other body piercing procedures and sharing used intravenous needles.
Spread through bites or licks on broken skin from an infected animal, rabies is fatal. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of post-bite vaccine is not available within 24 hours. Three injections are needed over a month. If you have not been vaccinated you will need a course of five injections starting within 24 hours or as soon as possible after the injury. Vaccination does not provide you with immunity, it merely buys you more time to seek appropriate medical help.
Tuberculosis (TB) is spread through close respiratory contact and occasionally through infected milk or milk products. BCG vaccine is recommended for those likely to be mixing closely with the local population. It is more important for those visiting family or planning on a long stay, and those employed as teachers and health-care workers. TB can be asymptomatic, although symptoms can include cough, weight loss or fever months or even years after exposure. An x-ray is the best way to confirm if you have TB. BCG gives a moderate degree of protection against TB. It causes a small permanent scar at the site of injection, and is usually only given in specialised chest clinics. As it's a live vaccine it should not be given to pregnant women or immunocompromised individuals. The BCG vaccine is not available in all countries.
Also known as enteric fever, typhoid is transmitted via food and water, and symptomless carriers, especially when they're working as food handlers, are an important source of infection. Typhoid is caused by a type of salmonella bacteria, Salmonella typhi. Paratyphoid is a similar but milder disease.
The symptoms are variable, but you almost always get a fever and headache to start with, which initially feels very similar to flu, with aches and pains, loss of appetite and general malaise. Typhoid may be confused with malaria. The fever gradually rises during a week. Characteristically your pulse is relatively slow for someone with a fever. Other symptoms you may have are constipation or diarrhoea and stomach pains.
You may feel worse in the second week, with a constant fever and sometimes a red skin rash. Other symptoms you may have are severe headache, sore throat and jaundice. Serious complications occur in about one in 10 cases, including, most commonly, damage to the gut wall with subsequent leakage of the gut contents into the abdominal cavity.
Seek medical help for any fever (38C and higher) that does not improve after 48 hours. Typhoid is a serious disease and is not something you should consider self-treating.
Re-hydration therapy is important if diarrhoea has been a feature of the illness, but antibiotics are the mainstay of treatment.
Yellow fever vaccination is not required for Morocco. However, the mosquito that spreads yellow fever has been known to be present in some parts of the Middle East and Africa. It is important to consult your local travel health clinic as part of your pre-departure plans for the latest details. For this reason, any travellers from a yellow fever endemic area will need to show proof of vaccination against yellow fever before entry. This normally means if arriving directly from an infected country or if the traveller been in an infected country during the last 10 days. We would recommend however that travellers carry a certificate if they have been in an infected country during the previous month to avoid any possible difficulties with immigration. Travellers should carry a certificate as evidence of vaccination if they have recently been in an infected country, to avoid any possible difficulties with immigration. For a full list of these countries visit the World Health Organization website (www.who.int/wer/) or the Centers for Disease Control and Prevention website (www.cdc.gov/travel/yb/outline.html). There is always the possibility that a traveller without a legally required, up-to-date certificate will be vaccinated and detained in isolation at the port of arrival for up to 10 days or possibly repatriated. The yellow fever vaccination must be given at a designated clinic and is valid for 10 years. It is a live vaccine and must not be given to immunocompromised or pregnant travellers.
