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Car jacking and 'smash and grabs' are the current main dangers and annoyances. Although the number of incidents and degree of violence are a far cry from Johannesburg and other notorious areas, it is a reality. There have been recent reports of smartly dressed young men asking drivers to wind down their windows to answer a query, whereupon the perpetrator sprays mace or something similar into the driver's eyes. Drivers must avoid stopping at traffic lights at night, should drive with all doors locked, ensure handbags and valuables are locked in the car boot (trunk), and windows should be wound up completely.
This disease is spread by flukes (minute worms) that are carried by a species of freshwater snail. The flukes are carried inside the snail, which then sheds them into slow-moving or still water. The parasites penetrate human skin during paddling or swimming and then migrate to the bladder or bowel. They are passed out via stool or urine and could contaminate fresh water, where the cycle starts again. Avoid paddling or swimming in suspect freshwater lakes or slow-running rivers. There might be no symptoms. There might be a transient fever and rash, and advanced cases might have blood in the stool or in the urine. A blood test can detect antibodies if you might have been exposed, and treatment is then possible in specialist travel or infectious disease clinics. If not treated the infection can cause kidney failure or permanent bowel damage. It is not possible for you to infect others. Self-treatment: none.
Cholera is usually only a problem during natural or artificial disasters, eg war, floods or earthquakes, although small outbreaks can also occur at other times. Travellers are rarely affected. It is caused by a bacteria and spread via contaminated drinking water. The main symptom is profuse watery diarrhoea, which causes collapse if fluids are not replaced quickly. An oral cholera vaccine is available in the USA, but it is not particularly effective. Most cases of cholera could be avoided by close attention to good drinking water and by avoiding potentially contaminated food. Treatment is by fluid replacement (orally or via a drip), but sometimes antibiotics are needed. Self-treatment is not advised.
If you are travelling in endemic areas it is extremely important to avoid mosquito bites and to take tablets to prevent this disease. Symptoms range from fever, chills and sweating, headache, diarrhoea and abdominal pains to a vague feeling of ill-health. Seek medical help immediately if malaria is suspected. Without treatment malaria can rapidly become more serious and can be fatal. If medical care is not available, malaria tablets can be used for treatment. You should seek medical advice, before you travel, on the right medication and dosage for you. If you do contract malaria, be sure to be re-tested for malaria once you return home as you can harbour malaria parasites in your body even if you are symptom free.
Travellers are advised to prevent mosquito bites at all times. The main messages are: wear light-coloured clothing; wear long trousers and long-sleeved shirts; use mosquito repellents containing the compound DEET on exposed areas (prolonged overuse of DEET may be harmful, especially to children, but its use is considered preferable to being bitten by disease-transmitting mosquitoes); avoid perfumes and aftershave; use a mosquito net impregnated with mosquito repellent (permethrin) - it may be worth taking your own, and impregnating clothes with permethrin effectively deters mosquitoes and other insects.
Found in all of Africa. Rabies is spread by receiving the bites or licks of an infected animal on broken skin. It is always fatal once the clinical symptoms start (which might be up to several months after an infected bite), so postbite vaccination should be given as soon as possible. Postbite vaccination (whether or not you've been vaccinated before the bite) prevents the virus from spreading to the central nervous system. Animal handlers should be vaccinated, as should those travelling to remote areas where a reliable source of postbite vaccine is not available within 24 hours. Three preventive injections are needed over a month. If you have not been vaccinated you will need a course of five injections starting 24 hours or as soon as possible after the injury. If you have been vaccinated, you will need fewer postbite injections, and have more time to seek medical help. Self-treatment: none.
Yellow fever is spread by infected mosquitoes. Symptoms range from a flulike illness to severe hepatitis (liver inflammation), jaundice and death. 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. Self-treatment: none.
HIV (Human Immuno-deficiency Virus) develops into AIDS (Acquired Immune Deficiency Syndrome), which is a fatal disease. Any exposure to blood, blood products or body fluids may put the individual at risk. The disease is often transmitted through sexual contact or dirty needles - body piercing, acupuncture, tattooing and vaccinations can be potentially as dangerous as intravenous drug use. HIV and AIDS can also be spread via infected blood transfusions, but blood supplies in most reputable hospitals are now screened, so the risk from transfusions is low. If you do need an injection, ask to see the syringe unwrapped in front of you, or take a needle and syringe pack with you. Fear of HIV infection should not preclude treatment for any serious medical conditions. Most countries have organisations and services for HIV-positive folks and people with AIDS. For a list of organisations divided by country, plus descriptions of their services, see www.aidsmap.com.
