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This diarrhoeal disease can cause rapid dehydration and death. Cholera is caused by a bacteria, Vibrio cholerae. It's transmitted from person to person by direct contact (often via healthy carriers of the disease) or via contaminated food and water. It can be spread by seafood, including crustaceans and shellfish, which get infected via sewage. Cholera exists where standards of environmental and personal hygiene are low. Every so often there are massive epidemics, usually due to contaminated water in conditions where there is a breakdown of the normal infrastructure.
The time between becoming infected and symptoms appearing is usually short, between one and five days. The diarrhoea starts suddenly, and pours out of you. It's characteristically described as 'ricewater' diarrhoea because it is watery and flecked with white mucus. Vomiting and muscle cramps are usual, but fever is rare. In its most serious form, it causes a massive outpouring of fluid (up to 20L a day). This is the worst case scenario - only about one in 10 sufferers get this severe form. It's a self-limiting illness, meaning that if you don't succumb to dehydration, it will end in about a week without any treatment.
You should seek medical help urgently; in the meantime, start re-hydration therapy with oral re-hydration salts. You may need antibiotic treatment with tetracycline, but fluid replacement is the single most important treatment strategy in cholera.
Prevention is by taking basic food and water precautions, avoiding seafood and having scrupulous personal hygiene. The currently available vaccine is not thought worthwhile as it provides only limited protection for a short time.
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. Hepatitis A is transmitted by contaminated food and drinking water. Seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious in pregnant women.
Hepatitis B is spread through contact with infected blood, blood products or body fluids, for example through sexual contact, unsterilised needles (and shaving equipment) and blood transfusions, or contact with blood via small breaks in the skin. 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. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.
There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types. Following the basic rules about food and water (hepatitis A and E) and avoiding risk situations (hepatitis B, C and D) are important preventative measures.
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.
Not every headache is likely to be meningitis. There is an effective vaccine available which is often recommended for travel to epidemic areas. Generally, you're at pretty low risk of getting meningococcal meningitis, unless an epidemic is ongoing, but the disease is important because it can be very serious and rapidly fatal. You get infected by breathing in droplets coughed or sneezed into the air by sufferers or, more likely, by healthy carriers of the bacteria. You're more at risk in crowded, poorly ventilated places, including public transport and eating places.
The symptoms of meningitis are fever, severe headache, neck stiffness that prevents you from bending your head forward, nausea, vomiting and sensitivity to light, which makes you prefer the darkness. With meningococcal meningitis, you may get a widespread, blotchy purple rash before any other symptoms appear. Meningococcal meningitis is an extremely serious disease that can cause death within a few hours of you first feeling unwell. Seek medical help without delay if you have any of the symptoms listed earlier, especially if you are in a risk area.
If you've been in close contact with a sufferer it's best to seek medical advice.
