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This Health Brief is only valid for this journey This Travel Health Brief was prepared for: Fee BellamyYear Of Birth - 1995 - Gender - Female Postcode - TA5 2EG Journey Details - Travelling to the following countries and returning on 15-Aug-2011
Destination: 1. South Africa
Arrival Date: 26-Jul-2011
The vaccination and malaria advice for your journey is summarised below. For further details please read the full Health Brief. The actual travel advice, vaccinations and malaria tablets given to you may vary and will depend on a number of factors. Please take any vaccination records to your travel clinic appointment.
Ensure you are in date for the standard UK vaccination schedule Recommended
To be considered
- Tetanus - Typhoid Fever - Hepatitis B - Rabies - Cholera - Tuberculosis (TB) Malaria is present in the following countries: Health Brief created on 02-Nov-2010 at 11:25 AM Page 1 of 6 This Health Brief is only valid for this journey There are no compulsory vaccinations for your journey Recommended Vaccinations For Your Journey Travellers should be in date for the standard UK vaccination schedule.
Diphtheria
Diphtheria is usually spread by close contact with infected persons. In the UK, the combined diphtheria/tetanus/polio vaccine is recommended when diphtheria boosters are indicated for adults. A diphtheria booster lasts 10 years.
Hepatitis A
Hepatitis A is a viral infection which occasionally causes severe liver disease. It is usually spread by contaminated food and water. Effective hepatitis A vaccines are available, and boosters last up to 20 years. The requirement for these vaccinations may depend on your activities, lifestyle or length of stay. You should discuss
these with your travel health adviser.

Tetanus is a serious infection, usually contracted following contamination of wounds. In the UK, after 5 doses of vaccine, tetanus boosters are not routinely required unless travelling to areas with limited medical care. In the UK, the combined diphtheria/tetanus/polio vaccine is recommended when tetanus boosters are indicated. A tetanus booster lasts 10 years.
Typhoid Fever
Typhoid fever is a bacterial infection usually spread by contaminated food and water. It can cause serious illness, but vaccines offer up to 80% protection. Vaccination is generally less important for short-stay travellers staying in good accommodation.
Hepatitis B
Hepatitis B is a viral infection which can cause serious liver disease. It is usually spread sexually and by contact with infected blood or body fluids (e.g. puncture of the skin with contaminated needles). Vaccination is recommended for long-stay travellers, and those at risk due to their medical history, activities, or work. The vaccine is usually given as a 3 dose course over 6 months but rapid courses are possible.
Rabies is a viral infection usually spread by the saliva of infected animals. Human cases are usually due to dog bites but many animals can be infected, and a scratch or lick may be sufficient to transmit the disease. Rabies is fatal once symptoms begin. Pre-exposure vaccination is recommended for long-stay travellers, those remote from medical help (>24 hours), and animal handlers. All travellers must seek prompt post-exposure vaccines if bitten/scratched.
Cholera is spread by contaminated food and water. It is rare in travellers, as outbreaks tend to occur in areas with poor sanitation. An oral vaccine is available for those at risk (e.g. those working in slum areas, refugee camps or hospitals, those visiting friends and family in areas reporting cases, military personnel in conflict zones, and those visiting rural areas with recent outbreaks).
Tuberculosis (TB)
TB is transmitted by close contact with infected people. The BCG vaccine is effective in preventing the more serious forms of TB in children but may be less effective in adults. Vaccination should be considered for those under 16 years of age who are going to live or mix with local people for more than 3 months. Older travellers may be considered for vaccination if at risk due to their work or activities. Boosting this vaccine is not recommended. The Mantoux skin test is generally required prior to BCG vaccination. Health Brief created on 02-Nov-2010 at 11:25 AM Page 2 of 6 This Health Brief is only valid for this journey Malaria is a dangerous disease that is spread by mosquitoes that bite from dusk to dawn.
Avoiding mosquito bites
Use an effective insect repellant and apply it regularly.
Wear long sleeved shirts and long trousers, especially in the evening.
Clear your room at night with a knock-down spray (fly spray).
Plug-in insecticide vaporisers are very effective.
Air conditioning provides an effective deterrent; otherwise consider sleeping under a mosquito net impregnated with residual insecticide.
Geographical Risk:
The following section describes the geographical risk of malaria, country by country, for your journey. This information is compiled using various reliable sources including the World Health Organisation, current UK Malaria Guidelines and local outbreak reports. If antimalarial drugs are recommended in your Health Brief they will provide cover for your whole journey as we do not generally advise changing antimalarials while you are travelling.
South Africa
Malaria (mainly Plasmodium falciparum) is present in the low altitude
areas of Mpumalanga Province (including the Kruger National Park),
Northern Province and north-eastern KwaZulu-Natal as far south as Jozini
(see darker shading on map). The risk is highest from September to May.
A low risk of malaria exists as far south as Richard's Bay. Antimalarial tablets are not usually recommended for this area (see lighter shading on map) but precautions against mosquito bites are recommended. Major cities (Johannesburg, Cape Town and Durban) have no malaria risk.
Malaria maps are for guidance only. Malaria borders can change. If there is any doubt, we advise you take antimalarial drugs.
Click on the map above to enlarge the image.
Recommended antimalarial drugs
If you are at risk of malaria (see above), one of the following schedules is recommended for your journey. They are all effective. Your travel health adviser should discuss which will be the most suitable for you. The schedules for children may be different. Please read the country specific malaria descriptions. Remember it is essential not to miss a dose.
Frequency
Doxycycline
Take with or after food with plenty of cool fluid. Do not lie down for at least one hour after taking the capsule/tablet. You should start taking these capsules/tablets 2 days before entering the first malarial area of your journey and continue them regularly for 4 weeks after leaving the last malarial area. Children under 12yrs and women who are pregnant or breast feeding should not take this drug. Rarely, this drug can make the skin sensitive to sunlight. A high factor sunscreen may help prevent this.
Malarone
Take with food or a milky drink at the same time each day. You should start these tablets 1-2 days before entering the first malarial area of your journey and continue them regularly for 1 week after leaving the last malarial area. In the UK, Malarone is licensed for use on trips up to 28 days, yet safety studies have shown no problems with 6 months use.
Mefloquine
Health Brief created on 02-Nov-2010 at 11:25 AM Page 3 of 6 This Health Brief is only valid for this journey Mefloquine is not suitable for everybody therefore its use MUST be discussed with your travel health adviser. You should start these tablets at least 1 week (preferably 2-3 weeks) before entering the first malarial area of your journey and continue them regularly for 4 weeks after leaving the last malarial area.
Alternative antimalarial drugs
If the above antimalarial drugs are not suitable for you, it is essential to discuss alternative drugs with your travel health adviser Malaria symptoms and treatment
The most important symptom to remember is a raised temperature of 38°C or higher starting at least 1 week after first potential exposure to malaria. Other symptoms are variable and cannot be relied on. If you do develop a fever a week or more after exposure to malaria, you must seek medical attention as soon as possible. If you cannot get to medical attention within 24 hours and your condition is deteriorating, you should consider emergency self-treatment. For Adults, 4 tablets of Malarone as a single dose on each of three consecutive days can be taken if you are not already taking Malarone to prevent malaria. If you are taking Malarone, your travel health adviser may wish to contact us to discuss alternative treatment options.
The following section includes some of the other health risks you may encounter on your journey.
Travellers' Diarrhoea
There is a significant risk of travellers’ diarrhoea on your journey. Most cases resolve without treatment, but take care with food and water hygiene. Avoid high risk foods such as salads, shellfish, raw/undercooked meat and fish, and unpasteurised dairy products. Drink bottled water with intact seals or boil/purify water. If you do get symptoms, drink plenty of non-alcoholic fluids to avoid dehydration. Oral rehydration solutions are useful for children and older travellers who can become dehydrated quickly in hot climates. If you feel hungry, continue to eat, but avoid fatty foods. A diarrhoea treatment pack with an antidiarrhoeal drug (e.g. loperamide) and antibiotic (e.g. ciprofloxacin - a prescription is needed) can help.
Chikungunya
Chikungunya fever is a viral infection spread by day-time biting mosquitoes. It causes fever, headache, tiredness, rash and muscle/joint pain. Symptoms usually last a few days and there is no specific treatment. Travellers should avoid mosquito bites.
Schistosomiasis (Bilharzia)
Schistosomiasis is a parasitic infection that can be contracted by swimming or wading in infested lakes and rivers. The infection can penetrate intact skin, and can cause long-term illness. Travellers should avoid wading, swimming, or other contact with freshwater in affected countries. If exposed, screening tests and effective treatment are available.
Sexually Transmitted Infections (STIs)
For various reasons travellers are more at risk of contracting sexually transmitted infections (STI's). Many countries report a high incidence of STI's such as HIV, hepatitis B, chlamydia, gonorrhea and syphilis. Casual, unprotected sexual contact is ill-advised.
The WHO estimate that around 18.1% of the adult population are living with HIV/AIDS. Various studies have shown the infection rate amongst sex workers to be 50-70%.
West Nile Fever
West Nile Fever is a viral infection spread by the bite of mosquitoes. It usually causes flu-like symptoms, but can rarely cause fatal brain infection. There is no specific treatment. Travellers should avoid mosquito bites.
Altitude Illness
Some regions on your journey are at high altitude. If travelling to high altitudes, gradual ascent is recommended as altitude illness can affect many travellers, and is not dependent on age, gender or level of fitness. It is caused by the reduced partial pressure of oxygen at altitude and is common over 2,500m. Acute mountain sickness is a mild form of the condition and symptoms include headache, loss of appetite, nausea and lethargy. If these symptoms are ignored then altitude illness may progress to high altitude pulmonary oedema and high altitude cerebral oedema both of which are potentially life threatening.
Health Brief created on 02-Nov-2010 at 11:25 AM Page 4 of 6 This Health Brief is only valid for this journey South Africa
African tick bite fever is a risk for travellers whose activities involve walking through bush and grasslands in South Africa. Travellers who are engaging in outdoor activities in rural areas, such as campers and hikers, should take precautions against tick bites, check their skin for ticks regularly, and remove any attached ticks promptly using a pair of tweezers or tick remover. The FCO report that hospital treatment in large cities of South Africa is good but can be expensive. Medical facilities in rural areas can be basic. In remote areas, air evacuation is sometimes the only option for medical emergencies. Rabies is frequently reported in South Africa. An outbreak amongst dogs has been reported in SW Johannesburg with the suspected death of a child, Sept 10. An Irish traveller working with animals died from rabies in 2008. Large outbreaks of measles have been reported in many regions including Cape Town, the Western Cape and North West Province during 2010. Over 15,500 cases, including 18 deaths, have been recorded, June 10. Local communities may have poor vaccination coverage. 2 doses of the MMR vaccine are recommended for protection.
Over 12,700 cases of cholera have been reported in South Africa Jan-July 09. Mplumalanga, Limpopo and Gauteng provinces have been most severely affected. Cases of cholera are predominately reported in slum areas and townships. 10,520 cases were officially reported by the WHO during 2009.
221 cases of Rift Valley fever (RVF) have been reported in Free State, Eastern Cape, North West and Northern Cape provinces, June 10. The majority of cases have been reported in farm workers or vets with close contact with infected livestock. Rift Valley fever is a potentially fatal viral infection. It is transmitted by infected mosquitoes or by direct contact with blood/bodily fluids of infected animals. Travellers should avoid mosquito bites by using effective repellents and wearing appropriate clothing. We have seen recent information suggesting that South African authorities will be asking for yellow fever vaccination certificates from travellers who transit through airports in countries with risk of yellow fever transmission. There is no risk of yellow fever in South Africa and yellow fever vaccination certificates are not required from travellers flying directly from Europe. However, some flights to South Africa will transit in Nairobi, Kenya. The risk of yellow fever is low in Nairobi, but Kenya is regarded to be a country with risk of transmission. Travellers in transit here should carry a valid International Certificate of Vaccination or Prophylaxis documenting vaccination against yellow fever or a medical letter of exemption. Media sources have reported increasing malaria cases in the Limpopo region, Jan 10. Nearly 1,000 cases have been reported since the start of the rainy season. Security Advice - summarised from the F.C.O. South Africa
There is a very high level of crime, but the most violent crimes occur in townships and isolated areas away from the normal tourist destinations. The standard of driving is variable and there are many fatal accidents. The World Health Organisation (WHO) has issued a health warning for Rift Valley Fever. 479,192 British Nationals visited South Africa in 2009 (Source: Statistics South Africa). Most visits are trouble-free. There is an underlying threat from terrorism. Attacks, although unlikely, could be indiscriminate, including in places visited by expatriates and foreign travellers. You should get comprehensive travel and medical insurance before travelling. You should have two blank pages in your passport on arrival.
Below you will find links to further information you may find useful based on the 'special considerations or specific risks' quetions you answered when obtaining your Health Brief. Further risk assessment questions will be asked at your travel health consultation. Are you going on an expedition or travelling remotely?
Taking part in an expedition or travelling remotely involves a number of additional risks. These risks relate predominantly to the fact that travel is often to hazardous environments and involves exposure to extreme climactic conditions. Furthermore, due to the remoteness of the destination, help is often difficult to obtain in an emergency. For more information please see the following fact sheet.
Are you travelling for healthcare/voluntary/charity work?
Individuals who travel overseas for voluntary work need to consider the additional risk associated with their work activities overseas. These might include working long hours, being exposed to difficult and distressing situations, and working under Health Brief created on 02-Nov-2010 at 11:25 AM Page 5 of 6 This Health Brief is only valid for this journey extreme conditions with minimal or limited resources and support. For more information please see the following fact sheet.
Accidents
• First aid kit containing plasters, bandages, antiseptic spray, scissors, tweezers, thermometer.
• Consider needle and syringe kit.
• Consider joining the Blood Care Foundation.
Insect Bites
purification
Medication
• Travel sickness medication if required.
• Antimalarial drugs if appropriate.
• Loperamide and oral rehydration salts for travellers diarrhoea.
• If away from medical attention consider emergency malaria treatment.
• Antifungals/antibiotics may be appropriate for expeditions.
• If you take regular medication: take more than you need and split it between your baggage. Consider taking a copy of your prescription or a generic list of the drugs you take.
• Copy of your policy and emergency contact numbers.
Insurance
This MASTA Travel Health Brief is provided in accordance with the terms and conditions of access and your attention is in particular drawn to the disclaimer in clause 12.
Health Brief created on 02-Nov-2010 at 11:25 AM Page 6 of 6

Source: http://outposts.co.uk/user_files/MASTA%20St%20Catherines%20South%20Africa%202011.pdf

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