When considering traveling, working, or volunteering abroad, the responsible healthcare professional heads to the travel clinic to get updated on the typical vaccinations, such as tetanus, meningitis, and hepatitis. Depending where they’ll wander, they may even get a yellow fever shot or a stock of malaria pills.

But what other bugs – whether rare or common – might one encounter, aside from the usual childhood diseases (e.g. mumps, measles, chicken pox) and other diseases familiar to North Americans (e.g. rabies, West Nile virus, Lyme disease, Norwalk virus, TB) …?

Today’s “bug” to beware of are miscellaneous menaces.

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Encephalitis, Tickborne (also known as Spring-Summer Encephalitis)

 

• How do you get it? – By being bitten by infected ticks (usually Ixodes ricinus) or by consuming unpasturized diary products from infected cows, goats, or sheep.
• What causes it? – A virus.
• What is it? – A viral infection of the CNS.
• Where is it found? – Scandinavia, western and central Europe, and countries of the former Soviet Union. The ticks are usually found in forests, fields, or pastures.
• Prevention? – A vaccine is available (in Europe and Canada), but since the risk is low for most travelers, it is not generally recommended.

Leptospirosis

 

• How do you get it? – Human infection occurs when broken skin or mucosa (e.g. nose) is exposed to water or soil contaminated by infected animals, or through swallowing contaminated food or water. It has been associated with canoeing, kayaking, wading, and swimming in contaminated, untreated open water.
• What causes it? – A bacterium called leptospira.
• What is it? – An animal disease that can be transmitted to humans, with common symptoms including fever, chills, myalgia, nausea, diarrhea, cough, and conjunctival suffusion. In severe cases, patients can suffer jaundice, renal failure, hemorrhage, pneumonitis, and hemodynamic collapse.
• Where is it found? – Worldwide, but with a higher incidence in tropical climates.
• Prevention? – No vaccine is available. Precautions include wearing protective clothing and minimizing contact with potentially contaminated water.

Schistosomiasis (also Bilharzia or (Katayama fever))

 

• How do you get it? – By exposure to contaminated fresh water through wading, swimming, or bathing. The water is contaminated either by a type of snails that carry schistosomes, or by the urine and/or feces of people who have been infected by the parasite.
• What causes it? – By one of five species of the parasite, Schistosoma (a flat worm, or fluke), burrowing into the skin.
• What is it? – A parasitic infection, that can initially result in a rash (“swimmer’s itch”). Most acute infections are asymptomatic, but the most common acute syndrome is fever. In rare cases, the CNS can be involved. Chronic infections can cause disease in the liver, intestinal tract, bladder (including bladder cancer), kidneys, or lungs.
• Where is it found? – Schistosomiasis is believed to occur worldwide, but is most prevalent in sub-Saharan Africa, southern China, the Philippines, and Brazil.
• Prevention? – No vaccine is available. Travelers should avoid fresh-water wading or swimming in rural areas of affected countries.

Viral Hemorrhagic Fevers (Ebola, Lassa, Marburg, and Rift Valley)

 

• How do you get it – Ebola? Ebola’s host animal is not known, but a report in the December 1, 2005 issue of Nature suggests it may be fruit bats. Ebola can be contracted by exposure to either the blood or other body fluids of infected individuals – including through infected objects.
• How do you get it – Lassa – Lassa’s host is a rodent called the multimammate rat; the disease can be contracted by contact with droppings from affected animals, through person-to-person contact, and by air contaminated with excretions.
• How do you get it – Marburg – Marburg’s host animal is not known; it can be contracted by exposure to either the blood or other body fluids of infected individuals – including through infected objects.
• How do you get it – Rift Valley – This is a mosquito-borne disease; it can be contracted by bites from mosquitoes and possibly other bloodsucking insects, or exposure to either the blood or other body fluids of infected animals.
• What causes them? – Viruses of one of four families: arenaviruses (Lassa), filoviruses (Ebola, Marburg), bunyaviruses (Rift Valley), and flaviviruses (Dengue Hemorrhagic Fever, as above).
• What are they? – These are acute viral diseases which may result in relatively mild illness including fever, fatigue, dizziness, muscle aches, loss of strength, and exhaustion, or severe multisystem syndrome, in which, characteristically, the overall vascular system is damaged, and the body’s ability to regulate itself is impaired. Human death rates: Ebola (50-90%), Lassa (about 1%), Marburg (23-25%), Rift Valley (about 1%).
• Where are they found? – Parts of Africa.
• Prevention? – Travelers should avoid areas of outbreaks, and avoid contact with the host rodents and take typical mosquito precautions (e.g. wearing clothing that covers the arms and legs, and using an insect repellent containing a substance like DEET). And good news for the future – a letter published online on June 5, 2005 in the journal Nature Medicine has shown 100% efficiacy of new preventive vaccines for Ebola and Marburg when tested on monkeys.

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