 | | | | | AFGHANISTAN
Travel Healthcare, Vaccination, Immunization, Travel Health Plan |  | Capital: Kabul Altitude: 1800 m Afghanistan is a landlocked country located in south central Asia. Its climate is characterized by dry summers with average temperatures ranging from 65-85°F (18-29°C) and cold winters (especially in the north) with average temperatures of 32°F (0°C). weather is milder during spring and fall. Afghanistan is a developing nation in the lowest 25% of the world's economies. Adequate medical care is available in Kabul at one or more internationally staffed out-patient clinics. Medical care is substandard throughout the rest of the country. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies will be encountered routinely. Evacuation coverage for travellers is not obtainable due to the regional conflict. In the event of serious medical conditions every effort should be made to go to Western Europe. Visa applicants may need to meet specific requirements. Review the application and contact Afghanistan's embassy if you have questions. Yellow fever: A yellow fever vaccination certificate is required from travellers coming from infected areas. Malaria: Malaria risk exists from May through November below 2000 m. | Summary of Recommendations Malaria: Protective measures against mosquito bites for all countries with malarious areas: geographical and seasonal distribution, altitude, predominant species, status of resistance.
The recommended prophylaxis for each country is decided on the basis of the following factors: the risk of contracting malaria; the prevailing species of malaria parasites in the area; the level and spread of drug resistance reported from the country.
And the possible risk of serious side-effects resulting from the use of the various prophylactic drugs.
Malaria: Avoidance of Bites
Mosquitoes cause much inconvenience because of local reactions to the bites themselves and from the infections they transmit. Mosquitoes spread malaria, yellow fever, dengue and Japanese B encephalitis.
Mosquitoes bite at any time of day but most bites occur in the evening.
Malaria: Precautions to take
1. Avoid mosquito bites, especially after sunset. If you are out at night wear long-sleeved clothing and long trousers.
2. Mosquitoes may bite through thin clothing, so spray an insecticide or repellent on them. Insect repellents should also be used on exposed skin.
3. Spraying insecticides in the room, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes.
4. If sleeping in an unscreened room, or out of doors, a mosquito net (which should be impregnated with insecticide) is a sensible precaution. Portable, lightweight nets are available.
5. Garlic, Vitamin B and ultrasound devices do not prevent bites!
Malaria: Taking Anti-Malaria Tablets
1. Start before travel as guided by your travel health advisor (with some tablets you should start three weeks before).
2. Take the tablets absolutely regularly, preferably with or after a meal.
3. It is extremely important to continue to take them for four weeks after you have returned, to cover the incubation period of the disease. (Malarone requires only 7 days post-travel)
Malaria: Prompt Treatment
Following these guidelines faithfully might not guarantee complete protection. If you get a fever between one week after first exposure and up to two years after your return, you should seek medical attention and tell the doctor that you have been in a malarious area. Routine vaccination: It is recommended that all travellers are fully vaccinated with the appropriate routine vaccines.
Schedules for booster doses should be followed at the recommended time intervals. Cholera: No country requires a certificate of vaccination against cholera as a condition for entry. Hepatitis A: Vaccination against hepatitis A is recommended for all travellers to developing countries and to countries with economies in transition. Typhoid Fever: If you are travelling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options. Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check for a refresher vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it. | Vaccines: Many adults don't know they are supposed to be immunized against a host of germs, thinking that vaccinations are just for kids.
But there are millions of adults who should be vaccinated for influenza, pneumonia, tetanus, diphtheria, hepatitis B and other diseases. Make sure you keep your vaccinations up to date. Don't leave your doctor's office without asking about the vaccinations you need, especially if you plan to travel outside to tropical or delveloping countries. What is Tetanus?
Tetanus, also known as lockjaw, is a serious but preventable disease that affects the body's muscles and nerves. It typically arises from a skin wound that becomes contaminated by a bacterium called Clostridium tetani, which is often found in soil.
Once the bacteria are in the body, they produce a neurotoxin (a protein that acts as a poison to the body's nervous system) known as tetanospasmin that causes muscle spasms. The toxin first affects nerves controlling the muscles near the wound. It can also travel to other parts of the body through the bloodstream and lymph system. As it circulates more widely, the toxin interferes with the normal activity of nerves throughout the body, leading to generalized muscle spasms. Without treatment, tetanus can be fatal.
Most cases of tetanus follow a cut or deep puncture injury, such as a wound caused by stepping on a nail. Sometimes the injury is so small that it is never seen by a doctor. Injuries that involve dead skin (such as burns, frostbite, gangrene, or crush injuries) are more likely to cause tetanus. Wounds contaminated with soil, saliva, or feces - especially if not properly cleaned - and skin punctures from nonsterile needles (such as with drug use or self-performed tattooing or body piercing) are also at increased risk.
Another form of tetanus, neonatal tetanus, occurs in newborns who are delivered in unsanitary conditions, especially if the umbilical cord stump becomes contaminated. Prior to immunizations, neonatal tetanus was much more common. Now, routine immunizations for tetanus produce antibodies that mothers pass to their unborn babies. These maternal antibodies and sanitary cord-care techniques have made newborn tetanus very rare in developed countries.
In fact, tetanus in general is rare with tetanus vaccination programs. However, many developing countries have no effective prevention and immunization programs against tetanus, so the disease is much more common there.
Signs and Symptoms:
Tetanus often begins with muscle spasms in the jaw (called trismus), accompanied by difficulty swallowing and stiffness or pain in the muscles of the neck, shoulders, or back. These spasms can spread to the muscles of the abdomen, upper arms, and thighs.
Neonatal tetanus causes the same symptoms in newborns.
Contagiousness:
Tetanus cannot be spread from person to person.
Prevention:
There are two important components of tetanus prevention: tetanus immunization (receiving routine tetanus vaccinations) and what's known as post-exposure tetanus prophylaxis (receiving a shot after an injury occurs).
For children, tetanus immunization is part of the DTaP (diphtheria, tetanus, and acellular pertussis) vaccinations. Children typically receive a series of four doses of DTaP vaccine before the age of 2 years, followed by a booster dose at 4 to 6 years of age. After that, a tetanus and diphtheria booster (Td) is recommended at 11 to 12 years of age, and then every 10 years through adulthood. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor will have the most current information.
Post-exposure tetanus prophylaxis also involves getting tetanus shots, but after an injury occurs. Which shots are given will depend on the number of years since the patient's last booster, the total number of tetanus vaccinations the patient has received, and the nature of the wound. The doctor may recommend a tetanus booster (Td or DTaP, depending on the patient's age) and/or an injection of tetanus immune globulin (TIG) to neutralize any toxin released by the bacteria.
Neonatal tetanus can be prevented by making sure that all pregnant women have had their tetanus immunizations and by delivering babies in sanitary conditions. If you are pregnant, discuss your immunization record with your obstetrician well before your due date.
What is Rabies?
Signs and Symptoms:
Rabies is a very serious infection of the nervous system that is caused by a virus. Rabies is usually transmitted by a bite from an infected animal, and humans who develop a rabies infection often have a history of being bitten by an animal about a month before rabies symptoms began.
Rabies starts with a PRODROMAL PERIOD (premonitory symptoms indicating the beginning of a disease) that usually lasts for 1 to 4 days. Symptoms during this prodromal period include: fever, headache, malaise (a generally ill feeling); muscle aches; loss of appetite; nausea; vomiting; sore throat; cough; and fatigue. There may also be a tingling or twitching sensation around the area of the animal bite. This is the one most specific symptom of rabies at this stage of the rabies infection.
After the prodromal period, a second stage begins with symptoms that look like those of an encephalitis (inflammation of the brain). There may be fever as high as 105 degrees F (40.6 degrees C) with any of the following symptoms: irritability; excessive movements or agitation; confusion; hallucinations; aggressiveness; bizarre or abnormal thoughts; muscle spasms; abnormal postures; seizure (convulsions); weakness or paralysis (person cannot move some part of the body); extreme sensitivity to bright lights, sounds, or touch; increased production of saliva or tears. Also, there may be inability to speak as the vocal cords become paralyzed.
The last stages of rabies produce symptoms that reflect the infection's destruction of many important areas of the nervous system. There may be double vision, problems in moving facial muscles, abnormal movements of the diaphragm and muscles that control breathing, and difficulty swallowing. It is the difficulty in swallowing - combined with increased production of saliva - that leads to the "foaming at the mouth" usually associated with a rabies infection.
Finally, the person with a rabies infection can slip into a coma and stop breathing. Without life support measures, death usually follows within 4 to 20 days after symptoms of rabies begin. Most people infected with rabies die regardless of medical care, and those who survive usually have severe neurological disability.
Description:
Rabies is an infection of the nervous system that is caused by the rabies virus. The rabies virus is carried in the saliva of infected animals and is usually transmitted to humans though an animal bite. In rarer cases, the virus may also spread to humans when an infected animal's saliva touches someone's mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or contacts an area of broken skin - a cut, scratch, bruise, or open wound.
Not all animals are equally likely to carry the rabies virus. The most common carriers of rabies are bats, raccoons, skunks, and foxes, with a few cases also reported in wolves, coyotes, bobcats, and ferrets. Animals that are not usually expected to carry rabies include small rodents (hamsters, squirrels, chipmunks, mice), rabbits, and hares.
Once the rabies virus enters the human body through an animal bite, it probably begins multiplying in the surrounding muscle. This is why part of the first doses of anti-rabies medicine (rabies immune globulin given to prevent infection after an animal bite) is usually injected right into the area around the animal bite. Eventually the rabies virus travels up a nearby nerve from the bite area to the brain. Once it reaches the brain, the rabies virus infects many important brain areas and usually causes death.
Prevention:
Rabies can be prevented by a series of vaccine injections, such as RabAvert. In humans, this vaccine is routinely given to persons who have jobs or lifestyles that carry an increased risk for rabies, including: veterinarians, animal handlers, cave explorers, and certain laboratory workers. You should ask your family doctor about receiving a vaccination before travelling to a high-risk rabies area, such as Asia, the Indian Subcontinent, or Africa.
Once a human has been bitten by an infected animal, rabies can be prevented by a series of injections. Not all animal bites carry the same risk of rabies, and the decision whether to begin the series of five prophylactic (disease-preventing) injections given over the course of a month is usually made by a doctor who follows the guidelines of local health authorities.
Because cats, dogs, and ferrets can also be infected by rabies, one of the most important ways of preventing rabies in humans is by vaccinating the pets that share our homes. It is also wise to report any stray animals to your local health authorities or animal-control officer. Also, remind your children that animals can be "strangers," too, and that they should never touch or feed stray cats or dogs wandering in the neighborhood or elsewhere. If your child is bitten by an animal, and the owner is known, you should get all the information regarding the animal including vaccination status and the owner's name and address and take it to the emergency room. The health department will need to be notified, especially if the animal hasn't been vaccinated.
If you suspect that your child has been bitten by an unknown dog, bat, rat, or other animal, contact your child's doctor immediately, or take your child to the emergency room. | Never forget the Medical Kit.
 It is sensible to carry a small, straightforward medical kit. A kit should include:
Aspirin or paracetamol (acetaminophen in the US) - for pain or fever. Antihistamine (such as Benadryl) - useful as a decongestant for colds and allergies, to ease the itch from insect bites or stings and to help prevent motion sickness. There are several antihistamines on the market, all with different pros and cons (eg a tendency to cause drowsiness), so it's worth discussing your requirements with a pharmacist or doctor.
Antihistamines may cause sedation and interact with alcohol so care should be taken when using them.
Antibiotics - useful if you're travelling well off the beaten track, but they must be prescribed and you should carry the prescription with you.
Loperamide (eg Imodium) or Lomotil for diarrhoea; prochlorperazine (eg Stemetil) or metaclopramide (eg Maxalon) for nausea and vomiting.
Rehydration mixture - for treatment of severe diarrhoea; this is particularly important if travelling with children.
Antiseptic such as povidone-iodine (eg Betadine) for cuts and grazes.
Multivitamins - especially for long trips when dietary vitamin intake may be inadequate.
Calamine lotion or aluminium sulphate spray (eg Stingose spray) to ease irritation from bites and stings.
Bandages and Band-aids - for minor injuries.
Scissors, tweezers and a thermometer (note that mercury thermometers are prohibited by airlines).
Insect repellent, sunscreen, chap stick and water purification tablets.
Cold and flu tablets and throat lozenges. Pseudoephedrine hydrochloride (Sudafed) may be useful if flying with a cold to avoid ear damage.
A couple of syringes and needles, in case you need injections in a country with medical hygiene problems. Ask your doctor for a note explaining why they have been prescribed. |
|  | Travellers who plan to visit developing or tropical countries and those embarking on prolonged vacations or arduous treks should take a number of precautions. A visit to the doctor is very important in preparing for travel to a developing nation. The following are some general guidelines for vaccinations and immunizations when travelling.
'Travel to Developing Countries' contents 20 comprehensive pages of useful information.
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