International Association For Medical Assistance to Travellers

ANTIGUA AND BARBUDA Travel Health Advice Google Maps

Immunizations

Required Vaccinations

Yellow Fever

A Yellow Fever vaccination certificate is only required for travellers coming from a country with risk of Yellow Fever transmission. The vaccination requirement is imposed by this country for protection against Yellow Fever since the principal mosquito vector Aedes aegypti is present in its territory. A Yellow Fever certificate is valid starting 10 days after vaccination.

Risk of Yellow Fever transmission exists in these countries:
AFRICA - Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Republic of the Congo, Democratic Republic of the Congo, Côte d'Ivoire, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Sudan, Togo, Uganda.

AMERICAS - Argentina, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Venezuela.

Children: A vaccination certificate is required for children over 1 year of age.

Note: If your medical practitioner has advised you against the Yellow Fever vaccine for medical reasons, a vaccination waiver should be issued. Be aware that problems may arise when crossing borders and your vaccination waiver may not be honoured.

>> Yellow Fever symptoms, prevention, and vaccine contraindications

Recommended Vaccinations

Routine Immunizations

Your trip is a good occasion for a reminder to keep your routine immunizations updated; more than 80% of adults in industrialized countries have not maintained their immunization status. The following vaccinations are recommended for your protection and to prevent the spread of infectious diseases. 

Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella, 
Polio should be reviewed and updated if necessary. Note: Many of these vaccine preventable illnesses are making a resurgence due to non-vaccination, incomplete vaccination, and waning immunity. It is important to keep your routine immunizations up-to-date.
 
Seasonal influenza
vaccination is recommended for all travellers over 6 months of age, especially for children, pregnant women, persons over 65, and those with chronic health conditions such as asthma, diabetes, lung disease, heart disease, immune-suppressive disorders, and organ transplant recipients. Note: In the northern hemisphere the flu season typically runs from November to April and from April to October in the southern hemisphere. If the flu vaccine is not available at the time of departure, contact your doctor or travel health clinic regarding influenza anti-viral protection.

Pneumococcal vaccine is recommended for persons over the age of 65 and persons of any age suffering from cardiovascular disease, diabetes, renal disorders, liver diseases, sickle cell disease, asplenia, or immuno-suppressive disorders.

Hepatitis A

The Hepatitis A virus (HAV) is primarily transmitted from person to person via the fecal-oral route and through contaminated water and food - such as shellfish, and uncooked vegetables or fruit prepared by infected food handlers.

Risk: The virus is present worldwide, but the level of prevalence depends on local sanitary conditions. HAV circulates widely in populations living in areas with poor hygiene infrastructure. In these areas, persons usually acquire the virus during childhood when the illness is asymptomatic (but still infective to others) or mild, and end up developing full immunity. Large outbreaks in these countries are rare. In contrast, a large number of non-immune persons are found in highly industrialized countries where community wide outbreaks can occur when proper food handling or good sanitation practices are not maintained including in daycare centres, prisons, or mass gatherings.

Symptoms: In many cases, the infection is asymptomatic (persons do not exhibit symptoms). Those with symptoms will usually get ill between 15 to 50 days after becoming infected. Symptoms include malaise, sudden onset of fever, nausea, abdominal pain, and jaundice after a few days. The illness can range from mild to severe lasting from one to two weeks or for several months. Severe cases can be fatal especially in older persons. Most infections are asymptomatic in children under six years of age, but infants and children can continue to shed the virus for up to six months after being infected, spreading the infection to others. Many countries are now including vaccination against Hepatitis A in their childhood vaccination schedules.

Prevention: Practice good personal hygiene, including washing your hands frequently and thoroughly, drink boiled or bottled water, eat well cooked foods, and peel your own fruits.

Vaccination: Recommended for all travellers over 1 year of age.
There are two inactivated vaccines available in Canada and the USA, including a combined Hepatitis A and Hepatitis B vaccine. A combined Hepatitis A and Typhoid Fever vaccine is also available in Canada and Europe. Hepatitis A vaccines confer long term protection and can be given in accelerated schedules. Discuss your options with your healthcare provider if you cannot finish the series prior to your departure. Immune Globulin may be recommended for some last-minute travellers.

The recommendations for vaccinations outlined above are intended as guidelines only. Your immunization needs depend on your health status, previous immunizations received, and your travel itinerary. Seek further advice from your doctor or travel health clinic.

Health Risks

SCHISTOSOMIASIS

Infection is transmitted by snails living in fresh water such as lakes, rivers, streams and ponds in the Caribbean, South America, Africa, and Southeast Asia.

Schistosomiasis risk is present in the country, areas of risk are specified:

Antigua has only seasonal transmission of schistosomiasis. The intermediate host is present in human-created pools, canals, and reservoirs that are potentially infected with S. mansoni.

Public health authorities report no human cases from known infected areas of Sweet's, Liberta, Bendals, and areas surrounding the settlement of John Hughes.

There is a risk of Schistosomiasis caused by: Schistosoma mansoni

The main intermediate host snail is: Biomphalaria glabrata.

Prevention Guidelines: Rules to prevent Schistosomiasis infection

SCHISTOSOMIASIS RISK WORLD MAP

OTHER HEALTH RISKS OF INTEREST TO TRAVELLERS

The health risks listed below are some of the most common non-vaccine preventable illnesses that can affect travellers. We update our travel health information daily with any new confirmed outbreaks so check back here before your trip for updates. Please note that some infectious diseases are not reported or under reported, preventing us from giving you the full picture of the health risk.

Air Pollution

Outdoor air pollution (a mix of chemicals, particulate matter, and biological materials that react with each other) contributes to breathing problems, chronic diseases, increased hospitalization, and premature mortality.

Risk: No matter where you travel, you will not be able to escape air pollution since cities and rural areas worldwide are affected by air pollution. Exposure and concentration of pollutants can adversely affect your health. When planning your trip, consider your health status, age, destination, length of trip and season to help you mitigate the effects of air pollution.

Symptoms: Short term symptoms resulting from exposure to air pollution include itchy eyes, nose and throat, wheezing, coughing, shortness of breath, chest pain, headaches, nausea, and upper respiratory infections (bronchitis and pneumonia). It also exacerbates asthma and emphysema. Long term effects include lung cancer, cardiovascular disease, chronic respiratory illness, and developing allergies. Air pollution is also associated with heart attacks and strokes.

Prevention:
Comply with air pollution advisories (ask around and observe what locals are doing) and avoid strenuous activity. If you have asthma or chronic obstructive pulmonary disease (COPD), carry an inhaler, antibiotic, and oral steroid (consult your doctor to see what is best for you). It is recommended that older travellers get a physical exam that includes a stress and lung capacity test prior to departure. Newborns and young children should minimize exposure as much as possible or consider not travelling to areas with poor air quality. Ask your medical practitioner if a face mask is advisable for you.

>> For city and country air pollution levels, see the
World Health Organization.

Chikungunya

Chikungunya is a viral infection transmitted to humans through the bite of infected daytime biting female mosquitos. The Aëdes aegypti mosquito is the primary vector, but the Aëdes albopictus mosquito is also responsible for transmitting the CHIK virus belonging to the Togaviridae family.

Risk: Travellers going to parts of the Caribbean, sub-Saharan Africa, southeast Asia, and the Indian subcontinent are at risk, especially during the rainy season. The mosquitos usually bite early morning and late afternoon and are typically found in and around domestic dwellings. Some mosquitos carrying the Chikungunya virus in Africa also live in forested areas. Monkeys and other wild animals are also believed to be reservoirs for the virus. Isolated cases of imported Chikungunya have occurred in the Americas and Europe.

Symptoms: The initial symptoms of sudden fever and sever muscle and joint pain usually appear between 3 to 7 days and sometimes until 12 days after the bite. Not everyone exhibits symptoms and the infection may go undetected. Other symptoms include headache, fatigue nausea, vomiting, and a rash. Although most patients fully recover, chronic joint pain may last for several weeks or months. Other persistent problems may include eye, gastrointestinal, neurological, and heart complications. Sometimes Chikungunya is misdiagnosed in areas where Dengue also occurs.

Persons with chronic health conditions, compromised immune systems, newborns, the elderly are at risk of developing complications with this infection. Chikungunya is rarely fatal.

Prevention: Travellers should take measures to prevent mosquito bites both indoors and outdoors, especially during the daytime. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray (or solution) to clothing and gear, wearing long sleeves and pants, getting rid of water containers around dwellings and ensuring that door and window screens work properly. There is no preventive vaccine against Chikungunya.

Antigua and Barbuda have reported cases of Chikungunya fever. For the latest information on Chikungunya fever outbreaks please go to: ProMED-mail. Chikungunya (51): Caribbean. ProMED-mail 2014; September 01: 20140901.2736911. <www.promedmail.org>. Accessed on September 05, 2014.

Ciguatera Fish Poisoning

Ciguatera Fish Poisoning is the most common seafood illness reported in travellers. It is caused by eating fish contaminated with ciguatoxins which are produced by dinoflagellates (small marine organisms living on or near coral reefs) belonging to the species Gambierdiscus toxicus. Herbivorous fish feed on these organisms and the ciguatoxins bio-accumulate along the marine food chain to larger predatory fish, usually over 2.7 kg / 6 lbs.

Risk:
Ciguatera fish poisoning commonly occurs in tropical and subtropical areas, particularly in the Pacific Ocean, the Indian Ocean, and the Caribbean Sea. Any reef fish can cause ciguatera poisoning, but species such as barracuda, grouper, red snapper, moray eel, amberjack, parrotfish, hogfish, sturgeonfish, kingfish, coral trout, and sea bass are the most commonly affected. Ciguatoxins are concentrated in the fish liver, intestines, heads, and roe. The toxins to not affect the taste, texture, or odour of the fish and cannot be destroyed by cooking, smoking, freezing, salting or any other method of food preparation. Outbreaks can occur seasonally or sporadically, particularly after storms. Not all fish of a given species or from a given area will be toxic. 

Symptoms:
Typically appear 1 to 3 hours after consuming contaminated fish. The illness is characterized by abdominal pain, nausea, vomiting, and diarrhea. This is followed by neurological complications appearing 3 to 72 later which include a tingling sensation, temperature reversal (cold items feel hot and hot items feel cold), itching, metallic taste in the mouth, feeling like teeth are loosening, blurred vision, and even temporary blindness. These symptoms usually last days to several weeks. Long term consequences include chronic fatigue, depression, muscle pain, headache, a slow or irregular heartbeat, and low blood pressure. Treatment includes supportive care of symptoms and can include intravenous mannitol to reduce neurological symptoms if given promptly.

Prevention:
Avoid eating reef fish over 2.7 kg / 6 lbs or filets of large fish. Also avoid liver, intestines, heads, and roe of smaller reef fish. Commercial ciguatera test kits are not always accurate and are expensive. There is no preventive medication or vaccine against Ciguatera Fish Poisoning.

Hookworm | Cutaneous Larva Migrans

Hookworm, also known as Cutaneous Larva Migrans (CLM), is a skin infection primarily caused by Ancyclostoma braziliense hookworms. It is acquired by walking barefoot or sitting on soil or sand contaminated with dog or cat feces containing hookworm larvae. The hookworm eggs hatch in the soil or sand and the larvae migrate through a person's skin forming red burrows or tracks underneath the outer skin layer.

Risk: Cutaneous Larva Migrans is prevalent in tropical and subtropical areas of the Caribbean, South America, Asia, and Africa, but can also occur during the hot months in temperate regions. Travellers taking beach vacations are at greater risk of acquiring this infection.

Symptoms: Itching (which can cause a secondary bacterial infection), mild swelling, and redness at the place of larval penetration, usually on a person's feet or buttocks. The burrows or tracks usually appear 1 to 5 days after exposure, but sometimes can take weeks to show up. In the majority of cases the infection suddenly disappears after a few weeks. Treatment includes applying anti-itch creams and taking anthelmintic drugs such as albendazole.

Prevention: Wear shoes or sandals. At the beach, always sit on a towel (washed after each use) and wash your hands and feet with soap and water after touching sand or soil. There is no preventive vaccine or medication against Hookworm.

Sexually Transmitted Infections

Sexually transmitted infections (STIs), also known as Sexually Transmitted Diseases (STDs), are caused by bacteria, viruses or parasites and are transmitted via unprotected sex (oral, anal, or oral) and skin to skin genital contact.

Bacterial infections include Bacterial Vaginosis, Chlamydia, Gonorrhea, Lyphogranuloma venerum (LGV) and Syphilis. Viruses cause Genital Herpes, Hepatitis B, Human Papillomavirus (HPV) and Human Immunodeficiency Virus (HIV). Parasites are responsible for Trichomoniasis and pubic lice.

STIs occur worldwide, but some infections like chancroid, lymphogranuloma vernerum (LGV), and Granuloma Inguinale are more common in less industrialized countries.

Risk: Travellers are at high risk of acquiring STIs if they have unprotected sex outside a monogamous relationship, engage in casual sex, or use the services of sex workers. During travel, some people may be less inclined to follow social mores dictating their behaviour back home and look for adventurous opportunities involving sex. Long term travellers may also be at increased risk due to feelings of loneliness or being homesick.

Travellers should also be aware of sexual tourismand how it spreads STIs. Sexual tourism is travel for the procurement of sex abroad. Travellers participating in this type of exploitive tourism use the services of sex workers or children that are forced to engage in the trade as a result of deceptive practices or are part of human trafficking networks. It’s illegal in many countries and you can be prosecuted in your home country for engaging in sexual exploitation of minors abroad. Sexual violence such as rape or assault can also increase risk of STI.

Symptoms: In many cases you can spread a sexually transmitted infection unknowingly because you are asymptomatic (do not exhibit symptoms). Depending on the infection, symptoms can appear within days or weeks (Chlamydia, Gonorrhea, Genital Herpes), weeks or months (Hepatitis B, Syphilis, HIV) after the initial infection. Common symptoms, which may appear alone or in combination include abnormal genital discharge, burning sensation when urinating, bleeding after intercourse or between periods, rashes and sores in the genital or anal areas, swollen lymph glands in the groin, and sudden fever or appearance of flu-like symptoms.

Note that the sudden or eventual disappearance of symptoms does not mean you are cured from the infection since it can return or manifest itself in different symptoms. Many sexually transmitted infections can be treated with antibiotics (although there is mounting evidence that Gonorrhea is becoming increasingly resistant to antibiotics) or antivirals. If left untreated, infections can lead to infertility, pelvic inflammatory disease, cancer, chronic liver conditions, pregnancy complications, and birth defects.

Prevention: Always practice safe sex. Pack your own male and / or female condoms. Note that condoms obtained abroad may have higher breakage rates, may be expired, or may have been stored in hot or humid places compromising their effectiveness. Use your condom correctly and do not use oil based lubes. If you engage in oral sex use a male condom or dental dam. Keep in mind that birth control methods such as oral contraceptives, injections, IUDs, or diaphragms do not prevent STI transmission, and that condoms aren’t fully effective from infections acquired via skin-to-skin contact like genital herpes.

Avoid behaviour that increases your chances of contracting an STI such as casual sex with a stranger or a sex worker. Drinking heavily or taking mind-altering drugs will impair your judgement and inhibitions during a sexual encounter, putting you at risk of making unsafe choices like not using a condom. If you already practice safe sex, avoid getting tattoos, body piercings, or acupuncture treatments. Also don’t share razors, toothbrushes, or needles. If you have engaged in risky sexual activities or suspect that you may have an STI, visit a healthcare provider immediately. If the results confirm that you have an STI, inform all your sex partners and encourage them to seek medical attention.

Hepatitis B and Human Papillomavirus (HPV) can also be prevented through vaccination.

Note: Some countries continue to have entry restrictions for travellers with HIV / AIDS. Consult your destination country's embassy or consulate to get the latest information. See also HIVTravel for details.

Traveller's Diarrhea

The term Traveller's Diarrhea is used to describe gastro-intestinal infections affecting travellers caused by ingesting bacteria, viruses, and protozoa. These micro-organisms are found worldwide and are typically transmitted from person to person via the fecal-oral route – an infected person who does not practice proper hand or body hygiene passes on the infection to another person when handling food and water. Traveller's Diarrhea is the most common illness among travellers.

Risk:
Traveller’s Diarrhea can happen when:

  • Eating raw, under cooked, unwashed, or improperly handled meat, poultry products, dairy products, fruits, vegetables, shellfish, and seafood.
  • Drinking contaminated water or beverages.
  • Inadvertently ingesting fecal matter, protozoa eggs, or viruses by touching the mouth with dirty or improperly washed hands.
  • Eating out in restaurants, from buffets, or from street vendors where food handling and hygienic practices are not followed properly.

Prevention: The golden rule to prevent gastro-intestinal infections is: Boil it, Cook it, Peel it, or Forget it! However, it’s not just about what you eat, it’s also important to consider where you eat. It’s not always easy to know if a restaurant or food vendor follows proper food handling and hygienic practices (properly cleaning cutting boards, utensils, sink to wash hands, refrigeration). Be cautious of food that has been stored uncovered, has been improperly refrigerated, or has been standing out for a long time such as buffets.

Consult your doctor for the best treatment options tailored to your needs, including taking prescription medication on your trip in case you suffer from diarrhea. Travellers with chronic conditions are more susceptible to infections and should consider taking preventive medication.


More information on Food and Water Safety:
>> How To Prevent Traveller's Diarrhea [PDF]
>> How To Prevent Food and Water Illnesses [PDF]
>> How To Prevent Illness by Washing Your Hands [PDF]
>> 24 World Food and Climate Charts

>> Guide to Healthy Travel

Food and Water Safety

Local water is potable and safe to drink.

Milk is pasteurized and safe to drink. Butter, cheese, yoghurt, and ice cream are safe.

Local meat, poultry, seafood, vegetables, and fruits are safe to eat.

Chemicals found in food and water

Globalized food production and shipping are making it harder for consumers to know if their food and water is safe. Travellers should be aware that food and water contamination not only occurs through improper food handling or poor hygiene practices. Air, soil, and water pollution resulting from heavy metals, dioxins, pesticides, agro-chemicals, and drugs given to food-production animals, occurs worldwide. IAMAT recommends eating locally sourced foods from reputable growers as much as possible. We will post any new information on outbreaks resulting from environmental contamination on this page. Don’t forget to consult our website before your trip!

Food allergies

Being prepared is important to preventing allergic reactions or anaphylactic shock during your trip.

  • Research the common foods of your destination country and talk to your health practitioner about your travel plans.
  • Pack the medications you need to prevent an adverse reaction like antihistamines or epinephrine injectors with refills.
  • Find a reputable doctor or hospital prior to your trip in case of an emergency. Carry your IAMAT Traveller Clinical Record outlining your food allergies so that healthcare providers abroad are aware of your condition. 
  • If you’re grocery shopping abroad, read labels and be aware of packaging that does not list ingredients. Note that in many countries there are no or weak food labelling regulations and some products may be partially labelled.
  • Tell others about your food allergy. Carry a personalized translated card detailing your allergies to show restaurant waiters, grocery store clerks, or food vendors. SelectWisely offers a wide range of professionally translated cards.

Traveller’s Diarrhea

The term Traveller's Diarrhea is used to describe gastro-intestinal infections affecting travellers caused by ingesting bacteria, viruses, and protozoa. These micro-organisms are found worldwide and are typically transmitted from person to person via the fecal-oral route – an infected person who does not practice proper hand or body hygiene passes on the infection to another person when handling food and water. Traveller's Diarrhea is the most common illness among travellers.

Risk: Traveller’s Diarrhea can happen when:

  • Eating raw, undercooked, unwashed, or improperly handled meat, poultry products, dairy products, fruits, vegetables, shellfish, and seafood.
  • Drinking contaminated water or beverages.
  • Inadvertently ingesting fecal matter, protozoa eggs, or viruses by touching the mouth with dirty or improperly washed hands.
  • Eating out in restaurants, from buffets, or from street vendors where food handling and hygienic practices are not followed properly.

Prevention: The golden rule to prevent gastro-intestinal infections is: Boil it, Cook it, Peel it, or Forget it! However, it’s not just about what you eat, it’s also important to consider where you eat. It’s not always easy to know if a restaurant or food vendor follows proper food handling and hygienic practices (properly cleaning cutting boards, utensils, sink to wash hands, refrigeration). Be cautious of food that has been stored uncovered, has been improperly refrigerated, or has been standing out for a long time, such as buffets.

More information on Food and Water Safety:
>> How To Prevent Traveller's Diarrhea [PDF]
>> How To Prevent Food and Water Illnesses [PDF]
>> How To Prevent Illness by Washing Your Hands [PDF]
>> 24 World Food and Climate Charts

>> Guide to Healthy Travel

Bacteria
Approximately 85% of Traveller’s Diarrhea is caused by bacteria. Symptoms involving bacterial infections generally appear within hours of eating contaminated food or water and can last 3 to 7 days. Typical symptoms include diarrhea, abdominal pain, nausea, general weakness, headache, low fever, and possible vomiting. Severe cases can cause dehydration.

The following are common bacteria causing food and water illnesses in travellers:
Enterotoxigenic Escherichia coli (ETEC)
– Commonly known as ‘E. coli’ and responsible for the majority of Traveller’s Diarrhea cases. The illness is associated with contaminated food and water. Symptoms appear 1 to 3 days after infection. Treatment includes supportive care of symptoms and in severe cases antibiotics are prescribed.

Campylobacter jejuni– Associated with contaminated water, undercooked poultry, unpasteurized milk. Symptoms appear 1 to 7 days after being infected and can last 2 to 3 weeks without treatment. Some patients also have bloody diarrhea. Post-infection complications can lead to Guillain-Barré Syndrome, where the immune system attacks the nerves and causes paralysis, or irritable bowel syndrome. Treatment includes antibiotics.

Salmonella enteritidis
– Associated with eggs, poultry, meat, raw fruits and vegetables. Symptoms usually appear 1 to 3 days after infection and can last up to 7 to 14 days. Infected persons can become asymptomatic carriers and shed the bacteria for weeks or months, becoming the source of infection for others through poor hygiene practices. Treatment includes supportive care of symptoms. Salmonella typhi is the cause of Typhoid Fever.

Shigellosis – Associated with contaminated food and water and caused by one of four Shigella species that spreads as a result of unsanitary conditions, contaminated food and water, and overcrowded living conditions. Symptoms usually last 4 to 7 days. The illness may progress to bloody diarrhea with mucous and the constant urge to pass stools. Shigella bacteria can be shed from your gastro-intestinal system for up to 3 months after symptoms disappear. Treatment includes antibiotics.

Vibrio cholera, Vibrio parahaemolyliticus, Vibrio vulnificus
– Associated with contaminated water, raw or undercooked fish and shellfish and causes Cholera, an acute gastro-intestinal infection. Risk to travellers is low and vaccination is advised only for medical and rescue personnel working in endemic areas. The infection can lead to severe dehydration and death in undernourished persons or those with compromised immune systems or kidneys.  Vibrio vulnificus has caused septicemia (blood poisoning) in persons with liver disorders.

Viruses

Approximately 5% of Traveller’s Diarrhea is caused by viruses. A person can become ill when touching contaminated surfaces with the virus (railings, door knobs), shaking hands, or coming into close contact with an infected person and then touching your mouth and eyes.

The most common viruses causing food and water illnesses in travellers are:
Norovirus
– Associated with outbreaks at large gatherings or on cruise ships. The illness is also caused by contaminated water and foods like salads, clams, and oysters. Symptoms can appear 10 hours to 2 days after infection and include nausea, vomiting, abdominal pain, diarrhea, and sometimes fever and dehydration. The illness usually last 1 to 4 days and treatment includes supportive care of symptoms.

Rotavirus – Particularly affects children less than 5 years old and is also associated with contaminated food and water. Symptoms appear 1 to 3 days after being infected and include vomiting, diarrhea, fever, abdominal pain, and headache. Dehydration and body limpness are characteristics of this illness which typically lasts 4 to 8 days. Vaccination is recommended for children. Treatment includes supportive care of symptoms for both children and adults.

Protozoa
Approximately 10% of Traveller’s Diarrhea is caused by protozoa. In addition to contaminated food and water, these one-celled microscopic organisms are also transmitted to humans by swallowing contaminated water from lakes, rivers, fountains, ponds, and other bodies of water or accidentally swallowing soil or sand containing protozoa eggs. Typical symptoms include abdominal pain and cramps, diarrhea, bloating, nausea, lack of appetite, fatigue, headache, and light fever. Prolonged infection causes dehydration and weight loss.

The most common protozoa causing food and water illnesses in travellers are:
Amoebiasis – Caused by Entamoeba histolytica protozoa. The majority of cases are asymptomatic (persons do not exhibit symptoms). Those who do exhibit symptoms usually develop them 2 to 4 weeks after being infected. Amoebic Dysentery is the more severe form of the illness where patients develop fever and blood in their stools. In rare cases, the protozoa can cause lesions in the liver. Treatment includes taking medication belonging to the nitroimidazole family of drugs.

Cryptosporidiosis –The infection, commonly referred to as ‘Crypto’, is primarily caused by Cryptosporidium hominis protozoa. The illness is associated with contaminated food or water, including swimming pools and other water bodies. Some people are asymptomatic (do not exhibit symptoms). Those who do exhibit symptoms usually develop them 2 to 10 days after being infected. Some patients may also have a cough, recurring headache, dizziness, eye pain, and joint pain. The illness can trigger irritable bowel syndrome and inflammatory bowel diseases. Symptoms usually disappear after 1 to 2 weeks as the protozoa are shed through feces. Treatment includes anti-protozoal medication or antibiotics.

Cyclosporiasis – Caused by the Cyclospora cayetanensis protozoa and associated with fresh produce like berries and lettuce. Symptoms usually appear 2 to 7 days after infection. Some patients may develop fever after a few days. The diarrhea may come and go throughout the duration of the illness which can last from 2 to 12 weeks if untreated. The infection tends to be seasonal for reasons yet unknown and disinfecting agents like chlorine do not seem to kill the protozoa. Treatment includes taking antibiotics.   

Giardiasis–Caused by Giardia intestinalis protozoa and associated with contaminated food and water. Symptoms usually appear 1-2 weeks after infection. The symptoms usually disappear 2-4 weeks later as the protozoa are shed through feces. Treatment includes taking medication belonging to the nitroimidazole family of drugs. Treatment includes taking medication belonging to the nitroimidazole family of drugs.

Foodborne Toxins

Another source of gastro-intestinal illness are foodborne toxins produced by bacterial spores that germinate on food – particularly meat, poultry, salads, baked goods, and dairy products – that is improperly stored or refrigerated, usually standing at room temperature for a prolonged period of time.Symptoms can appear within hours of ingesting contaminated food and include abdominal pain, diarrhea, nausea, and vomiting. The infection usually lasts 1 or 2 days and treatment includes supportive care of symptoms. Antibiotics are not recommended.

Common foodborne toxins affecting travellers include:
Clostridium perfringens – Associated with meat and poultry and is the most important agent causing food poisoning in industrialized countries. Symptoms appear within 6 to 24 hours after ingestion.

Staphylococcus aureus – Associated with creamy desserts, custards, meats, and baked goods. Enterotoxins are transmitted via unsanitary practices by infected persons. Symptoms appear within 30 minutes to 8 hours after ingestion.

Clostridium botulinum – Associated with improperly canned food, lightly preserved vegetables, salted fish, and meats. Symptoms usually appear within 12 to 48 hours and include nausea, vomiting, blurred and double vision, paralysis of respiratory and motor muscles that may progress rapidly.

Seafood and Shellfish Poisoning

Seafood and shellfish poisoning occurs as a result of eating marine food products contaminated with naturally occurring toxins in sea water. Travellers are at risk in any country as a result of the availability of these products (fresh or frozen) around the world.

The most common seafood and shellfish related illnesses in travellers are:
Ciguatera Fish Poisoning – Occurs when toxins created by dinoflagellate micro-organisms are passed up the marine food chain and bio-accumulate in large fish like barracuda, grouper, red snapper, moray eel, amberjack, parrotfish, hogfish, sturgeonfish, kingfish, coral trout, and sea bass. The toxins are not destroyed through cooking, smoking, or freezing, they are odorless and tasteless, and do not alter the appearance of the fish. For information on symptoms and prevention, see Ciguatera Fish Poisoning

Scombroid Poisoning – Results from improper handling and refrigeration of fish containing high levels of natural occurring histidine (amino acid in protein). Contamination with bacteria will convert histidine to histamine causing symptoms similar to allergic reactions, which occur very rapidly and include headache, abdominal cramps, diarrhea, itching, flushed face, dry mouth, heart palpitations, difficulty breathing. Symptoms rarely last over 8 to 12 hours. Scombroid poisoning affects fish from the Scombridae family: Tuna, mackerel, skipjack, and bonito. It can also affect other species such as herring, bluefish, sardine, anchovy, amberjack, and mahi-mahi. Treatment includes taking anti-histamines and supportive care of symptoms. Treatment in severe cases may include anti-inflammatory steroids and epinephrine related medication.

Shellfish Poisoning – Associated with the algal blooms (red tides) occurring in temperate and tropical areas. Oysters, clams, cockles, mussels, scallops, crabs, and lobsters filter or ingest toxins produced by dinoflagellates micro-organisms. There are four different illnesses associated with shellfish poisoning:

  1. Diarrheic shellfish poisoning can occur hours or days after eating contaminated shellfish. Symptoms include abdominal pain, nausea, vomiting, and diarrhea. Recovery occurs within 2 to 3 days and treatment includes supportive care of symptoms.
  2. Neurotoxic shellfish poisoning can occurs 1 to 6 hours after ingestion. Symptoms include nausea, vomiting, diarrhea, reversal of hot and cold temperature sensation, and involuntary muscle movement. Recovery occurs within 2 to 3 days and includes supportive care of symptoms.
  3. Paralytic shellfish poisoning can occur 30 minutes after eating contaminated shellfish. Symptoms include nausea, numbness of face arms and legs, headache, loss of coordination and dizziness. In severe cases respiratory failure and paralysis may lead to death.
  4. Amnesic shellfish poisoning can occur within 24 hours of ingestion and include nausea, vomiting, abdominal pain, and diarrhea. Within 48 hours, symptoms include headache, seizures, muscle weakness or paralysis, and disorientation. Permanent short-term memory loss has been observed, and in severe cases can lead to coma or death. Treatment includes supportive care of symptoms.

Puffer (Fugu) Fish Poisoning – Caused by a tetrodotoxin accumulating mainly in the liver, intestines and ovaries of puffer fish, ocean sunfish, globe fish, and porcupine fish. Symptoms appear between 6 and 20 hours and include nausea, abdominal pain, diarrhea, vomiting, profuse sweating, salivation, headache, hypothermia, heart palpitation. Neurological symptoms include numbness, loss of coordination, tremors, and paralysis. The illness can also cause respiratory failure and approximately 60% of patients die. Treatment involves supportive care of symptoms and may include cholinesterase inhibitors (anti-poisoning agents).

Travel and Mental Health

Travel is enjoyable, but there is no doubt that it can be stressful. Even if you don't have a prior history of mental illness, travel stress, mood changes, anxiety and other mental health concerns can unexpectedly affect you and potentially disrupt your trip. Studies show that psychiatric emergencies are the leading cause for air evacuations along with injuries and cardiovascular disease.

Factors Affecting Mental Health During Travel

Your mental and physical health prior to, and during, a trip determines how well you will cope with travel stress. Consider the following:

  • Tiredness, lack of sleep.
  • Major life events occurring prior to travel such as a birth, death, wedding, divorce, moving, or serious illness.
  • Difficult home or professional life; experiencing recent emotional exhaustion or financial strain.
  • Being lonely; prone to depression and anxiety.
  • Having pre-existing psychiatric, behavioural, neurological disorders; memory or cognitive deficits.
  • Dependence on, or misuse, of psychoactive substances.
  • Using medications that have psychiatric or neurological side effects (some anti-retrovirals and anti-malarials).
  • Type and length of travel; adventure, business, leisure, emergency aid work, missions.
  • Travel destination; travelling to politically unstable or war-torn areas, returning to a place where psychological trauma occurred.

Mental Health Abroad

Mental illness is an under recognized public health concern and travellers often have difficulty accessing adequate emergency psychiatric care abroad. While some countries are leading the way in mental healthcare and treatment, 30% of countries do not have a budget dedicated to mental health and 64% do not have any mental health legislation or it's outdated.

Accessibility to a psychiatrist varies from more than 10 per 100,000 to fewer than 1 per 300,000 people. Almost 70% of psychiatric beds are in mental hospitals rather than general hospitals or in integrated community care facilities.*

Persons with mental health concerns have the additional burden of dealing with stigma ? negative attitudes and behaviour towards their illness. Prejudice and discrimination towards mental illness may determine the type of medical care you will receive abroad.

* World Health Organization: Mental Health, Human Rights and Legislation Framework.
 

Download My Travel and Mental Health Checklists

What's inside:

  • Tips for coping with travel stress.
  • Tips for travellers with no prior history of mental illness.
  • Tips for travelling with medications.
  • Tips for travellers with:
    • Mood disorders (depression, bipolar disorder)
    • Anxiety disorders (panic attacks, phobias, obsessive compulsive disorders, posttraumatic stress disorder)
    • Psychotic disorders (acute situational psychosis, schizophrenia)
    • Substance dependence

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