Living in Singapore means easy accessibility to South East Asia’s exotic beaches and jungles, and the opportunity to try all kinds of adventurous foods. But, it also means risk of exposure to a variety of diseases that come with the region’s humid climate and the hygiene issues of some of the less-developed countries, among other factors. We asked Dr Leon Neoh, family physician at Raffles Medical, to share his travel health tips and the key preventive measures that can be taken to avoid contracting infectious diseases in South East Asia.
Preparing for your trip
Travellers should ideally arrange an appointment with their health professional at least four to six weeks before travel, recommends Dr Neoh. Even if you’re short on time and don’t have four to six weeks to spare before you leave, he says an appointment is still worthwhile.
“It provides an opportunity to assess health risks, taking into account a number of factors such as destination, medical history , and planned activities. For those with pre-existing health problems, an earlier appointment is recommended.”
Food and water hygiene
“There is a wide range of infectious diseases that are transmitted by contaminated food and water,” says Dr Neoh. “Many are caused by pathogens (bacteria, viruses or parasites) transmitted via the faecal-oral route (consumption of food and drinks contaminated with faeces). Swallowing or inhaling contaminated water in inadequately treated swimming pools, hot tubs and spas can also transmit pathogens that can cause diarrhoea, vomiting, or infection of the ears, eyes, skin, or the respiratory system.”
As contaminated food and water may be difficult to avoid in areas with poor sanitation, including many low-income regions, Dr Neoh recommends that travellers get vaccinated to prevent a number of diseases including cholera, a bacterial infection where an oral vaccine is available, typhoid, a bacterial illness that can be immunised with a jab (though boosters are required), and viral infection, hepatitis A, which can be immunised with two injections administered several months apart. Each vaccine has different recommended minimum ages, so it’s important to consult a doctor when immunising your children.
Mosquito bite avoidance
Insect and tick bites are relatively common in travellers, but usually cause only minor irritation, says Dr Neoh. However, a number of diseases and skin infections can be transmitted through insect bites. Although there are vaccines and preventive medications for some of these diseases, many of them still do not have immunisations or effective drugs available, leaving bite avoidance as the only form of prevention. Therefore, Dr Neoh suggests taking the following pre-emptive measures:
* Modify your travel activities to reduce the risk of exposure time and places, including rural areas, tall grass and stagnant water.
* Wear appropriate clothing such as long sleeved tops, pants, hats and covered shoes whenever possible.
* Apply insect repellent containing at least 20 -percent strength of DEET (an active ingredient in insect repellent) for longer protection and shorter re-application times.
* Infants, children and pregnant woman should sleep under mosquito nets.
According to Dr Neoh, mosquitoes are attracted by several factors, including the presence of carbon dioxide, heat, odours and movement. (Did you know: the female mosquito requires a blood meal in order to reproduce.) In addition to the much-talked about Dengue Fever and Zika virus (ZIKV), some of the top mosquito-borne illnesses to protect against when travelling to high-risk locations include:
Found in almost all South East Asian countries (excluding Singapore), this serious illness is an infection of red blood cells by a parasite transmitted through an infected mosquito. Dr Neoh says travellers should definitely take anti-malarials (malaria prevention tablets) if appropriate for the area visited. While no malarias are 100 percent effective, taking them in conjunction with mosquito bite avoidance measures will give substantial protection against malaria, he adds.
Typically seen in tropical and subtropical regions of the world, this viral infection is predominantly transmitted to humans through the bite of an infected Aedes mosquito, and has similar symptoms to dengue, including fever, joint and muscle pain, rash and headache. The infection usually resolves in one to two weeks and is rarely fatal, according to Dr Neoh; however, he says joint pain may persist for months or years.
Japanese encephalitis (JE)
This viral infection, which normally presents non-specific flu-like symptoms such as fever, headache, convulsions and an altered mental state, is transmitted to humans from animals (pigs and birds, for instance) by mosquitoes that typically breed in rice paddy fields, swamps and marshes, and predominantly feed between dusk and dawn, according to Dr Neoh. Luckily, there’s a vaccine available for JE, and it’s recommended for those intending to stay long periods in rural endemic regions with rice fields and marshland, particularly during the main transmission season.
Is Zika still a concern?
Dr Neoh says that the risk of ZIKV transmission is still present and all travellers to countries where ZIKV is known to occur are at risk of infection, although determining the actual level of risk can be difficult. Currently, there is no vaccine or specific antiviral treatment available for ZIKV, which is spread by day-biting mosquitos and has been proven to cause microcephaly and other birth defects, and Guillain-Barré syndrome. Therefore, Dr Neoh advises all travellers going to areas with ZIKV to get a comprehensive risk assessment by a doctor.
“The main risks can be categorised into destination-related factors, individual factors, and traveller activity and behaviour factors. Countries or areas with current or past ZIKV transmission have been given one of three risk ratings (high, moderate or low) based on ZIKV epidemiology,” he says. “In addition, there are also individual factors such as pregnancy, plans for pregnancy, immunosuppression and medical conditions that should be discussed with your doctor in detail before travelling.”
Learn more about travel vaccinations from Raffles Medical Group.
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