Health Brief

This Health Brief was prepared for: Enzo and was generated from the MASTA Public Web Site on 12/8/2003.

Journey Details

Country

Living Conditions

Arrival Date

Zimbabwe

Rural

04/12/2003

Mozambique

Rural

04/12/2003

Returning on 01/01/2004

Recommended immunisations for your journey

Travellers should be "in date" for the standard UK immunisation schedule.

Polio

Polio is a viral disease, usually transmitted via contaminated food and water. The live vaccine is usually given orally as drops on the tongue. An inactivated, injectable vaccine is available if the oral vaccine is contraindicated. Boosters are usually given every 10 years.

Hepatitis A

Hepatitis A virus, usually transmitted via contaminated food and water, attacks the liver and may lead to jaundice and a prolonged illness. Modern hepatitis A vaccines are highly effective and, if boosted at 6 - 12 months, provide long term (10 years or more) protection.

Typhoid Fever

When ingested, the bacteria which give rise to typhoid fever, pass through the intestine wall and cause a high fever which may progress to coma. Vaccines are available as a live oral preparation which is usually boosted yearly and an injected vaccine which is boosted every 3 years. Vaccination is generally less important for short stay travellers staying in good accommodation.

Tetanus

This serious bacterial disease is usually contracted following contamination of wounds (especially deep puncture wounds). The inactivated vaccine is boosted every 10 years. After 5 doses, routine boosters are no longer required but travellers to areas with poor medical facilities should be "in date". The Department of Health now recommend that the combined tetanus and diphtheria vaccine is used when tetanus boosters are indicated.

Immunisations to be considered

The requirement for these immunisations may depend on your activities, lifestyle or length of stay. You should discuss these with your travel health advisor.

Hepatitis B

The hepatitis B virus is transmitted sexually and by puncture of the skin with contaminated instruments such as needles. The disease can lead to liver damage and eventual liver failure. The vaccine is usually given as a 3 dose course over 6 months but accelerated regimes can be used if time is short.

Rabies

Rabies is transmitted via the saliva of infected animals. Human rabies usually results from dog bites but many animals can be infected and a scratch or a lick may be sufficient to transmit the disease. Rabies is invariably fatal once symptoms begin. Modern vaccines are highly purified and very effective.

T B

Transmitted by close contact with infected persons. BCG vaccine is effective in preventing the more serious manifestations of tuberculosis in children but may be less effective in adults. If over 3 months of age a Heaf, PPD or Mantoux Skin Test test is recommended prior to immunising with BCG vaccine. There is no benefit in boosting this vaccine.

Diphtheria

Usually transmitted by close contact with infected persons. The low dose diphtheria vaccine is used to boost adults and adolescents. A booster lasts 10 years.

Seasonal Diseases

The following seasonal diseases are a possible risk during your journey. If you have told us that you are travelling during the season and immunisation is recommended it will appear in one of the above immunisation sections. Should your travel plans change the details below will help you decide if you need to reconsider your immunisation schedule. Please note that seasons are not completely predictable; this information is for guidance only.

Zimbabwe

Meningococcal Meningitis

from April to November

Small outbreaks of meningitis have been reported in the past. These outbreaks are more likely to occur during the dry season April - November. The risk to travellers is generally low, unless there is a current outbreak (see latest health news).

Mozambique

Meningococcal Meningitis

from April to November

Meningitis outbreaks can ocur during the dry season. Long stay and rural travellers may wish to consider vaccination.

Malaria

Malaria is a dangerous disease that is spread by mosquitoes that bite from dusk to dawn.

This section of your Health Brief will detail the geographical risk of malaria, country by country, for your journey. It provides information on avoiding mosquito bites and on the correct antimalarial drugs to take to protect yourself.

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.

Geographical Risk

Important: Malaria maps are for guidance only. Malaria borders can change. If there is any doubt, we advise you to take chemoprophylaxis. Click on the map to enlarge

Antimalarial chemoprophylaxis may be advised. Check geographical data.

Zimbabwe

There is a malaria risk November to June in areas below 1,200m and throughout the year in the Zambezi valley. Activity is highest in the Zambezi valley in the north - if camping on the banks of the Zambezi consider mefloquine, doxycycline or Malarone as the antimalarial drugs of choice. Negligible risk in Harare and Bulawayo.
Key: Maximum risk +++++
Benign Malaria	Malignant Malaria	Chloroquine resistance	Fansidar resistance
+	+++	Yes	Not reported

Mozambique

Malaria is present in all areas of the country. B++ M+++++ CR FR
Key: Maximum risk +++++
Benign Malaria	Malignant Malaria	Chloroquine resistance	Fansidar resistance
++	+++++	Yes	Yes

Avoiding mosquito bites

Use an effective insect repellent 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 a residual insecticide.

Recommended antimalarial drugs

If you are at risk of malaria (see above), the following drugs are recommended for your journey. They will all be very effective. Your travel health adviser should discuss which will be the most suitable for you.

Drug

Dose

Frequency

Doxycycline

100mg

Take 1 capsule/tablet daily

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 malarious area of your journey, continue them while you are exposed to malaria and for the 4 weeks after exposure. It is very important not to miss a dose. 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. Doxycycline can precipitate vaginal candidiasis (thrush).

Malarone

250mg atovaquone/100mg proguanil

Take 1 tablet daily

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 country.

Mefloquine

250mg

Take 1 tablet weekly

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 country.

Alternative antimalarial drugs

If the above antimalarial drugs are not suitable for you to take, it is important that you 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 (the minimum incubation period). Other symptoms are very 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 as prophylaxis, your travel health adviser may wish to contact us to discuss alternative treatment options.

Travellers´ diarrhoea

There is a significant risk of travellers� diarrhoea on your journey. 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 travellers� diarrhoea, drink plenty of non alcoholic fluids to avoid dehydration. Oral rehydration solutions such as diarolyte are useful for children who can become dehydrated quickly in hot countries. Continue to eat if you feel hungry but avoid fatty foods. You may wish to consider taking a treatment pack with you containing an antidiarrhoeal agent such as loperamide (always read the instructions) and an antibiotic such as ciprofloxacin. Most cases of travellers� diarrhoea are self limiting within 3-4 days, a single dose of 500mg ciprofloxacin can often reduce this to 1 day (a prescription is needed).

Latest Health News

Zimbabwe

The media have reported an outbreak of typhoid in a number of suburbs in Harare (Nov 02). Take particular care with food/water hygiene.

Media reports in March 2002, state that health officials are warning of a rabies outbreak in Mhondoro. Regular dog vaccinations have been disturbed and most dogs roaming the streets are said to be unvaccinated. Long stay and rural travellers may wish to consider rabies pre-exposure vaccination.

The World Health Organisation has placed Zimbabwe and Mozambique on high alert until the end of June for a possible malaria epidemic following cyclones and floods (April 03). Travellers should take steps to avoid mosquito bites and take the recommended anti-malarials.

Over 500 people have been affected by a diarrhoeal illness in Chinhoyo (north west of Harare) in June 03. A diagnosis has not been confirmed but contaminated water supplies are thought to be responsible. Outbreaks of cholera are often reported in Zimbabwe. Travellers should take particular care with food and water hygiene.

74,782 AIDS cases reported. The WHO estimate that 2,300,000 people have HIV/AIDS. A report in The Lancet, July 03 states that 34% of adults in Zimbabwe are now HIV positive.

Government health spending has fallen. A report in The Lancet, July 03 states that immunisation programmes are being neglected, doctors are demoralised and in short supply, and rural hospitals are short of drugs and basic supplies of needles.

Mozambique

Rabies is known to be a risk but vaccine stocks are reported to be insufficient. Long stay and rural travellers are advised to have rabies pre-exposure vaccine, all travellers should know what to do if bitten.

25,094 AIDS cases have been officially reported. The WHO estimate that 1,100,000 people are living with HIV/AIDS. Casual sexual intercourse is risky & ill-advised. Risk is reduced but not eliminated by use of a condom.

The World Health Organisation has placed Zimbabwe and Mozambique on high alert for a possible malaria epidemic following cyclones and floods (April 03). Travellers should take steps to avoid mosquito bites and take the recommended anti-malarials.

The World Health Organisation have reported cholera outbreaks in 3 regions of the country (Jan-June 03). Over 11,000 cases have been recorded in Gaza, Maputo and Sofala Provinces. Travellers should take care with food and water hygiene. Boil or purify drinking water.

Security Advice - summarised from the F.C.O.

For full Foreign and Commonwealth Office advice visit the FCO Website at http://www.fco.gov.uk/travel .

The risk of indiscriminate terrorist attacks in public places, including tourist sites, will be especially high during military action in Iraq. Travellers should be vigilant, take sensible precautions and monitor the media for recent developments.

Zimbabwe

There is currently political and social unrest in Zimbabwe, coupled with deteriorating economic conditions. Recent nationwide strikes, "stayaways" and demonstrations have led to confrontations with security forces, violent incidents and arrests. These have been mainly targeted against opposition supporters, but some visitors and ordinary citizens have also been threatened, physically assaulted or detained. Exercise caution and to seek up-to-date local advice. Avoid demonstrations and political gatherings. There has been political unrest for more than 2 years, although the principal tourist areas have been largely unaffected. Wherever possible travel with a recognised tour group or operator and always avoid travelling alone. Be aware that an open hand is the symbol of one of the main political parties and a friendly wave may therefore be misinterpreted. Avoid demonstrations. Mugging and pickpocketing are becoming more prevalent in city centres especially in Harare. On 4th Jan 2003, an Australian tourist was murdered whilst travelling alone in the Victoria Falls National Park. There has been carjackings in major towns recently. Thefts from vehicles are common. There are growing shortages of basic foodstuffs and fuel, large areas of the country will soon be dependent on food aid. There is also an acute shortage of cash with many banks being unable to meet their customers demands. Although tourists exchanging foreign currency should not have a problem, this can not be guaranteed. British nationals now require a visa to enter Zimbabwe. Check the current entry requirements with the Zimbabwe High Commission, London (tel:- 020 7836 7755). Comprehensive insurance is essential.

Mozambique

Most visits are trouble-free but be aware of risks of violent crime, poor road safety standards and minimal health facilities. Like other countries in East Africa, there is an increased threat from terrorism. Armed robbery with knives and firearms is prevalent in Maputo. Don't carry /display cash/jewellery. Stay on well lit, populated streets. Avoid unfamiliar areas & downtown Maputo at night. Women should not walk alone on the beach anywhere. Always carry ID. Theft at gunpoint of vehicles is a hazard, some attacks have been vicious/fatal. No road should be considered safe at all times. Travel by road outside Maputo and other major cities in daylight, restrict to major metalled roads in reasonable states of repair. Travel in convoy. It is now possible to travel by road in the South though flood-damage still causes delays. Beware of unexploded mines on little-used roads outside Maputo. There have been incidence of violence, robberies and hijakings on the approach roads to the Kruger Park and in the general border areas with South Africa. A visa is needed. Register with the British High Commission on arrival. Keep photocopies of passports/ visas/entry stamps. There is currently a drought in southern parts of the country. Vehicles should be stocked with emergency supplies and be properly prepered for difficult conditions. If travelling via the Beira or Tete corridors, contact the High Commission in Harare or Lilongwe. Comprehensive insurance is essential.

Things to consider

Accidents		First aid kit containing plasters, bandages, antiseptic spray, scissors, tweezers, thermometer. Consider needle and syringe kit Consider emergency dental kit Record of your blood group Consider joining the Blood Care Foundation
Insect bites		Insect repellent Mosquito net Plug in insecticide vaporiser Knockdown spray (fly spray)
Water purification		Iodine resin water purifier
Sun		Sun block Calomine lotion
Sex		Condoms may be appropriate
Medication		Painkillers 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
Travel Insurance		Copy of your policy and emergency contact numbers

Disclaimer

Every effort has been made to ensure the accuracy of the information supplied herein but MASTA make no warranty, express or implied, as to accuracy, completeness or usefulness of the information and all liability is excluded save in respect of personal injury or death caused by the negligence of MASTA.