Vol 27 No 2 December - The Indian Society for Parasitology

82 Parasitic infections in travelers
JPD : Vol. 27 (2), 2003
areas. These infections are associated with a major threats to the health of a traveler, so that
protracted course, especially in immunocompromized appropriate prophylactic measures could be
individuals. Moreover, debility in the form of weight undertaken (Steffen et at, 1987).
loss is severe in patients with a prolonged illness.
To conclude, travel will continue to be source of
Increased awareness, leading to high index of clinical
human enlightenment, rejuvenation, and betterment
suspicion, timely diagnosis, and appropriate therapy
only when the traveler is safe, and is protected from the
can reduce morbidity and mortality to a great extent.
vices of nature. Increased knowledge and
Weekly chemo-prophylaxis against malaria, understanding of the epidemiology of tropical
protective clothing and insecticide-treated bed nets, parasites is one of the significant steps in the
application of insect repellants, adherence to safe sex achievement of this much-desired objective.
guidelines and selection of safe food and water may
protect the travelers from these infections. Traveling
Box I
to underdeveloped countries necessitates the Reasons for the increased susceptibility of travelers to
implementation of several important preventive parasitic infections
measures, such as vaccination and bringing water 1 False sense of security and confidence among travelers about
ecological, environmental, health, and hygienic measures in
boiling apparatus (Box II). It is recommended that different tourist resorts.
after arriving in the underdeveloped country, travelers 2 Lack of protective immunity among travelers from nonendemic
region visiting a country with high endemicity.
must avoid unheated water, ice, beverages containing
ice, raw vegetables, fruits cut by local people. 3 Absence or inadequate pro-travel advice or counseling.
However, many travelers do not pay much attention to 4 Adventure tourism in tropical countries with poor sanitation
and high vector density.
these points, resulting in increasing numbers of
5 Consumption of unboiled local water, beverages, ice, and ice
tropical orally contracted intestinal diseases. In containing beverages, fruit juices, and salads by travelers.
addition to the education of travelers about preventive 6 Inadequate personal protection like non-use or irregular use of
measures, doctors who will see patients returning mosquito nets, long sleeved garments, shoes.
from underdeveloped countries must be able to 7 Bathing in unclean water.
recognize and treat tropical diseases. Unfortunately, 8 Non-compliance to chemoprophylaxis.
this is often not the case in developed countries,
resulting in delays in diagnosis and treatment, it is
Box II
imperative to diagnose communicable diseases as Dos and don'ts for travelers visiting tropical countries
quickly as possible to avoid complications and
1. Wear protective clothing and shoes to avoid insect bites and
unnecessary secondary infections. Thus, for a traveler exposure of the feet to soil.
to the developing world accumulating knowledge on 2. Avoid bathing in unclean water.
the current hygienic conditions in the tropical country 3. Never drink unbottled water.
must also be one of the necessary preparations 4. Drink bottled mineral water from a reputed company.
(Sakaue, 1997).
5. Avoid consumption of ice, ice containing beverages, fruit
juices, salads.
Questionnaires can be an effective tool in the 6. Consult advice of counselors and physicians about
assessment of health-risk associated with short-term prophylactic measures to be adopted during or before travel.
(less than three months) travel to developing countries 7. Take chemoprophylactic drugs in adequate dosages as
recommended by a qualified physician.
from developed nations. Steffen and colleagues in a
8. Maintain strict compliance with chemopro-phylactic
study has shown the usefulness of questionnaires to
regimens.
assess health risk associated with travel to tropics, In 9. Take drugs in serious diseases under supervision.
their study, questionnaires designed to elict 10. Take prophylaxis for malaria 2 weeks before journey and
information regarding pre-travel vaccinations, continue for 4 weeks after return from endemic region.
malaria prophylaxis, and health problems during and 11. Discourage children and pregnant women from traveling to
after their journey in 10,524 travelers (with an answer endemic zones. The disease becomes more severe and may
even to lead to fatality in such cases. Incase, already affected,
rate of 73.8%) showed that the incidence of infection they should be shifted to the nearest hospital where special care
per month abroad was 7/1000 for giardiasis, 4/1000 can be given.
for amebiasis, and 1/1000 for malaria. Such 12. Carry the necessary itineraries like bed nets, personal
information was extremely valuable in identifying the prophylactic drugs and mosquito repellants right from
beginning of the journey.