HEPATITIS A

Hepatitis A is a viral disease that causes inflammation of the liver.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Hepatitis A is known or presumed to occur in this country.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis A is transmitted through contaminated food and water. Those at higher risk include travellers visiting friends and relatives, long-term travellers, and those exposed to conditions of poor sanitation.

Risk management

• Travellers should practice strict food, water and personal hygiene precautions.
• Vaccine should be givenAll travellers in risk categories should receive vaccine to travellers whose planned activities put them at risk (see above).
• Because hepatitis A vaccine is well tolerated and affords long-lasting protection, it may be givenMost travellers at low risk, consider vaccine for those in risk categories to all previously unvaccinated travellers.
• According to UK immunisation guidance, in addition to its indications for travel, vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to those with chronic liver disease or haemophilia, men who have sex with men, injecting drug users and those at occupational risk.

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HEPATITIS B

Hepatitis B is a viral disease that causes inflammation of the liver and may lead to chronic complications.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - 2 - 7 % of the population in this country is a carrier of hepatitis B virus (intermediate endemicity).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Hepatitis B is transmitted via infected blood or bodily fluids. Travellers may be exposed when receiving medical or dental treatment, via direct contact between open skin lesions, or if participating in risk behaviour such as needle sharing, unprotected sex or contact sports. Healthcare workers are at higher risk.

Risk management

• Travellers should avoid contact with blood or bodily fluids. Where contact is unavoidable, appropriate protective precautions should be taken.
• A sterile medical kit should be carried.
• Vaccination should be considered for all adult and child travellers.
• Vaccination should be givenAll travellers in risk categories should receive vaccine to those at risk due to the nature of their activities or occupation (see above).
• Vaccine should also be givenAll travellers in risk categories should receive vaccine to those with chronic kidney failure, liver disease or haemophilia, injecting drug users, men who have sex with men and individuals who change sexual partners frequently.

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RABIES

Rabies is a neurological disease caused by viruses of the Lyssavirus genus.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Rabies occurs or is presumed to occur in wild and domestic animals (including bats).
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Transmission may occur following contact with the saliva from an infected wild or domestic animal (including bats), most often via a bite or lick to an open wound. Risk of exposure is increased by type of activity (e.g. running, cycling), occupation (e.g. veterinarians) and longer duration of stay. Children are at increased risk as they are less likely to avoid contact with animals and to report a bite or lick.

Risk management

• Travellers should avoid contact with wild or domestic animals.
• Pre-exposure vaccination should be givenAll travellers in risk categories should receive vaccine to adults and children who are:
  • at risk of rabies (see above)
  • travelling to remote areas where medical care is not readily available.
• Following an animal bite, wounds should be thoroughly cleansed and an urgent medical assessment sought, even if the wound appears trivial. Prompt post-exposure treatment is required, even if pre-exposure vaccine has been received.
• Suitable vaccines and immunoglobulin may be in short supply or unavailable in some countries.

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TETANUS

Tetanus is caused by a toxin released from Clostridium tetani bacteria.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Tetanus bacteria are found worldwide.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch.

Risk management

• Travellers should thoroughly clean all wounds and seek appropriate medical attention
• Travellers should have completed a primary vaccination course according to the UK schedule.
• A booster dose should be givenAll travellers in risk categories should receive vaccine to travellers whose last dose of a tetanus-containing vaccine was given more than 10 years ago, and who will not have ready access to medical care; even if they have received five doses previously.

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TYPHOID

Typhoid fever is a systemic disease caused by Salmonella Typhi bacteria.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Typhoid fever is known or presumed to occur in this country.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Typhoid is transmitted through contaminated food and water. Travellers who will have access to safe food and water are likely to be at low risk. Those at higher risk include travellers visiting friends and relatives, young children, long-term travellers, and those visiting areas of poor sanitation.

Risk management

• Travellers should practice strict food, water and personal hygiene precautions even if vaccinated.
• Most travellers are at low risk and do not need vaccination.
• Vaccine may be givenMost travellers at low risk, consider vaccine for those in risk categories to travellers whose planned activities put them at higher risk (see above). Current vaccines against Salmonella Typhi are only 50-80% protective and do not protect against Salmonella Paratyphi. Previous typhoid illness does not confer reliable immunity.

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MALARIA

There is no risk of malaria in this country.

SCHISTOSOMIASIS

Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma.

Risk assessment

• EpidemiologyInformation on the occurrence of disease within this country - Schistosoma haematobium (urinary) is present in this country. Travellers are at very low risk.
• ExposureInformation on the mode of transmission and factors that may increase disease risk - Schistosomiasis is transmitted through exposure to fresh water streams, rivers or lakes during activities such as wading, swimming, bathing or washing clothes. Schistosoma larvae are released from infected freshwater snails and penetrate intact skin to establish infection.  

Risk management

• Travellers should avoid wading, swimming, or bathing in fresh water.
• Swimming in chlorinated water or sea water is not a risk for schistosomiasis.
• Topical application of insect repellent before exposure to water, or towel drying after accidental exposure to schistosomiasis are not reliable in preventing infection.
• There is no vaccine or tablets to prevent schistosomiasis.
• Travellers who may have been exposed to schistosomiasis should have a medical assessment.

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