Updated Yellow Fever Requirements for South Africa

Following our previous post there have been further changes to the  Yellow Fever Vaccination requirements for entry to and from South Africa. From 1st October 2011, The South African Department of Health have confimed that a yellow fever certificate will now be required by South African authoriities for travellers coming from or travelling to Zambia. Yellow Fever vaccination requirements can be subject to change so it is always wise to check the NATHNAC website for up to date country requirements.

Advice for Travellers

There is no Yellow Fever vaccination entry requirement for travellers visiting South Africa flying directly from the UK, however, if your journey includes travel or transit through certain African countries a Yellow Fever certificate will be required.
Proof of Yellow Fever vaccination is required for all travellers age 1 year and over who enter South Africa from the following countries:

• Democratic Republic of the Congo
• Eritrea
• Ethiopia
• Kenya
• Sao Tome and Principe
• Somalia
• United Republic of Tanzania

Travellers will be required to produce a certificate of vaccination even if they passed through the above countries in transit, this includes stopping at the airport for short periods. If you are unable to have the vaccine due to a medical condition, then an excemption certificate can be issued. Speak to your GP, nurse or travel clinic.

Meningitis Recommendations for Haj and other Pilgrimages

Every year over two million Muslims from around the world make the Hajj pilgrimage to Makkar (Mecca) in Saudi Arabia. A shorter pilgrimage, Umrah can be performed at any time during the year also attracts many visitors annually. It is estimated that Hajj will fall between 4 and 7 November 2011.
The Hajj consists of several rituals that symbolise devotion to God, brotherhood and unity and all Muslims are required to perform Hajj once in their lifetime if financially and physically able.

Vaccinations

If you are travelling to Hajj or Umrah you should make sure you are up to date with all your routine vaccinations such as Diphtheria, Tetanus and Polio. It is also recommended that you check you have received 2 doses of Measles, Mumps and Rubella or had the illnesses in childhood.

All travellers are required to be vaccinated against Meningitis ACWY and a certificate of vaccination is required for entry.

Sussex Travel Clinic is partner of the Muslim Council of Britain Meningococcal (ACWY) vaccination package programme and offer the vaccine at a reduced rate of £35 per dose- please call 01273 749100 to book or discuss.

Seasonal Flu- the Ministry of Health of Saudi Arabia recommends that pilgrims should be vaccinated with the flu vaccine before travel. Flu can be easily spread in crowded conditions through coughing and sneezing. You may be entitled to a free flu vaccinated from your NHS GP or we can provide a flu vaccine at the clinic. Clinics commence in October 2011.

Pilgrims should consider vaccination against Hepatitis B. Hepatitis B is a virus that is spread through blood contact or sexual contact.All males attending Hajj must have their heads shaved and the Saudi government provides licensed barbers who will use a new blade for each pilgrim, however unlicensed barbers may not do this. Sharing razors carries a risk of contracting blood borne viruses such as Hepatitis B, Hepatitis C and HIV. It is much safer to bring your own disposable razor.

Yellow Fever vaccination - the Saudi Arabian government requires travellers who arrive from yellow fever risk countries to be vaccinated against Yellow Fever. This is not a requirement if travelling from the UK. Yellow Fever risk countries can be viewed here Yellow Fever Risk Countries.

Travelling to Hajj can pose some health risks. The Hajj can be very physically demanding especially in the hot heat of Saudi Arabia so you will need to take plenty of high factor sun cream. Clean water and sanitation is harder to maintain in conditions like the Hajj, it is important to make sure you drink plenty of fluids and carry clean drinking water. A useful leaflet is available in several languages with tips on keeping healthy when travelling to the Hajj and Umrah- you can view it here.

What is Altitude Sickness?

Trekking in some of the world’s highest mountains is becoming much more common as travellers go off to destinations such as Mount Kilimanjaro in Tanzania and the Inca Trail in Peru on treks for charity or pleasure. Trekkers to these popular destinations are at risk of Altitude Sickness, though not all trekkers will experience it.

Mount Kilamanjaro, Tanzania - a popular trekking destination

What is Altitude Sickness?

Altitude sickness or Acute Mountain Sickness (AMS) is a potentially life threatening condition caused by a decrease in atmospheric pressure, which makes breathing difficult. AMS is caused when you are exposed to high altitude without acclimatising first and can occur at altitudes usually higher than 2,500 metres. At high altitudes the percentage of oxygen in the air remains the same, however partial pressure drops. This pressure drives oxygen into the blood stream and the decrease results in lower oxygen levels in the blood. The way our bodies cope with this lack of oxygen is to increase our breathing rate, which then increases carbon dioxide levels in the blood and symptoms of AMS occur. AMS symptoms usually occur 6 – 12 hours after arrival at altitude, but can begin more than 24 hours after ascent. Common symptoms include: headache, nausea, sleep disturbance, dizziness and exhaustion. If you start to experience these symptoms they will usually resolve within a couple of days if further ascent does not occur.

Am I at Risk?

It is difficult to predict who will get AMS, and being physically fit does not necessarily put you at lower risk. If a traveller has previously experienced no symptoms at altitude, they are less likely to get AMS, however even this may be unreliable. Rapid ascent is the highest risk factor. 50% of trekkers in Nepal developed AMS at altitudes of between 4,500 and 5000 metres. Another study showed that 84% of trekkers experienced AMS when they flew directly to 3,860 metres [1].

Prevention

The most important factor in the prevention of AMS is adequate acclimatisation and regular rest days. A short period of acclimatisation (1-3 days) at 3,000m should be followed by further ascent which should be gradual, with no more than a 300-500m increase in sleeping altitude per day. You should have a rest day every 3 days. If you start to experience mild AMS symptoms, no further ascent should be taken until symptoms have resolved. If you experience severe symptoms of AMS rapid descent should be immediate.

Diamox (Acetazolamide)

Diamox is used as prevention for AMS, although it is unlicensed in the UK. Diamox should not be considered as an alternative to adequate acclimatisation and gradual ascent, Diamox will hasten acclimatisation, and may help to relieve the symptoms of AMS but will not relieve symptoms immediately when taken for treatment. Symptoms usually resolve within 12-24 hours when used in treatment.
If travellers use Diamox, a trial dose of 250mg once daily for two days should be taken prior to travel.
If no adverse events are experienced, it should then be commenced one to two days prior to ascent to 3,500m and then continued for at least two more days after reaching the highest altitude.
Diamox can cause nausea, increase in urine output, and oral and finger tingling. More unusual side effects include rashes, flushing and thirst.
It is contraindicated in those with hypersensitivity to sulphonamides and anyone who has experienced an anaphylactic reaction in the past.


How Does It Work?

Put simply Diamox works by forcing the kidneys to excrete bicarbonate the base form of carbon dioxide.
It speeds up the acclimatisation process
It also stimulates breathing during the night
Lessens the symptoms of AMS


Severe Mountain Sickness

Acute mountain sickness progresses in less than 10% of cases to the more severe form where travellers experience lethargy, confusion and lack of coordination or muscle movements.
Initial symptoms include shortness of breath with exertion, and a dry cough, progressing to shortness of breath at rest. The cough may become productive with blood stained sputum.
Anyone with symptoms of severe mountain sickness should descend immediately. This can progress rapidly and death is the likely consequence if a descent is not made as soon as the symptoms are recognised.

References

1.     NATHNAC - http://www.nathnac.org/travel/factsheets/altitude.htm