Everyone going to
altitude is potentially at risk. Altitude sickness or Acute
Mountrain Sickness (AMS) is a very real problem that kills
people every year. Many people feel somewhat off colour if they
travel directly by plane or train from sea level to altitudes
above 3500m (11500 feet).
Most problems occur between 8000 to 13000ft (13000 - 18000 is
usually only reached by serious climbers) 80 - 90% of travellers
will develop AMS if they ascend too rapidly to 5000m (16400ft).
Acute Mountain Sickness is a result of the depleted level of
oxygen at altitude. As you ascend there is less oxygen available
in the air to breathe, this places strain on the body. Given
time the body can adjust to these depleted levels.
The fit and healthy may be more at risk of developing AMS. If
either traveller ascends too quickly due to fitness levels or
flying into destinations AMS may develop as inadequate time has
been allowed for the body to acclimatise.
Reputable tour companies will be aware of AMS -
listen to their advice - tragedies have occurred
when people have pushed on regardless
Familiarise yourself with signs and symptoms
The question of 'how high how fast' - is difficult
to answer because of individual responses however -
healthy people under 65 years may travel rapidly to
altitudes up to 3500m though some people will
develop mild symptoms of AMS. Above this height the
speed of further height gain should be gradual.
Spending a few days - a week before ascending
further is sensible. If any symptoms of AMS persist
you should descend and seek medical attention.
Acute Mountain Sickness is usually a self-limiting
condition without serious long-term consequences.
Malignant AMS: This is a severe form of Altitude
Sickness that could be potentially fatal if not
is not possible to predict who will develop Altitude
Sickness. Patients with heart disease, lung disease,
high blood pressure, and the elderly should seek
specialist advice if they plan trips above 4000m.
Loss of appetite
Un-due breathlessness on exertion
Sensation of the heart pounding
Caused by fluid building up in the lungs - the
Severe breathlessness after exercise or even at rest
(this can come on in a matter of minutes)
Coughing - with white or frothy pink sputum
Blueness of the lips
Caused by fluid building up in the brain the
Headache (sometimes with double vision)
Unsteadiness on the feet
Unusual behaviour/drowsiness which may lead to coma
Drugs and oxygen have little part to play in the treatment. The
best treatment is to descend. The sufferer may be irrational and
not in a position to help themselves. They must be brought down
AS SOON AS POSSIBLE. Even 1000ft can help. Descent by
2000-3000ft can bring rapid relief. DO NOT WAIT FOR A
HELICOPTER. DIAMOX (Acetazolamide) - this drug reduces fluid
retention and can help prevent AMS. It must be started at least
3 days before ascent. In a dose of one 250mg tablets twice
daily. Side effects include nausea and tingling in the fingers.
Cholera is usually rare in travellers other than those living in
very poor sanitary conditions. Large numbers of the organism are
required to make people sick - it is thought that there are
probably many mild cases which do not result in investigations
Via contaminated water and food.
It is believed that taking care with drinking water is more
effective than vaccination.
After an incubation period of 6 - 72 hours the infection results
in mild to extreme diarrhoea and extreme dehydration. This can
last from 1 - 7 days. Fever is not present.
Antibiotics and fluid replacement.
usually caused by eating contaminated food or water
Seldom lasts for more than a few days. If it
persists for more than a week or if at any time
blood is seen in the motions, a more serious
infection should be suspected and a doctor consulted
May be severe with frequent watery stools with
symptoms of DEHYDRATION (thirst, dry mouth and
tongue, headache and weakness) due to loss of body
fluids and salt.
treated by taking Oral rehydration Salts (ORS)
mixture and drinking plenty of fluids.
Should be started early to prevent dehydration. If dehydration
is already present it is essential to treat it to prevent
1) Pre-packed ORS mixtures are available at chemists and should
be taken according to the instructions on the packet
2) If not available, make up the following simple but effective
remedy and take 1 - 2 glassfuls for each loose stool passed:
ONE level teaspoonful of salt and EIGHT level teaspoons of sugar
dissolved in 1 litre of clean water (5-6 cupfuls), taken in
frequent small amounts (large swallows may cause nausea)
3) Drink enough extra fluid to maintain a good output of pale
urine. A total of three or more litres a day may be necessary.
If only small amounts of dark yellow or brown urine are being
passed - drink more water
VOMITING If vomiting is severe, the rehydration solutions should
be taken in small sips every few minutes. If there is no
improvement after a few hours a doctor should be called Anti
diarrhoea drugs may ease the symptoms in a mild attack, but are
best avoided unless the need is urgent
Antibiotics may make the condition worse and should only be
taken on the advice of a doctor. If preventative anti-biotics
are being taken they should be discontinued.
Milk and alcohol should be avoided.
Tetanus is a toxin produced by an anaerobe called Clostridium
Tetani which causes tetanus. The spores are distributed widely
in the environment and infection generally results from these
spores entering wounds at the time of injury. Polio is
predominantly contracted through contaminated food and water,
although acute infections may be passed on through the
nasopharyngeal droplets. Diphtheria is usually contracted by
respiratory droplet infection but can also be contracted by
articles soiled by infected soiled by infected persons. Skin
infection is common on the limbs of children in the tropics who
go around barefoot.
Tetanus distribution is worldwide. Polio has impacted
significantly on developing countries resulting in many people
being crippled. Effective vaccination has virtually eradicated
the disease, with the exception of Asian and African developing
countries. Diphtheria is in most of sub-Saharan Africa, parts of
South East Asia and South America. These countries present a
high risk of contracting diphtheria.
Tetanus has an incubation period of 3 – 21 days. During this
time muscle rigidity begins to increase, finally resulting in
‘Trismus’ – the inability to open the mouth widely, and rigidity
of spinal and abdominal muscles. Further deterioration follows
resulting is facial grimacing and back arching, and finally
tetanus can prove to be fatal. Polio has an incubation period of
7-14 days. With 90% of cases there are no symptoms - sometimes
resulting in lifetime immunity. A mild flu like illness with a
fever presents in 8% of cases, and the remaining 2% of cases,
symptoms include paralysis, bladder dysfunction, impaired
swallowing, breathing and speech (bulbar poliomyelitis) which
may be fatal. Diphtheria incubation period is usually 2-5 days.
Toxicity is most severe in pharyngeal diphtheria. Can cause
It is strongly recommended that travellers vaccinate against
Tetanus, Polio and Diphtheria.
Hepatitis A is present in all countries with poor sanitation and
Hepatitis A is spread through contaminated food and water,
particularly shellfish, or person to person contact when poor
hygiene is an issue. Travellers from countries where hygiene is
good are at risk because few would have developed immunity from
Hepatitis A has an incubation period of 3 – 6 weeks. The number
of people infected with Hepatitis A who exhibit symptoms is less
than 10%. The symptoms experienced by these people can include
mild fever, an upset stomach, sometimes a rash, nausea/vomiting
and diarrhoea. These symptoms are followed by jaundice and
itching. Once jaundice is established patients usually feel
better in themselves.
Infected mosquitoes spread malaria. The species that spreads
malaria tend to bite between dusk and dawn.
Distribution and Transmission
Malaria is a disease that affects Africa, South and Central America,
Asia and the Middle East. Because mosquitoes prefer humid conditions
and need fresh water to breed there is often a seasonal increase
noted, particularly in those areas that experience heavy rainfall.
Prevention of mosquito bites is the first stage of defence. This
includes wearing long sleeve shirts and trousers, using a good
mosquito repellent, using mosquito nets while sleeping and being
especially careful at dawn and dusk. Malaria tablets are also
recommended - there are several different prevention medications
that are recommended depending on the countries which you travelling
through. Please feel free to contact us so we can work out exactly
what you need for your travels - should you require prescription
tablets we are able to organise this for you.
Signs and Symptoms
The incubation period ranges from 2 weeks - 35 days. The disease
presents itself with a range of symptoms that may include:
Headache and muscle pain
Rigors (shivering) and extreme sweating
Diarrhoea, abdominal pain
If you develop a fever while travelling or having returned from your
trip it is essential to seek medical advice. Emergency treatment
should be carried if you are travelling to remote areas where
medical facilities are unavailable.
Infected mosquitoes spread Yellow fever. Although Yellow Fever
still impacts significantly on indigenous people its impact on
travellers is minimal because of the effectiveness of the
Yellow fever is present in tropical Africa and South America.
The main symptoms are fever, jaundice, haemorrhage and renal
Yellow Fever vaccination is the only remaining vaccination that
is required by the World Health Organisation. This vaccination
is documented on a Yellow Fever Certificate. This certificate is
required from travellers by some countries before they will let