Typhoid fever
What is typhoid fever?
Typhoid fever is an infectious intestinal disease caused by Salmonella Typhi bacteria. After infection, it takes one to two weeks for a person to become ill. The most common symptoms are fever, abdominal pain, headache, decreased appetite, red spots (mainly on the skin of the abdomen), constipation and, in some cases, diarrhoea. In severe cases, intestinal ulceration(s) with bleeding or intestinal perforation may occur.
How do you get typhoid fever and in which countries is it prevalent?
Typhoid fever occurs worldwide, but especially in parts of Africa and Asia. The disease primarily occurs in areas where sanitation is poor. Someone carrying the bacteria can pass it on through poor (hand) hygiene, for example, by not washing their hands after going to the toilet. This person can then contaminate other surfaces, such as door handles or food and drinks. This allows the disease to spread easily.
What can you do to prevent typhoid fever?
In general, it is important to pay attention to (hand) hygiene. Other recommendations include eating only well-done or freshly cooked food, drinking water only from (previously) unopened bottles, and avoiding ice cubes. If you are traveling to a country where typhoid fever is common, you can protect yourself through vaccination. Based on your destination and health, we would be happy to provide you with personalized advice.
What protection does the typhoid fever vaccination offer?
The typhoid fever vaccination consists of one shot and provides protection for three years. The vaccination protects 60-70% against the serious complications of typhoid fever and is available from the age of 2 years. It takes 1-2 weeks for the vaccine to be effective.
What are the side effects of a typhoid fever vaccination?
The typhoid fever vaccination may cause mild side effects. For example, the injection site may be painful or swollen. Some people experience mild flu symptoms such as fever, fatigue and a headache.
How much will a typhoid fever vaccination cost?
If you have supplementary insurance, the cost of a typhoid fever vaccination is covered by your health insurance in most cases. For more information, please visit our prices page.
Questions or schedule an appointment?
Do you have questions or would you like to book an appointment for a personal (travel)consultation? Use the button below, email us at info@vaccinatiecentrum.nl or call 085-9020303.
Rabies
Rabies
What is rabies?
Rabies is an infection of the brain or nervous system. This infection is caused by the rabies virus, which is transmitted through contact with infected animals. In general, rabies infections do not occur in the Netherlands; the disease is almost always contracted abroad. In the Netherlands, a mild version of the rabies virus occurs in bats, but this virus almost never causes infection in humans. It is recommended not to touch bats and to see a doctor if you have been scratched or bitten by a bat.
After infection, rabies progresses in several distinctive stages. Without treatment, it takes twenty to ninety days from the time of infection before symptoms develop. The length of this incubation period depends on the site of infection. The closer to the central nervous system the infection takes place, the faster the disease usually progresses.
In the first stage, the following symptoms occur:
· a reduced appetite;
· Nausea;
· Chills;
· Headache;
· Vomiting.
In the next stage, neurological symptoms occur, such as:
· Muscle spasms;
· Paralysis;
· Convulsions;
· Difficulty swallowing and breathing.
Because swallowing water or mucus might become very painful, some people develop hydrophobia.
The disease is fatal, a person often ends up dying from swallowing and breathing problems. For this reason, it is important for anyone going to an high risk area to take preventive measures. It is also important to take immediate action when someone does get bitten or scratched.
How do you get rabies?
The rabies virus can be found all over the world, except in Japan, New Zealand and Antarctica. The risk of a rabies infection can vary greatly from country to country. The likelihood of contact with certain mammals is higher in some countries than in others. The activities undertaken during travel also affect the risk a person faces.
The virus that causes rabies can be present in many mammals. It is therefore recommended to stay away from (wild) animals when abroad. These include dogs, cats, bats and monkeys. Contact with many of these animals is risky. Although the chance of the animal being infected with rabies is very low, any contact can be a potential danger. In such cases, treatment is imperative.
What can you do to prevent rabies?
It is always best to prevent infection, this is especially important when it comes to rabies. When abroad, avoid contact with animals and pay extra attention to children since children are more likely to touch animals. If in your situation there is an increased risk of rabies during your trip, it is advisable to take preventive measures but also to have an emergency plan at hand. You are at increased risk of a rabies infection when:
- You are travelling to an area where rabies is common;
- You expect to come into frequent contact with (wild or stray) animals, for example because of your profession;
- You plan to cycle a lot (cyclists are at increased risk of dog bites);
- You spend more than three months in a high-risk country or make frequent short trips;
- You are travelling with small children;
- Medical care not readily available during (part of) your trip.
If one or more of these conditions apply to your trip, it may be wise to get a preventive rabies vaccination. If you are vaccinated against rabies, treatment after a bite or scratch is easier and more readily available.
What to do if you are bitten or scratched?
Regardless of your vaccination status, you should first clean the wound properly. You do this by rinsing the wound for at least ten minutes with lukewarm water and soap. Then disinfect the wound, which can be done with alcohol 70% or iodine. You may dress the wound, but do not stitch it; it is important that the wound remains open.
What to do after disinfecting depends on whether you have been vaccinated or not. In any case, make sure you monitor the wound closely and keep your vaccination passport at hand. That way, the doctor treating you will know which vaccinations you have had and which treatment is best for you.
Even if you are fully vaccinated, you should still see a doctor as soon as possible. You will then receive two vaccinations in three days. Always have these vaccinations recorded in your vaccination passport.
Are you bitten or scratched but not vaccinated against rabies? In that case, use the emergency number of your health insurance and/or travel insurance. Within 12 to 24 hours, MARIG, or human anti-rabies immunoglobulin, should be started. This drug is difficult to obtain or of poor quality in many countries. At the same time, a vaccination series is started, consisting of at least four vaccinations. This is usually done on day 0, 3, 7, 14-28. An embassy or consulate can tell you where the vaccine is in stock.
When is it advisable to do a rabies antibody determination?
If your profession involves a lot of contact with animals that may be infected with the rabies virus, a different procedure applies to you. Are you a veterinarian, biologist or do you research bats? Then you are at greatly increased risk and it is advisable to do a titre check four weeks after your vaccination. This is a blood test that determines your level of protection against rabies.
Based on the result, it can be decided to do a booster vaccination. Another titre check is then done four weeks after the booster vaccination. After that, checks should be done every six months. This ensures that you can continue to do your job safely.
In addition, a booster vaccination may be recommended if you are travelling to a very remote area and are unlikely to be able to start your treatment within 24 hours. A booster vaccination provides long-term protection for at least five years.
What protection does the rabies vaccination offer?
The vaccination provides lifelong protection against rabies after a full pre-exposure prophylaxis (PrEP) series. As a treatment, anti-serum (MARIG) is no longer required. However, additional vaccinations may be required as treatment. This depends on the wound and what kind of animal it has been. Always have this assessed by a doctor or expert.
How much will a rabies vaccination cost?
If you meet a number of high-risk criteria, a rabies vaccination is usually covered by your health insurance. Check with your health insurance company whether the vaccination is (partially) covered. For more information on costs, please visit our prices page.
Questions or schedule an appointment?
Do you have questions or would you like to book an appointment for a personal (travel)consultation? Use the button below, email us at info@vaccinatiecentrum.nl or call 085-9020303.
Malaria profylaxe
Malaria: risks, prevention and advice for travellers
Malaria is a serious infectious disease transmitted by mosquitoes in tropical and subtropical regions. There is usually no vaccine available for travellers. You can prevent the disease by protecting yourself against mosquito bites and by taking malaria tablets. Whether you need malaria prophylaxis depends on your destination and the duration of your trip.
What is malaria?
Malaria is caused by the Plasmodium parasite, various species of which can cause infections in humans. You can become infected through the bite of an infected female Anopheles mosquito. These mosquitoes are mainly active between sunset and sunrise. After infection, the parasite ends up in the liver, where it multiplies and then enters the bloodstream.
There are five different forms of malaria. The most dangerous is malaria tropica. Infection with this form of malaria can lead to serious complications within a few days, possibly resulting in death. Treatment for this form of malaria is only possible at an early stage.
The other forms of malaria are less severe. The symptoms are the same, but no serious complications occur. The most recently discovered form of malaria infects monkeys (including macaques) in Southeast Asia and can also be transmitted to humans by mosquitoes.
Where does malaria occur?
Malaria occurs in parts of South and Central America, Africa and Asia. The highest risk of contracting malaria is in sub-Saharan Africa and parts of Asia and South America.
High-risk areas
- Sub-Saharan Africa
- Parts of Asia
- South America
Would you like to know if malaria is present at your travel destination? Then visit our country page, where you can see which diseases are present in each country. You can also read here which vaccinations are compulsory or recommended and what other health precautions you can take.
What are the symptoms of malaria?
The first symptoms of malaria usually appear ten to fourteen days after infection, but sometimes it can take several months. Common symptoms include:
- Fever
- Chills
- Headache
- Muscle pain
- Fatigue
- Diarrhoea and vomiting
- Shortness of breath
- Anaemia
In severe forms of malaria, such as malaria tropica, complications can occur, such as neurological symptoms (headache, seizures, coma or confusion), organ failure and even death.
Is there a vaccine against malaria?
A vaccine against malaria has been available since 2015. However, this vaccine does not provide sufficient protection against malaria for use by travellers. The vaccines (RTS,S and R21) are primarily intended for children in high-risk areas in Africa, not for travellers. As a traveller, you can prevent malaria by protecting yourself against mosquito bites and by taking malaria tablets (prophylaxis).
Do I need malaria tablets?
Whether you need malaria tablets depends on your destination, the length of your trip, your medication use and any pre-existing conditions you may have. This means you may receive different advice to one of your travel companions. You should therefore always seek personalised travel advice and not simply follow someone else’s advice.
You will probably need tablets if:
- Travelling to sub-Saharan Africa, parts of Asia and South America
- A stay of more than a week
- Staying overnight outside cities
What malaria tablets are available?
There are various types of malaria tablets. Commonly used medicines include atovaquone/proguanil (Malarone®), doxycycline and mefloquine (Lariam®). The dosage, possible side effects and the best way to take the tablets vary depending on the medicine. You will be given an explanation of this during your appointment with the travel nurse.
How can you prevent malaria whilst travelling?
Fortunately, malaria is easy to prevent. The most important measure is to avoid mosquito bites. Wear long-sleeved tops and long trousers, use insect repellents (such as DEET) and sleep under an impregnated mosquito net or in an air-conditioned room.
In areas where malaria is common, it is sometimes advisable to take malaria tablets (chemoprophylaxis). These medicines help prevent the parasites from taking hold in your body. It is important to start this medication on time and to complete the full course of treatment in accordance with the advice you have been given.
Are you travelling to a high-risk area where access to medical care is limited? If so, you may need to take emergency treatment with you on your trip.
In short:
- Sleep under a mosquito net
- Use DEET
- Wear long clothing
- Avoid stagnant water
- Seek advice from one of our travel nurses in advance and follow this advice carefully during your trip.
When should I seek medical advice about malaria?
If you have been in a malaria-endemic area in the last three months and have a fever, you should be tested for malaria if the fever lasts longer than 48 hours.
Frequently asked questions about malaria
The incubation period is 10–14 days after infection.
Yes, it is possible, but the risk of malaria in Thailand is low.
The most dangerous form of malaria, malaria tropica, can cause serious complications within a few days. This can sometimes be fatal.
That depends on your destination and the duration of your trip. The travel nurse will discuss this with you during your personal travel consultation.
All medicines can cause side effects, including malaria tablets. The side effects are usually mild, certainly compared to the symptoms of malaria itself. You can read about any side effects you might experience in the leaflet that comes with your malaria tablets.
The impact of rabies
Dit blog is gepubliceerd op 6 november 2019 en geschreven door Marchel Ratering
Rabies is an infectious disease that is relatively rare in the Netherlands. According to statistics, 3 people have died in the Netherlands from Rabies in the past 25 years.
The impact of a dog bite, or contact with a mammal in the sub(tropics) is usually significant. In recent years, advice to travellers on rabies has been given more frequently by vaccination centres. It is discussed whether or not to vaccinate after which people often choose not to vaccinate (partly influenced by protocols). People often choose not to vaccinate because of the extra cost and because they assume the chance of a mammal bite is small.
This is absolutely right as far as I am concerned. It is important that people who come to a vaccination centre are advised about this and that people know that it is better to stay away from animals. This means not petting dogs, cuddling cats or having their picture taken with a monkey and, of course, leaving bats alone.
Despite this, I have noticed that in recent years, people are having more and more contact with mammals in the tropics and that people are increasingly worried about infection. The number of people receiving treatment after a bite has increased. This means that people are more and more aware of the risk of Rabies and are worried about (even minimal) contact and would like treatment when this happens.
Rabies vaccination before a trip to the tropics is a very good investment
Let’s circle back for a moment to the 3 people in the Netherlands who died of Rabies in the past 25 years. All three had not been vaccinated against Rabies prior to their trip.
In my professional opinion, getting vaccinated before a trip to the tropics is a very good investment. You only need to do it once after which you are protected for the rest of your life. Protected in this case means that your body builds up immunological memory against this virus. This immunological memory lasts throughout your life and means that after a bite or contact with a mammal that might be infected with rabies, you don’t have to do anything but wash the wound with soap and water, disinfect it for a while and preferably get two Rabies vaccinations as soon as possible. How soon you should get these vaccinations depends on where on your body you have been scratched, bitten or licked and the severity of the wound. With scratching, there is a chance of infection but this chance is small. In case of biting, the chance is higher, so in that case, go and get a rabies vaccination as soon as possible. The vaccination stimulates your immune system’s memory cells to produce antibodies. As a result, your body makes its own protective immune cells.
If you are vaccinated before travelling, you don’t have to worry about getting immunoglobulins after coming into contact with a mammal (Marig: “human anti rabies immunoglobulin”). These immunoglobulins are difficult to obtain in many countries and the quality can also vary greatly in the tropics.
If you are going to the tropics, I recommend you read the information on Rabies carefully.
Travel safely and without worry
I myself was vaccinated against Rabies 10 years after my first trip.
It was only when I started travelling with my children that I noticed how vulnerable we are as human beings and that it is wise to protect yourself as much as possible. Even though the chances of getting sick while travelling are slim, you still have a lot less to worry about if you travel well prepared and with the right vaccinations.
As I was writing this blog, I received a call from a traveller who had been bitten by a dog in Thailand. He had not been vaccinated against rabies and told me that he had gone to the hospital in Thailand because he did not know what to do. There he received vaccinations against Rabies. After 2 weeks, he learned that he actually should have had Marig. Now he is worried because that means he actually didn’t get the right treatment.
Every day, travellers in the (sub)tropics are bitten or scratched by mammals. The impact of a bite during your trip is very significant. By getting vaccinated against rabies before your trip, you can travel safely and without worry.
Marchel Ratering, registered traveller nurse and owner of vaccinatiecentrum.nl