Irish students and tourists are travelling to farther-flung parts of the world than ever before, and more and more of them are returning with tropical diseases. Claire O'Connellgets advice from a specialist
Summer is on the horizon and for many, the dream holiday is fast approaching: maybe a jaunt to an exotic tropical island, or a round-the-world backpacking adventure with a group of friends. But how can you be sure that the only souvenirs you bring home will be the ones you pack in your suitcase? Every year, Irish tourists are stricken with tropical and infectious diseases, and travel health clinics here sometimes struggle to cope.
For Carol Lee, the culprit was the malaria parasite, that spreads to humans through bites from infected mosquitoes. Nine years after she was infected, she still has occasional relapses.
Lee and her husband Malcom had married in Cancun, Mexico and travelled back there to celebrate their first wedding anniversary.
The area is not usually a malaria hotspot, and the medical advice they got was that taking preventative anti-malaria drugs wasn't necessary. "They looked it up and said it was a low-risk area, and we had been there before so we weren't that worried," says Lee.
But when the couple travelled south towards Belize, they were caught in a storm that's thought to have blown infected mosquitoes further north than usual, and Lee got bitten by the insects. "On the last couple of days of the holiday, I started getting sick - it was like really bad food poisoning or flu, where you ache all over. I had no energy. I felt like I had been hit by a bus," she recalls.
After a nightmarish flight home and two weeks of quarantine, doctors figured out she had a strain of malaria. "They gave me medication to calm my body down and get me back to normal. I was so run down after being sick, but they said I'd have it for the rest of my life - and that I'd have to learn to live with it."
For the next two years, Lee had debilitating relapses every couple of months, but now suffers only if her body is under stress. "I get 'that feeling' and know I'm going to be hit again," she says. Travel health doctors currently see around 50-60 notified cases each year of travellers who return to Ireland infected with malaria. The symptoms, such as fever and headache, can come on quickly. "An acute case of malaria is a medical emergency and it does need to be seen that day rather than at any time later," says Dr Nancy Gallagher, medical director of the travel health centre at the Royal College of Surgeons in Ireland.
"The vast majority will present in the first two months after returning home, but some malarias can present very late, and if people have been abroad within the past year, really they should mention it to the doctor," she cautions. "Delays in diagnosis of malaria can be fatal."
While malaria is treatable when caught in time, prevention is better than cure, and Dr Sam McConkey, consultant in tropical medicine and infectious disease at Beaumont Hospital, practises what he preaches.
"I try to encourage travellers to be proactive in avoiding mosquito bites," he says. "I travel a lot to Africa and I wear long sleeves, long trousers, socks and I use mosquito repellent liberally. My wife jokes about how I am dipping the mosquito net as soon as I arrive, impregnating it with the insecticide and painting the windows and the screens of our little house to make sure the mosquitoes don't get in."
It's about eliminating the infection at source, he explains. And by avoiding mosquito bites, you could also be saving yourself from a dose of other diseases the insects can potentially carry, like dengue fever. Another condition that sometimes crops up in travellers returning to Ireland is the skin condition leishmaniasis, which is spread through sand-fly bites, particularly in the Middle East, parts of Africa and South America.
"It starts out like a little boil, but instead of healing up, it ulcerates. After a year or two, it often heals up and leaves a scar. We have had several people coming with that," says McConkey. Contaminated water can also harbour disease, and it might not just be the stuff you drink. Many freshwater lakes in Africa that look so inviting to swim in are infected with parasites that can quickly cross human skin, says McConkey. But if the thought of getting a parasitic disease is killing off your own travel bug, there's no need to bin the holiday brochures or cancel that round-the-world trip. Even if you are unlucky enough to pick up a tropical infection, most can be dealt with swiftly.
"One of the great things is that the vast majority of these infections are treatable if you catch them early enough," says McConkey. "So if people get symptoms when they return from abroad, they would want to get a health check and it's very important to say where you have been."
However, as foreign travel becomes easier, the facilities here for dealing with tropical diseases are often stretched, he adds. "People are going to more exotic locations. There is a need for more resources. Our clinics are full - we are seeing 50 or 60 people on our clinic days, three days a week. It's a bit of a struggle."For many young people in Ireland, a backpacking adventure can be a memorable watershed between college and career, or a treasured year out from the daily grind. But living for months in exotic cultures on a minimal budget can expose backpackers to a host of bugs that mainstream tourists might avoid. And to add insult, when a backpacker takes ill, their symptoms are sometimes just written off as the result of a hectic social life.
Six years ago, John Traynor from Ashbourne in Co Meath finished his apprenticeship as an electrician and headed off backpacking with his girlfriend and another couple. But he started to feel fluey when they arrived in Sydney after a fortnight in Thailand. "On his last phone call home, he told my mother he 'didn't feel the Mae West'," recalls John's sister, Sarah.
The local doctor he went to simply told him to ease up on the partying. "He wasn't taken seriously as a backpacker," she says.
John returned to the hostel, but his condition worsened and his friends urged him to go straight to hospital because he was getting dehydrated. Despite his illness he seemed in good spirits, says Sarah, but he asked the medical staff there to take him seriously. He was eventually admitted, but died of a heart attack the next day.
The hospital staff were in shock, says Sarah, who flew to Sydney with John's friend to bring her 25-year old brother home. She met one of the attending doctors.
"She said she was immediately drawn to his friendly face, she had chatted a lot to him and he promised to wire her new house. She was devastated and didn't sleep all the following night thinking about 'what ifs'."
Three days after his death, the doctors determined that John had been suffering from severe food poisoning. He had picked up an Asian strain of salmonella, probably through eating contaminated poultry in Thailand.
"The doctor said a lot of people would be very ill from it but not die, but it travelled to his heart, he was very unlucky," says Sarah. "They said the chances of it were less than winning the lotto."
"We tend to think of ourselves as sterile beings walking around the place and every so often, some horrible bug infects us. But we forget that we inhabit a biological soup and we are keeping bugs at bay," says Dr Paul McKeown, a consultant in public health and medicine in the Health Protection Surveillance Centre. He has a number of suggestions for globetrotters on how to keep healthy.
• Plan your itinerary, get travel health advice well in advance and ensure you have all relevant vaccinations.
• Take appropriate anti-malaria medication before going to affected regions, even if you are returning to an area where you lived before. "The natural immunity wears off."
• No one wants mosquito bites, whether disease-bearing or not, so cover up, use repellent on any exposed skin and sleep under a net. "If you avoid mosquitoes the kinds of things you will be preventing are malaria, Japanese encephalitis, West Nile virus, tick-borne encephalitis, yellow fever and dengue."
• Drinking clean water is an obvious precaution, but also peel fruit and steer clear of salads and vegetables that may have been washed in contaminated water. "If you take care with the food and the water you will be protecting yourself against things like cholera, salmonella, shigella and dysentery."
• Protect your skin from the sun. "Go with the Australian advice of slipping on a T-shirt, slapping on a hat and slopping on sun cream."
• Avoid unprotected sexual contact with people you don't know. "People are always worried by HIV/Aids, it's the granddaddy of them all. Also there are parts of the world where the risk of disease will be a lot higher than others - for example hepatitis B is much commoner in sub-Saharan Africa and southeast Asia than it would be in northern Europe."
For more information, see www.hpsc.ie; www.who.int; www.tmb.ie