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 - Less than 2% of the population in this country is a carrier of hepatitis B virus (low 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.
• Most travellers are at low risk.
• Vaccine should be givenAll travellers in risk categories should receive vaccine to adult and child travellers 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 - This country is presumed to be free of rabies but there is no surveillance reporting.

Risk management

• Travellers should avoid contact with wild or domestic animals. Infections other than rabies can be transmitted through bites.
• Following a bite, wounds should be thoroughly cleansed and a medical assessment sought.

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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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MALARIA

There is no risk of malaria in this country.

ALTITUDE

There is a point of elevation in this country higher than 2,500 metres (m).

Risk assessment

• Travel to destinations of 2,500-3,500 m (8,200-11,500 feet) or higher carries the risk of altitude illness. Important risk factors for altitude illness are the altitude gained, rate of ascent and sleeping altitude. Rapid ascent without a period of acclimatisation puts a traveller at higher risk.

Risk management

• The most important prevention measure is adequate acclimatisation.
• Travellers should spend a few days at an intermediate altitude below 3,000 m.
• Ascent above 3,000 m should be gradual with no more than a 300 - 500 m increase in sleeping altitude per day, with a rest day every three days.
• Acetazolamide is recognised for use in the prevention of altitude illness. It should not replace acclimatisation and gradual ascent.
• Travellers who develop symptoms of altitude illness (headache, fatigue, loss of appetite, nausea and sleep disturbance) should avoid further ascent. In the absence of improvement or with progression of symptoms the first response should be to descend.
• Development of more severe forms of altitude illness, high-altitude cerebral oedema (HACE) (confusion, difficulty with balance and coordination) or high-altitude pulmonary oedema (HAPE) (shortness of breath at rest, cough and chest tightness), require immediate descent and emergency medical treatment.

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