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Vent: Viral Hemorrhagic Fever will really mess up your vacation!!!

alert

Senior Moderator
Ebola. One of the scariest diseases known to man, but fortunately a very rare illness. Throughout the 1990s and early 2000s, as Africa developed and human civilization expanded into areas previously uninhabited, the number of Ebola/Marburg cases per year gradually increased. By 2008, the amount of time in which MSF was containing a VHF outbreak exceeded the amount of time in which there was no outbreak. It seemed like a time bomb waiting to explode.

But then, a funny thing happened. The outbreaks stopped coming. Better education of the population in areas where the viruses are native drastically reduced the number of outbreaks, and their size. MSF has been running campaigns in those areas to inform people how the viruses are spread and of their symptoms. People are taught to avoid contact with ill primates and not to have contact with people with Ebola symptoms. As a result, no African has contracted Marburg in nearly four years, and there has been just one Ebola case since January 1, 2009 (http://www.flutrackers.com/forum/showthread.php?t=167833&page=3), and that case was quickly isolated and did not transmit the virus to anyone else. And if that were the whole story, this would be a huge triumph.

But Africans aren't the only people in Africa. Many Western tourists visit Africa for a variety of reasons, and Ebola likely isn't on their radar at all; it's just too rare. Travel health preparations may include anti-malarials, a yellow fever vaccination, and such, but they usually don't involve the Ebola virus. Unfortunately, the number of tourists who have contracted these viruses over the past four years may actually exceed the number of locals, depending on what you count and in what time period.

Exhibit A:

http://www.flutrackers.com/forum/showthread.php?t=137060

An American woman from Denver travels to Uganda in January 2008, visits a cave, has contact with an infected bat, flies back home to Denver on a commercial jet, takes ill in Denver, and visits a Denver hospital where no one suspects VHF. The woman is triply lucky; she survives, she did not fly while ill, and she infects no one else. No one even discovers her illness is due to Marburg until six months later when:

Exhibit B:

http://www.flutrackers.com/forum/showthread.php?p=168391

A Dutch woman in July 2008 visits the SAME cave as Exhibit A, has contact with the same bats, flies back to the Netherlands, and takes ill there. The woman here is slightly less lucky; she dies, but fortunately does not travel while ill, and infects no one else.

Exhibit C:

http://www.flutrackers.com/forum/showthread.php?t=82019&page=4

A South African woman, Cecelia van Deventer, travels to Lusaka, Zambia, in late August 2008, where she has several unusual exposures, including contact with an ill horse, a tick bite, and travelling in the bush while barefoot. She takes ill in Zambia, is medevaced back to Johannesburg, South Africa, and dies. Two weeks later, the paramedic who medevaced her dies as well, as does a nurse who treated her in South Africa. The illness is determined to be caused by a new VHF virus, which gets named as the Lujo arenavirus in honor of the two cities Ms. Deventer was ill in. By the time the outbreak is contained, five people are infected, including four HCW, and four of the five die. But at least she didn't travel while ill on a commercial flight.

Exhibit D:

http://www.flutrackers.com/forum/showthread.php?p=417761

Over the past few weeks, the Devaney family from Wales has travelled to Uganda for a variety of reasons including missionary work and charity, as well as a safari. Their four-year-old son, James, who has had contact with animals, takes violently ill with an unknown hemorrhagic illness around July 13, and is medevaced to Nairobi, Kenya a few days later, where he dies on July 25 without being diagnosed. His body is then flown (how?) back to Wales, where his funeral is scheduled for August 11. On August 6, ProMED gets a hold of the story (http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1010,89671), and suspects Ebola. There is likely some kind of mad scramble now going on to track James's parents, and his two older sisters, who are in route from Kenya to Wales. The diagnosis is still unclear, and there are still no reports of any other illnesses, but the story is ongoing...

So that's three or four tourists, depending on the resolution of the current incident, and one native African in the past few years. The Ebola virus will really mess up your vacation; if you are travelling to areas where such viruses are found, do some research as to what the risks are and how to avoid them. The life you save might be your own...
 
Re: Vent: Viral Hemorrhagic Fever will really mess up your vacation!!!

Likely false alarm this time; the child may have died of Hemolytic Uremic Syndrome (HUS), and not a viral hemorrhagic fever.

Nevertheless, the tourists still lead the locals 3 to 1 in this dubious category.
 
Re: Vent: Viral Hemorrhagic Fever will really mess up your vacation!!!

As noted in this excerpt from the U.S. Dept. of State report on Uganda, viral hemorrhagic fevers are not high on the Consular Affairs' list of potential medical issues for travelers to Uganda.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Uganda, including Kampala, are limited and not equipped to handle most emergencies, especially those requiring surgery. Outside Kampala, hospitals are scarce and offer only basic services. Recently, U.S. citizens involved in automobile accidents required immediate evacuation from Uganda as surgery could not be performed due to insufficient blood supplies at the hospital where they sought treatment. Equipment and medicines are also often in short supply or unavailable. Travelers should carry their own supplies of prescription drugs and preventive medicines. A list of medical providers is available at the U.S. Embassy website.

Malaria is prevalent in Uganda. Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking. For additional information on malaria, including protective measures, see the CDC Travelers? Health website.

Due to a polio outbreak, children under the age of five crossing from endemic neighboring countries such as Democratic Republic of Congo, Sudan, and Kenya (as well as Nigeria, India, and Pakistan, where the disease is also prevalent), may be required to receive an oral polio drop vaccination upon entry if not already vaccinated.

In December 2010, as many as seven districts in northern Uganda reported occurrences of yellow fever - including two possible cases from southern Sudan. Almost all of the reported severe cases (characterized by fever, vomiting, and bleeding) continue to be concentrated in three districts, namely Abim (specifically Morulem sub-county), Agago (Omiya P?Chua, Adilang and Paimoi sub-counties), and Kitgum (Orum, Namokora, and Kitgum Town Council).

In light of these findings, the U.S. Mission in Kampala recommends that U.S. citizens residing and traveling in Uganda avoid travel to these areas of northern Uganda unless they have been vaccinated against Yellow Fever within the past 10 years. If vaccinated recently, do not travel to northern Uganda for at least 10 days after receiving the vaccination. (Yellow Fever vaccinations do not take effect for 10 days.) U.S. government officials who have not been vaccinated for Yellow Fever are not permitted to travel to the affected areas.You can find good information on vaccinations and other health precautions on the CDC website. For information about outbreaks of infectious diseases abroad, consult the World Health Organization (WHO) website. The WHO website also contains additional health information for travelers, including detailed country-specific health information.

Tuberculosis is an increasingly serious health concern in Uganda. For further information, please consult the CDC's information on TB.

Uganda has experienced recent outbreaks of Marburg Hemorrhagic Fever, Ebola Hemorrhagic Fever, Pneumonic Plague, Meningitis, Yellow Fever and other types of infectious diseases.

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http://travel.state.gov/travel/cis_pa_tw/cis/cis_1051.html
 
Re: Vent: Viral Hemorrhagic Fever will really mess up your vacation!!!

I appreciate your pulling together and organizing these topics, alert. People should educate themselves about risks before they travel, so they can protect themselves as much as possible.

I'll never forget meeting a very young Peace Corp worker who had returned from the Congo ill with what the CDC thought was a disease caused by an unidentified parasite. She had also been to the Mayo Clinic seeking help without success. At that point, she just knew she was dying and was making her peace with that.
 
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