World Travel Atlas Select Focus Maps. Course Content – First Block

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World Travel Atlas Select Focus Maps

Transcript of World Travel Atlas Select Focus Maps. Course Content – First Block

Page 1: World Travel Atlas Select Focus Maps. Course Content – First Block

World Travel AtlasSelect Focus Maps

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Course Content – First Block Course Content – First Block

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World Travel AtlasSelect Focus Maps

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World Travel AtlasWorld Travel AtlasSelect Focus: Major Health Risks over the World Select Focus: Major Health Risks over the World

ATLAS p. 39

Malaria

Pathogen: parasites of Plasmodium

Vector: (female) Anopheles (=> mosquito strain)

Benignant Forms (M. tertiana, M. quartana) - Plasmodium vivax, Plasmodium malariae

Malignant Form (M. tropica) - Plasmodium falciparum

Symptoms - fever, headache, chills, tiredness and vomiting - appear 10 to 15 days after a person is infected - malaria can cause severe illnesses, often fatal if not promptly treated

Anopheles

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ATLAS p. 39

Malaria – Cycle

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Malaria - Global and Regional Health Risk

40% of the world’s population are at risk (mostly those living in the world’s poorest countries )

Every year, more than 500 million people become severely ill with malaria

The vast majority of cases occur in children under the age of 5 years; pregnant women are also especially vulnerable.

Most cases and deaths are in sub-Saharan Africa (85– 90% of malaria fatalities occur). However, Asia, Latin America, the Middle East and parts of Europe are also affected

Travellers from malaria-free regions going to areas where there is malaria transmission are highly vulnerable – they have little or no immunity and are often exposed to delayed or wrong malaria diagnosis when returning to their home country.

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ATLAS p. 39

Malaria - Health Risk areas

Malaria occurs in over 100 countries

widespread in many tropical and subtropical countries

Large areas of Central and South America, Hispaniola (Haiti and the Dominican Republic), Africa, the Middle East, the Indian subcontinent, Southeast Asia, and Oceania are considered malaria-risk areas.

Some regions have a fairly constant number of cases throughout the year – these are malaria endemic – whereas in other areas there are “malaria” seasons, usually coinciding with the rainy season.

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ATLAS p. 39

Malaria – Health Risk areas

Malaria transmission differs in intensity and regularity depending on local factors such as:

- rainfall patterns,- proximity of mosquito breeding sites and mosquito species.

High risk transmission areas: Sub-Saharan Africa, Sumatra, Borneo, Papua Guinea, Area along Thailand and Burma’s border, India (+/-), Amazonas area, Solomon Islands / Vanuatu Low risk transmission areas (see maps) M. more common in rural areas than in cities; ( contrast to Dengue Fever - urban areas - greater risk).

E.g. the cities of the Vietnam, Laos and Cambodia are essentially malaria-free, but the disease is present in many rural regions

Africa malaria is present in both rural and urban areas, though the risk is lower in the larger cities

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ATLAS p. 39

No Malaria

Low-risk areas

High-risk areas

High-risk areas – Chemoprophylaxis recommended

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ATLAS p. 39

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World Travel AtlasWorld Travel AtlasSelect Focus: Major Health Risks over the World Select Focus: Major Health Risks over the World

ATLAS p. 39

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World Travel AtlasWorld Travel AtlasSelect Focus: Major Health Risks over the World Select Focus: Major Health Risks over the World

ATLAS p. 39

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Malaria - Antimalarial Prophylactic MeasuresExposure Prophylaxis:

Avoidance of Bites (long-sleeved clothing, a mosquito net which should be impregnated with insecticide)

Insect Repellents: use repellent on exposed skin spraying insecticides in the room

Chemoprophylaxis Pathogen-specific Tablets (e.g. Chloroquin, Proguanil, Mefloquin, etc.) The tablets you require depend on the

country to which you are travelling

no preventive vaccine (possibly available by 2010)

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Malaria - Antimalarial Therapy

CHEMOTHERAPYPathogen-specific Tablets or Injections (e.g.

Halofantrin,Doxycyclin, Lapdap*, Fosclin*, Artemisia-Derivatives*)

*Note: Latest medications

The drug treatment of malaria depends on the type and severity of the attack.

For more information

www.malaria.org (Malaria Foundation International)

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Drug resistance problem

spread of anti-malarial drug resistance over the past few decades

It is the plasmodia that cause malaria that develop resistance to anti-malarial drugs not the mosquitoes that transmit the disease.

The parasite's resistance to medicines continues to undermine malaria control efforts.

EXAMPLES

Resistance to CHLOROQUINE began from two epi-centres; Columbia (South America) and Thailand (South East Asia) in the early 1960s. Since then, resistance has been spreading world wide.

Recently, cases of MEFLOQUINE resistance have been reported from areas of Thailand bordering with Burma and Cambodia.

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Drug resistance problem

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Pathogen Resistance: Sickle-cell disease (Blood disease)

Sickle-cell disease is a group of genetic disorders caused by sickle haemoglobin

people concerned: only in tropical Africa‘s endemic Malaria zones (30%)

2 different types:

Heterozygous mutated cells (99% of people concerned): unimportant level of anaemia BUT greatly reduced chance of serious malaria tropica infection

Homozygous mutated cells (<1%): full sickle-cell disease, rarely live beyond adolescence, no Malaria immunity

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Socio-economic effects

Malaria causes an average loss of 1.3% annual economic growth in countries with intense transmission

Malaria traps families and communities in a downward spiral of poverty

affecting marginalized populations and poor people who cannot afford treatment or who have limited access to health care.

In some countries with a very heavy malaria burden, the disease may account for as much as 40% of public health expenditure

Malaria has lifelong effects through increased poverty, impaired learning and decreases attendance in schools and the workplace.

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Other Health Risks

Sleeping disease

Yellow Fever

Typhoid Fever

DENGUE FEVER (“Dandy Fever”, “Break Bone Fever”)

HIV/AIDS

HEPATITIS A

HEPATITIS B

HEPATITIS C, D, E

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Other Health Risks

POLIO

DIPHTHERIA

TETANUS

SARS (Serious Acute Respiratory Syndrome)

AVIAN FLU

JAPANESE B ENCEPHALITIS

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SLEEPING SICKNESS

Vector: Glossina (“Tsetse Fly”)

Pathogen: Trypanosoma gambiense(Protozoa)

Terminal disease, if untreated

Endemically affected area: Tropical Africa

Initial symptoms: Fever, weakness, tremors, headaches, drowsiness

Final stage: Encephalomyelitis, prolonged coma, death caused by heart failure

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Yellow Fever

Endemic/Infected zones: tropical

areas of Africa and South America

(WTA p.39)

Receptive zones

Pathogen: Y. F. Virus

Vector: Aédes aegypti

Carriers: Primates (humans, monkeys)

Lethality Rate: 10 – 50%

Immunization: Vaccine (long-lasting effect!)

Symptoms: Nausea, vomiting, intestinal bleeding, jaundice, circulatory breakdown

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Typhoid Fever

Serious intestinal condition

Highly contagious

Pathogen: Salmonella typhi

Transmission: Inadvertent ingestion of germ-contaminated food and liquids

Prevalence: Developing nations

Symptoms: Fever, fatigue, headaches

Proactive Measure: Vaccination (3-year immunization!)

Therapy: Antibiotics

3 – 5% of patients end up as permanent carriers

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Hepatitis

is an inflammation of the liver

most commonly caused by a viral infection

5 main hepatitis viruses: A, B, C, D and E.

Hepatitis A and E are typically caused by ingestion of contaminated food or water.

Hepatitis B, C and D usually occur as a result of contact with infected body fluids (e.g. from blood transfusions or invasive medical procedures using contaminated equipment). Hepatitis B is also transmitted by sexual contact.

Symptoms: jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

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Hepatitis E - ENDEMIC/INFECTED REGIONS:

The highest rates of infection: regions where low standards of sanitation promote the transmission of the virus.

Epidemics reported in Central and South-East Asia, North and West Africa, and in Mexico

Mortality rates ranging between 0.5% - 4.0%.

Hepatitis E is a self-limiting viral infection followed by recovery

VACCINE:, no commercially available vaccines exist for the prevention of Hepatitis E – BUT: in progress

PREVENTION: good personal hygiene, high quality standards for public water supplies, proper disposal of sanitary waste

For travelers to highly endemic areas: avoid drinking water and/or ice of unknown purity and eating uncooked shellfish, uncooked fruits or vegetables that are not peeled or prepared by the traveler

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Hepatitis B:

is a serious global public health problem = majority of the worldwide hepatitis burden (1.2 Mio worldwide killed a year)

most serious type of viral hepatitis and the only type causing chronic hepatitis for which a vaccine is available.

TRANSMISSION: by contact with blood or body fluids of an infected person in the same way as human immunodeficiency virus (HIV), the virus that causes AIDS. However, H.B. is 50 to 100 times more infectious than HIV.

The main ways of getting infected are: Perinatal (from mother to baby at the birth) Child-to-child transmission Unsafe injections and transfusions Sexual contact

Endemic Areas: primarily in Africa and Asia: In much of the developing world, (sub-Saharan Africa, most of Asia, and the Pacific), most people become infected with H.B during childhood, 8% to 10% of people in the general population chronically infected.

In these regions liver cancer caused by H.B. among first three causes death by cancer

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Hepatitis B:

VACCINE: preventable with safe and effective vaccines (available since 1982 )

Although the vaccine will not cure chronic hepatitis, it is 95% effective in preventing chronic infections from developing, and is the first vaccine against a major human cancer

for all children to receive the hepatitis B vaccine, and 116 countries have added this vaccine to their routine immunization programmes.

Of the 2 billion people who have been infected with the hepatitis B virus more than 350 million have chronic (lifelong) infections.

chronically infected: high risk of death from cirrhosis of the liver and liver cancer

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Hepatitis B:

TREATMENT:

Liver cancer is almost always fatal;

Chronic hepatitis B in some patients is treated with drugs called interferon or lamivudine can help some patients. BUT: therapy costs thousands of dollars

Patients with cirrhosis are sometimes given liver transplants, with varying success. It is preferable to prevent this disease with vaccine than to try and cure it.

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Hepatitis C:

is asymptomatic in 90% of cases In contrast with viral hepatitis A or B, jaundice is relatively rare,

the disease becomes chronic: Chronic hepatitis C disease is the first cause of liver transplantation in developed countries

No vaccine is yet available