Travel bugs lurk in a world of danger

Forty per cent of Kiwis travelling overseas become ill. In extreme cases, as with John Fitzgerald, they die. MICHELE HEWITSON looks at the microscopic perils of foreign trips.

The death of New Zealander John Fitzgerald in Egypt has a tragic irony: the meningococcal septicaemia that killed him is not considered a high risk to travellers in that part of the world.

And a vaccine for the strains of the bacterial infection that endanger travellers has been available since the 1970s.

Dr Marc Shaw, a specialist in travel medicine, says the infection that probably killed Mr Fitzgerald is most prevalent in a belt across Africa from Kenya to the Gambia in the west and from the Cameroon to Niger in the South.

"It can be normal in those areas for certain people," Dr Shaw says.

"But where they do have it and they're in close contact with other groups of travellers, then they're much more likely to cough and sneeze and pass it on to others. It's a disease of masses."

Because travel involves moving among those masses, from the airport queue to the backpackers hostel, it exposes people to diseases which carry no visas and respect no border controls.

The Saudi Arabian Government knows the dangers of large groups of people from all over the world converging in one place, and the 1.5 million followers of Islam who make the annual pilgrimage to Mecca from other countries must have had the meningococcal vaccine.

It is the only country which has that requirement, but in some parts of South America and Africa vaccination for yellow fever is required.

Exposure to people who have been to parts of the world where the infection is epidemic can be as dangerous to your health as dipping your toe into the Malawi River, where a nasty called schistosomiasis lies in wait.

And you wouldn't do that now, would you? Well, yes. You probably would.

As Dr Shaw points out - and in his younger days he was a recklessly optimistic traveller himself - when we travel we tend to pack everything except common sense. He has noticed that among young travellers, it is university students who tend not to bother getting vaccinations before they leave the country.

Other safety issues arise, too. Dr Shaw suggests that just because you happen to be in a country which has no laws governing the use of safety helmets or seatbelts, you shouldn't stop being aware of New Zealand standards of accident protection.

The main causes of death in New Zealanders overseas are accidents on the roads or in the water and heart attacks, rather than exotic diseases.

Dr Shaw says that of the one and a half million New Zealanders travelling every year, 40 per cent are likely to become unwell. That figure rises to 55 per cent for travellers to developing countries.

A study of 151 travellers done at the Worldwise Travellers Health and Vaccination Centres in Auckland and Hamilton between November 1997 and September last year found that 30 per cent of those who had become unwell suffered from diarrhoeal disease, the most common curse of the traveller. And not all nasties are in the food or water - 9 per cent of those included in the study attended the clinic for treatment or rabies tests after being bitten by dogs or monkeys.

"Rabies is a big issue," says Dr Shaw. "Three thousand people die of rabies in India every year. In the Third World, the dog is a pretty scungy-looking beast."

Other things can also bite you - while you're sleeping, as Hal Chapman discovered 10 years ago camping by the Daintree River in Cairns. About 300 mosquito bites swelled up into what he describes as "little hard blue volcanoes." He came down with fevers which lasted for six months "and left me as weak as a kitten."

Neither he nor his doctor realised that he had picked up Daintree River fever, a variant of the Ross and Murray River fevers. It was a warning, Mr Chapman says, that "Australia can be a nasty biting sort of place. It's made me a more cautious traveller."

But it's not easy to be cautious when travelling, says Dr Rod Ellis-Pegler, an infectious diseases physician at Auckland Hospital.

"You're not going there to try not to get things - you're going there to have fun and enjoy it and hope to minimise risk."

You minimise risk, he says, by doing all those things you already know about - boiling water if you possibly can, trying to eat cooked food rather than raw.

"But there are all sorts of unreal limitations. If you want to avoid these things you stay home.

"I do acknowledge that being armed with a little bit of information is sometimes useful, although there are some depressing studies which show that very fussy people do no better than unfussy people in terms of getting things."

The "things" we are talking about go by such names as cutaneous larva migrans which is, says Dr Ellis-Pegler, "an animal hookworm which gets into your feet and wanders around because you're the wrong host."

This particular worm is a "famous and itchy and exciting one - but it's very uncommon." A "big year," he says, would be one in which he saw five of the hookworms in returned travellers.

It is very treatable with an antiparasitic drench of the sort used by farmers.

The tapeworms of the apocryphal travel horror story are even rarer, Dr Ellis-Pegler says.

He sees them in immigrants but encounters the "big, exciting ones" - the ones you can ingest by eating inadequately cooked or chilled beef or pork - perhaps once every couple of years.

The reason travellers rarely come home with a gut worm is because our immune systems help us out.

"We've got quite good immune systems so it takes a bit for it to get established."

There is, however, one microscopic worm you really should avoid: the schistosomiasis.

Lake Malawi is where travellers are most likely to encounter the worm, which burrows through the skin, completes its life cycle and ends up around your bladder wall or, in women, the pelvic organs.

The worst possibility is that its eggs will enter the bloodstream and get into the spinal cord. Paralysis can result. It's easy to avoid - don't go in the water.

Which, says Dr Ellis-Pegler, is easier said than done.

"After the awful trip across the desert, I understand it's almost impossible not to want to swim in Lake Malawi. It's so beautiful. It's like heaven on earth. And in you go."

It's not a bad metaphor for the travel game. It's exotic, it's exciting and it's full of things that can make us sick. And in we go.

Take Garry Pitman, for example. He travels for his work as chief executive of a logging operation in the jungle on New Britain Island, off Papua New Guinea. He arrived in late October and two weeks later, despite taking medication, came down with suspected malaria.

He had a raging fever and temporarily lost the use of his legs. He will be going back next week.