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Health Essentials |
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There is a lot of paranoia concerning traveling to central Africa both concerning violence and disease.
Let me reassure you, I have lived in Kinshasa, the malaria capital of
the world, for the past 6 years with my family without any of us
getting sick or experiencing violence (not to say that we didn’t have
many ‘unusual’ experiences!). Having said that, there are a number of
precautions and preparations every traveler should make before going to
the DRC. I’ve included information below on health concerns. Most of it
comes from the CDC web site (http://www.cdc.gov/travel/cafrica.htm).
Violence With regards to violence, the country has settled
considerably since 1999 when we first arrived there. In the east side
of the country, tribal skirmishes and killings continue. However,
conditions are progressively improving in Kinshasa (the west) where
there has been no fighting for over 4 years. Kinshasa is made up of a
multitude of tribes. Here, people have been forced into social
conformity accepting a second identity as ‘Kinwa’, or ‘Kinshasa
citizens’ and learning Lingala. French is spoken as well, since this is
the language of education and government. Due to the desperate economic
conditions of the country, conditions have been, and will, be ripe for
a coop d’etat for some time to come. Kinshasa, being the capital city
and ‘ivory tower’ in terms of education, politics and business, is the
focus of any political activities. Our rule of thumb was, not to stay
out late at night, avoid mobs (turn the other way if a mob is sighted
down the street) and avoid the military.
NOTE: See your doctor at least 4-6 weeks before your trip to allow time for your shots to take effect
Health concerns (CDC information)
Meningitis: As of February 15, 2002, the World Health Organiztion (WHO) reported 898 cases of meningocococcal meningitis, including 104 deaths, in the Democratic Republic of Congo since the outbreak began in August 2001. It is recommended travelers to the Democratic Republic of Congo consult with a health care provider prior to travel to discuss the need for meningitis vaccination. For more information see: http://www.cdc.gov/travel/diseases/menin.htm
Traveler’s diarrhea: Food and waterborne diseases are the number one cause of illness in travelers. Traveler’s diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Central Africa and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera http://www.cdc.gov/travel/cholera.htm, and parasites), fever (typhoid fever http://www.cdc.gov/travel/diseases/typhoid.htm , and toxoplasmosis), or liver damage (hepatitis). Make sure your food and drinking water are safe.
Malaria: is a preventable infection that can be fatal if left untreated. Prevent infection by taking prescription antimalarial drugs and protecting yourself against mosquito bites. Travelers to Central Africa should take one of the following antimalarial drugs: mefloquine, doxycycline, or Malarone(tm). Your risk of malaria may be high in these countries, including cities. Document, http://www.cdc.gov/travel/regionalmalaria/cafrica.htm , has detailed information on malaria-risk areas and antimalarial drugs.
Yellow Fever: A certificate of yellow fever vaccination is required for entry into DRC. For detailed information, http://www.cdc.gov/travel/diseases/yellowfever.htm .
Other diseases: Dengue, filariasis, leishmaniasis and onchocerciasis are other diseases carried by insects that also occur in this region. Protecting yourself against insect bites will help to prevent these diseases. Schistosomiasis, a parasitic infection, is found in fresh water in this region. Do not swim in fresh water (except in well-chlorinated swimming pools) in Central African countries.
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CDC recommends the following vaccines (as appropriate for age):
• Hepatitis A or immune globulin (IG): exposure to contaminated water
• Hepatitis B: exposure to blood (medical treatment or mission activities).
• Yellow fever: required to get in the country
• Rabies: only if you’re super paranoid! You will have time to order in vaccine if bitten.
• Typhoid: exposure to contaminated water
• Tetanus-diphtheria, measles, and a one-time dose of polio vaccine: if boosters needed.
Malaria prophylaxis recommended:
• The adult dosage is 250 mg (one tablet) once a week.
• Take the first dose of mefloquine 1 week before arrival in the malaria-risk area.
• Take mefloquine once/week, on the same day of the week, while in the malaria-risk area.
• Take mefloquine once a week for 4 weeks after leaving the malaria-risk area.
• Mefloquine should be taken on a full stomach, for example, after dinner.
Side effects and warnings
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Mefloquine is usually well-tolerated; however, side effects can occur.
The most commonly reported minor side effects include headache, nausea,
dizziness, difficulty sleeping, anxiety, vivid dreams, and visual
disturbances. Mefloquine has rarely been reported to cause serious side
effects, such as seizures, depression, and psychosis. Mefloquine should
be used with caution in persons with psychiatric disturbances. Minor
side effects usually do not require stopping the drug. Travelers who
have serious side effects should see a health care provider.
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Do not take if
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• Ever had an allergic reaction to mefloquine;
• Epilepsy or other seizure disorders;
• Active depression or a history of psychosis;
• Been diagnosed or treated for an irregular heartbeat. |
| Doxycycline - RECOMMENDED |
• The adult dosage is 100 mg once a day.
• Take the first dose of doxycycline 1 or 2 days before arrival in the malaria-risk area.
• Take doxycycline once a day, at the same time each day, while in the malaria-risk area.
• Take doxycycline once a day for 4 weeks after leaving the malaria-risk area.
Side effects and warnings
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Taking doxycycline may cause travelers to sunburn faster than normal.
To prevent sunburn, avoid midday sun, wear a high-SPF sunblock, wear
long-sleeved shirts, long pants, and a hat. Take doxycycline on a full
stomach to lessen nausea; do not lie down for 1 hour after taking the
drug to prevent reflux of the drug (backing up into the esophagus).
Women who use doxycycline may develop a vaginal yeast infection. Take
along an over-the-counter yeast medication for use if vaginal itching
or discharge develops. |
Do not take if
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• Do not give doxycycline to children under the age of 8; teeth may become permanently stained.
• Do NOT take doxycycline if you are pregnant. |
Malarone is a new antimalarial drug in the United States. Malarone is a combination of two drugs (atovaquone and proguanil) and is an effective alternative for travelers who cannot or choose not to take mefloquine or doxycycline.
• The adult dosage is 1 adult tablet (250 mg atovaquone/100 mg proguanil) once a day.
• Take the first dose of Malarone 1 to 2 days before travel to the malaria-risk area.
• Take Malarone once a day while in the malaria-risk area.
• Take Malarone once a day for 7 days after leaving the malaria-risk area.
• Take the dose at the same time each day with food or milk.
Side effects
and
warnings
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Although side effects are rare, abdominal pain, nausea, vomiting, and headache can occur. |
Do not take
if
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• Malarone should not be taken by patients with severe renal impairment.
• Pregnant women or women breast-feeding infants weighing less than 11
kg (24 lbs) should NOT take Malarone to prevent malaria. Infants
weighing less than 11 kg (24 lbs) should NOT be given Malarone.
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Chloroquine (brand name Aralen®) – 30%+ resistance in DRC – NOT RECOMMENDED
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| Hydroxychloroquine sulfate (brand name Plaquenil®) – LIMITED EXPERIENCE
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• The adult dosage is 400 mg once a week.
• Take the first dose of hydroxychloroquine sulfate 1 week before arrival in the malaria-risk area.
• Take hydroxychloroquine sulfate once a week, on the same day of the week, while in the malaria-risk area.
• Take hydroxychloroquine sulfate once a week for 4 weeks after leaving the malaria-risk area.
• Take hydroxychloroquine sulfate on a full stomach, for example, after dinner, to minimize nausea.
• Hydroxychloroquine sulfate may be better tolerated than chloroquine.
Side effects
and
warnings
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Although side effects are rare, nausea and vomiting, headache,
dizziness, blurred vision, and itching have been reported.
Hydroxychloroquine sulfate may worsen the symptoms of psoriasis. |
After you return home:
If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (mefloquine or doxycycline) or 7 days (Malarone) after leaving the risk area. Travelers who become ill with a fever or flu-like illness up to 1 year after returning home should seek prompt medical attention and should tell the physician their travel history.
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