A warning to be careful for travelers going to some areas of Uganda for business or tourism.

Uganda’s President Yoweri Museveni on Wednesday, Sept. 28, 2022 said five people have died from Ebola in the country and 19 other deaths were likely caused by the same disease, as they had similar symptoms but no samples were taken to confirm this before their deaths. The other confirmed cases include six health workers, including four doctors, an anesthesiologist and a medical student.
The President added that he will never order a lockdown for this disease, even in affected areas, because the characteristics of Ebola are definitely easier to manage than COVID-19.

The outbreak of “hemorrhagic fever” from the highly deadly Sudan strain of Ebola virus was first reported last week Sept. 19, 2022, sparking fears of a major health crisis in the country of 45 million people. There is no vaccine for the Sudanese strain of the disease behind the latest infections in Uganda. (Sudan Virus Disease – SVD).
News comes that 19 other cases of the disease have also been confirmed.
The latest infections broke out in the Mubende district of central Uganda, about 140 kilometers west of the capital Kampala. It has since spread to two other districts. The index case is a 24-year-old male resident of Ngabano village, Madudu sub-county in Mubende district.

In addition, the outbreak was detected among people living around an active local gold mine, with a highly mobile population arriving and moving to many regions of the country. Patients have presented to various health facilities where they have died and have subsequently been buried traditionally with large ceremonies gathering large numbers of the population. In this context, the possibility of spread to other districts and importation of cases to neighboring countries cannot be ruled out.

Directions for International Travelers
International travelers to Uganda are, for the time being, not subject to any travel restrictions in the country. It is necessary, however, for anyone to be informed of the characteristics of the disease and what to do to prevent it.

Ebola, the characteristics:
Ebola is spread primarily through contact with the bodily fluids of an infected person. The highly debilitating acute viral illness presents with symptoms such as intense weakness, severe muscle aches, headache, sore throat, vomiting, diarrhea and rashes. Features after a few days petechiae and subcutaneous hemorrhagic suffusions to the point of blood loss from body orifices.

Ebola strain SVD
The World Health Organization says the Ebola Sudan strain is less transmissible and spreadable than other more aggressive strains, and has begun to show a lower mortality rate in previous outbreaks than its cousin Ebola Zaire, a strain that killed nearly 2,300 people in a 2018-2020 outbreak in neighboring Democratic Republic of Congo.

Behavioral directions:
Important to wash hands with soap and water or use an alcohol-based disinfectant. Avoid contact with the bodily fluids of any person.
In the absence of vaccines and specific therapies, control of this type of outbreak (SVD) disease prevention and control will rely solely on early detection, isolation, and case management, optimal IPC measures, robust risk communication, and community involvement.

Translated with www.DeepL.com/Translator (free version)

September 18, 2022 NewsDesk @bactiman63

In an update on the autochthonous dengue transmission in France this year, health officials now report 36 locally transmitted cases through September 14.

In the Occitania region:

• In the Pyrénées Orientales, in Perpignan, an indigenous case of dengue whose symptoms had started in mid-June. No other cases have since been identified and this episode is closed.
• In the Hautes Pyrénées, an outbreak of 4 cases in the municipalities of  Andrest  (3 cases) and Rabastens (1 case), the symptoms of which began between mid-July and the end of August.
• In Haute-Garonne at  Salvetat Saint Gilles  , an outbreak of 4 cases of dengue occurred in the same household, the symptoms of which began in the last fortnight of August.

In the Paca region :

• In the Var, in Fayence, an outbreak of 6 cases of dengue whose symptoms began between the end of June and the end of July. This episode is closed.
• In the Alpes Maritimes , an outbreak of 21 cases identified on September 13 in the neighboring municipalities of Saint Jeannet (14 cases), Gattières (6 cases) and Gaude (1 case). Symptoms started between early August and early September. This outbreak is ongoing and other cases will likely be identified.

A ProMED-mail post http://www.promedmail.org
International Society for Infectious Diseases

Date: Sat 10 Sep 2022
According to information from the State Health Institute (SZÚ), there are more cases of tick-borne diseases this year
[2022] by the end of August than in the same period last year [2021]. Doctors reported 441 cases of tick-borne
encephalitis and 2035 cases of Lyme disease this year [2022], last year's [2021] numbers were about a quarter lower for
Lyme disease and about 13% lower for encephalitis. At the same time, roughly a third of people become infected every
year in autumn.
Ticks are usually found in grassy and leafy vegetation until day or night temperatures permanently drop below 5 degrees
Celsius. As a result of global warming, they are also found in the Czech Republic in November and at higher altitudes
than was previously common.
Doctors reported 589 cases of tick-borne encephalitis by the end of August 2020, which was the most since 2013. A total
of 2429 people were infected with Lyme disease in the same period, there were more in 2016 and 2018, for example.
While for other infectious diseases, the number of cases dropped in the 1st year of the COVID-19 pandemic, the
situation was the opposite for tick-borne diseases. At the time, experts stated that more people headed to nature at a
time when other opportunities for enjoyment, whether sports or culture, were closed.
After returning from the forest, but also from the garden or park, people should therefore always look around. In tick-
borne encephalitis, the virus is transmitted from a bitten tick in just a few tens of minutes. The disease, against which
vaccination is possible, cannot be stopped. Doctors only suppress its symptoms, such as headaches, high fevers,
vomiting, and photophobia, but also brain swelling, as the virus attacks the brain and spinal cord.
We see long-term and permanent consequences in a number of patients. Frequent headaches, memory and
concentration disorders, deterioration or loss of hearing, but also severe, often permanent paralysis of the limbs. Several
patients with tick-borne encephalitis die every year, said the doctor in a press release about the suitability of vaccination
from the Department of Infectious Diseases of the 2nd Faculty of Medicine of Charles University and Bulovka Faculty
Hospital Dita Smíšková.
Lyme disease, against which vaccines are not yet available, is about 5 times more common. However, the virus is
transmitted to humans only 24 hours after the tick bite [starts]. The disease is most often treated with antibiotics.
Health insurance companies cover the tick-borne encephalitis vaccine for people over 50 this year [2022]. According to
earlier data from the SZÚ, people aged 60 to 64 are the most frequently infected. For young people, the health insurance
company reimburses part of the cost of the vaccination from the prevention fund after payment at the doctor’s office or at the vaccination center against proof.
Incidence of tick-borne diseases from 2013 to 2022 (January to August):
Year / Tick-borne encephalitis / Lyme disease
2013 / 350 / 2392
2014 / 233 / 2255
2015 / 231 / 1803
2016 / 435 / 2702
2017 / 390 / 2167
2018 / 480 / 2808
2019 / 432 / 2311
2020 / 589 / 2429
2021 / 384 / 1533
2022 al 2 giugno 441 / 2035
(Source: State Institute of Health)

A 2 Jun 2022 report indicated that there is a significant risk of tick-born encephalitis virus and Lyme borreliosis infections
this year but without giving case numbers at that time. The above report indicates that there are 441 cases of TBE and
2035 cases of Lyme disease so far this year (2022). Both pathogens are transmitted to humans through the bite of
infected _ixodes_ ticks and are endemic in the Czech Republic. As previously noted, a 2016 ProMED post indicated that
although Central and Eastern Europe countries are endemic for the European subtype of TBE virus and cases occur
there yearly, cases have declined significantly in Austria and remain low in Germany, Poland, and Slovakia, while
remaining high in recent years in the Czech Republic (The World Health Organization has stated that, approximately 10 000-12 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total;
Immunization offers the most effective protection against tickborne encephalitis. Currently, there are 4 widely used
vaccines of assured quality: FSME-Immun and Encepur, manufactured in Austria and Germany, respectively [and based
on European strains of the virus], and TBE-Moscow and EnceVir, manufactured in the Russian Federation [and based on
Far Eastern strains]. The 4 vaccines are considered to be safe and efficacious.

TBE is a viral infection caused by one of 3 TBE virus subtypes belonging to the Flaviviridae family: Central European,
Siberian, and Far Eastern (formerly known as Russian spring-summer encephalitis). – Mod.TY
Lyme borreliosis (Lyme disease or LD) is the commonest human tick-borne infectious disease in the northern
hemisphere, occurring predominantly in temperate regions of North America, Europe, and Asia. Of the more than 20
_Borrelia burgdorferi_ sensu lato (Bbsl) complex genospecies, only a few (for example, _B. afzelii_, _B. garinii_, and _B.
burgdorferi_ sensu stricto) are human pathogens: _B. burgdorferi_ sensu stricto (Bbss) is the predominant cause of LD
in North America; Bbss also occurs in Europe, but is less prevalent than _B. garinii_ or _B. afzelii_, the 2 major European
pathogenic genospecies.
The vectors of Bbsl, which feed on both humans and reservoir species are 4 species of hard-bodied _Ixodes_ ticks: _I.
scapularis_ is the main vector of Bbsl for humans in the eastern half of the US; _I. pacificus_, in the far-western US; _I.
ricinus_, in Europe; and _I. persulcatus_, in Asia. The Central European region (Austria, Czech Republic, southern
Germany, Switzerland, Slovakia, and Slovenia) has been reported to have the highest _Borrelia_ infection rates in _I.
ricinus_ ticks (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1287732/); in Switzerland, 13.6 to 49% of ticks were
infected. In the Austria/Switzerland region, of positive ticks, 25% were infected with _B. afzelii_, 44% with _B. garinii_,
and 25% with Bbss. The infection rate in adult ticks (18.6%) was higher than in nymphs (10.1%).
The clinical manifestations of LD also vary by geographical location. For example, acrodermatitis chronica atrophicans
and neuroborreliosis are commoner in Europe, whereas arthritis appears to be prevalent in the United States. Lyme
neuroborreliosis is multifaceted, causing symptoms as a result of central and/or peripheral nervous system involvement;
LD can cause meningitis, cranial neuritis, radiculoneuritis, peripheral neuropathy, and/or encephalopathy.
Individual hard-bodied ixodes ticks can be infected with more than one genospecies of the Bbsl complex, as well as
multiple other pathogens, including _Anaplasma phagocytophilum_, the cause of anaplasmosis (also known as human
granulocytic anaplasmosis or HGA), _Babesia microti_, the cause of babesiosis, _Borrelia miyamotoi_, the cause of a
relapsing fever-like illness, and tick-borne encephalitis virus or TBEV, the cause of tickborne encephalitis (TBE). It is,
therefore, possible that co-infections with 2 or more of these tick-borne pathogens may occur. – Mod.ML

Do you have a problem with malaria? are you sick? do you need information?

Dr. Paolo Meo, a specialist in tropical and infectious disease and Director of Cesmet Clinica del Viaggiatore, has acquired his experience in the diagnostics and treatment of malaria during 40 years of work, especially in African countries. He has operated in widely differing environments and has always personally performed malaria tests on his patients in various laboratories and then treated them either in hospitals or in their homes. From small villages in the bush or forest to hospitals in large African towns.

If you are traveling back from a trip to an area of the world considered to be at malaria risk and you have even some light symptoms or discomfort, you should never hesitate to consult an expert.
Dr. Paolo Meo is at your disposal for a 0nline consultation to help you understand the cause of your illness, when returning from exotic, tropical, or equatorial areas, and to find a solution. The experience of almost more than 40 years in many countries around the world, and the work done in the most diverse environment, allows the doctor to assess your health status, and the origin of your symptoms, and to deal with the problem correctly. You will be required to provide documentation and a summary report of the state of your health. In the end, if considered appropriate, you will be indicated remedies for your state of health. Remember that the ‘online visit’ is a remote consultation where there is no physical contact and no objective examination of your body. It is never to be considered a full medical examination. If necessary, you will still be invited to visit the Cesmet outpatient clinic or another facility specializing in tropical medicine for further investigations.

Book a consultation with the specialist here

summary: When female mosquitoes look for a human being to bite, they sniff a unique cocktail of body odors that we emit into the air. These odors then stimulate receptors in the mosquitoes’ antennae. Scientists have tried to eliminate these receptors in an attempt to make humans undetectable by mosquitoes.  However, even after eliminating an entire family of odor-sensitive receptors from the mosquito genome, mosquitoes still find a way to sting us. Now, a group of researchers, publishing in the journal Cell on 18 August, has discovered that mosquitoes have developed redundant security systems in their olfactory system that make sure they can always smell our scents. “Mosquitoes are breaking all our favorite rules about how animals smell things,” says Margo Herre, a scientist at Rockefeller University and one of the lead authors of the article.  In most animals, an olfactory neuron is only responsible for detecting one type of smell. “If you are a human being and you lose a single odor receptor, all the neurons expressing that receptor will lose the ability to smell that odor,” says Leslie Vosshall of the Howard Hughes Medical Institute and professor at Rockefeller University and senior author of the paper. But she and her colleagues have found that this is not the case with mosquitoes.  ‘More work needs to be done to eliminate mosquitoes because getting rid of a single receptor has no effect,’ says Vosshall. Any future attempts to control mosquitoes with repellents or anything else must take into account how inextricably they attract us.”  “This project started really unexpectedly when we were looking at how the human smell was encoded in the brains of mosquitoes,” says Meg Younger, a professor at Boston University and one of the lead authors of the paper.  They found that neurons stimulated by human odor 1-otten-3-ol are also stimulated by amines, another type of mosquito chemical used to seek out humans. This is unusual because, according to all existing rules on animal odor, neurons encode odor with narrow specificity, suggesting that 1-otten-3-ol neurons should not detect amines.   ‘Surprisingly, the neurons to detect humans through 1-otten-3-ol and amine receptors were not separate populations,’ says Younger. This could allow all human-related odors to activate ‘the human-detecting part’ of the mosquitoes’ brains even if some of the receptors are lost, acting as a safety device.

to read the article click here   science now

Diarrhoea? Info and advice. Are you sick? Request a specialist examination and laboratory tests. Book your examination or tests. Call 0639030481 or buy your consultation for personalised information and an interview with your specialist doctor.

What it is
How it manifests itself
The causes: bacteria, viruses and parasites
Areas of increased risk
How it is prevented
Treatment
Children and traveller’s diarrhoea

Useful facts about Traveller’s Diarrhoea

Traveller’s diarrhoea (VTD), also known as ‘Montezuma’s Revenge’, is a very common occurrence and occurs in most people who travel. Between 40% and 60% of travellers, anywhere in the world, are subject to at least one episode of diarrhoea. Those who live with a high level of hygiene suffer more from diarrhoea. The risk of diarrhoea increases in travellers with a high socio-economic status, in young people who go on adventurous holidays, paying little heed to preventive rules, in those with gastric achlorhydria (low levels of acid in the stomach) or undergoing antacid treatment, and in those with chronic debilitating diseases.

What is traveller’s diarrhoea

Traveller’s diarrhoea: 2 / 3 or more evacuations of unformed or liquid stools in 24 hours accompanied by other intestinal or general symptoms. Generally without fever or systemic symptoms. Rarely accompanied by fever and severe fatigue. It is a disease that occurs more in the young than in the elderly, with no difference between males and females.  It is caused by immune type mechanisms, but also by different travel patterns: more adventurous in the young, more careful about food hygiene in old age.

How traveller’s diarrhoea manifests itself

Traveller’s diarrhoea manifests itself with discharges of liquid or pasty stools, often with a strong fermenting odour, sometimes accompanied by

general malaise
nausea
vomiting
tiredness

barely noticeable symptoms, sometimes quite strong.

They are frequently associated with

abdominal cramps
belching and meteorism (hyperfermentation)
sensation of sulphur in the mouth.

In more severe cases, traveller’s diarrhoea is accompanied by mild or high fever. Diarrhoea generally appears in the first few days of travel, and lasts 3 to 5 days, causing the traveller discomfort.

It can wear off in 1 or 2 days in mild forms, especially by taking suitable drugs: rehydrating salts, intestinal disinfectants or antibiotics, protective bacterial flora, olive leaf extracts. It is essential to stick to an appropriate diet (anti-propulsive). The diarrhoea episode can also last longer than seven days and sometimes become chronic, prolonging the discomfort for months.

Causes of traveller’s diarrhoea

The main cause is microbiological, i.e. from bacteria, viruses, parasites or rarely mycetes.
The traveller’s contagion with microorganisms generally occurs through the ingestion of infected and contaminated food and water or liquids. Faecal residues deposited by flies and other insects, dirty hands, and inadequately cleaned furnishings are the primary causes of contagion. One’s own dirty hands, inadequately washed with soap and water, the use of contaminated towels or linen, frequenting environments with poor hygiene are causes of contagion.

People who come from countries with a high level of hygiene, due to the difficulty of contact with pathogenic microorganisms, do not develop sufficient immune defences both within the intestine and systemically. When these people travel to countries with a lower level of hygiene and a high presence of microbes, either for climatic or sanitary reasons, they have reduced local and systemic defences, a sudden mutation of the natural bacterial flora in their intestines. Due to these mechanisms, pathogenic microbiological forms gain the upper hand by overwhelming individual defence mechanisms.

Triggering or facilitating causes of diarrhoea: stress resulting from long journeys and time zone changes, climate or environmental variations, changes in diet and type of food, sensitisation to new foods, altitude. But these factors alone are not sufficient causes of diarrhoea.

Microbiology of traveller’s diarrhoea

Pathogenic bacteria

Enterotoxic Escherichia Coli ( ECET ):
the most frequent cause of traveller’s diarrhoea. More than 50% of diarrhoea originates from this bacterium . Watery diarrhoea with intestinal cramps, sometimes nausea and moderate fever.
Salmonella typhi or paratyphi:
Feverish gastroenteritis, with even severe symptoms and severe cramp-like abdominal pain. They can present with very different clinical pictures both in terms of manifestations and duration.
Salmonellosis is a ubiquitous disease, present in both developed and tropical countries, with a danger to the intestinal system derived from the aggressiveness of the bacterium. In industrialised countries it is among the major causes of food-associated diarrhoea. Rare is Salmonella dysentery, i.e. diarrhoea with blood and presence of mucus.
Shigella spp:
This is the cause of bacillary dysentery. It manifests itself with severe diarrhoea, mucus and blood with even very high fever. It occurs in an acute and even severe form. It is estimated that 20% of diarrhoea in the tropical zone originates from this bacterium.
Campylobacter jejuni
It is a bacterium that causes diarrhoea and general symptoms that can become chronic and last for many days with mild symptoms that sometimes worsen after quiescence for up to a few months.
Vibrio parahaemolyticus:
A spirillariform bacterium, a close relative of the cholera bacillus, it causes diarrhoeal symptoms that are less severe than cholera proper, but still debilitating. It is infected by eating shellfish, seafood and raw fish. Outbreaks of Vibrio parahaemolyticus diarrhoea often occur in travellers on cruises in the Caribbean, Japan and several Asian countries. Also present in Africa and Mediterranean countries.

Other pathogens cause traveller’s diarrhoea:

Other types of Escherichia coli ( enteroinvasive, enteroadhesive )
Yersinia enterocolitica
Vibrio cholerae 01, 0139
Aeromonas hydrophila

Pathogenic viruses

Rotaviruses:
These ubiquitous viruses are to be considered the cause of traveller’s diarrhoea in 30% of cases. They are the major cause of diarrhoea in children, particularly under 2 years of age. They are also frequently found in adults. The virus is often found in mixed infections with other microorganisms. Diarrhoea is generally watery, with few side symptoms, always mild. Fever is generally absent.
Norwalk viruses:
are viruses that manifest themselves with attacks of acute, sometimes febrile diarrhoea. They are very often asymptomatic. Studies carried out in several countries show that 10 – 15% of travellers have antibodies to these viruses. Epidemics are frequent during cruises and at large gatherings.

Other viruses can cause attacks of diarrhoea in travellers: Adenovirus, Astrovirus, Calicivirus, Coronavirus, Enterovirus

Pathogenic parasites

Several species of parasites, particularly of the Protozoa group, can cause attacks of diarrhoea, generally of a pasty consistency, with little general symptomatology. Symptoms appear at a distance and become chronic over time.
The most frequent parasites during travel include:

Giardia lamblia
Entamoeba histolytica
Cryptosporidium parvum
Cyclospora cayetanensis

Geographical areas of greatest risk for traveller’s diarrhoea

The incidence of traveller’s diarrhoea varies in relation to different destinations.
Within a country or geographical area, the incidence of the disease is related to the characteristics of the territory, seasonal trends, and attention to hygiene levels.
One can schematically distinguish 3 geographical areas with different incidence of the syndrome:

Western Europe and North America ⇒ 10% incidence
Southern Europe – Mediterranean Basin; Far Eastern Islands; Pacific Islands; Caribbean Islands⇒ incidence between 10% and 20%.
Rest of the world ⇒ incidence between 20% and 60%.

The risk of falling ill with diarrhoea is higher

in countries with low economic and sanitary conditions. These include most of the countries of Africa, most of the countries of Asia and a good part of the countries of Latin America. The countries of Central America. The countries of the Middle East.
Part of the Eastern European countries and the countries bordering the Mediterranean Basin on both the European and African coasts.

For further information see the PLANISPHERE or specific maps.

How it can be prevented

It is possible to reduce the risk of traveller’s diarrhoea by taking preventive measures involving food hygiene, using food and drink appropriate to one’s habits, avoiding excesses, and practising good and proper personal hygiene.
There is no single, safe vaccine that can prevent traveller’s diarrhoea as there are many causes.
Certainly, the typhoid vaccination is effective in preventing one of the most serious and widespread forms of typhoid on all continents, that of salmonellosis.

Using the oral cholera vaccine, currently on the market, not only prevents forms of this serious disease but also activates immune defences against certain particularly pathogenic bacteria.
It may be of some help to take bacterial flora, several types of which are commercially available, to be taken a few days before travelling, during travel, and during the first few days of your stay.

Certainly, the best form of prevention is to implement both food and personal hygiene measures.

Properly observing these hygiene rules drastically reduces the risk of contracting traveller’s diarrhoea.
It is also useful to purify and treat water with disinfectants.

The risk of falling ill is much lower by using cooked food and consuming it at known private homes or hotels than by eating it at street vendors or small restaurants whose hygiene standards are unknown.
Medications that reduce bowel movement and thus stop diarrhoeal episodes (such as loperamide – Imodium) can be taken in mild, paucisymptomatic diarrhoea, accompanied by the intake of intestinal disinfectants, mineral salts and bacterial flora. These substances can prevent the worsening and evolution of the disease, accompanying them with a suitable, light, semi-liquid diet, or even a short period of fasting, except for fluid intake.

The treatment of these intestinal forms must in fact be accompanied by copious fluid intake and an appropriate diet.
In the case of more severe diarrhoeas, accompanied by general symptoms and a feverish upsurge, antimicrobial treatment should be combined with antipropulsive drugs (loperamide).
The use of antibiotics as prophylaxis is to be considered exceptional, to be carried out under medical supervision and for short periods and for well-identified individuals. In particular in:

Diabetic subjects
Subjects suffering from chronic intestinal diseases such as ulcerative rectocolitis, Crohn’s disease
Immune-compromised subjects following HIV
Subjects with neoplasms
Individuals with blood diseases, including immunodepressions and other immunological disorders.

Individuals who have to undertake particularly important commitments while travelling (such as sports competitions or meetings or short business trips) may also use appropriate antimicrobials as a preventive measure or the use of antipropulsive drugs (loperamide) at the first symptoms of diarrhoea.
In any case, these travellers should always carry anti-propulsive drugs (such as loperamide) and some appropriate disinfectants or antibiotics in their luggage.

Dehydration and diarrhoea

Dehydration is a pathological state of the organism characterised by an excessive loss of liquids and salts and such as to alter the normal hydrosaline and consequently metabolic balance.
Traveller’s diarrhoea, sometimes accompanied by vomiting, can cause even severe dehydration. Dehydration is particularly feared in children and the elderly.

Three degrees of dehydration can be identified:

SLIGHT which presents ⇒ intense thirst, reduced diuresis, dark and dense urine.
MODERATE which presents ⇒ in addition to mild symptoms also restlessness, dry lips, rapid heartbeat.
SEVERE presenting ⇒ in addition to the preceding symptoms also very dry lips and mucous membranes, reduced or absent lacrimation, dry skin that can be lifted into folds, very accelerated heartbeat

Indications for the treatment of rehydration

In the case of mild to moderate dehydration, it is advisable to drink not only drinking and controlled water, in sufficient quantities, but also tea, fruit juices, orange juice, drinks possibly with added mineral salts, and vegetable broth. Saline solutions to dissolve in water are commercially available. In any case, balanced solutions suitable for proper oral rehydration can be prepared in any country or in any situation:

⇒ For each litre of water, add 7 teaspoons of sugar and 1 teaspoon of salt.

or

⇒ For each litre of water add

20 g of sugar ⇒ (equal to 4 big spoons)
3.5 g. of sodium chloride ⇒ (equal to 1 heaped teaspoon)
2.5 g. of sodium bicarbonate ⇒ (equal to 1 level teaspoon)
1.5 g potassium chloride ⇒ (may be replaced by grapefruit or orange juice)

Treatment

In the case of fluid loss due to diarrhoea, whether liquid or pasty, even mild, or vomiting, the first treatment is to ingest copious fluids to restore the water-saline balance.
Water can be acidified by adding lemon, which has a disinfectant and astringent function. Fruit juices and light drinks such as tea can also be given; caffeinated, carbonated and particularly cold drinks should be avoided.
Initially avoid full meals, but take saltine crackers and vegetable broth. This is to replenish small amounts of salts that have been lost with fluids. Rifaximin, an antimicrobial, is useful and recommended to stop bacterial growth. In cases of severe fluid loss, these fluids can be replenished by infusion through the administration of physiological and glucosate solutions.

Anti-propulsive drugs are used to reduce peristalsis of the intestine, caused by inflammation or irritation due to microbiological attack in conjunction with other physical factors. Among these, loperamide – Imodium, is one of the drugs to be used in cases of mild forms, and to reduce the number of discharges. With these drugs it is essential to add the use of Rifaximin.

In more serious cases of diarrhoea, in the presence of fever, the microbiological cause must be combated with the use of suitable, targeted antibiotics that aim to eliminate the root cause (causal therapy)
Initially, the diet should be liquid or semi-liquid, and then light foods should be included that do not further irritate the affected intestinal tract.

Read more here

Child and traveller’s diarrhoea

In the case of diarrhoea and vomiting in children, particularly under 2 years of age, the greatest risk is the loss of liquids and minerals and the onset of dehydration.
Dehydration in children is a dreaded and particularly serious event.
Action must be taken without delay by replenishing fluid and mineral salt losses. A cool, ventilated environment must be provided for children suffering from dehydration. Dehydration is prevented through the adequate administration of fluids, especially during trips to countries with particularly hot and dry climates, when losses are easy and inconspicuous, particularly if accompanied by pathological phenomena. Include in the diet soups, other safe, uncontaminated beverages and, if available, thin leeks that contain sufficient amounts of salts to help restore salt balances.

Infants

Babies under 6 months of age with mild diarrhoea should continue to be breastfed with the possible addition of small amounts of water, which should be boiled if of uncertain origin.

Directions and behaviour:

The ‘Guide on safe food for travellers’ (by the Wordl Health Organization) Sustainable Development and Healthy Environments,Water, Sanitation and HealthNoroviruses as a Cause of Diarrhoea in Travellers to Guatemala, India, and Mexico.
Ericsson C, DuPont H, Steffen R. Travelers’ Diarrhea. 2003 BC Decker
Keystone JS, Kozarsky PE, Nothdurft HD, et al. Travel Medicine. London: Harcourt Publishers Ltd., 2003

Useful links

American Society for Microbiology

International Society for Infectious Diseases

Federation of European Microbiological Societies

Centres for Disease Control

World Health Organisation

International Society of Travel Medicine

American Society of Travel Medicine

 

 

If you would like further information, please contact us by e-mail or call

Phone (08.30 – 18.30) – 06/39030481

 

 

 

 

UPDATE COVID19 TO 27/07/2022:

Entry into the country is still generally subject to possession of a visa. As of 5 April 2022, citizens of an increasing number of countries, including Italy, are once again allowed to enter Indonesia for tourism, through pre-established access points, including Jakarta’s Soekarno Hatta International Airport and Bali’s Ngurah Rai International Airport, where it is possible to obtain a special visa on arrival, valid for 30 days and renewable exclusively at the place of entry for no more than a further 30 days, at a cost of IDR 500,000, under the following conditions:
1. possess a passport still valid for at least six months;
2. present a round-trip air ticket or a one-way ticket if there is an additional travel document for onward travel outside Indonesia;
3. complete the e-HAC Indonesia self-report form, which is integrated into the PeduliLindungi application;
4. present a certificate (paper or digital) in English stating completion of a COVID-19 vaccination course at least 14 days before departure, validated on the website Ministry of Health of the Republic of Indonesia on the e-HAC International Indonesia form ( https://vaksinln.dto.kemkes.go.id/ );
5. have your body temperature and any symptoms related to Covid-19 checked; if you have symptoms and/or a body temperature above 37.5° you will need to undergo a PCR test on arrival at your own expense. In the case of a positive test, isolation at own expense in dedicated facilities identified by the Indonesian government or in a hospital in the case of severe symptoms will be required.

As of 18 May 2022, proof of a Covid-19 PCR test is no longer required.
As of 8 June 2022, it is no longer required to produce an insurance policy to cover any medical expenses, however, given the high costs in the country in case of illness, injury or in case of the need for hospitalisation, it is highly recommended to take out a medical insurance policy for the period of your intended stay in Indonesia.
Those who have completed a Covid-19 vaccination course at least 14 days prior to arrival in Indonesia are no longer required to undergo quarantine, while a 5-day quarantine requirement remains in place for those who have no vaccination or have not completed the Covid-19 vaccination course.
Upon arrival in Indonesia, checks are carried out for the presence of Covid-19 symptoms, including checking the body temperature. In the case of a temperature above 37.5°C, those affected will be subjected to a PCR test at their own expense, and in the case of a positive test, quarantine in dedicated facilities, again at the expense of those affected.
For minors under the age of 18, the rules valid for their parents or accompanying adults apply.
Exemptions from the obligation to present vaccination certificates are provided for
– for minors under the age of 18
– for those who have completed a quarantine period and have recovered from Covid-19, provided they produce medical certification to this effect issued by the competent health authorities in their country of origin;
– for those who have not been able to undergo vaccination for health reasons, provided they provide medical certification to this effect issued by the competent health authorities of their country of origin.
As of 17 July 2022, travel by land, sea and air within Indonesia does not require Covid-19 testing unless you have certification that you have received (at least) the third (booster) dose of vaccine.
If you have only received the second dose of vaccine, you must present proof of a negative result from a rapid antigen test carried out no more than 24 hours before departure or proof of a negative result from a PCR test carried out no more than 72 hours before departure.

If only the first dose of vaccine has been received, certification of a negative PCR test result carried out no more than 72 hours prior to departure must be presented.
Those suffering from illnesses or health conditions that prevent them from receiving the Covid-19 vaccination must present certification of a negative PCR test result carried out no more than 72 hours before departure, together with medical certification issued by the competent health authorities in their country of origin stating that they are unable to receive the Covid-19 vaccination.
Minors in the 6-17 age group are excluded from the obligation to present certification of a negative Covid-19 rapid or PCR test result, provided they have completed a vaccination cycle.
Children under the age of 6 are excluded from the above conditions, provided they are travelling with their parents or accompanying persons.
For further details, we suggest you consult the website of the Indonesian Ministry of Tourism at https://www.indonesia.travel/gb/en/news/new-international-travel-regulations-to-enter-indonesia-as-of-29-november-2021 , stressing that only the Indonesian authorities can provide official and up-to-date information on how to enter and stay within Indonesian territory, and you should contact them for any clarification on the matter and to check whether it is possible and how to obtain an entry visa for the type of activity you intend to carry out in Indonesia.

At the CESMET Traveller’s Clinic we perform:

– Molecular RT-PCR swabs with 6h / 12h / 24h /48h response, with COVID FREE medical certification in English;
– Antigenic Swabs with visual response with COVID FREE medical certification in English, with the following characteristics: specificity 99.5%, sensitivity 94.5%, affinity 94%)
– Serological tests for IgM, IgG for SARS-CoV-2 qualitative and quantitative
– FIT TO FLY certification for area companies and applicant countries;

The following infectious diseases medical certificates are also issued, valid in accordance with the law:

1) medical certificate of vaccination; with clinical evaluation and certification of the absence of symptoms from Covid-19
2) medical certificate of illness by Covid-19; with clinical evaluation and certification of the absence of symptoms by Covid-19
3) medical certificate of previous SARS-CoV-2 infection with positive serological examination and presence of IgG; with clinical evaluation and certification of absence of Covid-19 symptoms
4) medical certificate of completion of molecular swab

RETURN TO ITALY

COVID-19. NOTICE TO ALL TRAVELLERS
From 1 June 2022, the Green Pass or other equivalent certification is no longer required for entry/return to Italy from abroad. For further information .
Compatriots about to leave for foreign countries are reminded that destination countries may continue to adopt restrictive regulations for entry from abroad. It is recommended to consult the notices on this site for information on the measures adopted in the countries of destination.

Climate, weather and health
Weather forecast

Climate: Located on the equator, Indonesia has a hot humid climate with average temperatures of around 28 °C all year round. There are two distinct seasons: the dry season that runs from April to October and the monsoon season that runs from November to March with rainfall prevailing in January and February. The different altitude and the enormous size of the archipelago greatly influence the characteristics of the climate: above 1000 m, the temperature is never very high and it is cold at night. In general, the climate tends to be warmer and more humid during the day and more temperate at night.
Prevention and prophylaxis
Compulsory vaccinations
YELLOW FEVER if…

A yellow fever vaccination certificate is required for travellers over 9 months of age from areas where there is a risk of transmission of the disease.
Updated June 2022

Recommended vaccinations
HEPATITIS A

read more….

EPATITIS B

read more….

TYPHOID FEVER

read more….

POLIO

read more…

DIARRHOEAL AND CHOLERIFORM SYNDROMES

– Vaccination is not compulsory, but should be considered depending on the type of trip and stay, but above all on the epidemiological situation in the country at the time of the trip. The new ‘oral’ formulation of the cholera vaccine now also protects against intestinal infections caused by many enterotoxic agents that cause ‘traveller’s diarrhoea’. The vaccine is therefore recommended for travel to many countries in the world.

TETANUS

read more…

ROUTINE VACCINATIONS

Make sure you have had all the vaccinations required by the National Health System. These include: tetanus, diphtheria, polio, pertussis, haemophilus B, hepatitis B, measles, mumps, rubella, chickenpox.

JAPANESE ENCEPHALITIS

Japanese Encephalitis is a viral disease carried by mosquitoes of the Culex genus, endemic in a vast area of Asia, from China to Australia, Pakistan to Japan and the Philippines.
Transmission is generally predominant in agricultural and rural areas, often associated with rice production,
but more and more cases are also found in large urban agglomerations.

Learn more about malaria
WHAT IT IS

Malaria is an infectious, acute disease present in the country, very much linked to wet, rainy environments, seasons and weather conditions. Check your travel itinerary and the weather conditions in the areas where you will be staying before you leave. Remember that Malaria is a potentially serious and even fatal disease. Do not underestimate it. It can be prevented by paying attention to clothing that covers your uncovered parts at sunset and at night, the use of repellents and the use of appropriate prophylaxis drugs in the seasons of greatest risk. Read more about malaria

IN THE COUNTRY

There is a year-round risk of malaria in all areas of eastern Indonesia (Maluku, Maluku Utara, Nusa Tenggara Timur, Papua and Papua Barat provinces), including the city of Labuan Bajo and the Komodo Islands in the Nusa Tenggara region. Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi and Sumatra. Low transmission in rural areas of Java, including Pangandaran, Sukalumi and Ujung Kulong. None in the cities of Jakarta and Ubud, the resort areas of Bali and Java, and the Gili Islands and Thousand Islands (Pulau Seribu).
Reported resistance to chloroquine and sulfadoxine-pyrimethamine. Reported resistance of P. vivax to chloroquine.

(Updated June 2022)

PROFILASIS

Doxycycline is an excellent drug of choice for stays in tourist areas as well as on adventure trips, during trekking and when using tents or poorly controlled residences. Medication for stays in sheltered residences or mild-risk areas, as well as for high-risk stays. You should know that ‘doxycycline 100 mg’ is a drug of choice not only for the prevention of malaria infection, but also for the prevention of intestinal and skin bacterial infections, and towards infections caused by tick bites. Because of its characteristics, the drug is very versatile; it can be taken for very short or short stays, a few days or weeks, but also in the long term, i.e. for many months. We would like to remind you that tetracycline drugs, including doxycycline, are taken for more than a year by young people who develop acne, i.e. infections on the face or trunk. A safe, effective drug with no or few side effects. We should remember that at prophylactic doses of 100 mg a day, the effects of sensitisation to the sun’s rays are practically absent. In any case, remember the use of sun creams. Low-cost drug. Cannot be used under 12 years of age or during pregnancy, or in case of allergy or intolerance to tetracyclines. It is taken daily, during lunch, for one week after leaving the malaria risk area.

Atovaquone-Proguanil, a drug that has been on the market for almost 20 years still has good antimalarial coverage for chloroquine-resistant forms, even though resistant forms with low efficacy have been described for several years. Useful for paediatric use, used for periods of no more than 30 days, but usable for up to 60 days. One tablet is taken daily from 2/3 days before leaving to 1 week on return.

Mefloquine, a drug used for over 30 years, Effective in prophylaxis and therapy. Effective in adults as well as paediatric patients. Proven efficacy and safety even in pregnant women. Can be used in subjects in good health. Not to be used in heart patients, arrhythmics, neuro- and psychopathic subjects, in those suffering from insomnia. Reported irritability symptoms of the peripheral and central nervous system. To be avoided in those who dive, stay at high altitudes, repeated and prolonged air flights. Favourable mode of intake with a weekly dose from one week before departure to three to four weeks on return.

ON YOUR RETURN

In the event of fever, diarrhoea or otherwise feeling unwell, it is essential to consult a specialist doctor or expert in tropical diseases without delay (if possible within 24 hours, due to the possibility of having contracted malaria, if you are returning from a risk zone).

Health Alerts

Dengue – 9 April 2022

In the first 3 months of this year, more than 22 thousand cases of infection have been reported, mostly occurring in the 3 provinces of Java; West, East and Central, with 229 deaths, also rising sharply.

There is still no vaccine available, and the only form of prevention is to avoid mosquito bites by wearing covering clothing, mosquito nets and effective repellents

Health pills
How to avoid getting sick

Give your body time to acclimatise to the new climate and environment. Before the trip, if possible, devote a few hours to physical activity, and accustom your body to the new rhythms during the journey…read more

Who should be vaccinated against yellow fever

Vaccination against Yellow Fever or Anti-Amaryllic Vaccine, an acute viral disease transmitted by mosquito bite, is the only preventive practice that may be required by the health authorities of a country in order to enter through border crossings….

Read more

Malaria, beware….!

It is an infectious disease, acute, often but not always febrile, sometimes characterised by few symptoms but always with the presence of great fatigue, it can be highly debilitating, causing sometimes severe anaemia and very often metabolic and organic alterations. As soon as they enter the body, the parasites colonise liver cells, which are then gradually destroyed, creating areas of necrosis (cell death) and punctiform fibrosis. In the long run, the malarial parasite creates permanent lesions in the liver. (other than malaria drugs that are bad for the liver!).
Remember that the drugs used for prophylaxis (prevention) are effective and safe. Any side effects, which are rarely present, are certainly less harmful to your organism than the consequences of the disease itself. Such side effects, which are always temporary, may depend on incorrect dosages or individual intolerances. You should fear the destructive action of the parasite on your organism rather than the generally non-threatening side effects of anti-malarial drugs.
Fever, chills, sweating, nuchal headache and increasing tiredness are the most frequent and characteristic symptoms. But malaria does not always present itself in such a striking manner. A malaise on returning from a trip is enough to trigger attention.
GET LABORATORY TESTS IMMEDIATELY AT A SPECIALISED CENTRE. WE ARE WAITING FOR YOU AT CESMET TO RULE OUT THE POSSIBILITY THAT YOUR SYMPTOMS ARE DUE TO A MALARIA ATTACK BY MEANS OF AN EXAMINATION AND TARGETED TESTS.

CALL THE TROPICAL CLINICAL AND DIAGNOSTIC CENTRE 06 39030481 Malaria: fact sheet

Mosquitoes & co. – How to protect yourself

– mosquitoes that transmit diseases other than malaria are active during the day and wherever there is a collection of fresh water: wear light-coloured, long, wide-sleeved clothing, long, loose, light-coloured trousers, T-shirts or shirts with long, loose, light-coloured sleeves to tuck into the waistband of trousers….

read more

Swimming with precaution

To prevent the possible transmission of infectious diseases, you should only swim in pools with chlorinated water. Sea water is safe.
Bathing in contaminated water can be dangerous for the skin, eyes, ears, mucous membranes of the mouth, especially if…

read more

Packing

Mountain or sea, safari and adventure or restful holiday, hot or cold: you must prepare your luggage with care, attention, without exaggeration and above all by anticipating …… the unpredictable. Clothing appropriate to the climate and never forgetting a small travel pharmacy.

Returning home

When you return from a trip, remember to take a break long enough to readjust your organism to your environment and your pace of life. Tiredness, malaise, feeling empty, poor ability to concentrate….

read more

General information

Capital city: Jakarta

Weather: http://it.weather.yahoo.com/asia/Indonesia/http://www.tv5.org http://www.ssec.wisc.edu

Language: Bahasa Indonesia (official), Javanese, English

Currency: Indonesian Rupee

Time zone: GMT +6 +7 +8

History,Economy,Culture: https://www.cia.gov http://www.britannica.com

Security: www.viaggiaresicuri.it www.dovesiamonelmondo.it

The use of Imodium

Loperamide (IMODIUM) is only a symptomatic drug, that is, blocking the emission of liquid stool. This drug tends to eliminate the symptom (diarrhea) but does not act at all on the causes, that is, the bacteria or viruses that are the main causes of intestinal disease. IMODIUM acts by blocking the liquid discharge but does not eliminate the cause, which remains active within the intestine. The mechanism of “loperamide” is that it binds to certain receptors in the intestinal wall, blocking the release of certain internal molecules such as acetylcholine and prostaglandins, the decrease of which in the body reduces bowel movement (propulsive peristalsis) and increases intestinal transit time, greatly decreasing the discharge of liquids (blocking diarrhea). The real cause of diarrhea, namely the presence of bacteria, remains and indeed increases. In fact, the drug promotes internal fluid stagnation with the growth and sometimes ‘explosion’ of bacterial colonies. In such cases, however, a thorough stool examination is needed to identify the cause of the diarrhea.  Thus it is essential not to use Loperamide (Imodium) alone to resolve diarrhea but this medicine should always be accompanied by anti-infective drugs, which act by eliminating the microbiological cause of diarrhea. IMODIUM should never be taken alone as monotherapy.
The risk of diarrhea during travel, especially in children, especially toddlers, is to result in a major reduction of fluids and minerals within the body. It is very important along with anti-diarrheal medications to take fluids (water, tea, juices) and mineral salts.

How to prevent and how to treat diarrhea while traveling

How should we deal with diarrhea while traveling? The first advice is to “prevent” this sometimes dangerous situation. Preventive rules help us to avoid contact with those aggressive microorganisms, which put our travels at risk. Let’s include in our small “travel pharmacy” those medications that can first prevent and in case treat any attacks of diarrhea: This diarrhea in some more severe cases can become real “dysentery,” that is, diarrhea with blood and mucus, often accompanied by even high fever. Just think that about 60 percent of all travelers, worldwide, suffer from bowel problems, and the annoying symptom of diarrhea. Staggering numbers. These official tips and directions from the CDC in Atlanta USA.
Along with our small travel pharmacy ( read more), where we will put some preventive and other specific curative medications, before the trip we should consider “strengthening our defenses against these food infections, dirty hands, hotel or restaurant staff with little hygiene, thinking about the three basic vaccines against diarrhea from aggressive bacteria and viruses useful worldwide: hepatitis A vaccination, typhoid fever (salmonella) vaccination, traveler’s diarrhea vaccination and cholera vaccination.

A general rule of thumb while traveling is to promptly and appropriately treat symptoms of diarrhea, at an early stage that is, as soon as they appear, without waiting for the situation to worsen.  Replenishing lost fluids and minerals is the first rule to delay or control the worsening of symptoms. An initial semi-liquid diet and then a light and adequate diet is the condition for recovering from an attack of diarrhea. The causes of diarrhea are generally microbiological, that is, infectious. Therefore, one must always treat the cause, thinking then of the symptom. Among the drugs to be used for the treatment of acute enteritis or enterocolitis while traveling are Doxycycline 100mg, an excellent drug for the prevention and also the treatment of particularly acute forms, ; with the possible addition of Rifaximin 200 mg.

IMODIUM 2 mg, effervescent tablets, also contains electrolytes useful for replenishing salt losses. In addition to a certain amount of glucose, the tablets contain: sodium 260 mg, potassium 80 mg, chloride 234 mg
The presence of glucose conditions the use of IMODIUM in diabetic subjects.
The drug is easily absorbed from the intestines, almost completely extracted from the liver, where it is metabolized, and excreted back into the intestines by the biliary route.
Beware of taking IMODIUM in the following clinical situations:
1) in cases of acute dysentery, intestinal discharges characterized by the presence of blood and mucus in the stool often accompanied by high fever, the use of IMODIUM is not recommended as an attack therapy, especially as monotherapy.
2) in cases of acute ulcerative colitis or pseudomembranous colitis due to the use of broad-spectrum antibiotics and in patients with bacterial enteritis or colitis caused by invasive microorganisms such as Salmonella, Shigella, or Campylobacter.
3) in cases of intestinal hypermotility where intervention is needed to block peristalsis because of the possible risk of significant consequences such as ileus, megacolon and toxic megacolon.
If sudden constipation and major abdominal distension with the presence of air from hyperfermentation occurs with the use of IMODIUM, treatment should be discontinued immediately.
It is prudent not to administer IMODIUM in children under 12 years of age, pregnant women or during lactation.

 

Bassado (doxycycline) is an old tetracycline, an antibiotic from the 1970s, normally used for the treatment of important bacterial infections: bronchopneumonia, tonsillitis, otitis and sinusitis, nephritis, cystitis, urethritis. skin infections, intestinal infections, gynecological infections (Chlamydia and others); insect-borne infections;

Currently considered one of the most effective drugs for malaria chemoprevention. (effective and with few side effects).
Always useful during travel because of its efficacy as:
1) used to prevent and treat skin infections (during high sweating or skin contamination) It is also widely used in infections such as furunculosis, abscesses, infected wounds. I recall its use in the treatment of ACNE for young people.

2) used to prevent and especially to treat tick bite infections of animals (Rickettsia exanthematous typhus) so it is of great use while traveling.
3) used to prevent and treat even strong diarrhea from enterobacteria (enteritis, entero-colitis ) So drug of great interest during travel to combat and control “traveler’s diarrhea”
It is the drug used in the treatment of strong acute bacterial enteritis and is the drug of excellence even for the treatment of cholera.
Thus doxycycline is a great drug, suitable for multiple uses.

IF YOU TRAVEL CHECK HERE THE TAB OF THE COUNTRY DESTINATION OF YOUR TRIP

For “malaria prevention,” CESMET Clinic of the Traveler’s choice, after decades of experience, audits, studies, and after using all possible antimalarials on the market, especially in Africa, but also in Asia and the American Continent, fell precisely on Bassado tablets. Excellent Plasmodium response, broad-spectrum antibacterial activity, very manageable drug with few side effects. All characteristics that with the low cost make it preferable to other molecules that are increasingly less active

WHETHER YOU NEED MOLECULAR OR ANTIGENIC BUFFERING TO TRAVEL.

But why recommend Bassado (see CDC).
Contact with a wide variety of microorganisms is facilitated during travel. Our bodies are strong and defenses are powerful but the primary goal is to find a medicine, safe with little adverse effects and that protects us against the greatest number of diseases.

I remind everyone again of the use of this antibiotic for the prevention and treatment of so many infectious diseases of the skin and intestines of bacterial type, we treat many young people who have acne and furunculosis, administering the medicine for 8/10 months, every day, without creating any problems whatsoever. I remember its use for the prevention and treatment of many infectious diseases and even cholera.
I would like to emphasize the great effectiveness of doxycycline in the prevention of malaria. Excellent antimalarial drug that is manageable, safe, effective, ready-to-use, and can be started on the spot.
The drug is useful and effective for short periods but also for long administrations, in borderline cases of places with stable and continuous malaria.

These statements are the result of years of clinical and preventive practice under the most diverse conditions. We have quietly exceeded a thousand prescriptions for malaria chemoprophylaxis with very high protection. Even side effects (heaviness of stomach at intake, appearance of small and limited skin spots, mild asthenia in the first days of intake) have occurred in few individuals, out of a very high utilization. Most importantly, I have never experienced any psychic, neurological reactions reported for other antimalarial drugs.

So what should you do to prevent malaria?
Evaluate the country you are traveling to, the environment you are going to, the seasonal and weather conditions; don’t be fatalistic or obtuse in your choices and decisions of how to protect your health, that’s the worst approach to dealing with your trip. Do not give up and do not change your destination even if you know you will encounter malaria. Achieve your goal of protecting yourself by protecting yourself. Repellents, soothing agents, suitable clothing, be careful at dusk and during the night, mosquito nets better if treated, conditioned environments.

As a prophylaxis, again taking specialist advice, our advice is to supply yourself with a proper dose of Bassado 100 mg, to be taken once a day, at lunchtime, while in risk areas, and for seven days after leaving the malarial area. The drug is still effective and has shown very little resistance, perhaps because it is little used. Whether you travel in the forest or savanna, in the highlands or white tropical beaches, whether you stay in large hotels or resorts or face the journey in a tent, doxycycline protects you from a variety of parasite or bacterial infections, and for these multiple protections alone it is worth the choice.

Of course, like all drugs, there are definite contraindications: for children under 12 years of age and pregnant women, taking the drug should be avoided. For those allergic to tetracyclines, there are alternative medications such as malarone or lariam.

What about skin sensitization to sunlight?
I would like to provide a scientific answer but also my direct experience after years of use: 100 mg of tetracycline (low dose) does not sensitize our already melanin-rich Mediterranean skin. We are not Finns or Scots. We Mediterraneans have natural sun protection. So let’s dispel the urban legend of sun risk. In any case, it is a good idea to always protect ourselves from the sun’s friendly rays with suitable protection. Not the least reason for choice concerns cost. Less than 4 € per pack which is no bad thing.