Exotic Travel? Take Your Precautions Seriously. (Or Die.)

So, these deadlines: They’ve been intense. (I know, I said last week I thought I was done. I was wrong. But now I think I’m done — though chairing a conference for the rest of the week, so still busy.) While I’ve been underwater, there has been literal tons of news on this blog’s core topics, all of which I need to get back to. But while I’m getting re-oriented, here’s an intriguing piece of news that I stashed last month for consideration. It’s worth thinking about, if you’re planning exotic travel.

TL;DR: If you’re going somewhere where you run the risk of being exposed to a disease that your doctors back home might not recognize, and you can take simple steps to prevent it, you should. Really. Wear your bug repellent, stay out of the stagnant water, keep your skin covered, take your pills.

Or this might happen: In January and February, two European travelers who visited the Masai Mara Reserve in Kenya came home with high fevers, headaches, rashes, vertigo and nausea. Their doctors in Belgium and Italy suspected malaria, as you would. They were wrong. The men — one from Germany, one from Belgium — had human African trypanosomiasis, better known as sleeping sickness.

This is serious stuff. Sleeping sickness is caused by a protozoan transmitted by flies that invades the central nervous system, and it is a bad disease. The variety the two men had — caused by Trypanosoma brucei rhodesiense, the less common form of the organism — can cause death within days. Treatment requires two drugs, suramin and melarsoprol, that are both very toxic and so rare that they must be directly requested from the World Health Organization

Once the men were correctly diagnosed and treated — the drugs were sent in time, and both men recovered within a few weeks — physicians extracted the story of what they had been doing. Both had stayed at local lodges and gone on locally run safari or game-tracking excursions. The German man confessed that because it was hot, he had worn shorts and short-sleeved shirts, though he had sprayed himself with an insect repellent. (The Belgian man’s clothing choices were not recorded.) The advice for preventing trypanosomiasis is to wear long sleeves and long pants, preferably light-colored and treated with the repellent permethrin.

Now, it is narrowly correct to say that the men might not have known they were at risk for sleeping sickness; their cases, which were described last month in the journal Eurosurveillance, were the first reported from the Masai Mara (which is in southwest Kenya) in 12 years. However: The Masai Mara effectively continues across the Kenya-Tanzania border; in Tanzania, it is known as the Serengeti Park. And the Serengeti has consistent reports of trypanosomiasis in travelers. In fact, in 2007, another German tourist died of sleeping sickness after a visit to the Serengeti, and after a physician in Zanzibar misdiagnosed the problem as malaria and administered anti-malaria drugs.

It is unfortunately not unusual for travelers, especially to exotic once-in-a-lifetime places, to not want to harsh their thrill by researching possible health risks. In a 2010 study that I wrote about at the time, researchers from the Centers for Disease Control and Prevention found that 46 percent of travelers didn’t do any advance research before undertaking travel that might involve risky disease. Many of them didn’t even check to see whether their shots were up to date. This is a bad idea: A 2006 study of more than 17,000 travelers who reported to travel clinics after returning to the US and Europe found these among their souvenirs: malaria, dengue, hepatitis, cholera, meningitis and STDs.

A couple of years ago, I spent 12 months observing doctors on overnight shifts in ERs around the country. Every night, there were stabbings, and shootings, and the usual assortment of broken bones and fevers. But at least once a week, there was something mysterious. It was usually infectious, it was sometimes rare, and it was almost always some kind of tropical imported disease. Invariably, it made the doctors go: “Oooooh.”

So, your travel advice for the summer: Check your shots. Take your pills. Do what the books and clinics tell you to.

Don’t make us go “Ooooh.”


  • Gobbi F, Bisoffi Z. Human African trypanosomiasis in travellers to Kenya. Euro Surveill. 2012;17(10):pii=20109
  • Clerinx J, Vlieghe E, Asselman V, Van de Casteele S, Maes MB, Lejon V. Human African trypanosomiasis in a Belgian traveller returning from the Masai Mara area, Kenya, February 2012. Euro Surveill. 2012;17(10):pii=20111
  • Wolf T, Wichelhaus T, Göttig S, Kleine C, Brodt HR, Just-Nuebling G. Trypanosoma brucei rhodesiense infection in a German traveller returning from the Masai Mara area, Kenya, January 2012. Euro Surveill. 2012;17(10):pii=20114

(Note: for the rest of the week, I’ll be tweeting from the Association of Health Care Journalists’ annual conference, Health Journalism 2012, where I’m chairing a panel on global health and speaking on social media. If you’d like to listen in, the hashtag on Twitter is #ahcj12.)



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