TRAVEL HEALTH
J.T.D. Main, M.D.,DipSportMed
Senior District Medical Officer
Veterans Affairs Canada,
Birds of Paradise, Unit 524
jandjmain@hotmail.com
F. BITES / STINGS
El alacran; The common striped scorpion is
the most common and widespread scorpion in North America, and is often found
indoors. Most kinds of scorpions deliver stings that are painful, like a
wasp or bee sting, but not dangerous unless one is allergic; most reactions
include intense burning, swelling and numbness for several hours. Only the
bark scorpion, found in Arizona, New Mexico and Mexico, is a dangerous
threat to life; I’m not aware that they are a significant problem in our
area. Around houses, scorpions hide in crawl spaces, or inside clothing
(shoes) where they have crawled to avoid sunlight.
Always shake out shoes, socks, pants and
other clothing before dressing; check bedding and towels before using. An
Epipen is a must for those with previous severe allergic reactions to
stinging insects, such as wasps or bees; use it immediately after being
stung, and then seek medical attention at once. Icing the bite site, and
elevating the involved extremity will provide some comfort. Most people will
have local reactions only; if, however, systemic symptoms occur, such as a
rapid heart rate, breathing problems, trouble swallowing, restlessness, or
involuntary muscle jerking, you will require hospital treatment. The bottom
line is that, unless you have severe allergies, a scorpion bite is
essentially an unpleasant inconvenience.
Antihistamines can also minimize the
reaction. Locally, there is a product called Avapena (chloropiramina),
usually available at the guardhouse, although, when I checked, it wasn’t!
This is comparable to Chlor-Tripolon 4mg (chlorpheniramine) or Benadryl 25
or 50mg (diphenhydramine), which you can purchase over the counter in
Canada. You can also use INSECTRIN to spray around doors and windows to
discourage entry; your unit is also fumigated several times a year.
A few words concerning mosquitoes: they carry
many diseases – malaria, dengue fever, yellow fever, Japanese encephalitis.
Malaria is the most important – one strain, Plasmodium falciparum may be
fatal if improperly treated. There was an outbreak of dengue fever in Puerto
Vallarta, with deaths of young healthy people, in 2003; dengue is carried by
mosquitoes that bite after sunrise and before sunset. The main defense
against many of these diseases is prevention – clothing that covers arms,
legs, the use of DEET 30%, use of a bednet if necessary, or a closed room;
remember, for malaria, mosquitoes are most active from dusk to dawn. Check
with your travel clinic as to the prevalence of these, and if they recommend
medication, it is started before departure, taken during the time of your
stay, and for a time after returning home; most cases of malaria in
travelers occurs in people who have stopped taking their medication too
soon!
DEET/sunscreen combinations should not be
used because DEET can decrease the efficacy of sunscreens by up to 34%. If
the application of both products is required, apply the sunscreen first,
allowing it to penetrate the skin for 20 minutes before the application of
the DEET.
The following personal measures are very
important: limit outdoor exposure from dusk to dawn, use protective
clothing, use an insect repellent containing DEET (eg Muskol), use an insect
net at night (when necessary). Antimalarial medications lower your risk of
becoming ill; they do not prevent an infection; they merely suppress it.
SEEK IMMEDIATE MEDICAL CARE FOR ANY FEVER DURING AND AFTER TRAVEL TO A
MALARIA AREA (up to a year, but usually within the first three months)!!
Malaria is preventable!