DRAFT 14 February 2007
Disruption of sanitation, food and water supplies in regions affected by disasters may result in a higher risk of exposure to infectious diseases. If you become febrile or unwell in the period following your return to Australia, it is important to be aware of the possibility of infectious diseases, particularly those not frequently encountered in Australia. If you think you may be suffering any of the illnesses mentioned below, see a doctor. Tell the doctor that you have been in the disaster-affected area and take this sheet with you. Also, alert the your team leader in case others in the team have had a similar illness.
Disruption of sanitation, food and water supplies may have resulted in a risk of exposure to infectious diseases. The pattern of risks will change over time as reconstruction continues.
Symptoms of infectious diseases can include:
- Promptly seek medical attention if you have or develop symptoms, particularly those listed below.
- If you suffered animal bites or scratches while overseas you should seek advice about receiving post-exposure prophylaxis for rabies immediately.
- If your Mantoux test was negative (<10mm) prior to deployment, you should have a repeat test 2 months after you return to determine latent tuberculosis (TB) infection, risk of TB disease and the need for preventive measures.
- Fever, chills, shakes, or night sweats
- Cough, shortness of breath, chest pain, coughing up blood
- Jaundice (yellow discoloration of eyes and / or skin), dark urine or pale stools
- Severe headache
- Diarrhoea is common but see a doctor immediately if you are unable to keep fluids down, have fever, or if the diarrhoea is bloody or profuse and watery
- Vomiting, particularly if it occurs with fever
- Muscle aches and pains
- Red eyes
- Unexplained weight loss or loss of appetite
- Skin infection of any cuts or abrasions acquired while overseas.
Skin, wound, soft-tissue, chest and diarrhoeal infections acquired in Asia-Pacific disaster areas may be due to bacteria resistant to multiple antibiotics commonly used to treat these infections in Australia. Many other infections in affected areas, including sexually transmitted diseases,
are also resistant to multiple antibiotics. Early consultation with Infectious Diseases units in public hospitals is recommended.
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- Complete you malaria prophylaxis after leaving a malarious area. If you were taking doxycycline, continue taking 100mg of daily for 4 weeks. It is important not to forget to take any tablets.
- There is no drug regimen that provides complete protection against malaria and there is a chance that you could still contract malaria despite taking the preventive therapy.
- Malaria can be rapidly fatal. Seek urgent medical attention if you experience symptoms of malaria including fever, chills, shakes, sweating, headache, muscle aches, cough, vomiting and diarrhoea.
- Symptoms usually appear within 30 days but can present months or years later.
- Anyone returning to malaria-receptive areas of northern Australia should contact their public health unit or health department for advice about further follow-up.
Other infectious diseases
Working in the Asia-Pacific region carries the risk of exposure to infections that are rare or absent in Australia (see below for some of them). However, the risk will be low if you followed precautions will there. See your doctor if you have any symptoms or concerns.
Incubation period varies from days to months to years. Symptoms include fever, chills, bloody or mucoid diarrhoea, intermittent constipation, abdominal discomfort or pain, inflammation of the large bowel, ulceration around the anus, and liver abscesses. (Other parasitic infections may also need to be excluded.)
It is extremely unlikely that you will have been exposed to avian influenza. Human infection is very rare, and mainly in people who have had extensive exposure to infected birds. Human to human spread is very unlikely.
Incubation period is a few hours to 5 days; symptoms are profuse watery diarrhoea, nausea, vomiting, dehydration.
Incubation period is 3 to 14 days; symptoms are fever, intense headache (especially behind the eyes), muscle and joint pain, decreased appetite, gastrointestinal disturbances, rash. Other mosquito-borne diseases such as chikungunya occur in parts of Asia.
Incubation period is 6 to 12 months or longer; symptoms are recurrent fever, swollen lymph glands, asthma at night, swollen legs, arms, genitalia. (Note:
Filariasis is very unlikely unless you have had extensive mosquito exposure over a long period.)
Hepatitis A and E:
Incubation period is 15 to 50 days for hepatitis A and >60 days for hepatitis E; symptoms are fever, malaise, decreased appetite, nausea, abdominal discomfort, followed by jaundice (yellow skin and eyes).
Incubation period is 4 to 19 days; symptoms are fever, headache, chills, muscle pain especially in the calves and thighs, red eyes, neck stiffness and pain, rash, purple rash on skin and inside mouth, liver and kidney failure, yellow skin and eyes, confusion, depression, shortness of breath.
Incubation period is 1 to 21 days but may reactivate after many years; symptoms are variable - fever, septicaemia, pneumonia, prostatitis/prostatic abscess, deep abscesses in other sites, bone infection, skin ulcers and abscesses, wound infections.
Incubation period is usually 3 to 8 weeks but may be years. It is endemic in most of Asia. If you have suffered animal bites or scratches while overseas seek advice about receiving post-exposure prophylaxis for rabies immediately. Left untreated rabies is fatal. Symptoms include fever, headache, malaise, sensory changes around the bite site, spasm of the muscles of swallowing, progression to paralysis.
Shigellosis (bacillary dysentery):
Incubation period is 12 hours to 4 days; fever, nausea, vomiting, bloody or mucoid diarrhoea, abdominal cramping, inflammation of the large bowel.
Incubation period is usually 3 to 21 days but may be up to several months; symptoms are painful muscular spasm and rigidity (may be generalised or restricted to the jaw, abdominal muscles or the region of injury). If you have not had a tetanus booster in the past five years and you suffered any wounds during your stay, you should receive a tetanus booster dose.
Incubation is 2 to 10 weeks until primary disease develops or evidence of latent TB infection (LTBI) is demonstrated by positive Mantoux test. LTBI can reactivate months to years later; symptoms of TB are cough, fever, night sweats, loss of weight, fatigue, swollen lymph nodes (often in the neck), later lung disease with blood-stained sputum and chest pain.
Typhoid and paratyphoid fever:
Incubation period is 1 day to 1 month; symptoms are sustained fever, headache, malaise, decreased appetite, enlarged spleen, a distinct rash, constipation or diarrhoea.
Typhus (scrub and endemic):
Incubation period is 1 to 3 weeks depending on the species and symptoms may recur years later if not treated; symptoms are headache, fever, sweating, swollen lymph glands, rash, red eyes, general pains. A distinctive skin ulcer (eschar) can occur in scrub typhus.
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The stress of working in a disaster region is well recognised. First-responders to disasters are at risk of both immediate and long-term psychological effects. The long-term consequences of stress can be severe and included post-traumatic stress disorder. Stress-related symptoms include:
- Difficulty sleeping and nightmares: This would be the most common symptom in returning relief workers. It can happen when you have a fever but anxiety is the more common cause.
- Difficulty in returning to normal roles and life.
- Feelings of numbness or a loss of feelings.
- Negative feelings that you could or should have done more.
- Breathlessness may indicate a physical problem as well as anxiety.
- Sweats can appear with infections, but are common in anxiety.
- Risk behaviours such as heavy alcohol consumption, illicit drug use or risky sexual activity.
- Other physical responses to stress include diarrhoea or vomiting, headaches or other aches and pains, tiredness, and either over-eating or lack of appetite. Some stress-related symptoms are to be expected and everyone has their own coping style. Taking time off to readjust and be with friends and family may be all that is required, but if these symptoms become prolonged, persistent, disruptive or distressing, you need to seek professional help.
WHO TO CONTACT IF YOU REQUIRE FURTHER ADVICEFor specific information relating to infectious diseases contact:
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- Infectious diseases units in public hospitals
- State/Territory communicable disease control units or Public Health Units
- State/Territory mental health units
This document provides health advice about personal health protection to persons returning from travel from disaster-affected areas in the Asia-Pacific area as a member of an Australian government health team.
This health advice captures the knowledge of experienced professionals, build on past research efforts, and provide advice on best practice based upon the best available evidence at the time of completion.
The guidelines are necessarily general and readers should not rely solely on the information contained within these guidelines. The information contained within these guidelines is not intended to be a substitute for advice from other relevant sources including, but not limited to, the advice from a health professional. These guidelines are intended for information purposes only.
The information contained within these guidelines is based upon best available evidence at the time of completion. The membership of the Communicable Disease Network Australia (‘CDNA’) and the Commonwealth of Australia (‘the Commonwealth’), as represented by the Department of Health and Ageing, does not warrant or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of any information, or process disclosed at the time of viewing by interested parties.
The CDNA and the Commonwealth expressly disclaim all and any liability to any person, in respect of anything and of the consequences of anything done or omitted to be done by any person in reliance, whether in whole or in part, upon the whole or any part of the contents of this publication.