Egyptian travellers

My wife and I intend to go to Egypt at the end of August and I would like to know what your experts consider are the measures we can take prior to this.

We have been advised with regard to smallpox and typhoid but I am concerned about ye/low fever and especially about dysentery. Are there any required safe prophylactic measures for dysentery? Failing that, can you advise me about the most suitable drug to take should either of us develop dysentery whilst sailing up the Nile from Cairo to Aswan?

Vaccination can be divided into two distinct categories. First, those which are required by International Health Regulations and second, those which are medically recommended. In the first group,

travellers proceeding direct from the UK to Egypt do not require vaccination against smallpox, cholera or yellow fever from June 1, 1979. Yellow fever is only required if the travellers have come up from the south through the Sudan. For the medically recommended vaccinations, all travellers to Egypt should be adequately protected against typhoid tetanus and poliomyelitis. Infective hepatitis is prevalent in Egypt and so an injection of gamma globulin should be considered: 2 ml gives a family adequate cover for two months and 5 ml for 4 to 6 months.

Regarding protection against dysentery and other causes of diarrhoea, sensible food hygiene precautions are most important but the use of Streptotriad, one tablet twice daily whilst away and for the first 2 days after return has been found to be the most effective prophylactic. The 10 commandments for the prevention of diarrhoea are as follows.

1. Boil all drinking water or milk.

2. Be very careful of shellfish — preferably see them alive first.

3. All cooked food to be well and recently cooked.

4. All fruit, including tomatoes, to be peeled.

5. Lettuce and unpeeled fruit sterilized by chlorination — no watercress.

6. No leftovers or food on display.

7. Be wary of local ice cream — only from large firms.,

8. No food from street hawkers.

9. Avoid fly-infested restaurants. (10) Take one tablet of Streptotriad twice daily. Lomotil (Searle) or Imodium (Janssen) are certainly the most effective therapeutic agents for acute diarrhoea. Lomotil must not be given to anyone with an atropine sensitivity.

There are two other points which must be remembered.

1. Outside Cairo malaria is prevalent up the Nile Valley so an antimalarial should be taken. One tablet of Paludrine daily whilst away and for 28 days after leaving the malarious area is recom­ mended.

2. 'Schistosomiasis haematobium' is rampant in the Nile Valley and there should be no fresh-water bathing.

Vaccine sensitivity

, / have a patient whom I understand is allergic to tetanus vaccine. Her young daughter was given a 1/10 dosage of tetanus vaccine as a test. She was violently sick within about 10 days and it was some 2 or 3 days before she returned to

normal. In view of the family history the mother

has asked whether it would be wise to immunise

her second child.

Although tetanus is now relatively rare in Britain it remains a serious disease with an appreciable mortality. Most cases follow trivial wounds and children because of the frequency of minor injuries, must be considered at special risk. Every effort should be made to protect them.by immunization. The enquirer is understandably concerned about the risks of immunization because of the family history of sensitivity to tetanus vaccine. It does not necessarily follow, however, that the second child will react in the same way as the first. Nevertheless, it would be sensible to take • precautions against anaphylaxis and the following regimen is suggested.

Provided the child is not sensitive to aspirin an antihistamine together with aspirin should be given orally, in dosage appropriate for age; one hour before the injection of a test dose of vaccine. If there is no disturbance within 20 minutes the full dose of vaccine should be given.'If given before exposure to the allergen, antihistamines are of prophylactic value in type I hypersensitivity reactions and aspirin, by prostaglandin inhibition, is also hejpful in suppressing the effects of histamine, it would be wise to repeat the same regimen when subsequent dosages of vaccine are given.

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С. Лексические тесты.