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Routine Vaccines for Travel to Nepal

Question:

Discuss about the Emergent Issues and Vulnerability Factors.

It is to be mentioned that before travelling to Nepal, Declan and his family must take vaccines as precautions to avoid catching diseases. They must take the routine vaccines prior to travel if not already taken. Routine vaccines for the children include the following vaccines: Hepatitis B, DTap, Hib, Pneumococcal, Rotavirus, MMR, Flu, Chickenpox, Meningococcal, Hepatitis A and Polio. Routine vaccines for adults include Tetanus and Diphtheria, HPV, Pertussis, Shingles, Pneumococcal, Meningococcal, Hepatitis A and Hepatitis B. In addition to the routine vaccines the family is also required to take a Japanese Encephalitis vaccine as they will stay in Nepal for a long period and might have to travel to the rural areas of Nepal. It is recommended for every traveler travelling to Nepal to get a Typhoid vaccine as there is substantial risk of getting Typhoid from consuming contaminated water (8). It is also advised by the doctors to take a Rabies vaccine if any traveler plans to spend a lot of their time outdoors. It is advised as it will serve as a precaution in case the same traveler gets bitten by any animal during the course of his travel. It is even more essential for the children of the family to get this vaccine as children play with animals and tend to neglect minor animal bites and not tell their parents about the same. It is to be noted that animal bites can have fatal consequences on the health of human beings if the same animal was suffering from Rabies (9).

Dengue and Japanese Encephalitis are both the most common examples of vector borne diseases in Nepal. It is to be mentioned that due to Nepal’s location between the two countries if India and Bhutan Nepal has fallen prey to the fatal diseases (10). It is to be stated that both the diseases are spread by mosquitoes. Once a mosquito bites an infected person, it becomes an agent of the disease and again when it bites a healthy person, he also victim of the disease. Thus to avoid the same it is advised by the doctors to wear clothes that cover the body so as to eliminate the risk of getting bitten by mosquitoes. To prevent getting bitten by mosquitoes one must carry insect repellants and use mosquito nets during sleeping hours. Another important vector borne disease which is common in Nepal is Murian Typhus. It is transmitted by fleas. The fleas transmit the disease from rodents to humans. It is to be noted that the disease is caused by the fecal matter comes in contact with the area of the flea bite. Victims of Murian Typhus are found mostly to be residing in unhygienic houses which are infested by rats or rodents (11). The travelers to Nepal can prevent the aforementioned disease by residing in hygienic environment avoiding staying in any place which is infested by insects and rodents.

Japanese Encephalitis and Typhoid Vaccines

It is very common for travelers, travelling to places of high altitudes, to fall sick and even have breathing trouble. Children take the most time to adapt to a new environment and in the process fall sick. It is very common for children to have breathing trouble at high altitudes and also catch a cold which might lead to a fatal disease, Pneumonia. However the same can be prevented if inhalers and medicines for common cold are carried in the medical kit. Other anti Diarrhea medicines and anti malaria medicines should be carried. To avoid catching cold in high altitudes, warm and protective clothes should be worn that keep the body heated as well as protect it cold winds and snowfall in extreme temperatures.             It is to be noted that travelers should avoid drinking water from sources which are not pure otherwise they might become victims of water borne diseases the most common ones being Cholera, and typhoid. Another medical concern can be about Acute Mountain Sickness (12). It is to be noted that the when an individual travels to a region which is above the altitude of 2500 meters, the oxygen content in the air decreases. Decreased air pressure and low availability of oxygen result in leak of fluid from capillaries and leak of fluid from the brain which might be fatal for the human body. However the same can be prevented if the affected individual is brought down to a lower altitude and the same individual is taken to the higher altitude gradually so that his body gets acclimatized to the environment (14).

It can be stated that Nepal faced a catastrophe in the name of an earthquake in the year 2015. The results of the natural calamity had a devastating effect on the country (13). Its economy suffered a heavy blow as the country’s infrastructure had almost collapsed under the impact of the disaster. The loss incurred by the country due to the disaster was estimated to be approximately one billion dollars and it had an lasting impact n the country’s economy as the same could never recover from the setback. It received financial aids from all over the world in attempt to restore the country’s economy. The land and buildings of the country had collapsed and sustained severe damages. There were also many casualties due to the earthquake and many had become homeless (15). The tourism industry, a major source of revenue of the country’s economy was brought to a standstill. The political support was also not adequate as the country’s political system was ot prepared to deal with such a heavy blow.

Rabies Vaccine and Vector-Borne Diseases in Nepal

It is to be noted that a mechanical engineer named Carlos is travelling to remote areas of Ghana and Tanzania in Africa. He does not have any medical records. However it is to be mentioned that he was a smoker in the past and suffers from minor chest infections frequently. It is to be mentioned that Ghana has a bad history of people suffering as well as dying from respiratory diseases specially the diseases relating to the lower respiratory tract(1). The symptom of the disease are not detected early however are generally misdiagnosed as symptoms of Bronchitis, Pneumonia and influenza. It is one of the leading causes of death in the aforementioned place. As it has been mentioned earlier that Carlos suffers from frequent respiratory problems and that he was a smoker in the past, it makes him very prone to catching the infection even yielding to it. It is necessary for him to take certain vaccinations which would protect him from the infection. He has to take Pneumococcal polysaccharide vaccine (PPV) and he is middle and has been suffering from chronic chest infections and infections in the respiratory tract.  It is also to be mentioned that vaccination against flu is also necessary which would serve as a precaution against the same.

It has been mentioned that Carlos has not taken any vaccinations in last decade. Therefore it is very important for him to take certain courses of vaccination prior to his travel to Ghana. He needs to take the routine vaccines as well as the ones that are specifically important for travelling to Ghana(2). The routine vaccines for adults include vaccinations against Flu, Tetanus and Diphtheria, HPV, Shingles, Pneumococcal, Meningococcal, Hepatitis A, Hepatitis B. These vaccines are important to be taken because these act as precautions for the aforementioned critical and fatal diseases which can infect anyone if the vaccines are not taken. In addition to these it is important get one vaccinated against Yellow fever, Typhoid, Cholera, Meningitis and Rabies(4). It is to be mentioned that Yellow fever is common in some parts of Ghana and people travelling from other countries to Ghana are prone to catching Yellow fever if they are bitten by mosquitoes carrying the virus of the same disease. Any traveler travelling to the remote parts of Ghana which come under the Meningitis belt are prone to catching the disease. It is most widespread during the dry season (5). Typhoid and cholera are waterborne disease therefore travelers should avoid drinking contaminated water and food in Ghana.

Altitude Sickness and Water Borne Diseases in Nepal

Malaria Prophylaxis (3) is the treatment of malaria which is preventive in nature. It is recommended to people who are travelling to countries where occurrences of Malaria are common. For Carlos’s trip to Ghana he should consider taking Doxycycline as a medicine for Malaria Prophylaxis. He should consider taking the same because his trip would last for four weeks and this medicine is best for long trips as opposed to short trips. This medicine is inexpensive. It requires to be taken regularly during the period of travel and the course of the same starts 1 or 2 days prior to the travel. The aforementioned medicine also prevents certain infections other than being an anti-malarial drug. It is best suited for people who are planning to do any adventure activity like hike or swim during the period of their travel. Apart from taking this medicine, he should take some additional precautions to prevent any risk of being affected by Malaria. He should avoid exposing bare skin; he should wear full sleeve shirts to prevent mosquito bites. It is best to avoid contact with mosquitoes using mosquito bed nets and using sprays that keep insects away, in the bed room (6).

The diseases that are prevalent in Ghana and the ones that travelers should be made aware about are: Yellow fever, tuberculosis, AIDS, Trachoma, Chicken pox, Measles. Most of these diseases are preventable by taking vaccines prior to the travel. However it is to be mentioned that any person traveling to Ghana should avoid indulging in any sexual contact in West Africa as occurrences of the AIDS is very common in the region (16). Travelers should stay away from contaminated water and avoid drinking water which is not purified. As it has been mentioned earlier Yellow Fever is a common occurrence in Ghana and entry into the country is only permissible if one has taken a yellow fever vaccine. It is to be stated that any person travelling to any West African country should be vaccinated against Chicken Pox and Measles. Any vaccination to prevent trachoma is not available however the same can be prevented if proper hygiene is maintained which includes washing hands prior to eating, avoiding eating food which has been contaminated by flies and drinking clean water (7).

It is to be made sure that the traveler checks with his pharmacist if any of his medicines contain traces of opium as the same are banned by the Opium Act. It is to be mentioned that any one traveling to Ghana should carry anti-diarrheal medicines and anti-malarial medicines in his medical kit. Anti diarrhea antibiotics include Levofloxacin (Levaquin), ciprofloxacin (Cipro)(PDF) 500 mg or alternatively azithromycin (Zithromax) 500 mg, rifaximin (Xifaxan) 200 mg. Anti malarial medicines include atovaquone/proguanil (Malarone)(PDF), mefloquine (Lariam). However it is to be noted that the medicine, mefloquine (Lariam) cannot be prescribed to patients with a medical record of seizures, heat related health issues, psychiatric issues and allergy. It is to be mentioned that anti septic ointments, bandages are necessary to be carried in a traveler’s medical kit. In case of any cuts and bruises anti septic ointments and lotions play a vital role and prevent the cut or bruise from becoming infected. Pest repellant ointment is a must in the medical kit and the same is to be applied on the skin when one is going out to prevent any mosquito bite or any other insect bite.

Earthquake Aftermath in Nepal

References

who.int. International travel and health [Internet]. World Health Organization. 2017 [cited 3 November 2017].

Prevention C. Travelers' Health | CDC [Internet]. Cdc.gov. 2017 [cited 3 November 2017]. Available from: https://www.cdc.gov/travel/default.aspx

Amet S, Zimner-Rapuch S, Launay-Vacher V, Janus N, Deray G. Malaria Prophylaxis in Patients with Renal Impairment. Drug safety. 2013 Feb 1;36(2):83-91.

Barte H, Horvath TH, Rutherford GW. Yellow fever vaccine for patients with HIV infection. Cochrane Database Syst Rev. 2014 Jan 1;1.

Godot C, Levy C, Varon E, Picard C, Madhi F, Cohen R. Pneumococcal meningitis vaccine breakthroughs and failures after routine 7-valent and 13-valent pneumococcal conjugate vaccination in children in France. The Pediatric infectious disease journal. 2015 Oct 1;34(10):e260-3.

Ayub M, Sami A, Saeed M, Khursheed K. Dengue & malaria global burden: A cross sectional study of awareness & practice of dengue and malaria & its difference among different age group in Pakistan. JMR. 2015;1(2):55-8.

Smith JL, Flueckiger RM, Hooper PJ, Polack S, Cromwell EA, Palmer SL, Emerson PM, Mabey DC, Solomon AW, Haddad D, Brooker SJ. Correction: The Geographical Distribution and Burden of Trachoma in Africa. PLoS neglected tropical diseases. 2013 Dec;7(12).

Feasey NA, Levine MM. Typhoid vaccine development with a human challenge model. The Lancet. 2017 Sep 28.

Fooks AR, Koraka P, de Swart RL, Rupprecht CE, Osterhaus AD. Development of a multivalent paediatric human vaccine for rabies virus in combination with Measles-Mumps-Rubella (MMR). Vaccine. 2014 Apr 11;32(18):2020.

Takase M. Japanese encephalitis vaccine. Reactions. 2015 Nov;1576:163-7.

Afzal Z, Kallumadanda S, Wang F, Hemmige VS, Musher D. Murine Typhus: a Common Cause of Acute Febrile Illness with Potential for Serious Complications. InOpen Forum Infectious Diseases 2017 Oct 4 (Vol. 4, No. suppl_1, pp. S66-S66). US: Oxford University Press.

Borowska E. Acute mountain sickness. headache. 2014;1:2.

Moss RE, Thompson EM, Kieffer DS, Tiwari B, Hashash YM, Acharya I, Adhikari BR, Asimaki D, Clahan KB, Collins BD, Dahal S. Geotechnical effects of the 2015 magnitude 7.8 Gorkha, Nepal, earthquake and aftershocks. Seismological Research Letters. 2015 Nov 1;86(6):1514-23.

Julian CG, Subudhi AW, Hill RC, Wilson MJ, Dimmen AC, Hansen KC, Roach RC. Exploratory proteomic analysis of hypobaric hypoxia and acute mountain sickness in humans. Journal of Applied Physiology. 2014 Apr 1;116(7):937-44.

Khazai B, Anhorn J, Brink S, Girard T, Jimee GK, Parajuli B, Wagle S, Khanal O, Shresta S, Manandhar R. Emergent Issues and Vulnerability Factors in Temporary and Intermediate Shelters Following the 2015 Nepal Earthquake. Center for Disaster Management and Risk Reduction Technology (CEDIM) Karlsruhr Institute of Technology. 2015.

Poku NK. The political economy of AIDS in Africa. Taylor & Francis; 2017 Jul 5.

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