Crew Health Precautions

Prepared by: SHIREEN MOHAMMED

Crew Health Precautions
• Licence holders shall not exercise the privileges of their licence and
related ratings or certificates at any time when they:
o Are aware of any decrease in their medical fitness which might render
them unable to safely exercise those privileges;
o Take or use any prescribed or non-prescribed medication which is
likely to interfere with the safe exercise of the privileges of the
applicable licence;
o Receive any medical, surgical or other treatment that is likely to
interfere with flight safety.
• In addition, licence holders shall, without undue delay, seek aero-medical advice
when they:
o Have undergone a surgical operation or invasive procedure;
o Have commenced the regular use of any medication;
o Have suffered any significant personal injury involving incapacity to function as a
member of the flight crew;
o Have been suffering from any significant illness involving incapacity to function
as a member of the flight crew throughout a period of 21 days or more;
o Are pregnant; A crew member who becomes pregnant must immediately, upon
becoming aware of such pregnancy, notify her management. Certification of
“unfitness to fly” shall be in writing from the attending physician and shall indicate
the expected date of delivery. Upon receipt of such a notice, the crew member will
be removed from flying duties.
o Have been admitted to hospital or medical clinic for more than 12 hours;
o First require correcting lenses
• Cabin crew members shall not perform. duties on an aircraft and,
where applicable, shall not exercise the privileges of their cabin crew
attestation when they are aware of any decrease in their medical
fitness, to the extent that this condition might render them unable to
discharge their safety duties and responsibilities.
Crew Health Precaution Regulations and Guidance to all Crew Members

Alcohol and other Intoxicating Liquor Alcohol has a detrimental effect

on human skills and efficiency which is particularly noted in relation
to flying duties. The effects of alcohol are primarily related to the
levels in the blood which vary individually according to the quantity
and rate of consumption and may be significant long after the last
alcoholic intake. The following applies for all crew:
• It is offence for a person to be on board an aircraft as a member its
Flight/cabin Crew if under the influence of alcohol or a drug to an
extent which will impair his/her ability to perform his/her duties;
• Crew members shall not consume alcohol for a minimum of 8 hours before
reporting for duty or before a period of standby;
• Crew members shall not consume alcohol during a flying duty period or while
on standby;
• Crew members shall not commence a flying duty period with a blood alcohol
level in excess of 0.2 milligrams per litre;
• Flight crews should exercise restraint in their consumption of alcohol during the
24 hour period prior to the expected commencement of flight duty or standby.
Intake of alcohol should be restricted to no more than 5 units. (A unit of alcohol
is to be taken as one half pint of beer or lager, one small glass of wine or a small
measure of spirits.);
• As a matter of company policy, crew members in uniform (e.g., after
termination of flight duty; deadheading crew members) shall not consume
alcoholic beverages where they can be observed by third parties, i.e., the public.
Narcotics
The term “narcotics” covers heroin, morphine, cocaine, cannabis,
amphetamines and other stimulants. For crew members, the consumption
or use of narcotics is strictly prohibited.
Drugs
Drag is the general name for any substance (prescribed medication, over-
the-counter medication, drug, selfmedication etc.) that has an influence on
the mental or physical health of crew member. A crew member shall not
perform any duties on an aeroplane while under the influence of any drug
that may affect his faculties in a manner contrary to safety. Crew Members
shall not take any prescription or non-prescription medication or drug, or
undergo any other treatment, unless they are completely sure that the
medication, drug or treatment will not have any adverse effect on their
ability to perform safely their duties. If there is any doubt, advice shall be
sought by an aero medical doctor
 Sleeping Tablets
• Antibiotics such as the various Penicillin’s, Tetracycline’s and others may have short term or
delayed side effects which can affect pilot performance. More significantly, however, their
use usually indicates that an infection is present and thus the effects of this infection will
normally mean that a pilot in not fit to fly. Tranquillisers, anti – de pressants and sédatives.
Inability to react due to use of this group of medicines has been a contributory cause to
fatal aircraft accidents. Again, as with antibiotics, the underlying condition for which these
medications have been prescribed will almost certainly mean that a pilot’s mental state is
not compatible with the flying task. Stimulants such as caffeine, amphetamines etc. (often
known as “pep” pills) used to maintain wakefulness or suppress appetite are often habit
forming. Susceptibility to different stimulants varies from one individual to another, and all
may cause dangerous over confidence. Over dosage causes headaches, dizziness and
mental disturbance. The use of “pep” pills while flight is not permitted. Where coffee intake
does not offer sufficient stimulation, then an individual is not fit to fly. Remember that
excessive coffee drinking has harmful effects including disturbance of the heart’s rhythm.
• Anti – histamines can cause drowsiness. There are widely used in “cold
cures” and in treatment of hay fever, asthma and allergic rashes. They
may be in tablet form or a constituent of nose drops or spays. In many
cases the condition itself may preclude flying, so that, if treatment is
necessary, advice from the AMS (Aero medical Section), an AMC
(Aeromendical Centre) or an AME (Authorized Medical Examiner) should
be sought so that modem drugs, which do not degrade human
performance, can be prescribed. Certain drugs used to treat high blood
pressure can cause a change in the normal cardiovascular reflexes and
impair intellectual performance, both of which can seriously affect flight
safety. If the level of blood pressure is such that drug therapy is required
the pilot must be temporarily grounded and monitored for any side
effects. Any treatment instituted should be discussed with the AMS, and
AMC or an AME and a simulator assessment or line check may be
appropriate before return to flying.
• Following local, general and other anaesthetics, a period of time
should elapse before return to flying. The period will vary
considerably from individual to individual, but a pilot should not fly
for at least 12 hours after a local anaesthetic and for 48 hours after a
general or spinal anaesthetic. The more potent analgesics may
produce a significant decrement in human performance. If such
potent analgesics are required, the pain for which they are taken
generally indicates a condition which precludes flying.
•
 Anti-Depressants

• All these types of drugs preclude crew member from flight duties because of
the underlying condition for which they are being used as well as the possible
side effects resulting from them. Flying duties should not be resumed until
treatment with these types of drugs has been discontinued and until the
effects of the drugs have entirely worn off. This can take several days in some
instances. Note : Crew member shall consult AMC (Aero medical Centre) or
AME (Authorized Medical Examiner) before commencing flying duties.
Personnel must not engage in habitual use of psychoactive substance, staff
that are identified as engaging in any kind of problematic use of the
psychoactive substances will be removed from operational functions.
Pharmaceutical Preparations
• Many preparations are now marketed containing a combination of
medicines. It is essential therefore that if there is any new medication or
dosage, however slight, the effect should be observed by the pilot on the
ground prior to flying. Although the above are the commonest medicines
which adversely affect pilot performance, it should be noted that many
other forms of medication, although not normally affecting pilot
performance, may do so in individuals who are “oversensitive” to a
particular preparation. Individuals are therefore advised not to take any
medicines before or during flight unless they are completely familiar with
their effects on their own bodies. In cases of doubt, pilots should consult the
AMS (Aero medical Section), an AMC (Aero medical Centre) or an AME
(Authorized Medical Examiner).
1. If you are taking any medicine you should ask yourself the following three
questions:
o Do I feel fit to fly?
o Do I really need to take medication at all?
o Have I given this particular medication a personal trial on the ground of at
least 24 hours before flight to ensure that I will not have any adverse effects
whatever on my ability to fly?
2. Confirming the absence of adverse effects may well need expert advice
and the assistance of the AMS, an AMC or an AME.
3. If you are ill and need treatment it is vitally important that the doctor
whom you consult knows that you are a member of air crew and whether
or not you have recently been abroad.
• Other Treatments Alternative or complementary medicine, such as
acupuncture, homoeopathy, hypnotherapy and several other
disciplines, is developing and gaining greater credibility. Some such
treatments are more acceptable. in some States than others. There is
a need to ensure that "other treatments", as well as the underlying
condition, are declared and considered by the AMS, an AMC or an
AME when assessing fitness.
 Immunisation

• In accordance with the World Health Organizations (WHO) International Health

Regulations many countries prescribe vaccination of crew members and passengers
against defined diseases, often specifying that such immunisation is only required
upon entry “after leaving or transiting infected areas”. Each crew member scheduled
for flight duty abroad must satisfy any requirements for vaccinations, to have himself
vaccinated in time, and to be able to produce – during his tour of duty – the
appropriate WHO – approved “Certificate of Vaccination or Revaccination”. Vaccination
/ revaccination shall take place not less that 24 hours before commencement of flight
duty.
• In case of strong reaction medical advice shall be obtained in view of a possible
impairment of fitness for flight duty. No alcoholic beverages shall be consumed for a
period of at least 24 hours after vaccination.
• Kind of vaccinations Time interval prior to departure Effective period
Cholera 7 days 6 months
Yellow fever 10 days 10 years
Hepatits A 2 weeks 10-30 years
Hepatits B 2 months(after 3 vaccination) lifelong
Tetanus Possible until departure 10 years
Poliomyelitis(IPV) 4-6 weeks 10 years
Poliomyelitis(OPV) 4 weeks (after 3 vaccination) lifelong
Malaria prophylaxis, though not immunisation in the strict sense of the word,
should be mentioned here: crew members scheduled for flight duty to malaria
infected countries shall obtain, on the advice of their flight medical doctor, the
appropriate medication and apply is as prescribed.
• Observe strict hygiene in eating / drinking (amoebic dysentery, brucellosis);
• Do not bathe in stagnant water (bilharziasis);
• in infested (e.g. bush / jungle) areas, wear long-sleeved shirts and long
trousers to prevent for minimise bites by disease carrying insects (filariasis,
malaria, encephalitis, sleeping sickness) or by outright poisonous insects or
animals (spiders, scorpions, snakes) use insect repellent.
Note: Crew members shall be aware of the fact that there are many extremely
dangerous diseases against which vaccination is not possible. Only general
rules may be given here for health – conscious behaviour in foreign countries
 Deep Sea Diving

• Crew members must not participate in diving activities within 10 hours of

landing. Following a non-decompression dive, 24 hours must elapse
before a flying duty; this must be increased to 48 hours for dives requiring
decompression stops i.e. deep diving to a depth exceeding 10 meters.
Skiing or snowboarding is permitted whilst on layovers down route,
provided it is carried out on piste and does not include heli-skiing, ski
jumping, ski racing or any other activities with increased risk. It is the
individual’s responsibility to ensure that they have adequate insurance to
cover evacuation, treatment, and repatriation and to satisfy themselves of
the adequacy of local emergency services and hospitals.
 Blood / Bone Marrow Donation

Crew members should not normally act as blood/bone marrow donors due to the
potentially adverse effect of temporary blood deficiencies after donating blood
and/or bone marrow, the following restrictions shall apply to all “IRAQI AIRWAYS”
crew: a. The donor shall not undertake flying duties for a minimum period of 24
hours after donating blood; b. The donor shall not undertake flying duties for a
minimum period of 72 hours after donating bone marrow. “IRAQI AIRWAYS”
crew members who are scheduled for flight or standby duty , cannot participate
in blood donations within 24 hours or bone marrow donation within 72 hours of
their scheduled activity If, for any reason, they have done so, they are to advise
“IRAQI AIRWAYS” immediately following each donation.
Meals Precaution Prior to and During Flight
• Cases of acute food poisoning in the air continue to occur sporadically and
surveys of incapacitation of flight crew show that of these cases, gastro-
intestinal disorders pose by far the commonest threat to flight safety. No
other illness can put a whole crew out of action so suddenly and so severely,
thereby immediately and severely endangering a flight, as food poisoning.
Any food which has been kept in relatively high ambient temperatures for
several hours after preparation, should be regarded with extreme suspicion.
This applies particularly to the ice cream or pastry which is commonly part
of the aircraft meal. The re-heating process usually used in aircraft for the
main course of a meal rarely destroys food poisoning organisms and the
toxins. These toxins are tasteless and cause no unpleasant odors.
• Most acute forms of food poisoning frequently come on within 1 to 6 hours
after consumption of contaminated food. Hence, the crew member should
refrain from having a meal which may cause food poisoning, within 6 hours
before commencing flying duties. In particular, shellfish, especially mussels and
oysters that have high concentration of toxin in the edible part should be
avoided. A crew member before and during flight shall avoid consuming easily
perishable food. This is most important with milk and cream products,
mayonnaise, sauces, salads, meat pies and other meat products. Flight crew
member shall be cautious not to consume the same meals before or during a
flight. Meals served during flight, should be partaken separately, so that one
pilot is always fully aware and in charge of the aircraft operation.
•
Sleep and Rest
• Flight safety requires that all crew members receive regular and
sufficient sleep and are well rested when commencing flight duty.
Legal provisions (see Chapter 7) therefore prescribe maximum duty
and minimum rest times. All crew members are expected to utilize
their times of rest to relax and to regain their fitness. Therefore,
during rest times all activities shall be avoided which run counter to
those purposes.
•
Surgical Operations (Procedures)
• A fitness certificate signed by an aero medical doctor shall be
produced prior to returning to flying duties after any surgical
procedure.
Vision Correction
• All flight crew members who are required by the ICAA to wear
corrective lenses in order to satisfy visual requirements laid down for
granting of licences, are required to carry a spare pair of spectacles
with them on all occasions whilst operating their licence. Spectacles,
either corrective or anti-glare, when worn by flight crew during flight
should be of a type of frame that allows maximum peripheral vision.
The examination for the prescription of a spectacle correction should
ideally be carried out by an examiner with some understanding of the
problems of vision in aviation.
•
Near Vision Correction:
• Where the only correction necessary is for reading, pilots should
never use full lens spectacles while flying because the pilot's task
requires frequent changes from near to distant vision and the latter is
blurred by reading glasses. Half moon spectacles or lower segment
lenses with a neutral upper segment should be used in these
circumstances
Near and Distant Vision Correction:
• Where correction for both near and distant vision is required, bifocal
lenses are essential and pilots should discuss with their medical
examiner the shape and size most suitable for each segment. Where
triple correction is necessary for reading the instrument panel range
and distant vision, then specialist advice is required.
•
Diurnal Rhythm
It is a well-established fact that our bodies have a diurnal cycle or
rhythm. This means that our chemical, psychological and physiological
activities are high during our normal waking hours, and are low during
our normal sleeping hours. They reach the lowest point at about 3 to 5
in the morning. When we fly across time zones, i.e. either East to West
or West to East, we may interrupt our diurnal cycle. To minimise the
tiring effects of interruption to our day-night biological cycle we should:
• When away from home adhere as much as possible to home time for
sleeping, eating and bowel function (if on short layover); and.
• Take adequate rest before flight.
Fatigue
A crew member shall not commence a flight duty or continue a flight duty after an
intermediate landing if he is aware that he is too fatigued or will be too fatigued
before next landing. The basic responsibility in fatigue management rests with the
individual crew member who shall report for duty in a reasonably rested state and
in an emotionally fit state to perform his expected duty. This includes attention to
such factors as sleep, personal fitness, health, life style and activities prior to flight.
Due allowance for any adverse effects of these factors should be taken into
account to ensure that fatigue which would significantly affect operating
performance is not encountered during flight duties. In case of fatigue crew
member must seek the medical advice.
Medical Examinations

Period of Validity : Medical Certificates-Flight Crew Class 1 medical

certificates shall be valid for a period of 6 months for Commanders
(Holding Iraqi ATPL). Class 1 medical certificates shall be valid for a
period of 12 months for Co-Pilots (Holding Iraqi CPL or ATPL) and shall
be reduced to 6 months for license holders who have reached the age
of 40.
Medical Certificates
-Cabin Crew Cabin crew medical certificates shall be valid for 2 years for
all cabin crewmembers regardless of the age
Revalidation :
• If the medical revalidation of a medical certificate is conducted within
45 days prior to the expiry date of the medical certificate the period
of validity shall extend from the date of issue until 6 ,12, 24 calendar
months as applicable from the expiry date of that previous medical
check.
Renewal :
• If the medical examination is not taken within 45 days prior to the
date of expiry, the expiry of the new certificate will be calculated in
accordance with the period stated in the period of validity as
applicable, with effect from the date of the next general medical
examination
Requirements for Revalidation or Renewal :
• The requirements to be met for the revalidation or renewal of medical
certificate are the same as those for the initial issue of the certificate,
except where specifically stated otherwise.
 Additional Examination :
Where the Authority has reasonable doubt about the continuing fitness of the
holder of a medical certificate, the authorized body or institution may require the
holder to submit to further examination, investigation or tests. The reports shall
be forwarded to the authorized body or institution.
Note 1: Each crew member is personally responsible for the timely renewal of his
medical certificate. However, the crew will be notified 1 month prior to the expiry
of their medical certificate. A crew member shall ensure that a copy of the
renewed medical certificate is forwarded to the Flight Operation Department to
update the computerized records used to monitor the expiry dates.
Note 2: The Company will reimburse the cost of the aviation medical examination.
 Illness or Incapacitation While on Duty
Any crew member who becomes ill or incapacitated while on flight duty or
during a stopover period at an outstation must report the to the Commander
at the earliest opportunity. The Commander should be aware that a sudden
deterioration in health might be an indication of the onset of a dangerous or
infectious complaint. Carriage of a flight crew or cabin crew member who is ill
is not authorized without permission from the medical examiner. Carriage of
ill crew member could prejudice the Company's position in several ways :
• International health regulations;
• Liability to the staff member concerned, should a serious illness ensue; and.
• Invalidation of the insurance of the aircraft.
• The Commander must ensure that a doctor is called at the earliest
opportunity to examine the crew member concerned. A certificate
must be obtained stating whether the individual is fit for duty, or
alternatively for travel. The Commander is authorized to arrange any
tests necessary to ascertain the condition of the individual concerned.
A written report must be submitted by the Commander and the crew
member as soon as practicable after return to the main base. The
Commander has an overall responsibility for ensuring that all of the
crew are fit for duty, even if a report of sickness is not received.
Where any doubt exists, the Commander must ensure that the
individual concerned is seen by a doctor and that the report from that
doctor is forwarded to the company, if possible on the flight
concerned and, filing this, at the earliest opportunity. In the case of
the Commander being incapacitated the normal devolution of
command applies
International Regulations
The Commander/Agent must report all cases of illness on-board the
aircraft (excluding cases of airsickness and accidents) on landing at an
airport. The details are to be given in the appropriate part of the
Aircraft General Declaration. Cases of ill passengers disembarked during
the flight must also be reported on arrival.
 Quarantine Regulations
When a passenger on-board shows symptoms which might indicate the presence of a major
disease, the Commander of an arriving flight must ensure that the airport medical or health
authority have been informed. It is the responsibility of airport medical or health authority
to decide whether isolation of the aircraft, crew and passengers is necessary. On arrival of
the aircraft, nobody shall be permitted to board the aircraft or disembark or attempt to off
load cargo or catering until authorized by the airport medical or health authority. Each
station, in conjunction with the airport medical or health authorities will devise a plan that
would provide, when necessary for :
• Transportation of suspected cases of infectious diseases by selected ambulance to a
designated hospital.
• Transfer of passengers and crew to a designated lounge or waiting area where they can be
isolated from other passengers until cleared by the airport medical or health authorities.
• Decontamination of the aircraft, passenger baggage, cargo and mail and any isolation
lounges used by passengers or crew suspected of having infectious diseases
 Tropical Medicine

Tropical Climate In the tropical regions two types of climate can be expected,
these are :
1. Dry desert climate with very high day temperatures and very cold nights.
2. Hot, humid climate with high temperatures and humidity around 90% during
the day and at night. The hot and humid conditions can be extremely tiring and
tend to reduce working intensity. If one perspires a lot, the intake of liquid and
salt should be increased. It is important to protect oneself from ultraviolet
radiation of the sun. This radiation can cause sunburn or snow blindness. To
protect oneself against ultraviolet radiation, it is best to limit sunbathing to short
periods and to use sun block, lotions and reliable sunglasses. Intake of alcohol
should be restricted as it may add to dehydration. Taking rest during midday is
recommended.
Hygiene
Particular care should be taken regarding hygiene in hot countries.
• Drinking Water : Supply of pure drinking water is the exception in
tropical and sub-tropical areas. Water from the tap must be regarded as
infected, even when it is merely used for brushing the teeth. As a
guiding principle, do not drink any water that is not purified by boiling
or by chemical disinfecting (chlorinating). The common infections
acquired through contaminated water are typhoid fever, paratyphoid
fever, and dysentery.
• Milk : Unboiled milk can be a source of infection.
• Recommended drinks : Boiled drinks and beverages in bottles. Make sure the
bottles are opened in your presence.
• Ice : Ice is very often contaminated. Do not use ice in your drink.
• Fruit : Avoid eating raw fruit without peel. Only eat fruit that can be peeled. Safe
types of fruit include oranges, bananas, mangoes, pineapples …etc, and always wash
fruit before peeling. Wash grapes before eating.
• Salads and Raw Vegetables : Eating salads or raw vegetables increases the risk of
worm infestation or of contracting amoebic dysentery if not thoroughly cleaned.
• Meats : Eat only fresh meat that has been freshly cooked. Avoid raw or cold meats.
• Fish : Eat only freshly cooked fish. Avoid shellfish (especially oysters).
• Bathing : Use only purified pools or open sea. Fungal diseases are common in hot
humid climates.When bathing, it is advisable to plug your ears with cotton wool to
prevent fungal infection of ear canal. Also wear shoes at poolside to avoid fungal
infection of feet.
Tropical Diseases
Tropical diseases are not confined entirely to the tropics but can occur
almost anywhere. However their incidence and frequency are
influenced by local factors. Tropical diseases are mainly transmitted in
the following ways :
• Through insect stings or bites;
• Through healthy skin by other parasites;
• Through food and drink;
• From the ground; or.
• Person to person.
 Insects Transmit Disease : The following insects transmit disease :
• Mosquitoes transmit malaria, yellow fever, dengue fever and sandfly fever;
• Tsetse Fly (Central Africa) transmit sleeping sickness;
• Lice transmit typhus, relapsing fever, spotted fever;
• Rat Fleas transmit Plague. Protective measures against insects :
• Sleeping quarters should be free of insects. Use mosquito nets over beds. Nets should be taut and
should not come in contact with body, or use insecticide. Protect the skin by using an insect repellent.
6.8.2 Diseases contracted through the Skin : The following diseases are contracted through the skin :
• Bilharzia : Aquatic snails act as intermediaries. The larvae of worms pass from such snails into the
water and on contact with the skin into the human body;
• Weil's Disease : The germs of this disease are excreted in rat's urine. They can penetrate the skin of
bathers;
• Fungal Disease : The fungus is present in tropical and sub-tropical inland waters, in shallow rivers
and lakes, hardly ever in seawater. Protective measures to avoid contagion through the skin:
• Avoid inland water. Bathe only in pools with purified water or in the sea. Use cotton wool earplugs.
Wear shoes when walking around the pool.
Main Tropical Diseases
Amoebiasis (Amoebic Dysentery)
• Causative Parasite : Amoebiasis is due to the ingestion of a unicellular parasite, the Entamoeba
Histolytica. This mainly affects the intestinal tract.
• Distribution : Although most prevalent as an endemic disease of tropical and sub-tropical countries,
unhygienic disposal of excreta and primitive methods of water purification may result in its introduction
into temperate zones.
• Source of Infection : Water polluted by infected faeces is the commonest source of infection, hence
the prophylactic importance of safe drinking water. Other sources of infection are, foods grown on soils
manured by infected excreta, flies and infected food handlers.
• Clinical features : Clinically the disease is characterized by an insidious onset, frequent febrile
relapses and a tendency to chronicity. Diarrhea is the outstanding symptom, but it may be absent.
There is abdominal pain with blood and mucus in the stools.
• Complications : Inflammation of the liver.
• Liver abscesses : Inflammation of the gall bladder and bile ducts.
• Treatment : Consists of rest, diet and a course of therapy, which varies with the type of case.
• Prophylaxis : No vaccination or inoculation is available, nor is there any chemical prophylaxis such as,
is used to prevent Malaria. General measures of hygiene should be observed.
Malaria
• Transmission : Infection takes place through the bite of an infected anopheles mosquito and transmission
of the parasite into the human blood stream.
• Geographical Distribution : Variable, consult medical department.
• Incubation period : The incubation period usually ranges from 10 to 35 days.
• Morbidity : Malaria causes several million deaths each year.
• Symptoms : An acute, sometimes chronic, often recurrent, febrile disease characterized by periodic
paroxysms of chills followed by high fever and sweating due to the presence of parasites in blood. The early
stage of the illness can very easily be confused with many other infectious diseases, the more so if this occurs
after return to a temperate region where your doctor may not think immediately of the possibility of Malaria.
• Prophylaxis : Preventive measures include use of insect repellent sprays to protect skin, screens on doors
and windows, mosquito netting in bedrooms, sufficient clothing to cover as much as the skin surface as
possible against mosquito bites (this is important after sundown). It is not possible to produce permanent
immunity either chemically or by the use of vaccines. Therefore, chemical prophylactic drugs are only
effective as long as they are taken regularly.
• Treatment : Under medical supervision. Malaria can be fatal if treatment is delayed. Therefore after having
been in a malarial area, if you feel unwell or have an unusual temperature within four weeks of leaving the
area, tell your doctor; don't wait to be asked.
Typhoid and Paratyphoid Fevers
They are ingestion diseases characterized by high fever and intestinal symptoms.
• Transmission : Typhoid fever is conveyed through water contaminated by sewage, through food
grown in or gathered from water (e.g. shellfish and watercress) and through cooking utensils washed
in such water. Paratyphoid fever is rarely transmitted through water, and few epidemics have been
recorded. The disease is usually transmitted in food contaminated by carriers.
• Incubation Time : From 7 to 21 days.
• Geographical Incidence : The disease is likely to occur wherever the water supply is impure.
Generally speaking the less satisfactory the sanitation, more prevalent is enteric fever. However, with
use of adequate drugs, cases of death are now rare.
• Symptoms : Vague symptoms of illness tending to increase in severity throughout the first week.
Lassitude, frontal headache, general aches and pains, disturbed sleep, anorexia and thirst, abdominal
discomfort, temperature rising to 40°C, diarrhea with or without bleeding.
• Precautions : Strict hygiene of food and drink.
• Prophylaxis : Vaccination. The vaccination is not an international requirement for entry into any
country. Vaccination is strongly recommended when travelling to regions of poor general hygiene.
Note: Aircrew should not fly within 24 hours after vaccination. Vaccination may be followed by a slight
general feverish reaction
Cholera
• Geographical distribution : Outbreaks of the disease usually are explosive and
limited. Cholera is endemic in many areas of Asia.
• Transmission : Cholera is spread by the ingestion of water and foods
contaminated by the excrement of patients.
• Incubation period : Short, usually 1 to 6 days.
• Symptoms : Sudden onset. Initial symptoms are nausea, vomiting and diarrhea,
with variable degrees of fever and abdominal pain. If diarrhea is severe the
resultant dehydration may lead to intense thirst, muscle cramps and weakness.
• Prognosis : In many cases the outlook depends largely on early and adequate
therapy.
• Prophylaxis : Strict measures of hygiene (food and drink) should be observed. In
many countries cholera has been controlled by the purification of water supply and
proper disposal of human excreta.
Dysentery
• Definition : An acute infection of the bowel, characterized by frequent passage of blood and
mucus diarrhea accompanied by abdominal cramps, malaise and fever.
• Incidence : Incidence is world-wide, but it is particularly common in hot climates.
• Source of Infection : The source of infection is the excreta of infected individuals. Organisms
are spread from individual to individual by the direct faecal-oral route. Indirect spread by
contaminated food and inanimate objects is common, but water borne disease is rare. Flies
serve as carriers. Epidemics occur most frequently in overcrowded populations with inadequate
sanitation. It is particularly common in younger children living in endemic areas, whereas adults
of these regions are relatively resistant to infection and usually have less severe disease.
• Incubation period : Very short, some hours to a few days.
• Symptoms : Depend on severity. May have painful colicy diarrhea. Maybe raised temperature
and vomiting. The disease usually shows great individual variation.
• Prophylaxis : There is no effective inoculation. Strict measures of hygiene (food and drink)
should be observed.
• Treatment: There are many effective medicines available for disinfection of the gastro-
intestinal tract. It is advised to consult a doctor.
Yellow Fever
• Definition : An acute infectious virus disease occurring in tropical and sub-
tropical zones.
• Geographical Distribution : Particularly in tropical Africa and South and
Central America. Unknown in Asia.
• Incubation Period : 3 to 6 days.
• Causative Organism : The virus that causes the disease is transmitted by the
bite of a female mosquito, which previously has become infected through
feeding on the blood of a patient during the early stages of an attack.
• Symptoms : Characterized by sudden onset, fever with relatively slow pulse,
the face is flushed, eyes infected, gums congested, tongue red and pointed.
Vomiting and constipation are common. Jaundice appears after the third day.
• Prophylaxis: Effective 10 days after vaccination, and the immunity last for
about 10 years
Hepatitis A
• Incidence : Hepatitis A is a common infection among travellers. The risk of
contracting this viral infection is high wherever the water supply is impure and
sanitation is not satisfactory (mainly outside western and northern Europe, USA,
Canada, Australia and New Zealand).
• Transmission : Hepatitis A may be acquired from food or water which has been
contaminated by faeces or from direct contact with infected individuals. Person-to-
person transmission is particularly common among children and between sexual
partners.
• Symptoms : Hepatitis A, formerly called infectious hepatitis, is rarely fatal, although
most infected adults become quite ill, and many are unable to work for several
weeks or months. Typical symptoms include malaise, fever, loss of appetite,
gastrointestinal problems and jaundice and will appear 15 to 55 days after infection.
• Prophylaxis : Travellers from industrialized countries are likely to be most
susceptible to infection with Hepatitis A virus and should be vaccinated against
before travelling to endemic areas
 Hepatitis B
• Incidence / Prevalence : This infection is worldwide. It is prevalent in men who
have sex with men and intravenous drug users, but the greatest number of cases
result from heterosexual transmission. Persons with chronic Hepatitis B are at
substantial risk of cirrhosis and hepatocellular carcinoma particularly when acquired
early in life (up to 25-40%).
• Transmission: HBV is usually transmitted by inoculation of infected blood or blood
products or by sexual contact and is present in saliva, semen or vaginal secretion.
HbsAg positive mother may transmit HBV during delivery.
• Symptoms: About 30% of person has no signs or symptoms. Signs or symptoms
include jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting and
joint pain.
• Prophylaxis / Prevention: Hepatitis B vaccine is the best protection. Do not share
personal care items that might have blood on them (razors, toothbrushes … etc).
Practice safe sex. Consider the risk if you are getting a tattoo or body piercing. Do
not donate blood, organs or tissue if you are Hepatitis B positive