Clearly, the most common problems will be related to contamination of food and water: dysentery, salmonellosis and other forms of gastroenteritis.  Cholera is not currently encountered in Haiti.  There is no vaccine for these diseases, and preventative measures (if possible) will include adequate heating of food, bottled water, etc.  Many experts would also suggest that the traveler carry antibiotics (Azithromycin or Ciprofloxacin) to be taken in the event of symptoms.

Among the food / water-borne diseases, Hepatitis A (and possibly Hepatitis E) and typhoid constitute a genuine risk.  All travelers should be vaccinated as far in advance as possible before embarking for Haiti.  Several food borne parasitic infections are also common in Haiti.

The rate of AIDS in Haiti is particularly high.  Although most HIV infection in Haiti has been acquired through sex, exposure to blood will now become a major risk factor.

Malaria is endemic to 75% of Haiti.  Although the local parasite strain is often associated with severe illness, and even death, it is sensitive to anti-malarial drugs.   People traveling to Haiti should take two tablets of Choroquine, once weekly.  Another common mosquito-borne disease, dengue, can only be prevented by vigorous use of insect repellents.  Such measures might also prevent a number of local exotic parasitic diseases (Wuchereriasis, Mansonelliasis).

Animal contact should also be avoided – rabies, anthrax and other “zoonoses” are not uncommon in this country.

Contrary to common belief, contact with dead bodies is not considered a health risk.  A person who did not have cholera or typhoid in life will not begin to spread these diseases because she has died.

Anyone returning from Haiti should arrange for a stool examination – even if they feel well. Parasitic infestation is not necessarily associated with symptoms.  Needless to say, if fever, diarrhea, headache or any other symptom of infection develops, a physician should be consulted.

Also check out GIDEON’s free ebook: Infectious Diseases of Haiti

• Suggestions
• Dynamic diagnosis
• Usability improvements

Suggestions
Until now, GIDEON’s Diagnosis Compare function has ranked signs and symptoms which are most likely to impact the Differential Diagnosis list. Now, the top four clinical findings which are most likely to focus and shorten the list of possible diseases are displayed and dynamically updated as each new sign or symptom is entered. Clickable boxes which allow the user to enter a “yes”, “no” or “unknown”, appear and enlarge each time the mouse passes near a perspective finding.

Dynamic diagnosis

The Diagnose button has been eliminated! Now, the differential diagnosis list updates automatically as you enter signs and symptoms. This feature demonstrates the effects of each new sign or symptom as it is entered.
The First case scenario list still appears below the diagnosis list.
The familiar buttons: Compare, Why Not, Open case, Save case, Remove All, Print, Email are all in the Diagnosis Results area.

Usability improvements

Country and incubation period in symptom list
Country name and Incubation period have been appended to the Clinical Presentation list.  Now, whenever you indicate a country name, or dates of exposure, the Differential diagnosis list instantly re-adjusts accordingly.

Collapsible windows
Windows, such as Suggestions and Clinical Summary can be minimized and hidden. For example to not see suggestions, click on the minimize button to the left title.

Mouse overs
More mouse-overs have been added: Clickable boxes expand as you mouse over them, and display clear symbols to select “yes” or “no.”

Clinical Summary
You can now click on the signs and symptoms in the Clinical Summary. Clicking on Country will display “Worldwide”. Clicking again displays the country.

Quick sorting
Diagnosis results can be sorted alphabetically or by probability easily by clicking the column title.

Resize window
Changing vertical window size expands size of Clinical presentation and Diagnosis results sub-windows. This is a great feature for larger monitors.

Previous version
Click “Original diagnosis” to use the older interface.

1. Diarrhea – Not the most serious, but certainly the most common. Roughly 40% of travelers to less-developed countries will develop diarrhea within 48 hours of arrival. Much of the next few days of touring will be seriously damaged by searching for a clean bathroom … or even toilet paper. In recent years, scores of ocean voyages have been cut short by mass outbreaks of vomiting and diarrhea – related to Norovirus infection.
2. Skin disorders due to sun, heat, humidity and insect bites. Like diarrhea, not life threatening – but no fun while touring.
3. Insect-borne fevers. Dengue and Chikungunya are becoming increasingly common and are no longer limited to “local natives.” Both diseases are characterized by headache, high fever, muscle and joint pain. The incubation periods are short – meaning that the traveler is likely to still be on the road, with no chance for continued tourism and the risk of exposure to sub-standard health care.
4. Malaria. Like Dengue and Chikungunya, malaria is an insect-borne fever; however, the disease carries a real risk of severe complications, and even death. Unlike dengue and Chikungunya, malaria can be easily prevented and treated by specific medications.
5. Although not “diseases,” physical injuries represent a major medical risk to travelers. Accidents – airplane, boating, automobile, climbing, diving – may threaten life, often in situations where proper medical care is non-existent or carries risks for AIDS, hepatitis, wound infection, etc. Increasingly, this category will also include political violence, kidnapping and simply “being in the wrong place…” when terrorist acts are carried out.
6. Sexually-transmitted diseases are very common among tourists, and none can be prevented by drugs or vaccines. Tourists engage in a variety of reckless activities in foreign countries – which they would never dream of at home.
7. Intestinal and other parasites are often acquired through exposure to exotic, unhygienic or under-cooked food. Signs and symptoms may be subtle, and illness may progress for years following return from an exotic country – a situation compounded by the fact that physicians in the traveler’s home country are unfamiliar and ill-equipped to recognize these diseases.
8. Disorders associated with air travel: jet-lag, ear disorders associated with cabin pressure changes, thrombophlebitis (blood clots in the legs) associated with prolonged sitting in cramped conditions, exposure to infected passengers (measles, influenza, tuberculosis).
9. An increasing list of rare, exotic infections which are becoming common among travelers: Lassa fever, Schistosomiasis, African tick-bite fever, Trypanosomiasis, Yellow fever, Japanese encephalitis. In some cases, travel to the United States has become hazardous for tourists from overseas: Coccidioidomycosis, West Nile fever, Rocky Mountain spotted fever, Lyme disease
10. Legionnaire’s disease has been intimately associated with travel, since the first outbreak (1976) was reported among American Legion veterans who had traveled to a convention in Philadelphia. Travelers exposed to central air conditioning systems in hotels continue to account for a large proportion of victims of this disease.

Of course, there is also an infinite variety of “universal diseases” which may just happen to occur during travel. Not all diseases acquired in the developing world are “exotic.” Many of the returning travelers who consult me after returning home are found to have mundane conditions such as urinary tract infection, “strep throat” ear aches, bronchitis, allergies, arthritis, conjunctivitis, neuroses, etc .. all of which can still ruin a trip overseas.

Please let us know how this is working for you.

“The bottom line is it’s actually nothing to worry about,” says Steve Berger, director of microbiology and tropical medicine at the Tel Aviv Medical Center. “We’re living in a sea of bacteria. The germs that you’re dealing with are normal bacteria, and nobody’s going to catch anthrax or Ebola or anything from a keyboard.”

1. If you are planning a trip to any country, become aware of the local health situation, ongoing disease outbreaks, weather, emergency telephone numbers, availability of medicines you may be taking.
2. If you will be traveling to a tropical or developing country, consult a Travel Medicine Clinic for advice, vaccines and preventive medications.
3. Eat only well cooked foods, preferably in “clean” or “modern” facilities. Avoid eating fresh vegetables, exotic plants and animals and non-bottled water.
4. In areas where mosquito-borne diseases (malaria, dengue, etc) are endemic, use insect repellents and wear long-sleeved clothing appropriate to local weather.
5. Things to avoid: high-risk trauma which might result in “local” health care (injections, blood), unsafe sex, contact with animals.
6. If you feel ill following return home, consult an expert in Travel Medicine – bring a written itinerary which details dates of travel and return, exact places visited, foods eaten, health status of accompanying persons, vaccines and drugs received.