Security & Health

Typhoid - Is a bacterium caused by Salmonella Typhi which is only found in humans. It can be caught by drinking
contaminated water or by eating and drinking beverages that have been handled by a person carrying the bacterium.
Typhoid fever characteristically causes a high temperature (40 degrees), sweating, a loss of appetite, constipation &
rash. Vomiting and diarrhoea is common in children during this first stage. The second stage consists of a continued
fever, diarrhoea which can lead to dehydration and a weak & rapid pulse. The disease can last for several weeks, and
complications can be deadly if not treated. The WHO recommends the, oral Ty21a and the Typhim Vi vaccine.

Polio- Poliomyelitis is a viral infectious disease and is generally spread via the faecal-oral route. The virus enters the
blood stream and can cause muscle weakness and paralysis. The vaccine induces immunity to Polio and is
recommended because of the persistence of polio in Afghanistan.

Hepatitis B - Is known as a blood borne virus and can be transmitted whenever the bodily fluids come into contact with
broken skin or mucous membranes. Children can be exposed through scratches and cuts. Engerix-B is a vaccine
against hepatitis B. A total of three doses are needed over a period of several months.

MMR- Measles, Mumps & Rubella - these are serious diseases and spread from person to person through the air. It is
important to note that the Measles virus is especially concerning in children, it effects how ones immune system
functions for up to a year after the virus. Complications can lead to pneumonia, liver inflammation, myocarditis & ECG
abnormalities. The vaccines provide protection against all three of the diseases and two doses are recommended if
not previously given, unless blood tests show immunity.

Diphtheria & Tetanus - Diphtheria is spread through close respiratory contact. Tetanus is contracted through dirty
cuts and scratches. Re-vaccination is recommended every ten years.

Rabies is a virus which is spread through saliva on broken skin, from a bite or lick from an infected animal. Once bitten
the virus travels along the peripheral nerves to reach the spinal cord and brain. Dogs and foxes are the main
transmitters of Rabies to humans and should be avoided if possible.

Precaution - You will need three injections on day 0, 7 and 28 and a further booster every two - three years. The Rabies
vaccine does not provide you with full protection, it merely bides you time to seek post exposure treatment. This time is
extremely important especially in Afghanistan.

After Contact - If you have not had the precaution rabies vaccine, or it has been more than three years since your last
booster then you will need six injections. The first as soon as possible then on days 3, 7, 14, 30 and 90 as well as the
Immunoglobulin which helps to fight the rabies infection Immediately.

After Contact - If you have had the precautionary rabies vaccine and are up to date you will need two more injections.
One should be given as soon as possible and the second 3-7 days later. Mortality is 100% despite vaccination once
symptoms occur, vaccinations should be sought as soon as possible after exposure. Current guidelines from the WHO
for post-exposure treatment,

http://www.who.int/rabies/resources/en/Current%20WHO%20guide%20for%20Rabies.pdf

One should note that the post exposure vaccine and immunoglobulin is really hard to get hold of in Afghanistan and one
must evacuate immediately.

Cholera - The vaccine is generally not recommended even though cholera is widespread throughout Afghanistan
because travellers are seen as low risk.

Tuberculosis- kills nearly 2 million people per year yet it is completely curable and relatively inexpensive to treat.
IThere is a variety of antimalarial drugs available, Chloroquine plus proguanil is recommended in Afghanistan in the low
lying areas. Prevention of being bitten is highly advised. The mosquitoes bite between dusk and dawn so sleeping
under a permethrin - impregnated mosquito net can be highly effective. Use the DEET insect repellent on oneself and
spray the room, wear long sleeves and trousers and the mosquito coils.