Read below for travel health advice on Togo from the MDtravelhealth channel on Red Planet Travel.
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An outbreak of H5N1 avian influenza ("bird flu") was reported in June 2007 from a poultry farm in Maritime province, south Togo, followed in August by outbreaks in the Lacs, Golfe and Zio regions east of Lome, the capital city. Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The World Health Organization and the Centers for Disease Control do not advise against travel to countries affected by avian influenza, but recommend that travelers to affected areas should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Togo should seek immediate medical attention, which may include testing for avian influenza.
Three cases of yellow fever were reported in December 2006 from two adjacent districts in northern Togo: Dankpen district, Kara region, and Oti district, Savanes region. Two more cases were reported in late January 2007: one from the Kozah district, Kara region, and the other from Lacs district, Maritime region. Yellow fever vaccine is required for all travelers to Togo greater than one year of age.
An outbreak of meningococcal disease was reported from January through April 2002, reaching epidemic levels in the districts of Assoli, Tchamba, Sotouboua, Blitta, and Wawa. A previous outbreak began in November 1996, chiefly affecting the Savanes District in northern Togo. Meningococcal vaccine is recommended for travel during the dry season (November through June), especially if prolonged contact with the populace is likely.
Food and water precautions
Tap water in Togo should not be consumed unless it has been boiled, filtered, or chemically disinfected. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Fruits and vegetables should not be eaten unless they have been peeled or cooked. Foods that have been cooked but left at room temperature, such as buffets, should be avoided, as well as raw or undercooked meat or fish. Do not buy food or beverages from street vendors.
All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), and azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Insect and Tick Protection
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 20-35% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be reapplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.
The areas infested with tsetse flies are generally known to local inhabitants. When visiting these areas, you should wear long sleeves and long pants of medium weight fabric in neutral colors that blend with the environment. Also, you should avoid riding in the back of open vehicles, since dust may attract tsetse flies, and take care not to disturb bushes (where tsetse flies rest) during the warmer parts of the day. Insect repellents are ineffective against tsetse flies.
Swimming and bathing precautions
Because of the risk of schistosomiasis, which is transmitted by exposure to contaminated water, you should avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of becoming infected, but does not reliably prevent the disease.
Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.
Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.
Medical care is extremely limited. Essential medications and supplies may be unavailable. There are no adequate emergency services. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.
Availability of medications is extremely limited. Travelers should be sure to bring along all medications they might need, in their original bottles.
Traveling with children
All children should be up-to-date on routine childhood immunizations. If you're traveling with a child less than one year of age, be sure to ask your pediatrician whether or not certain vaccines should be given ahead of schedule.
Because yellow fever vaccine is not approved for use in children less than nine months of age, children in this age group should not in general be brought to Togo.
The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.
When traveling with young children, be particularly careful about what you allow them to eat and drink, because diarrhea can be especially dangerous in this age group. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.
Be sure to pack a medical kit when traveling with children, including plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.
Travel and pregnancy
Because of the risk of malaria and yellow fever, pregnant women should not in general travel to Togo. Yellow fever vaccine is not approved for use during pregnancy, because it contains live virus. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to areas with malaria and yellow fever is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.
All travelers should visit either their personal physician or atravel health clinic 4-8 weeks before departure.
Malaria:Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for all areas.
|Hepatitis A||Recommended for all travelers|
|Typhoid||Recommended for all travelers|
|Yellow fever||Required for all travelers greater than one year of age|
|Meningococcus||Recommended during the dry season (November through June)|
|Polio||One-time booster recommended for any adult traveler who completed the childhood series but never had polio vaccine as an adult|
|Hepatitis B||Recommended for all travelers|
|Rabies||For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats|
|Measles, mumps, rubella (MMR)||Two doses recommended for all travelers born after 1956, if not previously given|
|Tetanus-diphtheria||Revaccination recommended every 10 years|
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