The holiday diseases that can strike months after you get home

THEY are the debilitating and deadly diseases that hit months after you return from your holiday. And vaccinations won't always protect you. Here's the truth about travel illnesses.

A nurse works in a ward for patients affected with dengue fever. Picture: AFP

KATHERINE Robinson brought back many souvenirs from her eight months teaching English in Indonesia - including one that was unexpected and unwelcome.

Within a week of returning home in June she suffered fatigue, loss of appetite, weight loss and a cough when she bent over.

Her GP initially suspected a chest infection and prescribed antibiotics, but the symptoms did not clear up and when, two weeks after getting back, Katherine developed breathlessness, a severe ache in her upper back and night sweats, she returned to her doctor.

An X-ray revealed the area between her left lung and her ribcage was about two-thirds full of liquid. While we all naturally have some fluid - a few spoonfuls - here to lubricate the lungs, Katherine had two-and-a-half litres drained during a week-long stay in hospital (the fluid had been compressing her lung, causing the discomfort and a cough).

Doctors suspected pneumonia, and she was prescribed more antibiotics, but as a precaution they ran other tests, and six weeks after becoming ill Katherine was shocked to learn she had tuberculosis (TB).

"The doctors are almost certain I caught it while I was in Indonesia," says Katherine, 34, from the UK. As a teenager she had been given the BCG vaccine (Bacillus Calmette-Guerin) against TB and assumed she was protected.

TB is spread by inhaling tiny droplets from coughs or sneezes of an infected person. Most common in sub-Saharan Africa and South-East Asia, it's one of several diseases still prevalent in far-flung destinations.

The concern is that with tropical travel now viewed as routine - whether for a two-week holiday or a longer period - it's easy to forget that many of these unpleasant and even deadly diseases still pose a serious risk.

And while you might think you're covered by a jab, as Katherine did, there are many cases when protection is limited at best.

"Jabs give people a false sense of security when they travel because they don't provide 100 per cent protection," says Dr Ron Behrens, of the Faculty of Infectious and Tropical Diseases at the London School of Hygiene and Tropical Medicine.

Although childhood vaccinations give good protection for life, people should always be cautious when it comes to what they eat and drink, adds Dr Hilary Longhurst, consultant immunologist at Barts and the London NHS Trust.

This image shows the Mycobacterium tuberculosis (TB) bacteria in a high magnification. Picture: AP

"It also depends where you travel," she said. "Some vaccines, such as typhoid, only protect against one strain of two, and even then have varying efficacy depending where you are and the resistance of the strains there.

"One study in Nepal showed the efficacy of the typhoid jab was 75 per cent, while in South Africa it was only 55 per cent."

Another problem for many affected travellers is that the symptoms don't manifest themselves until they're back home.

This can be because the disease only becomes active when your immune system is low, or because the incubation period means you may not see symptoms for days or weeks after infection.

The downside of getting ill once back home is that diagnosis and treatment is likely to be slower because doctors here are not used to dealing with such diseases.

Poppy Mardall, 30, from London, is all too well aware of these problems.

Despite being vaccinated against typhoid when she went backpacking in Ghana for five weeks with her husband in 2011, she still contracted the disease.

Highly contagious, the typhoid bacterium is spread through food - often poultry - and less commonly water contaminated by faeces from an infected person.

"I began to feel ill on the way home - washed out and hot," recalls Poppy. "But I put it down to the long flight. The fever came and went after I got home, but I felt well enough to go to Belgium for a few days after coming back."

But while in Belgium, Poppy's symptoms worsened. Her temperature shot up at night.

"My sheets would be drenched in sweat in the morning. I also felt exhausted and my body ached enormously. It was as if I could feel every internal organ aching. Even my eyeballs ached."

Poppy came back early and saw her GP, who couldn't diagnose the problem but said to go to hospital if her symptoms worsened. For the next week her condition fluctuated, but when her temperature hit 40.5C, her husband took her to the hospital.

"At this point I was starting to hallucinate," she says. "Every time I closed my eyes I was convinced I could hear a band drumming. At one point the light switches seemed to be dripping from the walls. I also totally lost my balance."

Poppy was placed in an isolation ward for infectious diseases and finally diagnosed with typhoid a few days later.

"It wasn't something I expected, especially considering I'd been vaccinated," she said. After a week in hospital Poppy was discharged, but five days later her condition deteriorated. After a second stint in hospital, on stronger antibiotics, she was allowed home again.

But her recovery was painfully slow. She had extreme fatigue and it was eight months before she was feeling better.

Dr Behrens points out the typhoid vaccination is only about 60 per cent effective for those who live in countries where typhoid is prevalent, and likely to be much less for tourists who've never been exposed to the bugs.

"I don't believe the vaccine actually works in tourists," he said. "The only studies that have been done are on people who live in these countries and they will have a certain amount of natural immunity, so you can't say that it worked for them so it will work for someone who's never seen the bug."

The problem is also diagnosing such illnesses when most doctors at home have very little, if no, clinical experience in them.

"It's very important that if you get ill after coming home from travelling, you say where you've been, especially as some illnesses may not display symptoms until weeks later," Dr Behrens said.

Katherine and Poppy both told their doctors where they had been.

Dr Behrens adds: "Flu, pneumonia and TB have symptoms common to each other so are easily misdiagnosed. The implications can be very serious."

Dengue fever is spread by mosquitoes. Picture: Brian Cassey

Artist Alex Florschutz learned this the hard way. The 44-year-old contracted dengue fever while visiting Bali in the summer of 2009.

A common, but sometimes fatal, viral infection found in tropical regions, dengue fever is spread by mosquitoes - there is currently no vaccine (though one is in development) and no cure. Alex had been bitten twice by mosquitoes the day before she flew home from Bali.

"I got ill within a few days of arriving back, but it took doctors three weeks to diagnose me. People are always terrified about going to hospitals abroad, but if I'd been ill in Bali, I'm sure dengue would have been diagnosed sooner because it's so much more common there," she said.

Although she mentioned where she had been on holiday to her doctor, she was initially told she had the flu. Her symptoms started with vomiting, diarrhoea, and mild lung and urine infections. "After a few days I couldn't lift my head off the pillow," she says.

Because her return home in 2009 coincided with an outbreak of swine flu, doctors assumed this was what she had. "But then I started bleeding, like a heavy period, and I was struggling to read - the type was blurry."

An eye specialist thought she might have type 2 diabetes, then friends suggested dengue fever.

A blood test confirmed Alex had the potentially fatal haemorrhagic dengue fever, which kills by triggering internal bleeding - her blurred vision was caused by bleeding behind her eye.

Four years later, Alex still suffers from fatigue, while for Poppy, catching typhoid has changed her outlook for ever.

"It was very scary, but gave me a new respect for my body and made me fearless about life," she says. While previously an art expert, she has now launched a business that provides a family-led funeral service.

Meanwhile, Katherine is finally on the mend after taking strong antibiotics for six months.

But while the past two-and-a-half months have been tough, she's also had something to celebrate - she's pregnant.

Thankfully she's been told neither the TB, nor her treatment, will affect her baby. Due in December and conceived with her fiance in Java, Indonesia, it will be a far happier reminder of her time there.