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The Hot Zones: A Year in Review of Travel Illness

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No one likes to think about getting sick on a vacation, and the fact is that most of us never will. However, 2014 has thrown up some very lurid headlines about just such a subject. Sadly, they weren't exactly hype. This year and last, some very serious outbreaks hit the globe, many with treatment, but no cure. For those packing their bags either within the United States or without, there are few precautions you need to take.

Africa: Ebola
It's big, it's bad, it's back, and it is out of control. An outbreak in the West African nations of Guinea, Sierra Leone and Liberia claimed 672 deaths as of July 23, with no end in sight. In addition to the dead, the Centers for the Disease Control and Prevention announced a cumulative total of 1,201 suspected and confirmed cases of Ebola virus disease (EVD). Of those, 814 cases have been laboratory confirmed as an Ebola virus infection so far.

Not since the Black Plague has a disease become so synonymous with a death sentence, for good reason: A viral hemorrhagic fever causing massive internal bleeding, Ebola carries a 90 percent fatality rate. And like the Black Plague, Ebola has a nasty habit of striking at a time and a place where the medical infrastructure is either basic or lacking altogether, allowing for panicked populations to go on the move and possible carry the virus with them. Cases are already appearing outside the initial hot zone; Patrick Sawyer, an American health care worker, recently died from the infection after arriving in Nigeria by air from the afflicted region -- but not before stopping in Ghana and Togo along the way. Officials in those countries are scrambling to identify passengers from the same flight who may represent an outbreak risk within their borders.

While there is no cure, rapid hydration of the patient has had some notable successes. However, risk of an Ebola infection is fairly low under the right conditions (read "sanitary"). The virus cannot spread through the air like the flu, but only by direct contact with bodily fluids or products. That being said, the incubation period can be up to 21 days, meaning nearly a month can go by before any symptoms appear.

The Caribbean & Florida: Chikungunya and Dengue Fever
It's a mouthful, but mosquito-borne chikungunya, once contained to the Old World tropics, just had its New World debut last year in the Caribbean and Florida. It is a classic example of modern travel enabling diseases long restricted by geography to appear around the world in the span of hours; unknown in Europe, Italy experienced an outbreak in 2007. The CDC officially lists the virus as having reached an epidemic stage.

The good news is that chikungunya rarely kills. That being said, it certainly makes you feel as if you are getting close to that point. Those infected can look forward to a week of high fever (40°C/ 104°F), joint pain, joint swelling, rashes, nausea, and a laundry list of other aches and pains. Chikungunya can't get very far into temperate regions, but as global warming does its work, formally cool regions can expect cases to appear.

The bad news is, chikungunya symptoms can look a lot like those of a much more serious disease, dengue fever. Like chikungunya, dengue is from the Old World, is a tropical virus, spreads via mosquitoes, and leaves you feeling miserable. Unlike chikungunya, dengue can go from aches and pains to dengue hemorrhagic fever, which can kill. If you come down with a bug that leaves you with severe abdominal pain or persistent vomiting, red spots or patches on the skin, bleeding from nose or gums, or vomiting blood, get to a hospital at once.

The Middle East: MERS
Remember SARS? First reported in 2003 in Pacific Asia, Severe Acute Respiratory Syndrome (SARS) had the world in a panic for months as health officials tried to contain it. Even though its kill-rate is defined as 9.6 percent, that still meant 775 people died, with infections showing up in 37 countries.

The Middle East is now grappling with Middle East Respiratory Syndrome (MERS), a close cousin to SARS and with a whopping 30 percent fatality rate that killed 282 in Saudi Arabia alone. Spread through close contact like its 2003 predecessor, MERS is largely contained to the Arabian Peninsula for the moment, but won't be for long. As pilgrims pour from across the globe into Mecca for the yearly Hajj and then scatter back to their homelands, health officials are looking at a huge window of infection.

So far, a massive MERS epidemic has not occurred, but isolated cases outside the Arabian Peninsula have been reported all over the globe, including two cases in the United States. The CDC recommends precaution in all Middle Eastern countries from the Levant to Iran. A report from CNN suggests that MERS may have begun as an infection in camels that jumped species.

All of this can seem pretty grim, but the irony is that there are some very simple preventative measures one can take to prevent an infection -- any infection. The easiest is to not go anywhere that is in the middle of an outbreak. However, far be it from me to tell a Muslim not to go on pilgrimage or vacationer to St. Barts. For the former, cover your mouth when you cough. For the latter, insect repellent. Washing your hands regularly is always a good idea wherever you go. And if you do come down with something, don't be afraid to go to the doctor.