Public health authorities are once again reminding Canadian travellers thinking of a tropical getaway to the Dominican Republic that they need to take anti-malarial medication.
But many travellers say they haven't been getting the message.
Last week, the Public Health Agency of Canada (PHAC) released an advisory reminding travellers that "anti-malarial medication and the use of personal protective measures against mosquito bites are recommended to prevent getting malaria while visiting certain areas in the Dominican Republic."
It said there is a risk of acquiring the potentially fatal illness in resort areas within the province of La Altagracia -- where the popular destinations of Punta Cana and Bavaro are located.
As well, the risk is higher in all rural areas of the Dominican Republic especially in areas bordering Haiti, where malaria is endemic (meaning it occurs regularly there).
PHAC recommends that travellers use "protective measures" against mosquito bites and use appropriate anti-malarial medication, such as chloroquine, mefloquine or doxycycline. They also recommend sleeping under a mosquito net and staying within completely enclosed, air-conditioned areas.
Despite the advisory, many travellers say they are not being warned by their travel agents of the risks.
Natalie Basil went to the Dominican Republic last December for the sun and the sand, but came down with malaria symptoms within weeks of returning home.
"I started to feel very sick, lethargic, I had no energy, my skin was grey-green... I had bad fever and chills," she recalls.
The kind of malaria that she developed can be fatal in three of four days. She was sick for several weeks but eventually recovered.
In November, a couple from Germany, both 71, developed malaria after travelling to Punta Cana, despite regularly using mosquito repellent. Neither had taken anti-malaria pills.
Even though PHAC has been warning about the malaria risk in the Dominican Republic for more than two years, Basil says no one told her.
"I booked through a travel agent. He did not tell us anything to be aware of," she says. "We've traveled with this agent before and they're good, but they didn't say anything about travel precautions."
Â鶹´«Ã½ contacted six travel agencies by phone to book a trip to the DR and recorded the agents' responses. Not one warned our reporters we might need to take precautions.
"There's no shots, nothing is required to go there," one agent told us.
"It's not really that season right now. It's not a bad time for mosquitos in Punta Cana," another agent said.
Dr. Jay Keystone, a travel medicine specialist at the Medisys Travel Health Clinic at Toronto General Hospital, says he's baffled as to why travel agents aren't warning their clients.
"Of course it is worrisome when the travel industry does not tell clients about the risks. It basically says: 'We're more concerned about booking the trip than the health of the traveller'," he says.
He notes that malaria is not the only health risk in the Caribbean. There's also hepatitis A, traveller's diarrhea, dengue fever and sometimes other illness that travellers need to think about.
ACTA, the Association of Travel Agencies in Canada, which represents about 80 per cent of travel agents in Canada, has a code of ethics that says that travel agents must inform clients of any known health risks at the time of booking.
"Should we be made aware that members are not abiding by this, we would go back to that member and let them know it should be for them to do so," ATAC's Christiane Theberge told Â鶹´«Ã½.
Keystone believes that travelers really should do their own research before embarking on travel to tropical locations, but he thinks travel agents should help out too.
"I do think there is responsibility there to advise the traveler, if they know. But if they don't know, they can point travellers to travel clinics, send them to their family doctor. And finally, they can point them to a travel health website, such as the one from the CDC (U.S. Centers for Disease Control)," he says.
Keystone says he wouldn't discourage anyone from going to the Caribbean for travel because there are simple ways to avoid illness.
"The public needs to understand this: malaria is absolutely preventable with precautions and with safe and effective medications," he says.
"But in order to take malaria medications, you have to know you have to take it and you need to be informed in advance."
PHAC strongly recommends that Canadian travellers consult their doctor or a travel clinic at least six weeks prior to international travel -- regardless of destination -- to determine their individual health risks and their need for vaccination and/or preventative medication.
The agency also recommends that travellers who become sick or feel unwell on their return to Canada seek medical attention as soon as possible and inform their doctor, without being asked, that they have been travelling outside of Canada.
Symptoms of malaria include:
- fever
- headache
- nausea and vomiting,
- muscle pain and malaise.
- severe shakes or muscle spasms and chills often occur.
- Acute infection can cause enlargement of the spleen and make the liver tender.
- Cerebral malaria, which affects the brain, causes symptoms such as personality change, confusion, lethargy and seizures.
Infection with two species of the malaria parasite, P. vivax and P. ovale, can remain dormant in the liver for months, thus delaying symptoms for several months or causing relapses of malaria infection.
If identified early, almost all malaria can be completely cured. However, even short delays in diagnosis can make treatment more difficult and less successful.
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
