Travelling to Namibia and Cape Town with CF

Question

Dear Expert team,

I have CF and would like to travel to Namibia for three weeks in June/July (tour from Etosha National Park via Windhoek to the very south) and then fly to Cape Town for a few days. This would be an organized trip with a tour guide and accommodation in (at least) mid-range hotels. My lung function is stable at about 60% FEV1 and I have already taken several long-haul flights and long-distance trips without any problems. My CF doctor does not have any objections to the journey, but we have not yet talked about the details such as required vaccinations, etc.

According to the public health department, all travellers are advised to get vaccinated against tetanus/diphtheria/polio, measles, pertussis and hepatitis A, as well as to take along stand-by medication against malaria (there is supposed to be a small risk of malaria at Etosha National Part at this time of year). Are there any further vaccination recommendations particularly for CF (and diabetes), or other risks to be considered/precautionary measures to be taken due to CF? Are there any objections against the possible intake of malaria drugs because of CF? I take the “usual” CF drugs (acithromycin, colistin, Viani® -- fluticason/salmeterol, … )

Many thanks and kind regards.

Answer

Dear questioner,

I would like to warmly recommend for you to consult the Foreign Office’s web site for information on travel and security advice for Namibia. There you will probably find all the information necessary for tourists who would like to travel there. [Translator’s note: web site links relevant only to Germany were omitted in the translation.]

Now let me answer your individual questions.

Question 1
For people travelling to Namibia, there are the following vaccination recommendations: vaccination against diphtheria, tetanus, polio, hepatitis A, measles (or immunity after disease). For risk groups (this also includes CF patients with or without diabetes), vaccination against typhus, hepatitis B, rabies, meningococci, pneumococci and influenza is recommended as well.

Question 2
Unfortunately we cannot answer your question concerning further risks and precautionary measures in detail without knowing you and your disease/progression better. (Just as an example: long-distance air travel would not be recommended to patients who have had repeated pneumothoraces/lung ruptures.) However, since you mention that you have already talked to your treating doctor about your planned trip and that she does not have any objections, I think that you have already gotten a competent answer.

I would nevertheless like to point you to the following important health risks applying to Namibia:
- intestinal infections: please pay close attention to careful hygiene measures with food and drinking water
- bilharziosis (worm disease): avoid contact with fresh water (rivers, lakes, streams); this particularly concerns the Caprivi Strip
- HIV/AIDS: please remember that the disease can be transmitted not only during sexual intercourse (use of condoms!), but also by blood contact (e.g. piercing, tattooing, etc. – pay attention to sterile syringes and needles!).

Question 3
Depending on the compound, malaria drugs can interact with other drugs. To give a few examples: certain heart drugs (antiarrhythmic agents, beta receptor blockers, calcium antagonist drugs, antihistamines, antidepressants), drugs preventing epileptic fits, antibiotics (tetracylines). Interactions with oral antidiabetic medication cannot be ruled out, either. Therefore, if taking a malaria drug, you should have your blood sugar adjustment checked before departure. (How is your diabetes treated? With tablets or insulin? Talk to your doctor about this if necessary.)

To conclude, I would like to point out a paper (in English) that fits your question and deals with the issue of “travelling with CF” in detail:

“Travelling with cystic fibrosis: Recommendations for patients and care team members”; T.O. Hirche, J. Bradley, D. d'Alquen, K. De Boeck, B. Dembski, J.S. Elborn, W. Gleiber, C. Lais, A. Malfroot, T.O.F. Wagner.

You can download this paper via the following link: www.ecfs.eu/files/webfm/webfiles/File/documents/JCF%20Articles/JCF_619.pdf

I hope my answers are helpful!

Kind regards and have a good trip,
Dr. Christina Smaczny

22.03.2012