Travel Health Sri Lanka

AS A COUPLE
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Sri Lanka is less challenging from a health point of view than many other tropical countries: standards of hygiene are reasonable, medical care is of a decent standard and even malaria has now been eliminated. Nevertheless, the island does play host to the usual gamut of tropical diseases, and it’s important to make sure you protect yourself against serious illness.

You should start planning the health aspect of your trip well in advance of departure, especially if you’re having vaccines for things like rabies or Japanese encephalitis, which need to be administered over the course of a month. Vaccinations and medical advice are available from your doctor or – more conveniently but expensively – a specialist travel clinic. It’s also crucial to have adequate medical insurance.

Ensure that you’re up to date with the following standard vaccinations: diphtheria, tetanus, and hepatitis A. Other jabs you might consider are tuberculosis, meningitis and typhoid.

The best way to avoid falling ill is to look after yourself. Eat properly, make sure you get enough sleep and don’t try to cram too much strenuous activity into your holiday, especially in the first few days before you’ve acclimatized to the sun, water and food, and while you’re probably still suffering jetlag. Luckily, standards of medical care in Sri Lanka are good. Most doctors speak English and a significant number have trained in Europe, North America or Australia. All large towns have a hospital, and you’ll also find private medical clinics in Colombo. If you pay for treatment, remember to get receipts so that you can claim on your insurance policy. All larger towns have well-appointed pharmacies (signed by a red cross on a white circle) and can usually produce an English-speaking pharmacist. If stuck, any reputable hotel or guesthouse should be able to put you in touch with a local English-speaking doctor.

Water and food

Avoid drinking tap water in Sri Lanka. Although it’s generally chlorinated and safe to drink, the unfamiliar micro-organisms it contains (compared with what you’re used to at home) can easily precipitate a stomach upset. Also avoid ice, unless you’re sure that it’s been made with boiled or purified water. Mineral water is widely available, although always check that the seal hasn’t been broken – it’s not unknown for bottles to be refilled with tap water. Whatever precautions you take, however, you’re still likely to come into contact with local water at various points – your eating utensils will be washed in it, and it will probably be used without your knowledge in things like fruit juices – so it’s not worth getting paranoid about.

Though Sri Lankan standards of food hygiene are reasonable, it still pays to be careful, and the old travellers’ adage usually applies: if you can’t cook, boil or peel something, don’t eat it (although if you can’t peel something, you can always wash it thoroughly in purified water). Stick to hot food that has been freshly prepared. Avoid salads and anything which looks like it has been sitting uncovered for a while; short eats (see Vegetarian food in Sri Lanka) are particularly likely to be old and to have been poked by many fingers. The busier the establishment, the less probability that the food’s been sitting around all day. Obviously you’ll need to use your discretion: the buffet at a five-star hotel has more chance of being OK than a local café’s tureen of curry, which has been keeping the flies fat since dawn. Finally, remember that refrigerators stop working during power cuts, so unless you’re eating at a place with its own generator, avoid any food (including meat and ice cream) that might have been unfrozen and then refrozen.

Diarrhoea, dysentery and giardiasis

Diarrhoea remains the most common complaint amongst tourists visiting Sri Lanka. It can have many causes, including serious diseases like typhoid or cholera, but in the vast majority of cases diarrhoea is a result of contaminated food or drink and will pass naturally in a few days. Such diarrhoea is also often accompanied by cramps, nausea and vomiting, and fever in more severe cases.

You should seek medical advice if diarrhoea continues for more than five days or if there is blood mixed up in the faeces, in which case you could be suffering from giardiasis or amoebic dysentery. With giardiasis you may suffer stomach cramps, nausea and a bloated stomach. In amoebic dysentery, diarrhoea is severe, with bloody stools and fever. If any of the above symptoms apply, see a doctor.

Treatment

One of the biggest problems with diarrhoea, particularly in a hot country like Sri Lanka, is dehydration; it’s vital you keep topped up with fluids – aim for about four litres every 24 hours. If you’re having more than five bouts of diarrhoea a day or are unable to eat, take oral rehydration salts to replace lost salt and minerals. These can be bought ready-prepared in sachets from pharmacies and camping shops. Alternatively, you can make your own by mixing eight teaspoons of sugar and half a teaspoon of salt in a litre of purified water.

Coconut water is a good alternative, especially if you add a pinch of salt. Children with diarrhoea dehydrate much more quickly than adults, and it’s even more vital to keep them hydrated. If you have to go on a long journey where you won’t have access to a toilet, you can temporarily bung yourself up with a blocking drug like lomotil or loperamide, though these simply suppress symptoms and have no curative value. Whilst recovering, stick to bland foods (rice and yoghurt are traditionally recommended, and bananas help replace lost potassium) and get plenty of rest – this is not the moment to go rushing up Adam’s Peak.

Malaria

Sri Lanka was officially declared free of malaria by the World Health Organization (WHO) in 2016 after over three years without a single incidence of the disease being reported – a remarkable achievement. There’s no guarantee, of course, that the disease won’t reappear, although your doctor is unlikely to recommend you take anti-malarials at present.

Dengue fever

The mosquito-borne disease dengue fever, by contrast, remains a genuine concern. Dengue is particularly common in Colombo and along the west coast, with regular outbreaks following the southwest monsoon in October/November (one particular violent epidemic in the first half of 2017 saw 80,000 cases reported, with 215 deaths). There are four subtypes of dengue fever, so unfortunately it’s possible to catch it more than once. The disease is typically characterized by the sudden onset of high fever accompanied by chills, headache, a skin rash and muscle or joint pains (usually affecting the limbs and back, hence dengue fever’s nickname “break-bone fever”). The fever usually lasts three to seven days, while post-viral weakness, lethargy and sometimes depression can persist for anything up to several weeks. A rare but potentially fatal complication is dengue haemorrhagic fever (DHF), which is almost entirely confined to children under fifteen who have previously been infected with dengue fever.

There is no vaccine for dengue fever, which makes avoiding getting bitten in the first place all the more important, although unfortunately the mosquitoes that transmit dengue bite during the day, making them harder to guard against than malarial mosquitoes.

Avoiding bites

Regardless of the diseases mosquitoes may carry, you should avoid being bitten for the sheer fact that the bites are annoyingly itchy. The temptation is to scratch them, which can make them bleed. Although it’s difficult to avoid being bitten there are a few standard avoidance techniques you can use:

  • wear light-coloured clothing with long sleeves
  • use a repellent
  • always sleep under a net
  • burn a mosquito coil in your room or put one under the table while you eat.
  • Pyrethroid tablets – an alternative to coils, which you place on a tray and put in a plug; the electricity heats the tray and vaporizes the Pyrethroid.
  • Citronella oil (available from many chemists in Sri Lanka) is also thought to be good for repelling mosquitoes.

Japanese encephalitis

A third mosquito-borne disease is Japanese encephalitis (JE), a virus transmitted by mosquitoes which bite at night. It’s particularly associated with rural areas, as the virus lives in wading birds, pigs and flooded rice fields. JE is most prevalent following periods of heavy rainfall resulting in large areas of stagnant water.

JE is an extremely dangerous disease, with mortality rates of up to forty percent (though tourists are only rarely affected). As with dengue fever, you won’t contract JE if you don’t get bitten. Symptoms include drowsiness, sensitivity to light and confusion. An effective vaccine exists for JE (three shots administered over 28 days), though the standard advice is that it’s only worth considering if you’re travelling in high-risk areas during the monsoon for a period of over a month, and especially if you’ll be spending a lot of time in the country and/or camping out a lot.

Sun

The potential health risks associated with the sun are easily underestimated – especially since a desire to soak up the rays is often a major reason to come to Sri Lanka in the first place. Sunscreen should always be applied to exposed skin when outdoors; young children are particularly vulnerable to burns and should be kept out of the sun at all times. Older kids should wear the highest factor sunblock and a hat. For all ages, eyes also need to be protected by proper sunglasses. If you do get sunburnt, take plenty of warm (not cold) showers, apply calamine lotion or aloe vera gel, and drink lots of water.

A common but minor irritant is prickly heat, usually afflicting newly arrived visitors. It’s caused by excessive perspiration trapped under the skin, producing an itchy rash. Keep cool (a/c is good), shower frequently, use talcum powder on the affected skin and wear loose (ideally cotton) clothing. At its worst, prolonged exposure to the sun and dehydration can lead to heatstroke, a serious and potentially life-threatening condition. Symptoms are a lack of sweat, high temperature, severe headaches, lack of coordination and confusion. If untreated, heatstroke can lead to potentially fatal convulsions and delirium. If you’re suffering from heatstroke, get out of the sun, get into a tepid shower and drink plenty of water.

Hepatitis

Hepatitis is an inflammation of the liver. The disease exists in various forms, though with a shared range of symptoms, typically jaundiced skin, yellowing of the whites of the eyes and a general range of flu-like symptoms. Hepatitis A and hepatitis E are spread by contaminated food and water. If you become infected, there’s little you can do except rest – unfortunately, it can take a couple of weeks or more to shake off the effects. The much more serious hepatitis B can result in long-term liver damage and liver cancer. Like the HIV virus, it’s spread via infected blood or body fluids, most commonly through sex or needle sharing. Hepatitis C and D are similar.

You can (and should) be vaccinated against hepatitis A. The hepatitis B vaccine is usually only recommended to those at especially high risk, such as health-care workers. There are no vaccines for other types of hepatitis.

Rabies

Rabies, an animal disease transmitted to humans by bites, scratches or licking is usually associated with dogs, but can also be transmitted by cats, monkeys, bats or any other warm-blooded animal. Rabies, once symptoms have developed, is fatal. You are at risk if you suffer a bite that draws blood or breaks the skin, or if you are licked by an animal on an open wound. Bites to the face, neck and fingertips are particularly dangerous.

Fortunately, a safe and effective vaccine exists (three shots over 28 days), usually only recommended in Sri Lanka for long-stay visitors or those likely to be in close contact with animals.

Regardless of whether you’ve been vaccinated or not, if you’re bitten or scratched (or licked on an open wound) by an animal, clean the wound thoroughly with disinfectant as soon as possible. Iodine is ideal, but alcohol or even soap and water are better than nothing. If you’ve already been vaccinated, you’ll need two booster shots three days apart. If you haven’t been vaccinated, you will need to be given five shots of the rabies vaccine over 28 days (the first must be administered as soon as possible after you’ve been bitten), along with a single injection of rabies antibody serum.

Other diseases

Typhoid

Typhoid is a gut infection caused by contaminated water or food, and which leads to a high fever and diarrhoea. Oral and injected vaccines are available and usually recommended. A vaccination against meningitis is also available. This cerebral virus, transmitted by airborne bacteria, can be fatal. Symptoms include a severe headache, fever, a stiff neck and a stomach rash. If you think you have it, seek medical attention immediately. Sri Lanka has experienced occasional outbreaks of cholera, although this typically occurs in epidemics in areas of poor sanitation, and almost never affects tourists.

Tetanus

Initial symptoms of tetanus (“lockjaw”) can be discomfort in swallowing and stiffness in the jaw and neck, followed by convulsions – potentially fatal. The vaccination is a standard childhood jab in developed countries. “Booster” vaccinations are sometimes recommended for travellers to Asia.

Typhus

Typhus is spread by the bites of ticks, lice and mites. Symptoms include fever, headache and muscle pains, followed after a few days by a rash, while the bite itself often develops into a painful sore. A shot of antibiotics will shift it.

STDs, HIV and AIDS

Sri Lanka has relatively few reported HIV and AIDS cases, although the obvious warnings and precautions apply.

Animals and insects

Leeches are common after rain in Sinharaja, Adam’s Peak and elsewhere in the hills. They’re difficult to avoid, attaching themselves to your shoes and climbing up your leg until they find flesh, and are quite capable of burrowing through a pair of socks. Once latched on, leeches will suck your blood until sated, after which they drop off of their own accord – perfectly painless, but not terribly pleasant. You can make leeches drop off harmlessly with the end of a lighted cigarette or the flame from a lighter, or by putting salt on them. Don’t pull them off, however, or bits of leech might break off and become embedded in your flesh, increasing the risk of the bite becoming infected.

Sri Lanka has the dubious distinction of having one of the highest number of snakebite fatalities, per capita, of any country in the world, and any form of bite should be treated as quickly as possible. The island boasts five species of poisonous snake, all relatively common, especially in northern dry zones; they include the cobra and the extremely dangerous Russell’s viper. Avoid wandering through heavy undergrowth in bare feet and flipflops; wear proper shoes or boots, socks and long trousers.

If bitten, you should ideally lie down in a safe place while medical help is summoned, remaining as still as possible to slow the spread of venom and removing any shoes/jewellery/watches near the bite (but do not apply a tourniquet). Try to note the appearance of the snake if at all possible in order to identify it so that the correct anti-venom can be administered.

Marine hazards

Besides the risks of drowning, swimmers are also at a small potential risk of marine stings. Jellyfish are common, and some can inflict painful stings; coral scratches and cuts can also be painful (although more of a problem for the coral itself, which dies on contact). Occasionally people develop quasi-allergic reactions to stings; if you start to wheeze or swell up around the face, go to hospital immediately.

The other thing you need to think about is how clean the water is: beaches in the vicinity of town centres are obviously prone to pollution. In addition, parts of some beaches are filthy. Look out for broken glass, fishing hooks, syringes and other rubbish; dog faeces is also common. If you cut your foot, disinfect it immediately and seek medical advice, since you may need a tetanus booster and/or a hepatitis B vaccine.

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