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Travellers over a year old arriving from infected areas require a yellow fever vaccination certificate. Polio and tetanus vaccinations are recommended. Mains water on Anguilla is chlorinated, but bottled water is available and recommended for visitors. All food on the island is safe to eat. There are three private medical clinics and a small hospital, which can deal with minor emergencies, but serious cases are transferred to neighbouring islands or the USA mainland. Adequate medical insurance is therefore strongly advised.

Tetanus

Disease: Tetanus is acquired through environmental exposure to the spores of Clostridium tetani, which are present in soil worldwide. The disease is caused by the action of a potent neurotoxin produced by the bacterium in dead tissue (e.g. dirty wounds). Clinical symptoms of tetanus are muscle spasms, initially muscles of mastication causing trismus or "lockjaw", which results in a characteristic facial expression-risus sardonicus. Trismus can be followed by sustained spasm of the back muscles (opisthotonus) and by spasms of other muscles. Finally, mild external stimuli may trigger generalized, tetanic seizures, which contribute to the serious complications of tetanus (dysphagia, aspiration pneumonia) and lead to death unless intense supportive treatment is rapidly initiated. Occurrence: Dirty wounds can become infected with the tetanus spores anywhere in the world. Risk for travellers: Every traveller should be fully protected against tetanus. Almost any form of injury, from a simple laceration to a motor-vehicle accident, can expose the individual to the spores. Vaccine: All travellers should be up to date with the vaccine. The primary immunizing course of three doses of DTP is given in the first months of life. Booster doses are most easily given as Td, but certainly all doses given to individuals aged 7 years and above should be Td. A booster dose of Td should generally be used in preference to tetanus toxoid (TT) immediately following trauma. However, no such booster is needed if the last dose was given less than 5 (for dirty wounds) to 10 years (for clean wounds) previously. Precautions and contraindications: Mild local reactions occur in up to 95% of vaccine recipients. Reactions increase in frequency and severity as the number of doses increases. After booster doses of TT, 50-80% of people experience some pain or tenderness at the injection site. True hypersensitivity reactions to TT occur very rarely. Source: WHO.

Hepatitis B

Cause: Hepatitis B virus (HBV), belonging to the Hepadnaviridae. Transmission: Hepatitis B is transmitted from person to person by contact with infected body fluids. Sexual contact is an important mode of transmission, but infection is also transmitted by transfusion of contaminated blood or blood products, or by use of contaminated needles or syringes for injections. There is also a potential risk of Hepatitis B transmission through other skin-penetrating procedures including acupuncture, piercing and tattooing. Perinatal transmission may occur from mother to baby. There is no insect vector or animal reservoir. Nature of the disease: Many HBV infections are asymptomatic (e.g. causes no symptoms) or cause mild symptoms, which are often unrecognised in adults. When clinical hepatitis results from infection, it has a gradual onset, with anorexia, abdominal discomfort, nausea, vomiting, arthralgia and rash, followed by the development of jaundice in some cases. In adults, about 1% of cases are fatal. Chronic HBV infection persists in a proportion of adults, some of whom later develop cirrhosis and/or liver cancer. Geographical distribution: Worldwide, but with differing levels of endemicity. In north America, Australia, northern and western Europe and New Zealand, prevalence of chronic HBV infection is relatively low (less than 2% of the general population). Risk for travellers: Negligible for those vaccinated against hepatitis B. Unvaccinated travellers are at risk if they have unprotected sex or use contaminated needles or syringes for injection, acupuncture, piercing or tattooing. An accident or medical emergency requiring blood transfusion may result in infection if the blood has not been screened for HBV. Travellers engaged in humanitarian relief activities may be exposed to infected blood or other body fluids in health care settings. Prophylaxis (protective treatment): Vaccination. Precautions: Adopt safe sexual practices and avoid the use of any potentially contaminated instruments for injection or other skin-piercing activity. Source: WHO.

Hepatitis A

Cause: Hepatitis A virus, a member of the picornavirus family. Transmission: The virus is acquired directly from infected persons by the faecal-oral route or by close contact, or by consumption of contaminated food or drinking water. There is no insect vector or animal reservoir (although some non-human primates are sometimes infected). Nature of the disease: An acute viral hepatitis with abrupt onset of fever, malaise, nausea and abdominal discomfort, followed by the development of jaundice a few days later. Infection in very young children is usually mild or asymptomatic (e.g. causes no symptoms); older children are at risk of symptomatic disease. The disease is more severe in adults, with illness lasting several weeks and recovery taking several months; case-fatality is greater than 2% for those over 40 years of age and 4% for those over 60. Geographical distribution: Worldwide, but most common where sanitary conditions are poor and the safety of drinking water is not well controlled. Risk for travellers: Non-immune travellers to developing countries are at significant risk of infection. The risk is particularly high for travellers exposed to poor conditions of hygiene, sanitation and drinking water control. Prophylaxis (protective treatment): Vaccination. Precautions: Travellers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Source: WHO.