Cameroon: Development and Social Change

TABLE OF CONTENTS should optimize good health during your stay abroad. GENERAL INFORMATION ...... 2 You may find that local customs and practice, as PREVENTION OF INSECT-BORNE ILLNESSES well as varying US physicians’ approaches, at times ...... 2 conflict with these guidelines. It is essential that you PREVENTION OF FOOD- AND WATER-BORNE review these health guidelines and requirements ILLNESSES ...... 4 with your physician, to discuss individual issues such as pre-existing medical problems and allergies OTHER DISEASES ...... 6 to specific drugs. Any further questions or concerns IMMUNIZATIONS ...... 8 should be directed to the US Centers for Disease IMMUNIZATION SCHEDULE ...... 9 Control and Prevention (CDC) in Atlanta (www.cdc.gov/travel) or to your own physician.

PREVENTION OF INSECT- BORNE ILLNESSES Malaria Malaria is present in Cameroon and prophylaxis is recommended. CDC guidelines suggest that prevention of malaria is possible if you carefully follow personal protective measures as described below and take one of the following antimalarial drugs (listed alphabetically) as directed by your health care provider: atovaquone/proguanil (Malarone), doxycycline, mefloquine, or tafenoquine (Arakoda). The selection should be discussed

with your physician or health-care provider. If, in SIT Study Abroad programs may venture off the spite of adherence to these preventive measures, usual tourist track. Pay careful attention to you develop symptoms of malaria, prompt medical health and safety guidelines. attention lessens the severity of the illness. GENERAL INFORMATION To protect your health in Cameroon, you need Personal Protective Measures The following insect precautions should be followed, certain pre-departure immunizations followed by especially after dark, to prevent mosquito bites that reasonable health precautions while in the country. may transmit malaria: The following health guidelines and requirements • are based on years of experience and the current Wear long-sleeved shirts and long pants. • recommendations from the US Centers for Disease Use mosquito netting over bedding. • Control and Prevention. They are designed to inform Use insect repellents on bedding and netting. (e.g. permethrin – commonly known as you of health concerns that may be present in Permanone). Cameroon especially as you venture to smaller • Use insect repellents on skin and clothing. cities off the usual tourist track or spend time in DEET-containing products (e.g. Off, Off Deep small villages and rural areas for extended periods. Woods, Jungle Juice, and Muskol) may be used Although no information sheet can address every on skin in concentrations up to 30–40% and on conceivable contingency, the following health clothing in higher concentrations. Permethrin guidelines and requirements are an attempt to (Permanone) may also be used on clothing. provide you with a standard, which if followed,

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Malaria prophylaxis drugs to be discussed alternative drugs. More severe side effects such with your physician: as fainting, vomiting, vertigo, depression, or confusion may require stopping mefloquine and • Atovaquone/proguanil (Malarone) is a combination drug of atovaquone and proguanil contacting a physician to consider one of the that stops the development of malaria parasites. alternative drugs.

It is used for prevention of malaria in a daily dose with food or milk starting 1–2 days before There are potential adverse drug interactions travel to malarious area and continuing for 7 between mefloquine and other medicines and days after return. Although Malarone may cause drugs, including alcohol. Treatment for malaria mild headache, nausea, vomiting, and some using quinine or chloroquine should not be muscle pain, it has fewer neuropsychiatric side administered less than 12 hours after the effects than mefloquine. previous dose of mefloquine. Any cardiac medication especially beta blockers or calcium channel blockers, should be approved by a • Doxycycline is an antibiotic that prevents the physician who is familiar with mefloquine’s drug development of malaria-causing parasites in the interactions and who knows you are receiving blood. It is related to the antibiotic tetracycline. mefloquine for malaria prophylaxis. Doxycycline prophylaxis can begin 1–2 days

before travel to malarious areas. It should be • was recently approved continued daily during travel in the malarious Tafenoquine (Arakoda) areas and for 4 weeks after the traveler leaves as a prophylaxis by the US Food and Drug the malarious area. The dosage of doxycycline Administration (FDA) as a new drug for the prevention of malaria in travelers 18 years of is one capsule daily. Travelers who use doxycycline should be cautioned about possible age and older. Tafenoquine should be taken as adverse reactions due to sunlight exposure, a single dose once weekly to prevent malaria, such as sunburn and photosensitivity, as well as starting 3 days before travel to a malarious area. other side effects including diarrhea, nausea, Upon return from travel, the final dose should and vaginal yeast infection in women. occur 7 days after the last maintenance dose taken in the malarious area. Possible adverse

reactions include: headache, dizziness, back • Mefloquine is an antimalarial drug for pain, diarrhea, nausea, vomiting, motion prophylaxis. The regimen consists of a single sickness, insomnia, depression, abnormal dose of mefloquine to be taken , starting weekly dreams and anxiety. 1to 3 weeks before travel. Prophylaxis should be continued weekly during travel in malarious Tafenoquine should not be administered if one areas and for 4 weeks after a person leaves has a deficiency of an enzyme G6PD. such areas. SIT Study Abroad suggests that if you have further Mefloquine should be used with caution. Many questions, do not hesitate to contact the Malarial people using mefloquine may experience minor Division of CDC at 888-232-3228 for recorded side effects initially including nausea, mild headache, dizziness, or bad dreams. Because information or visit the CDC website: of the potentially serious results of contracting http://www.cdc.gov/malaria/travelers/index.html malaria, your physician may recommend continuing the medication unless the symptoms Dengue become intolerable. This is a viral disease and is transmitted by mosquitoes which bite primarily in the daytime. It If you are pregnant or have a history of occurs in the urban as well as rural areas including significant emotional or psychiatric problems, in Yaounde´. There is no licensed vaccine against it, including depression, severe anxiety, but personal protective measures against mosquito anorexia/bulimia, schizophrenia, and bipolar bites are effective in prevention (see under malaria disorder, or medical problems including epilepsy section). The disease causes considerable and cardiac conduction abnormalities, you must discomfort (fever, body aching), but is self-limited in communicate with your physician at home regarding the use of mefloquine and possible adults in most cases. 3 Cameroon 2020

There is no vaccine or drug to prevent African Yellow Fever trypanosomiasis. Insect precautions are This is a viral disease transmitted by mosquitoes recommended and wearing light-colored (not blue) that occurs only in parts of Africa and South heavyweight clothing. America. Yellow fever is characterized by severe hepatitis with fever. It may be prevented by avoiding mosquito bites (personal protective measures) and by getting the vaccination shots that are available at any yellow fever vaccination center (consult your physician for the nearest center). A yellow fever vaccination certificate is an entry requirement for Cameroon from any country.

Chikungunya Chikungunya is an arboviral infection that is transmitted by day-biting Aedes mosquitoes. It is prevalent in tropical Africa and Asia, parts of Central and South America, and the Caribbean. Low risk is limited to the southern half of the country-including PREVENTION OF FOOD-AND Yaounde´. Symptoms are typically fever and joint WATER-BORNE ILLNESSES pain. There is no licensed vaccine against it, but Diarrhea-Producing Infections insect precautions and personal protective “Traveler’s diarrhea” is the most common form of measures (especially during peak times (early diarrhea in Cameroon. This is a self-limited diarrhea morning and late afternoon) are the main prevention lasting from a few to several days, characterized by strategy. watery, non-bloody bowel movements. Traveler’s diarrhea usually requires no treatment other than Zika fluid replacement including ORS (the World Health Zika is a viral infection that is also transmitted by the Organization’s oral rehydration solution which bite of the Aedes mosquitoes. Symptoms include comes in package form) or other homemade mild fever, rash, conjunctivitis (red eyes), joint or solutions such as 1 teaspoon salt, 1/2 teaspoon muscle pain and headache. Low risk exists in baking soda, and 2–3 tablespoons sugar or honey Cameroon. The disease causes considerable in 1 liter of clean water; or carbonated soda diluted discomfort, but is mild and self-limited, lasting for by one half. Antidiarrheals such as Imodium or several days to a week. Lomotil may be used short-term in some There are no vaccines or medications available to circumstances. Pepto Bismol in large amounts and prevent or treat Zika infections therefore students certain antibiotics (doxycycline, sulfa-TMP, should be vigilant in using insect precautions and ciprofloxacin) can prevent or attenuate the infection. personal protection measures against day-biting Antibiotics are indicated for more severe cases of mosquitoes (see insect precautions section above). traveler’s diarrhea. CDC recommends that pregnant women consider More protracted and disabling diarrheal illnesses postponing travel to countries where the Zika virus may be due to giardiasis and amoebic dysentery is prevalent. (caused by parasites) and bacillary dysentery (caused by bacteria), including cholera and typhoid. African Trypanosomiasis These infections (as well as “traveler’s diarrhea”) Also called “sleeping sickness,” African are caused by contaminated food and water. Trypanosomiasis is a serious parasitic disease that Therefore, the best way to avoid such infections is is transmitted by the bite of tsetse flies. It is endemic to respect certain do’s and don’ts: in focal areas in the east, south, and south-west areas of Cameroon. 4 Cameroon 2020

DO WASH your hands scrupulously with non- consumption of unpasteurized milk and milk contaminated water and soap before eating and products should be strictly avoided. snacking. There may be times when refusing an offer of food DO DRINK or beverage, even a drink with ice or avoiding a • Bottled or canned beverages (water, soda, soft salad will be considered rude. You must decide for drinks) from a trusted source (ensure caps are yourself, but polite refusals, thought out in advance, sealed). are often handy. Discuss these alternatives with

• Hot beverages (coffee, tea). your Academic Director(s).

• Water that reached a rolling boil for at least one minute at sea level (longer at higher altitudes). • Carbonated mineral water.

DON’T DRINK • Tap water, even in ice; don’t risk using it for brushing your teeth either. • Tap water in larger cities is often safe, but the water in rural areas is probably not, so be sure to check with a reliable source before using, and if in any doubt, take all the recommended precautions.

DO USE • Commercial iodide or tinctured liquid iodine to

treat water, ONLY if bottled water (from a trusted source) is not available and boiling water is not possible. Chlorine in various forms is less Hepatitis A reliable than iodine. These provide substantial Hepatitis A is a highly contagious virus that causes protection when added to tap water. liver inflammation. It is most commonly spread through contaminated food and water. Most DO EAT Americans have not previously been exposed to the • Cooked vegetables, fruits with thick covering hepatitis A virus and are at risk of contracting the (citrus, bananas, and melons); and well-washed disease during travel to areas where the disease is raw fruits and vegetables. more prevalent. A very effective vaccine is available • Meat or fish that is thoroughly cooked (pork and and should be administered 2–3 weeks prior to lamb should be very well done). travel. • Pasteurized dairy products from large commercial dairies. Schistosomiasis (Bilharzia)

Schistosomiasis is prevalent in Cameroon. The DON’T EAT Peace Corps lists it as one of the country’s major • Unwashed or unpeeled raw fruits and medical problems. It is acquired by contact with vegetables. • Fruits that do not have a thick, disposable fluke-like parasites, which live on fresh-water snail outside covering. hosts and can penetrate the skin of people and • Rare or raw meat or fish or shellfish. animals, causing serious illness. There is at present • Dairy products from small, independent vendors no chemoprophylaxis or immunization for this, but it without pasteurizing facilities, including food of can be avoided by following these precautions: any kind that has been left out in the sun, • DO NOT SWIM OR WADE IN FRESH WATER. especially custards, creams, and mayonnaise. • Heat bathing water to 50°C (122°F) for 5 • Raw (unpasteurized) milk or milk products. minutes (if using untreated water that comes Tuberculosis and brucellosis, both serious directly from a freshwater source such as diseases are transmitted in this way, so the canals, lakes, rivers, streams or springs). This 5 Cameroon 2020

will destroy the parasites. Iodine treatment alone will not guarantee that water is safe and free of all parasites. • Filter untreated water with a tightly woven cloth or with paper filters. This may also be effective in removing the parasites from untreated bathing water. If these measures are not feasible, allow untreated bathing water to stand for 3 days, since the parasites live only 48 hours. • Properly chlorinated water that is piped into homes, chlorinated pools and salt water are generally safe from infectious diseases. • If accidental exposure to suspected water occurs, immediate and vigorous towel drying or OTHER DISEASES rapid application of rubbing alcohol to exposed Hepatitis B areas may reduce the risk of infection. Hepatitis B is a serious and often chronic viral infection of the liver. Since this type of hepatitis is If you suspect that you are infected, contact a doctor most often acquired from contact with infected or hospital immediately and obtain urine and stool blood, sexual contact (as with HIV), or skin-to-skin tests. If you do test positive, praziquantel is the contact of mutual open cuts and sores, appropriate treatment of choice. precautions to avoid these types of exposure are necessary. This includes avoiding getting tattoos, or Cholera ear/body piercings and avoiding cuddling children Cholera is an acute intestinal infection caused by a with sores or draining insect bites. A series of three bacterium (vibrio cholerae). It is usually mild and immunizing injections is recommended. This series self- limited but can be associated with severe, should be initiated as early as possible so that at profuse watery diarrhea requiring medical attention least two doses are taken prior to departure. This for fluid replacement. The guidelines for preventing will provide partial protection. The third shot should diarrheal infections apply to preventing cholera as be taken five months after the second dose, and well including strict food and beverage precautions may be given after returning home to achieve full, and hygiene measures. The Cholera vaccine is now long-lasting immunity. An accelerated schedule can available in the US and should be administered at also be used as an alternative. least 10 days prior to travel. HIV/AIDS and Blood Supplies Typhoid Fever HIV/AIDS is a concern worldwide. The HIV virus is Typhoid is an infection caused by a particular transmitted by way of bodily fluids from an infected species of the salmonella bacterium. It is spread by person. HIV is spread mainly by having anal or contaminated food and water. Symptoms include vaginal sex or sharing drug injection equipment with fever, severe toxicity, rash, and in about half the a person who has HIV. AIDS is an acquired immune cases, bloody diarrhea. Untreated, there is a 30% deficiency that can result in life- threatening mortality rate. Vaccines are 60–70% effective in infections and is the most advanced stage of the prevention. One vaccine involves a single injection, HIV infection. It is the student's responsibility to with immunity lasting 2 years. A second one is protect him /herself from acquiring the disease administered orally every other day for 4 doses, and through sexual transmission. Students anticipating lasts 5 years. Antibiotic resistance has been even the possibility of sexual activity are strongly developing, but treatment of the disease with certain urged to bring their own condom supply. Other well-known antibiotics is usually effective. As with all potential routes of infected blood transmission such diarrheal illnesses, careful dietary discretion as tattooing, body piercing and needle sharing must continues to be the main line of defense. be strictly avoided.

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With regard to blood transfusions, our Academic pulmonary TB or by ingestion of TB-contaminated Directors have identified hospitals, through unpasteurized milk products. Transmission is more consultation with the local US embassy, where safe likely in conditions of crowding and poverty. A TB blood is available. In a life-threatening situation, the skin test can indicate prior exposure to tuberculosis risks versus benefits of an emergency blood and is recommended prior to travel (unless already transfusion must be examined carefully and a known to be positive). A repeat test is also decision made based on the best information at recommended after returning to the US even if the hand. pre-departure test was negative.

Meningitis Coronavirus COVID-19 Meningitis is an infection of the brain and spinal cord COVID-19 is a newly identified respiratory virus that is caused by many different types of bacteria and was discovered in China. Cases of the virus have viruses. Meningococcal meningitis, a serious type of spread rapidly in China and have also been bacterial meningitis, has the highest rate in sub- reported in over 100 other countries, including the Saharan Africa. The disease is quite contagious and United States. The World Health Organization can occur in sudden epidemics, especially in (WHO) has declared this disease a global pandemic crowded areas. There is a very effective vaccine for the worldwide spread of a new disease for which against the meningococcal disease and it is prudent most people do not have immunity. COVID-19 is for all travelers to this region to be immunized. usually spread through direct contact with an infected person as well as through respiratory Rabies droplets produced when an infected person coughs Rabies is a viral disease almost always caused by or sneezes. It is unknown if the virus can spread animal bites (especially dogs). Risk occurs in from contact with contaminated surfaces or objects. Cameroon and, therefore, you should take Symptoms of COVID-19 are fever, cough, and measures to prevent it. Given the serious danger shortness of breath, and may appear 2-14 days posed by rabies as a uniformly fatal disease, follow after exposure. The illness can also cause body these important guidelines: aches, sore throat, vomiting and diarrhea. Reported • Consider pre-exposure immunization (if illnesses have ranged from mild symptoms to available). severe illness and death for confirmed coronavirus • Avoid bites from all animals and especially avoid disease 2019 (COVID-19) cases. handling or feeding puppies, kittens, monkeys, There is currently no vaccine to prevent coronavirus or other animals. They can have rabies before it disease 2019 (COVID-19). The best way to is obvious. prevent illness is to avoid being exposed to this • If you have been bitten or have had direct virus and protect yourself! contact with the saliva of a suspected rabid • Clean your hands often-wash your animal, immediately wash the affected area with hands carefully and frequently with soap and a soap solution and running water thoroughly to water for at least 20 seconds especially after neutralize and to rinse out the virus. Then you have been in a public place, or after blowing proceed immediately for post-exposure your nose, coughing, or sneezing. If soap and treatment, the sooner the better; depending on water are not readily available, use a hand the location of the bite, you may have little time. sanitizer that contains at least 60% alcohol. • If possible, the animal should be captured and Cover all surfaces of your hands and rub them kept under cautious surveillance until the together until they feel dry. Avoid touching your diagnosis and therapy are completed. If capture eyes, nose, and mouth with unwashed hands. is not possible, a clear description of the animal • Cover your mouth and nose with a tissue and the circumstance of contact should be when you cough or sneeze or use the inside of carefully recorded. your elbow. Throw used tissues in the trash. • Clean AND disinfect frequently touched Tuberculosis surfaces daily. This includes tables, doorknobs, Tuberculosis (TB) is a bacterial disease spread by airborne droplets from a person with untreated 7 Cameroon 2020

light switches, countertops, handles, desks, since some immunizations require more than one phones, keyboards, toilets, faucets, and sinks. dose for effectiveness. The physician administering • Avoid close contact. Practice social the inoculations should record all immunizations on distancing. Put distance between yourself and the International Certificate of Vaccination or other people if possible. Prophylaxis (ICVP, also known as the WHO card). • Inform your Academic Director immediately if The WHO card should be kept with you at all times you have a pulmonary disease or any respiratory while in the host country. illness; have a fever or feeling sick; if you have

been in close contact with a person known to have COVID-19; and/or have recently traveled REQUIRED (for participation in program): from an area with widespread or ongoing • MMR (measles, mumps, rubella): You will community spread of COVID-19. need to be immunized if you have not had 2 • Contact ISOS and a medical doctor, if you doses of live measles vaccine. develop symptoms; • Avoid travel if you are sick or have a fever. • Tetanus, diphtheria, pertussis: The primary Your Academic Director will make appropriate child series is required. Boosters (Td or Tdap) accommodations for students who are ill. are effective for 10 years. If you are uncertain • Wear a facemask, especially when you are when you had your last injection, we around other people (e.g., sharing a room or recommend that you get another booster. vehicle) and before you enter a healthcare provider’s office. • Meningococcal (meningitis): At least one dose • Most importantly, stay connected: especially of the meningococcal vaccine is required. during your Independent Study Project or Internship. Communicate daily with your SIT • Yellow fever: Academic Director. SIT continues to update its Certification of contingency and evacuation plans to ensure that yellow fever we are prepared to take appropriate action in the vaccination (enter it event of a change in circumstances. on your WHO card) is required for all Sun Exposure travelers arriving SIT Study Abroad recommends the use of from ALL , sunglasses, wide-brimmed hats, sunscreen lotions, COUNTRIES including the United and lip protection to reduce problems related to sun States and Canada. exposure. Cameroon is in the Yellow Fever IMMUNIZATIONS FOR Endemic Zone.

CAMEROON Immunizations fall under two categories: 1) those RECOMMENDED (as a health precaution - that are required for SIT Study Abroad admission or consult your physician): entry into the country and 2) those that are • Hepatitis A: Hepatitis A vaccine, which provides recommended to protect your health and well-being long-term immunity, is recommended. by building up your immune defenses against specific prevalent diseases. In addition, certain • Hepatitis B: A series of 3 immunization basic immunizations are required by US law. injections is recommended. See section on Hepatitis B. Immunization for yellow fever is required for entry into the country. Plan well in advance for the • Influenza: Influenza vaccine should be yellow fever inoculation since it is not as widely considered for any individual wishing to available as others. decrease risk of influenza or non-specific Plan ahead at least 10 weeks, as laid out in the respiratory illness especially those who are at sample schedule at the end of these instructions, high risk for complications from influenza 8 Cameroon 2020

including those with asthma, COPD, diabetes, With reasonable attention to health and hygiene chronic cardiovascular disease and rules, your stay in Cameroon should be a healthy immunocompromised conditions. one. Aside from minor ailments due to adjustments to the new food, water and climate, the large • Cholera: This single dose oral vaccine should majority of SIT Study Abroad students remain be given at least 10 days prior to travel to a healthy throughout their semester. We do, however, cholera endemic area. recommend you see your physician when you return

to the US in order to test for any possible lingering • Rabies: Follow carefully the special instructions infection contracted overseas. in the section on rabies. Take good care of yourself! • Typhoid: This vaccine is strongly urged as a viable protective measure. The vaccine is given either orally or by injection. Discuss the relative merits of each with your doctor.

SAMPLE IMMUNIZATION SCHEDULE FOR CAMEROON To assist your planning, we suggest the following schedule for required and recommended immunizations. For your own comfort and protection, do not leave shots to the last minute!

Before the start of program Immunizations

10 weeks Yellow fever (for visa)

First rabies pre-exposure 8 weeks (Imovax, RabAvert)

7 weeks Second rabies; Influenza

Typhoid (injection or oral) 5 weeks Third rabies Tetanus (Td, Tdap) 4 weeks Booster

3 weeks Hepatitis A; Cholera Start weekly malaria 1-3 weeks prophylaxis, (if using mefloquine) Start daily dose of malaria prophylaxis (if using doxycycline or 1-3 days Malarone); Start weekly malaria prophylaxis, (if using tafenoquine)

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