Unwelcome souvenir can be part of trip to homeland

Immigrants at risk for disease on return to native country

September 01, 2006|By Stephanie Beasley | Stephanie Beasley,Sun reporter

Kishor Gheewala has lived in the United States for more than 30 years.

Throughout those years, the 63-year-old native of Bombay (now Mumbai), had made so many trips home to India that he was confident he knew everything that he needed to take with him and everything he needed to look out for once he arrived. In the past few years, however, he has run into an unwelcome surprise - dysentery.

Dysentery is caused by bacteria and spread through contaminated food and water. Gheewala has had two bouts with the ailment, once in 1998 and again this year.

"What happened to me this time is that I ate some fruit off the street and didn't really wait to wash it off properly," the Hanover resident said.

Since then, Gheewala has been more cautious. "I believe that if there is any precaution that can be taken without any side effects or risk, then I will take them," he said.

Yet, Gheewala may be unusual in his vigilance.

Doctors say it's common for immigrants to return to their homeland without taking the precautions that other visitors would. Most think that since they have already been exposed to the region's parasites, viruses and bacteria, their chances of catching something are marginal.

"Some people think that just because they lived in that country, they are not at risk," said Dr. Michael Zimring, director of the Center for Wilderness and Travel Medicine at Mercy Hospital and co-author of the book Healthy Travel - Don't Travel Without It. "Say someone who left a country goes back 10 years later - they are just as much at risk as anybody else."

The Center for Immigration Studies in Washington estimates the U.S. immigrant population at 35.2 million as of March 2005. Many of these immigrants return home for visits that could be dangerous.

India, for example, may expose travelers to several mosquito-borne diseases, including malaria, dengue and chikungunya. In fact, malaria is endemic to more than 100 countries visited by more than 125 million international travelers per year, according to the World Health Organization. Malaria symptoms include fever, chills, headaches, muscle pains, nausea and vomiting.

More than 10,000 travelers report infections after returning home, but WHO officials say the actual number infected is closer to 30,000.

A majority of the cases in a 1994 malaria outbreak in Maryland were attributed to immigrants returning from recent trips to their native country. Health officials call these trips VFRs (visiting families and relatives), and the federal Centers for Disease Control and Prevention lists specific cautionary advice on its Web site for travelers in this category.

Although residents of malaria-prone areas may have suffered repeat infections and built up an immunity to the disease, health officials say they don't realize that they lose that protection over time when they move to the United States or other countries where they are no longer exposed.

"I think that the public health clinics have to take some responsibility, because they are also guilty of these preconceptions," said Kip Baggett, a medical epidemiologist for the CDC.

Precautions for travelers to malaria-infected areas include taking anti-malarial medications and wearing a bug repellent with DEET.

"You have to consider the second generation that is brought up in this mindset," said Baggett, who notes that immigrant parents should be aware that their American-born children are at the same risk of contracting disease abroad as any other children.

Another disease that threatens travelers regardless of previous exposure is dengue. "Dengue is probably more dangerous than malaria right now," said Dr. Robert Edelman, director of the University of Maryland's traveler's clinic in Baltimore.

The clinic holds monthly consultations to advise travelers what vaccinations are necessary for their destination countries.

Edelman said that there are four strains of dengue, which means that even those with previous infections or exposure run the risk of being reinfected if they come in contact with another strain. "If you got infected with `dengue one' when you were in Nicaragua and you go back and `dengue two' is circulating, you're just as likely to get a serious dengue infection," he said.

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