by Dr. Pitt Reitmaier Tropical Hygiene and Medicine
We will be happy seeing you travel back home, sun tanned, content and healthy, after a fulfilling vacation in Cape Verde. The risks are few, most of them easily controllable, if you knew them before and followed basic rules to avoid them or to mitigate them by seeking and finding the appropriate solution in time. No doubt, the tourism industry rightly underpins that no mandatory vaccinations are required and that a modern health service system cares for local people and travelers on all islands. Nevertheless, Cape Verde is a poor country with many limitations. Some additional information to travelers from industrialized countries makes sense: infection risks, especially from water and food are higher intervention capacity is lower there is no search and rescue system in the mountains After having spent holidays in a tropical country, one in four travelers looses a day of work or more due to a health problem acquired there.
Epidemics are rare in Cape Verde and even a devastating Cholera-epidemy in 1995, short outbrake of Polio in 2000, the Dengue-fever outbreak in 2009 and Zika-Virus in 2015/16 did not affect tourists. Endemic diseases are of higher importance for travelers.
In the second half of 2017, an outbreak of epidemic malaria in the capital of Praia on Santiago island is a problem requiring special attention and prevention. None of the other islands is affected. See below
Hepatitis A and B are frequent. Children in Cape Verde are vaccinated agains, while their European and american peers normally aren´t! The following website reflects the actual epidemiological situation worldwide: www.fit-for-travel.de
All preventive measures can be taken over by your family practioner. In case you get to Cape Verde via a country where yellow fever is present, you need a yeallow fever immunization. Youl get it at an institute or tropical medicine or at the clinic of a specialist in tropical medicine. Your local travel-agency knows where to find one.
An Overseas - Travel Insurance, covering risks outside the European Union and an emergency flight back home, is highly recommended. Standard mandatory health insurance contracts do not include those benefits!
Standards of Public Hygiene, especially the drinking water supply, sewage and litter removal and nutrition hygiene continue on lower levels than in the countries most visitors come from.
Awareness and improved personal hygiene can compensate for good part of the risks.
Granma's rules of everyday hygiene
are perfectly appropriate in resouce-constraint settings:
make friends with every Aircraft-Carrier for
lice, bugs and flees (dogs, cats, guinee-pigs)
shoes (injuries, hookworm and chiggers)
camping! Where a goat has died of Anthrax
50 years ago, there still are spores
in the ground.
bathing water for small children
use baby bottles or dummies
Granma's nutrition hygiene rules
are as valid: Cook it,
Peel it of Forget it!
fruits you can peel
salad and fruits in desinfection solutions
(the easiest is chlorine)
done (port. bem passado)
pasteurized cheese and milk only(Brucellose, Tuberkulose)
sea-fruit and crustaceas when you are
not sure that they haven't spent weeks
in deep frezer with blackouts.
Drinking Water Desinfection
All kind of drinking water must be desinfected before use.
Water imported or loacally produced in plastic bottles looks great, but according to studies from Europe and the US, they are not perfectly safe! Frequently they are infected while filling. Refilling is not considered a crime or bad service in poor countries. And they are a horror to the environment. In the sea they survive for centuries, are eaten by turtles and see-birds. Tourism demands for 40 Million+ bottles per year to Cape Verde alone. A change of attitude is an emergency! It is not sufficient to blame your neighbour.
Desinfection with Lixivia (chlorine) or Silver Nitrate
Chlorine is the best know and most economic means to desinfect chemically surface- or tank waters to prepare them for human or animal ingestion.
A droplet dispensing device as used for eye-drops, filled with chlorine (Lixivia)1) lasts for months and guarantees safe water and fruits at any time in any place.
Lixivia is the common name for a variety of brands of chlorine solution. It is mainly used for washing clothes and desinfecting surfaces in bathrooms etc. Household packs are much too large for travellers needs. Best practice is to bring an empty droplet bottle with you, ask your B&B owner to fill it for you.
1) Katadyn markets a mix of chlorine and silver nitrate under the name
Micropur Forte flüssig® .
One droplet bottle is good for 1000 Liter of water.
Lixivia / Liter Water
|Preparing clear water from a spring or household tank for drining / bathing small children
|Washing of fruits, salad etc.
rinse after washing with drinking water
Prevention and treatment
is caused by the oral intake of substances polutec by feces of other peole or animals. It can provoce symptoms ranging of from noisance to life-threatening. Almost all travellers diarrhoea can be prevented by the simple rules and means of hygiene!
The objective of diarrhoea-treatment
is not to stop the diarrhoea immediately, but to keep water and minerals in the body in a balance. This is done by Oral Rehydratation and the least of interruption of diet !
Drugs for prevention and treatment of diarrhoea are little convincing in their principles and in their effects.
- Drugs imobilizing the colon like Imodium® are a good means to overcome the nervousness of an exam day in university. In the case of an infectious agent causing diarrhoea, they mean hindering the self-cleaning mechanism of intestine. In salmonella infection, this may lead to perforation of the guts, a severe surgical complication. While in Europe considered counter-indicated and forbidden to prescribe to small children, in poor countries the substance is heavily marketed and sold over the counter.
- Desinfectans and antibiotics without previous laboratory tests and microscopy of the stool, are not likely to hit the nail. It is not recommended to take the risk of drug-resistance and allergy without knowing about the efficacy of the drug taken.
- Vegetal coal and so called adstringents do not have any effect beyond the "cosmetic" change of viscosity of feces.
- Yeast-preparations promise to out-compete pathogenous germs. There is not a single study providing suffient evidence for the assumed protective or therapeutic effect.
Orale Rehydaratation Therapy, starting after the first liquid defecation,
however, is always right and important. It is the only intervention to prevent and treat dehydration. In small children it is life-saving!
- Rehydration-sal-packages (port.: ORALITE) are available in pharmacies (port.: farmácias) and all health facilieites. They are easily prepared with drinking water. Who travels with small children, always should carry some of the packs.
- Ricewater is even better in its efficacy, but the preparation is more difficult to manage and takes longer time
A good spoonfull (the big one for the soup) of (grinded) rice in one Liter of Water and half a tea-spoon of salt are boilt for an hour - refill to 1 liter.. The greyish solution, after cooling down, is taken in large amounts. To have enough for a night, it is wise to prepare 2-3 liters. The capeverdian owner or employees of your hotel also knows how to do.
tend to be more counterproductive than helpful. Most of them reduce just the defecation frequency by reducing food intake. Others are stool-cosmetics in the sense to change the viscosity of the stool. Patients, and this applies to children as well, are allowed to take up frequent small meals and sweets if they want so. To keep body fluids and energy household balanced is paramount! A little malabsorption of a little food is better than no malabsorption of no food!
Chronic-Diarrhoea / Dysentery
In the case of chronic diarrhoea ) (for more than 3-4 days) or whenever there is blood in the stool (dysentery), see a doctor! This kind of diarrhoea requires microscopic and lab exams and must be treated spedifically. After return, patients should see a specialist.
General preventive measures
Cape Verde has more days of sunshine than the desert of Arizona and there is virtually no shadow if you don't bring it with you! Sun Creams with a protection factor of 30 and Lipsticks of 30+ are the right ones. As you hardly ever find them in Cape Verdean shops, purchase them at home.
A hat or cap
must sheeld the face and resist strong winds. For hikers, a white tissue over the neck is a useful asset.
There are no mandatory vaccination except the rare case of sombody coming from a yellow fever country (e.g. Angola, Senegal) directly to Cape Verde. Routine-Vaccinations against Tetanus, Diphteria, Pertussis and Polio should be controlled and freshed up if neede. Please remember that most of those "childhood"-diseases have a worse impact on the adult! Vaccinations agains Typhoid and Hepatitis A and B as well as BCG against Tuberculosis are highly recommended for backpackers working or living with the the local popuation. 10 years after the last inoculation, the latest, update shots are needed. BCG last life-long, oral typhoid vaccines 3 years. If you never had completed your vaccination schedule in childhood, what is not so rare in the generations born from the 1960th onwards, you should close this gap. Several different vaccines can be applied the same day without additional risks, but in order to be protected, some vaccines require a second or third shot after one months at least. Some vaccinations depend on previous lab test. The complete process might take several months, so please see your GP in time! For none of the recommended vaccinations and a prophylaxis you need to go to an institute of tropical hygiene or medicine. Your GP can perform them all.
Ebola Virus Disease EVD
There has never been a case of Ebola in Cape Verde. During the epidemic in West-Africa (2014) flights were cancelled and ships coming from ports in the affected countries were kept rigorously in quarantine.
Dengue-Fieber - Dengue Hemorrhagic Fever
see: Dengue-Chigungunya in Cape Verde
is considered endemic in the South of Santiago Island, concentrating in Praia town. The low incidence does not justify to recommend routine malara prophylaxis with antimalarial drugs for all districts. A similar number of importet cases from the continent does not start epidemics because the mosquito population is predominantly zoophil. In 2016, 47 autochtonous and 28 imported cases were observed.
I the second half of 2017, a cumulative number of 425, 407 autochthonous and 18 imported cases, were registered until 5ht of November, exclusively in in the city of Praia. October, so far, was the of most intensive month of the epidemic and in early November it continues on a slowly reduced speed. Recommendations:
- CDC Atlanta recommends for travelers to the city of Praia on Santiago Island, to take antimalarials for prevention. Effective antimalarial options include atovaquone-proguanil, doxycycline, and mefloquine. Pregnant women are not recommnded to visit Praia District. Contact a specialist for tropical diseases and your gynaecologist.
- avoid mosquito-bites
- wear light-coloured long trousers and long-sleeved blouses, shirts and socks.
- use mosquito nets, mosquito coils and air conditioning
- Apply repellents throughout the evening and night
The strain of the malaria parasite plasmodium falciparum is higly resistant to Chlorquine and other anti-malarials. In case a person fall sick with heavy fever, headake, backpain and other unspecific symptoms, the diagnosis must be done and treatment started immediately, as plasmodium falciparum is able to kill within 24 hours after onset of the first symptoms! There is no time to loose! The interval between the mosquito-byte and the first symptos is 7 to 14 days (in average 11 days). Under certain circumstances, like an unspecific treatment with antibiotics, initial symptoms might dwindle and the lab test become negative for weeks or month before they return.
Falling sick (high fever, body-pain and headache) within a year after a stay in Santiago or after a (however short) stop over on the african continent (Banjul, Dakar), please INFORM YOUR PHYSICIAN THAT YOU HAVE TRAVELLED TO MALARIA REGIONS!
HIV / AIDS
Sero-prevalence in the population is on a similar level like in western Europe. Well-performed intersectoral control-measures, aiming at a change of attitude especially of hight-risk groups (prisoner, prostitutes and others) the number of new cases got well reduced. There is no reason to panic if travelers find out, they are staying with infected people in the same houshold.
- in everyday life, without sexual contacts, there is no infection risk, even when living together very closely.
- Blood and blood products used in emergency surgery are controlled and safe.
- Immunizations, emergency treatment and dentist tretment is also safe as one-way material is used.
The number of male and female Sex Tourists in Cape Verde has increased with beach tourism. Prevalence of all kind of sexually transmitted infections among prostitutes of both sexes is hig. Even higher it is among those nice boys and girlies at the beach and next to the sailing harbour, discos and everywhere where tourists are. Sexual contacts between globetrotters are also quite risky. Finally, there is a risk everywhere, and the hope for a lower risk is the mother o infection.
The only logical consequence:
Use condoms and avoid practices with direct mucousal contact. Condoms (crioulo: camisinha) you find in Pharmacies (Farmácia) and in Reproductive Health Centres, called PMI.
Babies and Toddlers
should follow the vaccination calender of their home country with one exception only: Measles vaccinaton should start earlier - from the 10th month onwards! It Europe it is recommended for the 13th month of life. The likelyhood to acquire measles in Cape Verde today is low, but in other developing countries very high. There it continues to be a prime cause of mortality and blindness. Important to know that a good nutritional status does not protect a child from severe measles!
The debate about immunization in Europe is mainly about side effects. Nevertheless, risks for children not vaccinated are uncomparibly higher! Parents taking their children without full vaccination to subtropical and tropical destinations do act to their detriment!!
Diarrhoea in early childhood
is more dangerous than for adults.
- start Oral Rehydration Therapie after the first liquid defecation
- Continue breast-feeding
- Continue to feed the child
- in case of loss of consciensness, unability to swallow or other serious symptoms, taking the child to a health centre or hospital without delay
Desinfection of water for bathing
is a useful logical element of prevention as small children tend to swallow large amounts of water when bathing.
Nappies or Diapers
Paper and plastic diapers are found in all shops. Their disadvantage in hot climate is that they form a humid chamber and provoce skin eruptions and infections. Take a few cloth diapers with you!
Toddlers Ready Meals
The offer is small and it is recommended to check the validity dates! People still know how to prepare within minutes a porridge from maize flour and vegetables. .
Breastmilk Substitutes (port.: leite fórmula)
can be found in the bigger supermarkets and farmacies. Beware Normal milkpowder is not appropriate for babies! Delay weaning to the time AFTER the voyage.
can be found in any shop. Check the validity dates!
is not sold in shops. If purchased from the producer, boil it to avoid Brucellosis / Tuberculosis.
Feeding bottles and dummies
in resource constraint settings are a hygienic and nutrition desaster and cost the lifes o many babies. Where there is no breastmilk available, even small babies can be spoonfed. The breastmilk substitute is offered from the larger part of a soupspoon. The bigger the spoon, the easier to learn for both, the baby and the mother! The metal spoon is acompanied by an inox mug.
Pregnancy and travelling
Read about the 2017 malaria-epidemic in Praia city. No other islands is affected! See above-
Routine Vaccinations against Tetanus, Diphteria, Hepatitis B, Polio, and Typhoid as well as the passive protection against Hepatitis A by gamma-globulines are possible in pregnancy. Nevertheless, some doubts remain, because topics like this are hardly ever possible to study in sufficient sample sizes, justifying the reluctancy of many medics to apply any vaccine before the 13th week of pregnancy. Active vaccinations like Tbc, measles, parotitis and rubeola are risky and not needed in travel medicine. Yellow fever vaccination can be applied after the 13th week.
see page Zika-Viurs in Cape Verde.
Can pregnant women fly?
Pregnant women beyond the 35th week of gestation and parturients in the first week after delivery are not accepted by the airlines.
Delivery care in Cape Verde
Cape Verde has the lowest maternal mortality rate of all african countries. Maternities are better run and equiped when compared to african standards, but, nevertheless, they stay behind european standards, esecially when it comes to risk-pregnancy and low-birthweight babies.
The world of attitudes and perceptions
changes during pregnancy for the woman herself and for her partner. They tend to become more caeful, wisely preparing for childrearing times, more sensitive and coutious, more responsable and more hesitating. It is a good cultural transition going along with a physiological and social transition in life. If you or your partner have become afraid of a vaccation under unusual conditions, you may experience the challenges of heat, noise, poor higiene and poverty as an over-challenge. In this case it is better to allow for aholiday in your familiar environment, to relax quietly before delivery and early parenthood. There are wonderful destinations at your doorstep!
A little councelling on Alcolhol and Smoking is always appropriate - in antenatal care it is more promissing than ever!
In conclusion, travelling to Cape Verde during pregnancy ist fine:
- if there were no complications to date
- if the woman and her partner are not psychologically overburdened
- if Routine Vaccinations are complete
- if Zika-Virus infection areas are avoided
- if you have no Stop-Over on the african continent
- if you will be back home until the 34th week of gestation
All information to the best of our knowledge and belief - No warranty !
For individual recommendation, please contact your physician!