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Malaria Prevention

Malaria is transmitted by mosquitoes, just as Yellow Fever and Dengue Fever are, and it is considered one of the most severe infectious diseases that travelers could encounter. Likely, most cases of Malaria are preventable! The best methods of prevention are awareness of risk, avoidance of mosquito bits, and chemoprophylaxis (antimalarial medication).

Awareness: Research the area that you will be visiting and determine if there is a risk of contracting malaria. This can be done by visiting the CDCs website or by calling a travel health clinic.

Avoidance: Once you determine that malaria is present in the country you are traveling to then it is time to do some shopping. The best methods of prevention are insect repellents.

– Wear protective clothing (Make sure you cover as must body surface area as possible to reduce exposed skin.)

– Apply insect repellents as directed by the manufacturer (The best insect repellent is one that contains 20%-50% DEET. Other active ingredients that are recommended are Picaridin and Lemon Eucalyptus.).

– Sleep in areas protected by screens and netting. Netting impregnated with a residual insecticide provide the best protection.

Chemoprophylaxis: There are many options when it comes to antimalarial drugs, determining which one will work best for you is dependent on two things: what country you are visiting and your concern with frequency of dosing and potential side effects. The best  way to determine what will work best for you is by contacting a travel health clinic.

If upon return (up to one year after traveling) from your trip you are experiencing any signs and symptoms of illness (example: fever, diarrhea, respiratory illness or rash) please be sure to contact your healthcare provider as soon as possible. It is important to inform your provider of your recent travels to aid them in determining the cause of your symptoms.

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What is Pertussis?

‘Whooping Cough’ is the short answer. Talk to anyone over 50 and chances are, they’ve had pertussis as a child. A real rib-breaker cough as I recall! Before we had the vaccine, there were nearly a quarter million cases a year in the US alone. Vaccine use in the US had brought that statistic to an all-time low in the 1970′s.  Sadly, there are still more than a quarter million deaths of infants and children worldwide because of pertussis. Non-availability, misuse, and underused of the vaccine in undeserved nations leave many without protection against pertussis. It is highly communicable and especially dangerous  for infants with tiny respiratory tracts.  They are unable to clear trapped mucus preventing adequate oxygenation of the infant.  Infants at the beginning of immunization series are not fully immune to pertusis and the bacterium invades quickly, lingers for weeks or more and can lead to very serious complications such as pneumonia, bleeding in the brain, or death. The CDC reports that from 2004-2008 there were 111 deaths from pertussis, and 83% were infants under 3 months of age. (US DHHS Epidemiology and Prevention of Vaccine-Preventable Diseases/Pink Book/12th ed. p.217)

It was previously thought that once you contracted pertussis, a life-long immunity ensued. However, there has been a resurgence of pertussis for several reasons.  First, we now know there was only temporary protection from reinfection. While we routinely immunized children and adolescents with Tdap (Tetanus, diptheria and pertussis), we re-immunized adults with “Td” leaving them vulnerable for pertussis.  Second, disease is only a plane/ship/car ride away and a traveler can be in close contact with an infected individual of any age, anywhere.  Unprecedented numbers of international travelers can transport diseases across continents within hours infecting communities. (Remember H1N1 in 2009?) And finally, some families have opted out of vaccination for their children, leaving their children and countless others around them at risk for contracting pertussis and other vaccine preventable diseases. The World Health Organization and our own CDC has recommended a Tdap for all adults especially grandparents, child and healthcare workers, anyone who lives with or cares for immune compromised folks, and travelers. Ask your primary care MD about pertussis and when you travel call HealthSmartVaccines 703-961-0733 to discuss this and other recommended travel vaccines!

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Hepatitis: Did you know

There are 5 known types of Hepatitis disease. Most travelers are familiar with Hepatitis A & B, the only 2 which are vaccine-preventable…. but what do we know about the others and can we get them during travel?

Hepatitis C is acquired by blood to blood and body fluid contact with an infected person or instrument such as needles shared by drug users. Travelers who use tattoo/piercing facilities, receive blood transfusions or organ transplants from poorly screened donors, or participate in surgical procedures overseas may be at risk.  Usually there are no symptoms, it is lifelong and can result in death. The baby-boomer generation is most at risk along with anyone who may have received a blood transfusion prior to the 1990′s. A blood test can confirm that a person has acquired Hepatitis C. There is treatment available.

Hepatitis D can only occur if a person already has Hepatitis B. Open wounds, blood and bodily fluid exchange with an infected person can result in acute or chronic Hepatitis D for which there is NO treatment.

Hepatitis E is an uncommon virus in the United States. Water contaminated with feces can be common in Africa, Central America, South America and parts of Asia and the Middle East. Hep E can be extremely serious for pregnant women and there is NO treatment.  Travelers should take care to avoid water from unknown sources. Drinking only bottled water, boiling or use of chlorinated tablets is the only way to avoid Hep E.

Hepatitis A is prevalent all over the world. Prior to the vaccine being available in the 1990′s,  it was a very common illness acquired during travel outside the US.  Mild to severe symptoms can occur following ingestion of food or drink contaminated with feces of an infected person. Never assume that other nations have the same strict food handling standards as we do in the US. Eat well cooked foods, stay away from raw salad and seafood unless sure of the source. Drink bottled water. Heat can destroy the virus, freezing does not!

Hepatitis B  Since the introduction of the vaccine in the early 1990′s, there has been an 82% decrease in reported hepatitis B infections in the US. Remarkable! Globally, about 2 billion have Hep B. Most have chronic infection, are carriers and many have died as Hep B can lead to cirrhosis and death. Travelers are at high risk. There may be NO “standard precautions” in facilities outside the US.  Contact with blood and body fluids during sex, medical procedures using contaminated instruments during medical tourism, dental procedures you didn’t expect or accidents in which you are hospitalized and may possibly face blood transfusion from unknown resources. You cannot tell by looking at someone they carry the Hep B virus, therefore BE PREPARED-GET VACCINATED!

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Vaccines REQUIRED or RECOMMENDED?

Disease patterns around the globe determine the recommendation of vaccination prior to international travel. For more than 60 years the World Health Organization has made its health information available to all countries with the goal of identifying, preventing and/or containing vaccine preventable diseases. Many diseases that have been eliminated in the United States and Canada are still prevalent in many countries putting travellers  at risk of acquiring one of these diseases again and infecting those around them upon their return! Public health emergencies of international concern(PHEIC) like Polio in the 1950′s and more recent, the 2009 pandemic H1N1, prompted immediate global response. It was recommended that all U.S. citizens receive the H1N1 vaccine. Travellers are especially at high risk for the seasonal flu and many other preventable diseases. Our CDC makes the recommendations of travel vaccines and health information based on WHO surveillance and reporting of disease as well as risk to our citizens.

Travel to parts of South America or Africa, and you will encounter a requirement of Yellow Fever vaccine prior to entering certain countries. All countries have a responsibility to protect their citizens against a disease like Yellow Fever which could endanger entire populations at any time. The traveller must present an International Certificate of Immunization (ICVP) or face possible quarantine in some countries.  You may be at low risk based on your itinerary, accommodations, or season of travel BUT low risk is not NO risk!  A CDC authorized Yellow Fever center such as HealthSmartVaccines, can provide more in-depth travel health information, recommended or required vaccines and certificate of proof for all vaccines. Call 703-961-0733 for more information.

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Probiotics for Travel

Bacteria almost always gets a bad rap! But there is good bacteria that lives in our intestinal tract, a.k.a. our G.I. tract or less formally our “gut”. It provides a complicated chemical balance in our body aiding in digestion, absorption of nutrients, and even immunity and disease prevention. But sometimes, because of a dietary changes, illness and drug treatment, stress, or chronic disease, the good bacteria balance gets disrupted. We may get a “tummy ache” or have diarrhea as a result. Lately, major medical journals have been reporting some of the preliminary results of years of looking at the role of PROBIOTICS for our intestinal health. Generally the reports are encouraging with very few side effects reported so far. Some of the more well known uses for PROBIOTICS are for prevention of, or, shortening a course of diarrhea in children and adults who are on antibiotic therapy, have genito-urinary yeast infections or chronic bowel disease to name a few. Antibiotics, whose sole purpose is to knockout bad bacteria, doesn’t necessarily differentiate between the good and bad bacteria. The gut may be deprived of the good bacteria upsetting the normal balance; diarrhea can result. We can feel bad, not feel like eating, become dehydrated, and good nutrients may be lost. We must adjust our diet, activity and drug regimen in extreme instances. Most recently, travelers have been the beneficiaries of this good news that PROBIOTICS possibly can prevent or shorten a diarrhea episode. Travelers may experiment with foods grown, fertilized, cleaned and processed, stored and prepared differently than what we are used to. We can be exposed to bacteria, virus’, parasites and other intestinal invaders from food sources during travel. At rough glance, many international travelers have benefited from self-administering the over the counter and inexpensive PROBIOTICS during their travels. Lactobacillus is the most well-known PROBIOTIC. Brands offering protection with many billions of cells of the PROBIOTIC can be found at any pharmacy. Happy Trails!

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Travel Tips

We want your trip to be the best yet. Here are some travel tips we’ve gathered over the years.

  • Get vaccinated at least ONE month prior to travel. Depending on the vaccine, it may take your immune system 2 or 3 weeks to achieve maximum immunity.
  • Carry first aid supplies and all medications in your carry on luggage, not your checked baggage.
  • Contact your health insurance plan and determine health coverage outside the United States. Most policies do not cover international travel.
  • Purchase travel and evacuation insurance. Medical evacuation may cost in excess of $5,000 and difficult to arrange. Evacuation insurers have the resourses to manage the process for you.
  • Be prepared to self manage travelers diarrhea by packing the medications to relieve this distressing event. Consult with your travel health professional or family physician for a recommended list of medications.
  • If traveling to a malaria zone, carry insect repellent, protective clothing and sleep under mosquitoe netting. Consultant with your travel health professional or physician about use of an antimalarial.
  • At this time malaria is NOT a vaccine preventable infection. Avoid contact with animals, especially in rural areas.

 

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Flu Season

Getting a slow start to “flu season”…not entirely unusual…. as we saw in 2013, CDC reported an alarming rise in cases of the flu. The actual map of surveillance can be seen on the CDC website. It is never too late to get your flu shot. Especially true for new parents; newborns have little immunity and can be extraordinarily vulnerable to complications of the flu. Also, if you live with an immunocompromised person, if you care for children, elderly or ill people, its important to protect yourself AND them from the flu virus. Air, land and sea travelers have constant exposure to all virus’, especially the seasonal flu! The pesky virus is spread via droplets from the respiratory system of the infected person by coughing, sneezing, into the air, on to their hands and other surfaces within 5-6 feet of another individual. The virus affects the next victim, you, within 1-4 days! Next thing YOU know, you have sudden aches and pains all over, maybe a fever, a dry cough, sore throat and just want to crawl into a corner for a couple of days of sleep!

Pneumonia, a complication from having the flu, can be potentially deadly for the medically fragile population such as those who live with chronic disease that are still in the work force, surgical patients, cardiac and respiratory compromised persons, the elderly, diabetics, infants and children, just to name a few. Whether these folks are readily identified or not, its a good idea to protect ourselves and those around us. Its affordable, available, safe and highly recommended! Contact us at www.HealthSmartVaccines.com and get your flu shot. If you already have, well, thanks for protecting us both!

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