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INFORMATION POTPOURRI
It is our intention to update this handout frequently. Please let us know if there is any other topic you would like covered.
NON-INFECTIOUS CONCERNS
General: Carry on your person at all times originals of your passport, yellow fever immunization certificate, credit cards, cash and travelers’ checks. You may wish to use a concealed wallet for this purpose. In your
carryon luggage, pack enough of your daily medications to last the whole trip and a letter from your doctor detailing any medical problems you may have. In your
checked luggage, pack a second complete supply of medications as well as copies of the above documents.
For more detailed instructions on personal safety, access US State Dept.
safety information on our home page.
Altitude sickness may occur in anyone who travels above 10,000 feet (1 meter is about 3 feet) and in those who ascend rapidly to 6000 feet or more. Mild altitude illness may cause self limited headache, loss of appetite, nausea or fatigue. Severe altitude illness usually occurs in those who ascend to 14,000 feet or in those who ascend rapidly
above 10,000 feet, and may consist of life threatening cerebral edema or pulmonary edema. All travelers are advised to limit ascent over 10,000 feet to 1000 feet per day. Trekkers are advised to “hike high and sleep low”. Those who exert at high altitude are more susceptible to altitude illness. Descending immediately at the first
signs of shortness of breath or confusion, regardless of your planned itinerary, may be lifesaving and is the only known effective treatment. Acetazolamide
(Diamox) 125 mg twice daily starting the day before ascent and usually continued until descent has begun is helpful preventive treatment. Diamox should not be used if pregnant, nursing or if allergic to
sulfa.
First aid kit appropriate for your needs might include appropriate bandages and tape for wounds, an elastic bandage, a minor analgesic
(acetominophen or aspirin), bacitracin or polysporin (not containing neomycin) ointment for minor skin wounds, a decongestant
(pseudoephedrine tablets or oxymetazoline nasal spray) for nasal congestion related to allergies or a
cold (especially important before flying), miconazole cream for athlete’s foot or
vaginitis, tweezers for splinter or tick removal, small scissors and thermometer. These products are all available without prescription. You may wish for us to provide treatment for traveler’s diarrhea for you to carry along should diarrhea occur. If you are planning to be more remote, you may wish to prepare a more extensive kit.
A sterile syringe kit may be purchased in our office.
Jet lag may be a problem for passengers on any long flight or a trip which crosses more than two time zones. Be certain that you get a good night’s sleep and are well rested before you depart. East to west travel is more easily adjusted to than west to east travel. The problem is that your internal clock will still be on your old time and your destination is on a different sun time. Avoid alcohol during your flight. Drink plenty of nonalcoholic fluids. Walk in the aisle for a few minutes each hour you are awake. Setting your watch to your destination time when you board your flight and regulating your activities, especially your sleep-wake cycle, according to the time at your destination, are often successful. For east to west travel, it may simply mean that you need to stay up longer. If it is 10 pm or so at your destination, you should consider sleeping for 8 hours or so, even if the sun is shining brightly where you are and you do not feel like sleeping. We can prescribe a mild, short-acting sedative
(Ambien, Sonata or what has worked for you in the past). Since any sedative can cause confusion, it is important that you do not take any sedative until you are safe in your seat and ready to sleep. Consider using devices to exclude sound and unwanted light and especially designed pillows so your in-flight sleep is as comfortable as possible.
Links to up-to-date CDC travel information and traveler products may also be accessed from
the link on our website home
page at http://www.TravelClinicOregon.com.
Medical insurance is available for travelers, as is evacuation insurance. Please
inquire by typing "travel
medical insurance" into the internet search engine Google, or
click the "Medical and Insurance" button on our home page.
Motion sickness sufferers usually know who they are. Scopolamine patches are once again available by prescription. Apply the patch at least 4 hours before being at risk. Please read the patient information in the box. It is VERY important to wash your hands well after applying the patch.
Sun protection with sunscreens (the higher the SPF the better), especially midday (10 am to 2 pm or so), especially during
late spring, summer and early fall, especially in the tropics. Be sure to reapply frequently since the active ingredient may wash off with perspiration.
Travel advisories and warnings from the U.S. State Department about political unrest are constantly changing. You can access the latest information using the link
on our website home
page at http://www.TravelClinicOregon.com
or we would be glad to print a copy for you.
INFECTIOUS CONCERNS
This information is most appropriate for travelers who were raised and received their childhood immunizations in the U.S. The approach might be different or other issues may arise in travelers who were raised outside the U.S., including travelers who are returning to their country of origin. Because of their common prevalence and ready, safe measures to prevent them, malaria and hepatitis A are the most important items in this category.
You may wish to access CDC information regarding disease risk by
destination using the link on our website home
page at http://www.TravelClinicOregon.com or we would be glad to print a copy for you.
Diseases which might be caught overseas may be considered by category of transmission. The
maps and handouts referred to are available in our
office and our website home
page at at http://www.TravelClinicOregon.com.
Food and water-borne (usually gastrointestinal) diseases
Cholera is a diarrheal disease present in most developing countries. It causes massive fluid loss, but is self-limited and responds to fluid replacement alone. The vaccine was ineffective and is no longer available. It is rare to see cholera in travelers from the U.S.
Diarrhea/dysentery: see handout on food/water precautions/travelers’ diarrhea..
Food and Water-borne Diseases and precautions: see the handouts on
food/water precautions, water disinfection and water filters. Good precautions can help prevent travelers’ diarrhea, campylobacter, cryptosporidiosis, E. coli 0157 disease, amebic dysentery, giardia, hepatitis A (and E), leptospirosis, typhoid fever, other salmonella infections, shigella and a variety of worms and other protozoa (“parasites”). See
Hepatitis map
A which is a good map for all of these diseases.
Hepatitis A: See handout and map
A.
Typhoid fever generally exists in the same areas of the world as hepatitis A (the parts of Asia, Africa, Southern or Western Europe and Latin America indicated on map A) for the same reasons: lower standards of public water treatment and sewage treatment. Careful food and water precautions will go a long way towards preventing typhoid fever. We have 2 vaccines. The oral vaccine is preferred because of longer duration of treatment, fewer side effects and lower cost.
Insect-borne diseases
African Sleeping Sickness is transmitted by tsetse fly bite. Use light colored clothing and
Permethrin-containing compounds on your clothing, though they may not be affected much by any insect repellent. See
Chaga’s disease handout and the paragraph below on insect repellents.
Chaga’s disease: see map and handout
E.
Dengue (DENG-ee) or dengue fever is a mosquito-borne virus with no specific, antibiotic treatment, either to prevent infection or after infection is transmitted. It is present in many tropical and temperate areas of the world. The only defense is to use insect repellent when you see flying insects. See
Map F and the section below on insect repellents and in the malaria handout for more information.
Encephalitis, Japanese: Whether to take this vaccine can be a complicated decision to make. The disease may be severe;
the vaccine is expensive and has some side effects. The vaccine is usually reserved for those who will be residing in a risk area for a month or more. Others should rely on insect repellent. See handout and
map J.
Insect repellent should be used whenever you see flying insects in the tropics (even if you have received yellow fever vaccine and are using antimalarial drugs) to prevent other insect-borne illnesses, such as
leishmaniasis, dengue, trypanosomiasis, etc. Travelers to Africa should note that the tsetse fly, the vector of sleeping sickness, can bite through lightweight clothing. Treatment of clothing with permethrin is safe and may be a way to avoid this problem. Permethrin should not be applied to skin, but will survive several washings after application to clothing. See the
Malaria and Chaga’s Disease handouts for more information about insect repellents.
Leishmaniasis: Protozoal disease transmitted by sandfly bite; different forms exist in the Western and Eastern hemispheres. It is not always easy to treat.
Use insect repellent appropriately.
Malaria: see handout and map C-1,
C-1a and
C-2.
Yellow fever: see map
H. Travelers to affected areas should be immunized; those immunized will receive a yellow fever certificate of vaccination.
Diseases caught by contact with other people
Diphtheria: adults should receive a Td booster after having received a basic series of 3 in earlier life, then one every 10 years, especially if you are going to an area with
diphtheria (ask your travel provider).
Hepatitis B: See map
G. Transmitted by sex, blood, needles, birth and close household contact
(eg, living with a family in an endemic area). There is an effective vaccine which could be considered as a reasonable vaccine for anyone in the general population. Health care workers who deal with needles, knives and blood should receive this vaccine and have a post-immunization blood test a month after the third dose to determine whether the vaccine was effective.
HIV disease affected people have special concerns. Please discuss your diagnosis with us and your travel plans with your doctor.
Influenza: see influenza handout reprint of a Consumer Reports
article. Transmission likely occurs readily in airports and airplanes. There have been outbreaks on cruise ships. Getting the vaccine
annually is especially important for travelers.
Measles (hard measles, red measles, 14 day measles) is nearly eradicated in the U.S. and most cases are now imported. However, if you are going to the developing world AND were born after 1956 AND have never had measles disease AND have had one or fewer doses of measles vaccine, you may be a candidate for an MMR or measles booster. There is a blood test to find out if you are immune to measles.
MMR vaccine should not be given to pregnant women.
Meningococcal disease: see map
K. This disease may involve meningitis and/or blood stream infection
which can be deadly or disabling. Candidates for the vaccine are travelers
to central Africa or to Saudi Arabia during the Hajj. College freshmen who
will be living in dorms in the US or in any country are candidates for the
vaccine.
Poliomyelitis (polio) is on its way to being eradicated. Travelers to an area with active polio disease who had a basic series of vaccine doses earlier may wish to receive one last adult booster dose. See
map B.
Rubella (German measles, 3 day measles): Women who may become pregnant AND who have never received rubella vaccine or MMR AND who have not had a blood test demonstrating immunity to rubella should have a dose of rubella vaccine when they are not pregnant.
Sexually transmitted diseases deserve special mention. Limiting sex to a mutually monogamous partner is the best way to avoid STDs including hepatitis B, HIV disease, etc., whether traveling or not. Otherwise, using a condom with a spermicide is appropriate.
Uganda has had extraordinary success in decreasing STDs with a campaign
emphasizing the ABCs of STD
prevention: Abstinence; if you can't do that, Be
faithful; if you can't do that, use Condoms.
Smallpox is no longer a threat except via biological warfare. The vaccine may have substantial side effects if given to the general population and is not available outside government
agencies as of this writing.
Tuberculosis: Those traveling to the developing world may wish to have a skin test for TB 2 months after return. Doing a baseline test before your trip is an option. Factors which would favor addressing this issue include travel to Asia, Africa, Latin America and Eastern or Southern Europe, spending prolonged periods of time in a crowded urban environment, living with a family which may have a member with tuberculosis, trips of several months or more duration or providing medical care during your stay
Varicella (chicken pox): A blood test is available to see whether you are immune. A vaccine is available if you are not immune. Using these tools is particularly important if you have no history of chicken pox OR you may become pregnant OR you will be delivering medical care to children and patients with malignancies or immune suppression, particularly in a hospital setting.
Other topics
“In-country”: If you are going to be more than a day’s travel away from any but the most rudimentary medical care, you may choose to carry presumptive treatment for dysentery and malaria,
as well as updating a Td booster now if it has been over 5 years since your
last (the "five year" guideline). Please see the Food/Water/Diarrhea and the malaria handouts. Rabies vaccine deserves
consideration in these circumstances.
Rabies: Those who will be at increased likelihood for an animal bite, bicyclists and spelunkers are candidates for a rabies vaccine series, as are those who will be away from refrigeration and modern
biologicals. Vaccines are available for effective preventive immunization, either before or after exposure to a potentially rabid animal. Receiving pre-exposure immunization makes
complete post- exposure medical care simpler, less expensive and more available.
Returning travelers from Asia, Africa and Latin America who were not able to control their food and water sources or were in-country for several weeks or more may wish to have a stool checked for protozoa and worm eggs (ova and parasites) upon return, whether symptoms are present or not. Those who have been at risk for tuberculosis transmission may wish to have a skin test for TB
(PPD) about two months after their return. Schistosomiasis, hepatitis A and B can be tested for if a traveler is believed to have been at risk. Absence of fever is a reasonably reliable indicator that active malaria is not present; doing
malaria tests without fever or symptoms to indicate active disease would
not be useful. Travelers who experienced many mosquito bites while in a malarious area are candidates for additional treatment with primaquine to eradicate the liver phase of some malaria species. See the
malaria handout.
Schistosomiasis (Bilharziasis) is transmitted by touching fresh water infested by this microscopic parasite. See
map and handout
D.
Tetanus is transmitted from soil through even small, clean wounds throughout the world. Adults who are not traveling should receive a Td (tetanus toxoid with diphtheria toxoid) booster after having received a basic series of 3 in earlier life, then one every 10 years. Travelers who will be at risk for a moderate to major wound on their trip should have a Td booster even if it has been only 5 years since their last.
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