They're back...

Black flies, mosquitoes and ticks are upon us here in New Hampshire. Although we only have these pests seasonally, they exist year round in many places you may travel to. 

So what’s the best way to protect yourself from bites?  Covering up with clothing and tucking pants in to shoes will help.  But ticks still manage to find you. Using products with 25% DEET or higher also work but have limitations. They need to be reapplied and product duration varies so you have to check the label and make sure you comply with the directions. If you are swimming or sweating, you will need to reapply even more often. They smell and you will want to wash it off when you are no longer worried about the bugs.  

You can treat your clothing to make them insect repellent by spraying on or soaking them with permetherin. Permetherin is a man made version of a natural insect repellant found in chrysanthemums. It is inexpensive and after treatment they are insecticidal for 6 weeks or 6 launderings, whichever comes first.

Recently a new line of clothing has been developed with permetherin impregnated into the fibers that lasts for 70 washing which equals the life of the garment.  Insect shield clothing is available at outdoor clothing companies, travel clothing companies and  on amazon. The clothing is odorless and repels mosquitoes, ticks, fleas and flies. They are a bit more expensive and you will still need to use some insect repellent on your exposed skin but together they provide the most protection.  Remember to also perform a tick check every day and if you find any, remove them properly. 

Malaria in the Bahamas 2012

The Centers for Disease Control and Prevention (CDC) has recently received an official report of a confirmed case of malaria in a U.S. traveler who visited the island of Great Exuma, Bahamas in February and March of this year. The last documented case of malaria there was in 2008.  Malaria control measures and increased surveillance have been started.

If you have traveled to the Bahamas this winter and develop flu like symptoms, especially fever, see your health care provider and tell them you’ve been to a malaria area. You could develop symptoms for up to a year after exposure. Malaria can be detected by a special blood test. Treatment is most effective if started early.  Do not donate blood for a year after possible malaria exposure.

If you are planning on going to the Bahamas, be sure to use insect repellent with 30% DEET, cover up exposure skin and sleep in air conditioned rooms or with screens or be nets. For more info on malaria prevention go to the CDC and www.malariahotspots.co.uk/

I Can't Find My Shot Records

Want to know what vaccines you'll need for your next trip? You will need to know what vaccines you’ve already had first. Don't have a clue what you've had? Here’s some suggestions for trying to find your records.

1. Ask your parent if he/she has any record of your childhood immunizations.

2. Look through any old papers saved from your childhood, such as a baby book.

3. Ask your high school, post-secondary school, college health service, or previous employers (including the military) for dates of any immunizations.

4. Ask all previous health care providers you’ve seen as an adult for a copy of any immunization records they have.

5. If a previous provider is no longer in practice, his or her records may still be accessible. Call the hospital closest to the where the provider was located and ask if they know who has the records and how you might obtain yours.

6. If you’ve been treated in an emergency room for trauma, especially if you had stitches, you may have received a tetanus booster. Write to the hospital’s medical records department and ask for all immunization records.


If you can't document having received a vaccine in the past, you may have to be re-vaccinated. Sometimes blood tests, called titers, can be done to see if you are immune. Receiving extra doses of these vaccines will not harm you but why get extra shots if you don't need them.

Start keeping your own immunization record now. Many health care providers can give you one or you can download an adult immunization record card.
There are even apps for that now, too.

Questions about Vaccines?

Getting shots to protect you from disease when you travel is a big part of a visit to a travel clinic. You may be getting shots for diseases you may have never even heard of before. Your travel health specialist can help you decide which shots make sense for you get based on where you are going, when you are going and what you might be doing while you are there. The Center for Disease Control (CDC) produces handouts called Vaccine Information Statements or VIS’s for every vaccine for kids and adults. These are available in over 35 languages.

VIS explain what the disease is, who should get it, and when it is given. It lists who should not get the vaccine and what the risks and possible reactions might be. This way you can weigh the risks and the benefits and decide how to best protect yourself from vaccine preventative diseases when you travel.

Everything

A traveler, new to our clinic, called me about a month ago and asked me to call in prescriptions for her for malaria without seeing her. She had gone to the CDC web site for Thailand and so knew what she needed. She went to her primary care provider, who gave her the shots she asked for based on what she read on the web site, but he wouldn’t prescribe the malaria pills.

I asked her what she got for this 2 week trip and he gave her hepatitis A and B, a tetanus booster (don’t know what kind), rabies shots and Ixiaro, to prevent Japanese encephalitis. “Did he give you a flu shot? “ I asked. “No.” Then I asked where she was staying and what she was planning to do for activities there.

She asked , “What has that got to do with anything?”

And I said, “Everything .”

A backpacker planning on visiting a refugee camp on the Thailand – Cambodian border has very different needs than the company executive staying at a high end hotel in Bangkok whose needs are entirely different than the couple on their honeymoon at the beaches. The CDC web site is a great reference but it consists of one size fits all information not tailored to individuals.

She was planning a trip with a tour group and visiting the traditional tourist sites. She didn’t need the Ixiaro or the rabies vaccines, which cost her almost $1,000. She’s not sure her insurance company will pay for that, either. She did need a flu shot for that long plane ride during peak flu season, cost $25. So I gave her an appointment where we also discussed jet lag, dengue fever and traveler’s diarrhea prevention, gave her the flu shot and a prescription for malaria and azithromycin for $125.

She’s planning a trip to see her daughter in Peru next summer. She’s planning on coming to us first, for that trip.

Norovirus

It’s in our community now, it’s on cruise ships and it’s in the news. Norovirus is its real name although many people call it the “stomach flu”. And it’s no fun.

It’s well known for its sudden onset of symptoms- vomiting, diarrhea and stomach pain mostly and sometimes fever, chills, and muscle aches. It spreads quickly, especially in crowded enclosed places, schools, cruise ships, and hotels. Some people shed the virus before the onset of symptoms but most at the onset of symptoms and for up to 3 days after. It’s spread by contact with contaminated food, beverages, and by touching contaminated surfaces such as elevator buttons, door knobs, etc.

It hits fast and fortunately doesn’t last long. There is no vaccine or specific treatment. Antibiotics don’t work because it is a virus not a bacteria. The very young, elderly and people with other health issues are more suspect able to complications.

To prevent it, wash your hands! Keep your hands and fingers out of your mouth. If you are traveling take Oral Rehydration Solution packets with you to help you stay hydrated if you get ill.

Now What?

“I just booked a trip to(a great destination outside the USA - fill in the blank)and I
don't want to get sick or injured. There is so much information out there. I don’t want to be paranoid or foolish and I don’t want to spend a fortune. What do I do?”

Research a little first. Get some information about your destination and think about some of the activities you might do there. The CDC web site is compact, user friendly, complete and current. Start a folder either paper or electronic and keep your information all together. Get a current copy of all your immunizations.

Visit a travel clinic before you see your PCP. Travel health is a lot more than just shots. You may need some immunizations and sometimes they must be given in a certain order to be effective. At Travel Health of NH, we review the required, recommended and routine vaccinations and make a plan- which ones you actually need, a schedule to receive them and the least expensive way to do this. You will also get prescriptions for malaria prevention and self treatment of many common travel related health problems individualized for you and your trip.

Get travel health insurance. At least emergency evacuation insurance. Most US health plans don’t cover travel related health expenses at all or very poorly. To compare options go to www.insuremytrip.com. What might seem like a simple problem here, isn’t in many other countries. Accidents and injuries are the leading cause of serious health problems for travelers.

Pack a basic first aid kit. Consider water purification system (SteriPen), sea sickness acupressure bands, analgesics, antacids, think about common products you use that may be nonexistent where you are going.

Make a list of important numbers. Make a file and scan a copy of your passport, include emergency travel health information, past medical history and med list, immunization record, international phone number to report loss or theft of a credit card and email it to yourself. You can access email almost anywhere in the world. There are programs like mail2web.com to retrieve email if you don’t use a major account such as Gmail or yahoo.

Plan ahead, prepare and you’ll have a lot less to worry about when you travel.