Online tools can help Doctors aid patients travelling abroad

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Despite the fact that more than 1 billion people travel internationally, few American adults are up-to-date on their recommended vaccinations.

According to the Centers for Disease Control and Prevention (CDC), adult vaccination rates remain low. In 2013, pneumococcal vaccination coverage was just 21.2% for adults aged 19 to 64; tetanus vaccinations were 62.9% in adults aged 19 to 49, 64% in adults aged 50 to 64, and 56.4% in adults over age 64; full Tdap coverage was 17.2%; hepatitis A coverage was 9% for adults overall; hepatitis B was 25%; and herpes zoster coverage to prevent shingles was 24.2%. Additionally, HPV coverage was 36.9% in women aged 19 to 26.

In a new report in the Journal of the American Medical Association, public health experts recommend travelers visit their physician four weeks to six weeks before planned international travel to make sure they have up-to-date vaccinations. Routine vaccinations like those listed above should certainly be up-to-date, but other vaccinations than might not normally be needed in the United States might be added depending on the individual’s travel plans.

Physicians should be sure to question patients planning international travel about their destination, and review possible health and outbreak warnings for that area. For example, yellow fever is an acute haemorrhagic disease endemic in areas of Africa and Latin America that kills about half of the people it infects. Vaccination against yellow fever is highly effective and lasts for life, but must be given 10 to 30 days before travel.

The World Health Organization (WHO) maintains a database that can be searched by country that details the prevalence of vaccine-preventable conditions across the globe.

Travel to Africa and Asia should be most scrutinized in terms of vaccinating against preventable diseases, according to the Council on Foreign Relations, which maintains aninteractive map of vaccine-preventable disease outbreaks around the world. In 2015, there were nearly 200,000 cases of measles worldwide, more than 8,000 cases of pertussis, 2,000 cases of mumps, and 86 cases of polio.

Edward T. Ryan, MD, director of the global infectious diseases program, the tropical and geographic medicine center and the travelers’ advice and immunization center at Massachusetts General Hospital, co-directs GlobalTravEpiNet program, a CDC-supported national program charged with advancing the healthcare of international travelers from U.S.

“International travelers are at risk of acquiring geographically distributed infections and infections that are more common in resource-limited areas of the world (measles, dengue, zika, malaria, Ebola, typhoid, SARs, MERs, influenza),” Ryan told Medical Economics. “International travel not only poses this risk of infection for the individual traveler, but also can lead to the importation of diseases into the U.S.”

Responding to these diseases is expensive and time-consuming, and most importantly, preventable, he says.

“Data suggest that most people do not seek any medical advice and care before they travel, or if they do, they seek it on the Internet or from their primary care provider,” Ryan says. “The CDC recommends that all travelers touch base with their medical provider to make sure their routine immunization are up to date (for example measles, flu, tetanus, and chicken pox), and that travelers to higher risk or resource poor areas consider additional immunizations against typhoid, hepatitis A and yellow fever, if indicated, as well as malaria and diarrhea pills.”

Ryan says international travelers should also receive education on insect bites (dengue, malaria, chikungunya, zika), as well as accidents and trauma (the leading cause of death of healthy Americans overseas).

“Ideally the traveler would seek medical care at least 4 to 6 weeks before their trip; however, significant benefits can occur from even a last minute visit to the health care provider,” he says.

Ryan also recommends travelers utilize the Heading Home Healthy Program and TRhIPtool to learn about risks of travel, and vaccines and medications that they may need. There is also a rapid assessment tool for primary care physicians that can quickly provide travel recommendations based on the patient’s information and destination.

Comments: These are some wonderful and innovative ideas that can help new age doctors help the patients in a fast, cost effective and accurate manner. All travel health specialists should certainly have a look at these resources, and even travelers themselves will find these tools easy to use and quite effective

Dr Nimako: What to know about Meningitis & Yellow Fever - The Ghana Experience

Health news in Ghana over the past 2 weeks has been dominated by the outbreak of meningitis in the Brong-Ahafo Region and Yellow fever in the Northern Region. Both diseases are of high public health importance and we all need to understand them well, in order to be able to better protect ourselves and to allay unnecessary fear and panic.

Here is a briefing about the two diseases.

Meningitis

Meningitis simply means inflammation of the membranes covering the brain and spinal cord (the meninges). This inflammation is usually due to bacterial or viral infections, but may also result from parasitic infections and non-infectious agents like irritation from blood and cancer cells.

In the context of an outbreak, meningitis refers to a bacterial infection of the meninges.

There are many types of bacterial infections that can cause meningitis outbreaks: Neisseria meningitides, which is highly infectious is the major cause of outbreaks, but in adolescents Pneumococcus, which is not as infectious, is a common culprit, like we are seeing in the current outbreak. The term Cerebrospinal meningitis (CSM) is a term reserved for meningitis caused by Neisseria meningitides.

Meningitis is mainly transmitted through the inhalation of respiratory droplets (from e.g. sneezing or coughing) from an infected individual (NB: infected individuals do not necessarily show symptoms; some are silent carriers).

The classic triad of symptoms is fever, severe headache and neck stiffness. Other symptoms are nausea, vomiting and photophobia (intolerance of bright light). Seizures, irritability, confusion and coma may also occur. Complications like kidney failure and bleeding disorders may occur in severe cases. Survivors of severe disease may end up with permanent disability like blindness, hearing impairment and mental retardation.

Diagnosis is through the laboratory analysis of a sample of spinal fluid tapped from the lower back, a procedure referred to as a lumbar puncture.

Bacterial meningitis is fatal without treatment. A delay in initiating treatment worsens the prognosis. Treatment involves the administration of appropriate antibiotics and supportive therapy as necessary.

Vaccination is a potent way to prevent severe infections. The immunization schedule of children in Ghana include vaccination against some of the organisms that cause meningitis. Immunization drives are also organized periodically for vulnerable populations to ensure they are protected, as happened in 2012 in Northern Ghana. There are also vaccines that are deployed during outbreaks with particular strains of Neisseria meningitides to protect individuals in the outbreak zone; this current outbreak is not one such.

Prevention also involves avoiding crowded places, hand hygiene (washing hands regularly and using hand sanitizers) and covering the nose and mouth when coughing or sneezing.

Outbreaks of diseases may occur from time to time, but once we are aware of how to protect ourselves, such outbreaks should not cause much havoc. The ministry of health and its agencies are doing their best to contain the situation; let’s do our bit to stay safe.

Yellow fever

Yellow fever is a viral infection of humans. It derives its name from the yellowing of skin and eyes (jaundice) that occurs late in the disease, when it causes liver damage.

It is transmitted through the bite of an infected female Aedes aegypti mosquito (in most cases), which is different from the Anopheles mosquito that causes Malaria.

In Ghana and other African countries, yellow fever typically occurs in epidemic form.

The outbreaks usually occur in urban settlements near forest areas, since the organism maintains its life in forest primates like monkeys. When an infected primate is bitten by a mosquito and that same mosquito bites man, an outbreak can occur, with the virus spreading from person to person through the bite of the female Aedes aegypti mosquito. This mosquito– unlike the malaria-causing Anopheles mosquito which bites at night– bites in the mornings and early evenings.

The initial (acute) symptoms are fever, chills, muscle aches, headaches, loss of appetite, nausea and vomiting. These symptoms are common to many other infections and this non-specificity in symptomatology makes disease difficult to diagnose in the early stages. This acute phase typically lasts a few days (about 4 days) and resolves spontaneously without complications. This is the case for most of the infections.

About 15 percent of cases will progress to a toxic phase where the virus affects the liver, causing liver damage and resultant jaundice and bleeding- from any orifice. This results in multiple organ failure in about 20% of such severe cases, eventually leading to death.

Treatment is purely supportive- that is, medical personnel manage the symptoms as they arise and allow the infection time to “blow over”. Such supportive therapy may include antipyretics for fever, fluids for dehydration, analgesics for bodily pains and blood transfusions as necessary. There is no cure and prevention is thus very important.

“Vaccination is the most important preventive measure against yellow fever. The vaccine is safe, affordable and highly effective, and a single dose of yellow fever vaccine is sufficient to confer sustained immunity and life-long protection against yellow fever disease and a booster dose of yellow fever vaccine is not needed.” (WHO, March, 2014). The earliest age for vaccination is 9 months.

Survivors of the infection also have lifelong protection from the disease.

Preventing mosquito bites, by wearing protective clothing when outdoors in forest regions, using mosquito repellants and sleeping in insecticide-treated mosquito nets is also important in preventing infection in the non-vaccinated population.

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By: K.T. Nimako (MB ChB)

Dr. Kojo Nimako is a private medical practitioner with an interest in public health, and Citi FM’s Chief Medical Correspondent. He is also the editor of healthbloggh.com and the Executive Director of Helping Hand Medical Outreach, an NGO focused on health education.

Follow on Twitter: @KTNimako

Send an e-mail: kojotwumnimako@gmail.com

- See more at: http://citifmonline.com/2016/01/22/dr-nimako-what-to-know-about-meningitis/#sthash.IgYNFpUw.dpuf

CDC Issues Zika Travel Alert

Pregnant women in any trimester should consider postponing travel to 14 countries and territories in South and Central America and the Caribbean where mosquitos are spreading the Zika virus, the Centers for Disease Control and Prevention (CDC) announced tonight. Viral infection in pregnant women has been associated with microcephaly in infants.

In what it calls a level 2 travel alert, the CDC also advises women who are thinking about becoming pregnant to consult with their physician before traveling to these areas, and if they do, follow strict precautions to avoid mosquito bites. Safeguards include wearing long-sleeve shirts and long pants and using insect repellent.

The 14 countries and territories covered by the travel alert are Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and the Commonwealth of Puerto Rico.

Lyle Petersen, MD, director of the CDC's Division of Vector-Borne Diseases, told reporters at a 7 PM ET briefing that the travel alert couldn't wait until Monday.

"We believe this is a fairly serious problem," said Dr Petersen. "Because there's growing evidence of a link between Zika and microcephaly, we thought it was important to warn people as soon as possible."

Babies with microcephaly have a smaller-than-expected head. They often have smaller brains as well that may not have developed properly. Problems associated with microcephaly, which include seizures, developmental delays, intellectual and motor disabilities, and hearing loss can range from mild to life-threatening.

Microcephaly aside, the Zika virus normally does not cause illness that requires hospitalization or leads to fatalities. Roughly one in five people infected with the virus will develop symptoms such as fever, rash, joint pain, and conjunctivitis. The symptoms usually are mild and last a few days to a week. There is no vaccine to prevent Zika, or medicine to treat it.

Microcephaly Uncommon Here

Of the 14 countries and territories cited in the travel alert, Brazil troubles the CDC the most. The agency said Brazilian public health authorities have identified 3500 cases of microcephaly, some severe and fatal, between October 2015 and January 2016.

Cynthia Moore, MD, PhD, director of the agency’s Division of Birth Defects and Developmental Disabilities, told reporters tonight that this number represented a definite but unquantified increase over the normal incidence of microcephaly in Brazil. The baseline for the condition there, Dr Moore said, is hard to determine. However, even half of the reported cases "would be quite a large increase."

Brazilian health authorities provided the CDC with samples from two pregnancies that ended in miscarriages, and from two infants with microcephaly who died soon after birth. All four mothers said they had experienced Zika symptoms. CDC tests showed that the Zika virus was in the brain of the two full-term infants, and a genetic sequence analysis showed that the virus in all four cases matched that of the Zika virus circulating in Brazil.

Dr Petersen said his agency is working with Brazilian health authorities and other groups to better understand the link between the Zika virus and microcephaly.

Microcephaly is uncommon in the United States, affecting an estimated two to 12 babies per 10,000 live births, according to the CDC.

More information about the CDC travel alert is on the agency's website.

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NDMC to accept online applications for yellow fever vaccines in New Delhi

PTI | Jul 12, 2015, 11.14 AM IST

Around 5,000 people come to the NDMC centre for vaccination annually. The fee for vaccination is Rs 300 per dose.

NEW DELHI: Delhiites travelling to tropical and sub-tropical places in Africa and South America can now apply online for yellow fever vaccination on the website of New Delhi Municipal Council (NDMC).

The online facility was launched last week. Earlier, the travellers had to visit NDMC headquarters to submit applications for yellow fever vaccination, following which the council used to allot them an available slot.

Yellow fever is a haemorrhagic disease caused by a virus of the genus Flavivirus transmitted to humans by the bite of infected mosquitoes.

Though the epidemic is not prevalent in India, climatic conditions for propagation of the virus and vector responsible for transmission are present in the country. So it is mandatory for Indians travelling to Africa and South America to be vaccinated.

Anyone, except for infants upto the age of 9 months, arriving by air or sea without yellow fever vaccination certificate is detained in isolation for upto 6 days if the person has arrived through an airport situated in an area with risk of yellow fever transmission.

"Once the travellers plan their trip, they can apply online and select the earliest vacant slot available. There will be 50 vaccination slots available weekly," a senior NDMC official said.

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It will be a great advantage for travellers to and from S.America and Africa when the online application process will ... Read MoreZokhuma Lushai

Travellers can get vaccinated at the International Inoculation Centre on Mandir Marg in the council's jurisdiction from 2pm to 4pm every Wednesday and Friday.

Around 5,000 people come to the NDMC centre for vaccination annually. The fee for vaccination is Rs 300 per dose.

Travellers can also submit their applications to the Municipal Corporation of Delhi, however, there is no online application process available yet.

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Comment: A traveler who visited our clinic has confirmed that the process works, even though some time is needed in the clinic itself.

Also it must be remembered that the government centers across India generally use an unbranded multidose Yellow Fever vaccination and inject 5-10 people with a single dose. TravelSafe Clinic on the other hand uses only SINGLE DOSE WHO approved STAMARIL vaccine from France, and provides the original sticker of the vaccination on the certificate itself. We have a center in NOIDA that provides Yellow Fever Vaccination in National Capital Region. You can call us at +918010777722 or email noida@travelsafeclinic.com for more information