We are NOT authorized by Govt of India for Yellow Fever Vaccination

Friday, November 20, 2015

Everything You Need to Know About Visiting a Travel Clinic

Until recently I had never visited a travel clinic. But after going once, I'm a convert, and from now on will always go before I take far-flung trips.
After going to Thailand and meeting a handful of people with friends who had contracted malaria on their trips, I vowed to start making a visit to the travel clinic part of my pre-trip prep work before going to developing or at-risk countries. So, when I recently traveled to Colombia I decided to follow through on this promise. When I researched online and checked out the CDC website, I found mixed opinions on whether to get certain vaccines. I knew what to do next: get a professional opinion on what exactly I needed for the areas I was headed.
I contacted my primary care doctor, who referred me back to the CDC website, and after explaining that I'd already done the initial research, they decided to schedule me for a yellow fever vaccine. However, the yellow fever vaccine at the time was on a national back order, and my primary care doctor would not have it in enough time to administer it before my trip. The wild-goose chase to find a yellow fever vaccine led me to the Harvard Vanguard Travel Medicine Department.
I made an appointment a little over a week before my trip. When I arrived, I met with a nurse who asked which areas I was traveling to and went over my immunization chart they had from my primary care office. Shortly after, the doctor came in and handed me a thick folder with information I didn't even know I needed. She went over the Travax Traveler Health Report for Colombia, which included health concerns, requirements for entry (i.e. necessary visas, immunization requirements—some countries require proof of a yellow fever vaccine for reentry if you've been to Colombia), recommended immunizations, travel advisories, general information (i.e. entry and exit fees, currency, unusual laws, driving laws, civil unrest warnings), embassy contact information, basic preventative measures, and finally a pre-travel checklist. Access to Shoreland Travax reports are restricted to licensed professionals only, so you can only receive this information at a clinical visit.
We also went over a detailed map of the country with at-risk areas for yellow fever and malaria and determined I should take malaria pills and get the yellow fever vaccine since I was going to a national park. She also recommended I get the typhoid vaccine, since mine was outdated and gave me a prescription for traveler's diarrhea medicine, since most areas in the country are at high risk.
She also helped me register in STEP (Smart Traveler Enrollment Program) and verified my travel insurance coverage through work with GeoBlue. I also got a handy over-the-counter travel medicine/product list to keep for future travels.
Overall, I had a surprisingly pleasant experience and will make sure to visit the clinic before any travels to developing countries or destinations where I am unsure of what health and safety precautions I should take.

Things to Consider Before You Go

The CDC website is a good place to start; however, the amount of information can be overwhelming and sometimes vague or conflicting. If your primary care office has its own travel medicine department, call them first and see what they recommend. In some cases (like mine) you may end up needing additional vaccines or prescriptions, so having an appointment or consultation is best in person so the doctor can order everything you need at the time of your visit. If your primary care office does not have a travel medicine department, call around and find a clinic covered by insurance in your area, as consultations and vaccines can be pricey if not covered.
Keep in mind that some vaccines can take up to six weeks to be active, so you will need to make your visit well in advance (something I will make note of for my next trip). Also, some vaccines cannot be given at the same time, or need to be given in doses, so it's extra important to give yourself plenty of time in advance for the necessary vaccinations.

What to Bring With You

A copy of your itinerary or at least a list of places you are going to as well as an updated immunization list if you are visiting a clinic outside of your primary care office. Also make sure to notify the clinic of any allergies, especially to medications.

What to Expect

My visit was short and sweet. I got all of the information (and more) that I needed. My two shots were administered at the time of my visit and I filled out a card to keep with my passport verifying I had the yellow fever immunization.

Preparing for Your Trip

In addition to any prescriptions needed, this basic list for health and safety comes in handy for international travel:
  • Antihistamines: Benadryl, Zyrtec, or Claritin
  • Pain/Fever Relief: Asprin, Ibuprofen, or Tylenol
  • Insect Repellent: 30 percent DEET spray, and permethrin clothing spray
  • Anti-Diarrhea and Rehydration: Loperamide, Pepto Bismol, Pedialyte powder packets, Gatorade powder packets
  • Probiotics: Culturelle
  • Motion Sickness: Meclizine
  • Other Supplies: Hydrocortisone cream, flight compression socks, digital thermometer, bed net for mosquitos

After Your Trip

Make sure you take all of the recommended doses of your prescriptions, as oftentimes it's necessary to take them for a few weeks after travel. Watch for any signs of diseases, as symptoms can have delayed onset.

More from SmarterTravel:

Ashley Rossi is always ready for her next trip. Follow her on Twitter and Instagram @ashley_stravel for more advice on travel hacks and destination ideas.
Find Related Stories: Ashley Rossi, health and safety
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Monday, November 16, 2015

Current status of Polio in Nigeria - no longer on the endemic list - Nov 2015 (CDC)

Polio in Nigeria

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

What is the current situation?

The latest wild poliovirus case in Nigeria occurred on July 24, 2014. Because more than a year has passed since this case occurred, the World Health Organization has removed Nigeria from the list of polio-endemic countries; only Afghanistan and Pakistan remain. According to Global Polio Eradication Initiative, one vaccine-derived poliovirus case was identified in Nigeria in May 2015. Vaccine-derived poliovirus can circulate in areas with low coverage of oral polio vaccine (OPV).
CDC recommends that all travelers to Nigeria be fully vaccinated against polio. In addition, adults who have been fully vaccinated should receive a single lifetime booster dose of polio vaccine. (Inactivated polio vaccine [IPV] is used in the United States instead of OPV. IPV does not contain live virus, so it cannot cause vaccine-derived polio.)

What is polio?

Polio is a disease caused by a virus that affects the nervous system, and is mainly spread by person-to-person contact. Polio can also be spread by drinking water or other drinks or eating raw or undercooked food that has been contaminated by the feces of an infected person.
Most people with polio do not feel sick. Some people have only minor symptoms, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. Most people recover completely. In rare cases, polio infection causes permanent loss of muscle function in the arms or legs (usually the legs); if there is loss of function of the muscles used for breathing or an infection of the brain, death can occur.

What can travelers do to prevent polio?

  • Get the polio vaccine:
    • Ask your doctor or nurse to find out if you are up-to-date with your polio vaccination and whether you need a booster dose before traveling. Even if you were vaccinated as a child or have been sick with polio before, you may need a booster dose to make sure that you are protected. See individual destination pages for vaccine recommendation information.
    • Make sure children are vaccinated.
    • See Vaccine Information Statements (VIS) for more information.
  • Eat foods and drink beverages that are considered safe: Follow the Food and Water Safety tips to avoid eating or drinking things that could be contaminated with polio.
  • Practice hygiene and cleanliness:
    • Wash your hands often.
    • If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
    • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
    • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Traveler Information

Clinician Information

All travelers to any country should be up-to-date on routine vaccinations, including polio vaccine. CDC recommends a single lifetime IPV booster dose for travelers to certain countries. See the Vaccine section in Chapter 3, Poliomyelitis,CDC Health Information for International Travel, for specific vaccination details.

Additional Information

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The world is running short of yellow fever vaccines—and millions are at risk

Until the early 20th century large epidemics of yellow fever erupted routinely in Africa, Europe and the Americas, killing hundreds of thousands. The viral disease, spread by a mosquito, is fatal in about 20% cases—making it a serious threat for about 900 million people living in the 45 countries where the virus is present. While yellow fever cannot be eliminated from the wild and there is no cure for it, immunizing at least 70% of the population in at-risk areas effectively eliminates the risk of outbreaks, a goal that had been reached in the decades following the introduction of the vaccine in the 1930s.

The immunization coverage, however, has not been maintained, and there are currently an estimated 200,000 cases of yellow fever ever year, with 30,000 deaths. Of 17 high-risk countries, 14 are in Africa, where 90% of the cases and deaths occur, while between 1933 and 1961 the high vaccination coverage had successfully wiped out the epidemic in West and Central Africa.

The resurgence of yellow fever in Africa is a classic tale of complacency: not only the routine immunizations aren’t kept up with the required levels, but the vaccine supply doesn’t match the world’s requirements.According to UNICEF (pdf, p.2), the world needs about 64 million yellow fever vaccine doses, but only 35 million are produced—42% under the required quantity.

In 2003, an emergency stockpile had been created by the World Health Organization (WHO) and the Global Alliance for Vaccine and Immunization (GAVI) to provide six million emergency doses per year. The quantity, however, is not enough to make up for the shortage of doses—nor is the role of an emergency stockpile to routinely make up for the lack of production.

While highly effective—a single dose protects 99% immunized patients for 35 years or more—the yellow fever vaccine is relatively complex to produce, and there are currently only four facilities—in Brazil, Senegal, Russia, and France—equipped with the required technology.

Orin Levine, who directs the vaccine team of the Gates Foundation points out the situation is rather telling of the general attitude towards diseases that are being kept under control through, albeit in need of continued immunization efforts. “Nobody was looking after it until we didn’t have as many doses as we needed,” he told Quartz.

The good news, however, is we’re still in time to fix this—and with a relatively small investment. Just recently, Levine said, the Gates Foundation has invested to both ensure the lifeline of the Institut Pasteur de Dakar, the manufacturer of vaccine in Senegal, and to increase the dosage: “$1.6 million—that’s all it took to help maintain the supply,” Levine told Quartz.

It’s a good first step, but not enough to successfully solve the shortage—until the supply exceeds the world demand of vaccines, and the system is equipped to produce enough doses even in extreme cases (for instance, if one factory closed), the alert needs to stay high.

Sign up for the Quartz Africa Weekly Brief — the most important and interesting news from across the continent, in your inbox.
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Mosquitos Are best repelled by DEET

A recent study concluded that while DEET is the best way to repel mosquitos, an Eau de Parfum from Victoria’s Secret was also an effective option.
Published in the October edition of Journal of Insect Science, the work was done by researchers from New Mexico State University’s College of Arts and Sciences, who were looking to proof the efficacy of mosquito repellents.
The research team took 10 commercially available products and put them to the test against the yellow fever mosquito (Aedes aegypti) and the tiger mosquito (Aedes albopictus), both known to transmit diseases.
“People need to protect themselves, especially if they travel to the tropics,” said Immo Hansen, an NMSU associate professor of biology when discussing the study with the New Mexico State University’s website, “Insect repellents can be highly efficient, but you need to find out which work.”
The testing included three sprays that use diethyltoluamide: Repel 100 Insect Repellent, OFF Deep Woods Insect Repellent VIII and Cutter Skinsations Insect Repellent — as well as four DEET-free options: Cutter Natural Insect Repellent, EcoSmart Organic Insect Repellent, Cutter Lemon Eucalyptus Insect Repellent, and Avon Skin So Soft Bug Guard. According to the study, while “DEET is considered a very safe repellent… fear of possible side effects of DEET and general chemophobia has resulted in the development of a multitude of “DEET-free” mosquito repellents.”
To test the products, a volunteer placed a hand at one angled end of a Y-shaped tube — at the far end of the same tube was a chamber holding 20 mosquitos — with the other Y branch a free space.
Once the helper’s scent was fanned toward the chamber (as mosquitos are attracted to lactic acid and octanol, components of human sweat), the target hand was anointed with each of the repellents in question. Once the test began, the mosquitos were watched to see if there was immediate and eventual biting over a four-hour period, with observation points at zero minutes, 30 minutes, 120, and 240 minutes.
A repellent-free hand was used at first — which drew 61 percent of the 20 yellow fever mosquitos, 41 percent of the tigers.
Of the applications that followed, the DEET-containing sprays OFF Deep Woods Insect Repellent VIII, Repel 100 Insect Repellent, and Cutter Skinsations Insect Repellent were the most successful. All three kept both the yellow fever and tiger mosquito biting under 20 percent as late as 120 minutes into their tests, and Repel 100 took the prize by scoring a bite percentage of 14 at the 240-minute mark.
On the other hand, the four DEET-free options tested (Cutter Natural Insect Repellent, Cutter Lemon Eucalyptus Insect Repellent, Avon Skin So Soft Bug Guard, EcoSmart Organic Insect Repellent) were all subject to an over-50 percent yellow fever mosquito biting by the 120 minute post—save the Cutter Lemon Eucalyptus, at only 13 percent. Additionally, all four non-DEET options were subject to tiger mosquitos biting under 25 percent at two hours — except for Cutter Natural, which was recorded to have a 120-minute mark biting percentage of 37.
As for the final three test subjects, an AgraCo Technologies vitamin B1-based Mosquito Skin Patch, Avon brand Skin So Soft Bath Oil, and Victoria’s Secret Bombshell perfume — it was the patch that was recorded as least effective, with 48 percent of the yellow fever and 34 percent of the tiger mosquitos recorded biting at 120 minutes. Skin So Soft saw 43 yellow fever/ 36 tiger at that same mark — but as for the “Bombshell” perfume, only 18 percent of the yellows and 17 percent of the tigers were biting at that point, making it (in this study) statistically effective.
The Victoria’s Secret website describes the fragrance as “Sexy today, sexy tomorrow, sexy forever.”
To a mosquito? Maybe not so much.
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