It Only Takes One Mosquito

Malaria. Not something to which most in the United States give much thought. Sunday, April 26th is World Malaria Day… a day to take a moment to learn and to think about a disease which is prevalent in other parts of the world, but one about which you might know little or nothing.

To much of the underdeveloped and developing world, the parasitic disease of malaria is a disease that is dealt with on a near constant basis. It is estimated that there are 300-500 MILLION clinical cases of malaria worldwide per year. Malaria takes 2.5 million lives every year, many of those the lives of the most vulnerable: the elderly, the chronically ill, and children. For every death from HIV/AIDS there are fifty deaths from malaria. Malaria affects over 40% of the world’s population.

Malaria is a disease which is carried by the female anopheles mosquito from person to person through its “stinger”, which is actually a tube through which blood is “sucked” out of its victim. While having its meal, the mosquito can introduce the protozoa which cause malaria into the body of its victim. There are a number of different organisms which cause malaria: Plasmodium falciparum, P.vivax, P. ovale and P. malariae. The most deadly of these is P. falciparum. Complicating the current world malaria situation is the emergence of drug resistant and multi-drug resistant malaria. At this time, though work continues to find one, there is no vaccine fro malaria.

So, just how much exposure to these protozoa does it take to cause malaria? How many times does a person need to be “bitten” to contract the disease? The answer might surprise you. It only takes one mosquito “bite” from one infected mosquito to cause malaria. Those who live in malarial areas may acquire a level of immunity to various disease (malaria included) to which they are exposed on a regular basis, but many who live in these areas battle malaria on a regular basis nonetheless. Children are especially at risk for malaria as it takes time for this acquired immunity to develop. Even in areas that have a winter when the temperatures are colder and the potential for contracting malaria is decreases, the risk is still present.

Malaria, when identified early and treated appropriately, is completely curable. It is a common misperception that once you have malaria, you always have malaria. Some who have had malaria treated early and well go on the be free of malaria, even to the point where they are able to donate blood. Although there is no vaccine for malaria, there are medications available that are taken prophylactically that disrupt the malarial protozoa’s life cycle and its ability to cause disease. For those who live with the constant threat of malaria, it is not reasonable to take medications to keep from getting the disease. It is only reasonable to take other preventative measures and to treat the diseas when it is contracted. A difficulty of life added to life which is already usually difficult enough. That is “them”.

YOUR life becomes potentially directly affected by malaria when traveling internationally. When traveling to areas where there is malaria, it is an important part of your travel plans to seek assistance from travel health professionals to determine appropriate prophylaxis to help protect you from contracting malaria. While a person who is taking prophylactic medications can still contract the disease, the chances of doing so are decreased dramatically. Anti-malarials when chosen and taken appropriately are very effective. Because of the rise of drug resistance forms of the disease, it is important to get the most up-to-date information on which drug is the most appropriate for your itinerary. All types of malaria medications need to be taken for a time prior to entering a malarial region, the entire time the traveler is in a malarial region, and for a prescribed amount of time after leaving the malarial region. The lengths of times take before and after being in the malarial region will very depending on the type of medication to be taken.

Symptoms of malaria include fever, chills, rigor, nausea, vomiting, loss of appetite, diarrhea, muscle aches, sweating, flu-like symptoms, fatigue and headache. Onset of the diseas is usually between 7-14 days after exposure. For shorter trips, this can mean that symptoms may appear after you have already returned home. Should you develop these symptoms during or after a trip to a malarial area, it is important to be checked for malaria as earlier treatment gives the best outcome. Symptoms can come and go as the parasite goes through its life cycle. Symptoms which might be malaria should be evaluated as such for up to a year or even longer after diagnosis and treatment of malaria, so it is very important to specifically request screening for the disease even though it might seem unlikely to be the cause.

In addition to taking prophylactic medications, it is important to take other measures to protect yourself from insenct bites. There are many other diseases which insencts transmit for which there are no vaccinations or prohylactic medications. Mosquito nets, permethrin-treated clothing, spray insecticides, bug repellents containing DEET, and clothing which covers most of the body are important elements to limiting exposure risk. DEET is not an insecticide. DEET works by making you “invisible” to mosquitoes. The higher the DEET concentration, the longer it is effective. The female anopheles mosquito feeds between dusk and dawn, so even at night, it is most most important to be vigilant in personal protection. There are other mosquitoes which carry dengue fever and yellow fever which bite at other times during the day. It is important to protect yourself around the clock against mosquito and all other insect bites using a number of different approaches. Anti-malarials alone are not enough. DEET alone is not enough. Mosquito nets alone are not enough.

The Travel Health Specialists at Passport Health Colorado will assist you in determining your level of risk and make recommendations for appropriate medications and personal protection to help you keep as safe from malaria as possible. Information is power. The information your Travel Care Specialist gives you is designed to help you be a confident, healthy, and safe traveler.

Please call our offices at: 303-442-8728; 719-387-5528 or at 970-484-2148 to set up your appointment for your journey overseas, and to allow us to serve and help you in determining what your risks would be at your destination.

What can YOU do to help? There are organizations whose focus is on the distribution of sleeping nets, vector spraying, malaria treatment, and the development of a vaccine. Inform yourself. Act. You might not be able to solve the malaria problem for the whole world, but you can help one person, and to that person, their world would be a better and safer place. Find an organization you like and be generous in your support. You could be saving a life.

Written by: Linda R. Norris, R.N.; Nurse for Passport Health Colorado

Our New Fort Collins Office!

We are proud to announce the opening of our new office in Fort Collins, our sixth office on the Front Range.

Our offices are among the over 160 Passport Health offices nationally. The new Fort Collins office reflects the fact that travel medicine clinics are among the fastest growth areas in the health care delivery arena, treating more than 60,000 clients each month.

In all of our offices, we provide destination-specific travel health information and immunizations for international travelers. Our biggest clients include major corporations, universities and non-governmental organizations operating in the developing world.

Our Travel Medicine Specialists administer and prescribe vaccinations and medications recommended by the CDC, WHO, and other world surveillance organizations that constantly monitor outbreaks and other health hazards. Our services include the full range of travel health information and immunizations, anti-malarial prescriptions, protective vaccines for a healthy lifestyle, on-site flu clinics, and on-site immunizations for groups and organizations.

We carry a full line of specialty travel health products including protection kits for malaria, diarrhea, and water purification. Each office has a full stock of all vaccines that are recommended or required for international travel including: pre-exposure Rabies, Yellow Fever, Hepatitis A and B, Meningococcal, Typhoid, Japanese Encephalititis and Tetanus/Diphtheria/Pertussis. We also respond to the community’s need for speciality vaccines that are not necessarily related to travel, including Influenza, Pneumococcal and Shingles vaccinations.

For more information on Passport Health Colorado, visit www.passporthealthco.com or call 303-442-8728.
To reach the new Fort Collins office, call 970-484-2148.

Written by: Erich Kirshner, Passport Health Colorado’s Media Relations Contact (erich@kirshnercommunications.com)

Pertussis: Are You Protected?

What is pertussis? Also known as whooping cough, pertussis is a highly contagious bacterial illness that causes an upper respiratory infection; thick, sticky mucus; and a long-lasting, severe cough. The paroxysmal coughing can also lead to a whooping sound when breathing, vomiting, and broken ribs. The disease can be fatal for infants and very young children who are unvaccinated. In adults, pertussis tends to cause fatigue and a severe cough that hangs on for several weeks or months.

Where is pertussis breaking out? Right here at home. Pertussis cases are on the rise, with over 25,000 reported cases in the US in 2005. A number of schools in the Boulder, CO area reported pertussis outbreaks in the 2005-06 school year; through 2007, Boulder’s pertussis disease rates remained as high as 15 times the national average. Anyone who has close contact with children is at risk of picking up and transmitting this disease to other adults and children. Pertussis is also a risk for travelers to any country outside the United States.

Haven’t I already been vaccinated for pertussis? Children in the US receive 4 doses of pertussis vaccine in the routine childhood vaccination schedule, with the last dose given at age 4-6. That immunity tends to wear off with age. For this reason, a pertussis booster is recommended for teenagers (when they receive their tetanus booster at age 12 or after) and for adults (one-time booster).

Who needs a pertussis booster? Any adolescent or adult under the age of 65 who has not received the pertussis booster previously is a candidate for the pertussis vaccine. Healthcare workers, childcare workers, and those with chronic medical conditions are at high risk from this disease. The pertussis booster vaccine is currently offered along with tetanus and diphtheria boosters, in a combination vaccine called Adacel or Boostrix (TDaP). This vaccine came on the market in 2005. If you haven’t had a tetanus booster since 2005, ask for TDaP on your next vaccination visit.

To schedule an appointment for your tetanus/diphtheria/pertussis vaccine, please call our Passport Health Colorado offices at 303-442-8728 or 719-387-5528.

Colorado Flu News for 2008

Colorado has entered flu season once again. Passport Health Colorado began offering flu vaccine in our offices in September, with a large number of walk-in and corporate flu clinics taking place during October and early November. Flu season in Colorado is generally October – April, with the peak usually occurring in January – February. Some years, however, flu cases have been reported as early as October, so an early flu shot is your best protection.

 

Any child under 9 years old who is being vaccinated against flu for the first time this season will need to receive two doses, given at least 4 weeks apart. All others need a single dose of vaccine. You can expect immunity from your flu vaccine within 2 weeks for 6 months or more. The main side effect from the injectable vaccine is muscle soreness; from the FluMist intranasal vaccine, nasal congestion. You cannot get the flu from either version of the flu vaccine. Some people do respond to vaccination with muscle aches and mild fever; this is a boosted immune response, not influenza symptoms.

 

The 2008 flu guidelines recommend vaccination for the following populations: all children aged 6 months – 18 years old, those 50 and older, all pregnant women, anyone taking aspirin therapy, anyone with a chronic medical condition, anyone living in long-term-care facilities, all healthcare personnel, any household contacts of children under age 5, and those traveling outside the United States to areas with flu activity. The bottom line is that flu vaccine is right for anyone who wants to prevent getting the flu this season or transmitting it to others.

This year’s flu vaccine contains three strains of flu virus that are most likely to infect humans this year. We stock thimerasol-free flu vaccine, as well as preservative-free vaccine doses (which may contain a tiny trace of thimerasol from the manufacturing process).

 

Our offices still have flu vaccine in stock:

 

Pediatric Thimerasol- Free (ages 6-35 months): SOLD OUT

 

Pediatric Thimerasol-Free (ages 3-18): SOLD OUT

 

Adult Thimerasol -Free (ages 18+): AVAILABLE, cost is $25

 

Flu Vaccine(contains thimerasol)- (ages 6 months+): AVAILABLE, cost is $25

 

FluMist Nasal Spray (ages 2-49): AVAILABLE, cost is $40 (Thimerasol-free)

 

If you haven’t received your flu shot this year, please call us to schedule a quick visit at any of our five offices (Colorado Springs, Centennial, Lakewood, Cherry Creek, and Boulder) at 303-442-8729 or 719-387-5528.

 

Written by: Rebecca Sundhagen, RN, BSN; Nurse Manager for Passport Health

Global Outreach and Aid

Recently, we’ve seen an increased number of mission travelers and people who are either going overseas for religious purposes or humanitarian aid. Of those travelers, few have known that vaccines or prescriptions would be needed in order to ensure their safety. And, few knew what health practices prior to leaving the States and while abroad would keep them healthy and safe so they could complete their objectives. Sometimes, as in my own experience, it’s simply caused by miscommunication while planning, the lack of knowledge that anything might be recommended or required, or that the destination is currently an outbreak zone. At other times, it’s due to insufficient monetary access while fund raising. Unfortunately, in this case, health is the first item to be set aside in the long list of other needs. Travelers end up weighing the options of that is the greater need and have to choose between one item or another. Unfortunately many travelers, like me, put themselves at risk by choosing their health as a lower priority need.

I’ve been traveling extensively for the past 10 years, most of that time I didn’t even think about taking care of preventative health needs. It was during my travel to China that I became of the need to look into travel health services prior to leaving the States. In China, I had contracted a parasite from eating fruit. It took two Chinese doctors, one American doctor, a lot of time driving to different locations within China, a lot of money I didn’t really have, and 6 weeks on bed-rest eating only white rice for breakfast, lunch, and dinner till I realized that I should’ve thought about how to keep myself healthy and safe before I traveled. If I had looked into preventative travel health services, I would have been informed of the current in-country diseases and recommendations for preventative vaccines and prescriptions, as well as safe eating and drinking habits and a plethora of other information to ensure that I was educated on how to protect myself, and I probably would not have contracted a parasite. Having to spend 6 weeks out of 3 months, half of my trip, in bed eating very bland rice and not able to go do anything, absolutely ruined my entire trip. Now, I’m a big proponent of seeking medical advice from a professional prior to travel overseas; I have done this on every trip since China and I have not gotten sick in any manner after making it a part of my pre-trip preparation and planning.

Passport Health continually educates the organizations we partner with, as well as the general public, in thinking ahead about the precautions they might have to take in order to be fully prepared before they depart. The cost of treating an illness is substantially higher (sometimes by 10’s or 100’s of thousands of dollars!) than if preventative care had been sought beforehand. For the most part, we are seeing more and more people think ahead and plan the need for protecting their health in with their trip as time moves on. This is a positive trend to be sure.

In short, any time you travel outside of the United States, you will need to seek preventative medical advice for diseases that are in areas where health standards aren’t necessarily what we’ve come to regard as commonplace here. Outbreaks of various diseases occur all over the globe every day. Our medical staff here at Passport Health Colorado specializes in travel medicine. We get daily updates on the latest disease and vaccine news in order to provide you with the most current information possible. We want to ensure your safety in every aspect that we can to make sure that you have an enjoyable and memorable experience while traveling abroad.

Written by: Holly McCluskie, Office Manager, Passport Health Colorado

The Importance of Experience

One of our recent clients, Linda, decided to write a report of how her visit in our office impacted her. She tells of her experience and how the conversation with Becky, a Passport Health Colorado Registered Nurse located in Colorado Springs, helped her identify what kinds of medications and vaccinations she needed for the regions she will be traveling to on her upcoming trip to Malawi and Ethiopia. Click here to read her story and to see how satisfied she was with our Travel Health Nurse Specialist Becky.

Measles Awareness Report

In 2007, when Japanese tourists were restricted from the flight home from Canada due to 1-2 members of the group contracting the measles disease, every person in the 42-person group who did not have a record of being vaccinated for measles had to be quarantined for 3-5 days before being allowed to complete their trip back to Japan. In 2004, 25% of students contracted measles while on a trip to India and the containment efforts have been estimated to cost $142,452 (Dayan GH, Ortega-Sanchez IR, LeBaron CW, et al. Iowa, 2004. Pediatrics 2005; 116:e1-e4).

Due to low vaccine coverage in areas with high reports of the disease and the increase of tourism travel to these areas, eradication programs continue to be complicated and face resistence. Many people aren’t fully aware of the disease itself, much less the need for vaccination against it. Even in the United States, measles are starting to outbreak due to people who have not been properly vaccinated coming back from overseas travel to areas where the disease is prevelant. The latest report of outbreak is ongoing in Arizona and is linked to importation; the alert was sent on April 3, 2008 via a Health Advisory to all healthcare providers.

Measles is a highly contagious infectious diseas, with potentially fatal complication, and still stands as a cause of public health concern in developing countries (ISTM, Journal of Travel Medicine, Volume 15, Issue 2, 2008, pp124-125). It is recommended that anyone born after 1957 get properly vaccinated with a primary series as a pediatric and one booster as an adult. Passport Health Colorado offers the MMR (Mumps, Measles, Rubella) vaccine in all of our locations along the Front Range, please call us at: 303-442-8728 or 719-387-5528 if you have further questions or concerns.

Top Ten Health Tips for International Travel

Michelle Reesman, RN, Executive Director of Passport Health Colorado says far too many international travelers, from business travelers to the more adventurous types, leave home without taking the basic steps she suggests below. “People need to put the same kind of preparation into their health as they do into their destination choice, passport acquisition or flight plans,” Reesman advises.

1. Get advice from a travel health professional. Four to six weeks before departure, consult a travel medicine specialist for the most up-to-date immunization, malaria recommendations and consultation. They can answer your questions and prepare you for a safe and healthy trip. It’s important to get your immunizations early, as some of the medication take time to effectively immunize you.
2. Protect yourself from disease-bearing insects. Wear protective clothing and use products containing 20-30% DEET, the insect repellent permethrin and bed nets.
3. Never go barefoot, even on the beach.
4. Make sure your water is purified. Do not use tap water when brushing your teeth.
5. Consume only well-cooked food. Fruits and veggies? Peel it, boil it or forget it!
6. Pre-fill your prescriptions, they may not be available at your destination. Take extra in case your trip is extended. In some countries counterfeit medications can be a problem. Carry medications in their original packaging and pack in your carry-on luggage.
7. Don’t swim in rivers, lakes, ponds or streams. Well-chlorinated pools and salt water are usually considered safe.
8. Take a basic first aid kit. Include medications for pain relief, such as ibuprofen and Tylenol, topical preparations for minor skin wounds and infections, and medications for allergic reactions (Benadryl). Consider presumptive treatment (Imodium and an antibiotic) for traveler’s diarrhea. Discuss the appropriate antibiotics for your destination with a travel health specialist.
9. Motor vehicle accidents are the leading cause of medical problems among tourists. Avoid riding motorcycles, or wear a helmet, and don’t drink and drive. Wear a seat-belt and only travel during daylight hours.
10. Purchase travel insurance that includes emergency medical evacuation. Most medical insurance plans aren’t accepted when you travel internationally. One travel insurance company we recommend, called Seven Corners (formerly known as Liaison International) It can also be accessed from our website, just scroll to the bottom and the link will be on the right-hand side.

Here at Passport Health Colorado, our travel health professionals assess your individual needs, prescribe and administer immunizations and medication, and discuss any precautionary measures for dietary and recreational activities. You will also receive the latest information of health risks and requirements for each destination on your travel itinerary. We use a variety of resources including the Center for Disease Controls (CDC), World Health Organization (WHO) and the U.S. Department of State so that we can stay abreast of the latest developments in travel medicine and safe travel and give you the most current education to help you make an informed decision regarding your health.

Yellow Fever Update

Due to the recent alerts about outbreaks of Yellow Fever, specifically throughout South America, and the vaccine being required in more countries as this current time, we want to be sure that travelers are as protected as possible and are aware of the recent outbreaks in the areas and regions they will be visiting. Please see our previous post about the differences in Required vs. Recommended here.

Yellow Fever is also found in some areas of Africa and Southern Central America, so it is not a disease restricted to areas where alerts are currently being released. At Passport Health Colorado, we offer the Yellow Fever vaccine in a couple of ways. First, we offer a multi-dose vial which contains 5 doses of the vaccine and is perfect to give to a group of travelers who all need the vaccine or are traveling to the same place. Second, we offer the single-dose Yellow Fever as well for the individual traveler. We currently have the Yellow Fever vaccine in stock, in both forms, at all of our locations along the Front Range.

As for the latest alerts, you can see the newest press release and alert for Paraguay here from the Pan American Health Organization.

The alert for Brazil is here from Folha Online (the site is in Portuguese, but I’ve written the English version, sent from the International Society of Infectious Diseases, below):

“The Department of Health of Parana (Brazil) confirmed this Weds (12 Mar 2008) 2 cases of autochthous yellow fever (contracted in the state itself). One person died.

This is the 1st record of a case, and death, due to the disease in Parana since 1966. In that year, there were 32 deaths, according to the government.

According to the State Secretary of Health, Gilberto Martin, the 2 patients — who contracted the sylvan form of the disease — were infected in Laranjal, 423 km from the state capital, Curitiba.

One man, 35 years old, died on 29 Feb 2008. The other, 27 years old, is hospitalized in Ivaipora and not at risk of death. The 2 brothers were infected and worked in the rural area of Laranjal in the logging business.

This year (2008), 2 other cases had already been recorded in the state, but both were imported. On 8 Jan 2008, a retired banker died in Maringa, but he was infected in Caldas Novas (Goias state).

Vaccination has begun in Laranjal, where the 2 cases were confirmed. In the municipality, 84.7% of the 7400 inhabitants live in the rural area. Beyond the area of risk, some 127 municipalities of a total of 399 in Parana have been included in the areas of transition of the disease. The government of Parana wants to achieve 100% vaccination of the population that lives in the area of risk.

The distribution of the municipalities considered areas of risk is wide in Parana, reaching the regions in the west, centre, centre-south, southwest and northwest. As of Monday (17 Mar 2008), house to house vaccination will be started throughout the rural area of 157 municipalities, that are considered at risk for sylvan yellow fever.

The urban population of the municipalities will be attended at health posts. Vaccination in the area of risk will be massive and will extend until 4 Apr 2008. In counties considered areas of transition, vaccination will be held until 25 Apr 2008. In those regions, the majority of the population is already vaccinated against yellow fever.

Byline: Jose Maschio, Agencia Folha, Londrina & Dimitris Valle, Agencia Folha, Curitiba”

Botswana: Capturing the Chase

Every day was the most awe inspiring thing I’ve ever seen, but the day we took a boat ride through the Okavango Delta with our guide, K.D., was like being in the Garden of Eden! We left Xiegra Camp in the morning and traveled with K.D. toward Chiefs Island, it was about a 3 hour drive. As we got deeper into the delta, the thicker the birds became. There were Kingfishers, Great White Egrets, Herons, Herons, Herons (of all sizes), Pelicans, Whistling Ducks, Spoonbills, and so on. There were thousands of them! In the background were zebras, impalas, hippos, baboons and elephants, among other wild animals. We stopped for lunch and the zebra and giraffe slowly walked away. We sat under a huge tree with these animals and birds in front of us and on all sides. It was a beautiful gourmet lunch the camp had brought in another boat. 

After lunch, we continued up the delta. We were still in awe of the many birds flying in front of us when K.D. yelled “LION RUNNING, IMPALA!” We all looked and right in front of us, a female lion was chasing a herd of impala. One ran into the water not 40 feet from us and the lioness brought it down. She sat on it in the water and then another lioness came sauntering up. Then the king himself came out and he just grabbed it from the 2 females and walked off with the impala in his mouth. He was the first to have lunch behind a bush. The two females just stood and stared at us, then they left. The whole encounter took about 6 minutes! We were stunned!

Back at camp, we shared our photos on our computer with the other guides. They said that some people come on 10-20 safaris to see what we saw. I guess it was just first time luck!

Written by: Peggy Romano, client of Passport Health Colorado