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

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.

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”

Required vs. Recommended Vaccines

Many people try to look on-line to see what kind of vaccines or prescriptions they will need for their particular destination. However, there is no resource available to find out this information in it’s entirety. There are general guidelines for most countries, but that is not always accurate information for the region within the country you may be traveling to.

For example, someone might look on the CDC website and see that the only vaccine which is required to enter or leave the country is Yellow Fever. However, there are major misconceptions roaming around about this requirement. Most people don’t realize that that Yellow Fever requirement has nothing to do with their personal health. What the country officials are doing is protecting their citizens from you. Many times, this means that there is currently NO Yellow Fever in the country or area, and they want to keep it that way so they require everyone traveling there to have proof of vaccination. This ensures that Yellow Fever will not become a problem.

Another scenario on why a vaccine may be required or highly recommended is if there is an outbreak that results in deaths or reported hospitalizations and treatment from a particular disease.

When thinking of ‘Required vs. Recommended’ vaccines, remember that just because only one vaccine may be required, does NOT mean that it’s the only disease that may be a problem at your destination, if it’s present at all.

Recommended vaccines are a larger list of precautions that help protect you from any and all other diseases that are present in the area. If there are outbreaks, we will discuss those and all other information you may need to have a safe trip and return healthy.

Here at Passport Health, we want to make sure that you are as protected as possible, and that means giving you a complete list of any required and recommended vaccines and prescriptions for your particular trip.

Surfing Costa Rica

Costa Rica was awesome. We stayed at Hotel Las Tortugas in Playa Grande on the Nicoya Peninsula, just north of Tamarindo (Pacific Coast). This area is a preserved beach for the nesting of leather-back turtles, thanks to the owner of the hotel. The hotel is set back far enough from the ocean as to not disturb the natural ecosystem, and the staff was fabulous (Note: this isn’t a hotel geared for the tourist, but rather the traveler who isn’t looking for a pool or beach side service, or room service), and the room offered a view of the jungle. We awoke most mornings to the sounds of howler monkeys, which was pretty sweet.

Playa Grande has one of the most consistent waves for surfing in the areas. The locals were friendly and deserve respect. The waves were as high as or higher than your head most of the week, and it’s best around high tide. There are nearby beaches within 20-30 minutes hike that offer complete seclusion, but with a small price. You have to cross over an estuary with crocodiles around, which is only a problem at high tide. During low tide, you are safe. There is a black sand beach about 45 minutes north and is only accessible by hike (Playa Carbon), with awesome little tide-pools for a quick cool down dip. Make sure to time it right, because if high tide comes in, you might get stuck!

Between surfing, two “day trips” into the jungle for some waterfalls, canopy tours and the variety of animals we got to see, we had an amazing 10-day adventure; most of the days we were up by sunrise and in bed by 8:30pm. There isn’t much of a night life unless you want to hang outside with some friendly locals and learn their customs. But there is so much nature to enjoy and plenty of good surf.

The main tourist spot is Tamarindo, just south of Playa Grande, if you want fancy hotels and a busy nightlife. But if you want to relax and be somewhat secluded, then Playa Grande is the right place. We also met some really nice travelers from Wales, Montreal, France, Spain, Texas and California; mostly surfers and surf families. One of the benefits being a traveler (and not a tourist) is the chance to meet people from all over the world. I would definitely recommend this spot.

Written by: Ricardo Khan, client of Passport Health

Tips for Holiday Travel

Beginning prior to Thanksgiving and lasting through the New Year, we experience this annual phenomena of stress with traveling over the holidays. Denver International Airport(DIA) has some helpful tips to help lessen the stress involved with waiting in lines and going through security checks. They’ve also issued a press release giving more specific information about holiday travel. The press release is summarized here:

“It’s not a new message, but it’s even more applicable this year: If you’re flying this holiday season, be sure to allow plenty of time.

‘We’ve said it every year, and we’re saying it again this year,’ Dan Melfi, DIA’s holiday spokesperson, ‘Travelers should be in the airline check-in lines in the terminal at least 2 hours before their flights are to depart. Add an additional hour if you’re traveling internationally.’

A number of airlines offer self-service check-in kiosks that can save travelers some time. But those are generally for people traveling only with carry-on luggage. If you’re checking bags, you may still need to go to a ticket counter after using the kiosk. Also, the federal government says wait times for security screening are getting longer at DIA as well.

Even though new TSA carry-on restrictions have been in place for more than a year, some travelers are still confused. To remember the rules, just think “3-1-1″: 3 ounces or smaller containers of liquid or gel are allowed in carry-on luggage; 1 quart-sized clear, plastic, zip-top bag holding ALL of the 3-oz containers; 1 bag per traveler. You must take these bags out of your carry-on luggage and place it in a separate security bin for screening. Travel tips concerning security-screening – including a list of items that cannot be taken on the aircraft – are available at the TSA’s Website. Other travel suggestions from the airport include:

• Check with your airline before leaving home to confirm that status of your flight.
• Check-in online if possible. Checking bags at curbside may save time, but some airlines charge a small fee for this service.
• Leave Christmas packages unwrapped. The TSA may open wrapped packages to see what’s inside.
• Travelers are allowed only 1 carry-on bag and 1 personal item (purse, laptop, etc.), so check as much luggage as possible. Put medications and other required items in your carry-on bag.
• Electronic signs and variable messages are also broadcast on DIA’s radio channel, 540AM. Detailed parking information and maps are available on the DIA website.
• Parking or stopping along any airport roadway is illegal and dangerous, and violators are subject to towing and a fine.
• The $9.00/day economy lots next to the terminal garages usually fill up first, followed by the $5.00/day shuttle lots. Allow an extra 20-30 minutes if you are using the Pikes Peak or Mt. Elbert shuttle lots.
• All 13,000 of the airport’s garage spaces will be available during the holiday period. Curbside parking at Jeppesen Terminal is prohibited. If you’re picking up or dropping off passengers, the $2.00/hour garages are handy to park for a short time. The free 45-minute waiting area is also available near the former Access Plaza.
• All vehicles, travelers and bags entering the airport are subject to random search.

Here are some helpful airport telephone numbers as you prepare to travel this holiday season:

Information on security-screening waiting times: 303-342-TIPS (8477)
Information on parking availability in airport lots: 303-342-PARK (7275)
Information on taxis, buses, shuttles & other transportation: 303-342-4059 or email ground.transportation@diadenver.net

All of us here at Passport Health Colorado/Wyoming wish you safe & happy travels this 2007 holiday season!

What Shots Do I Need?

This is a common question we get, regardless of where our travelers are going. As Travel Medicine Specialists, we are always trying to raise awareness of the need to start thinking about this question well in advance of your trip to make sure you are as covered as possible for potential and real health risks while overseas.

Due to numerous variables that come into play when recommending vaccines and anti-malarial prescriptions, it is vital for us to actually see you and discuss this question with you in our office. The variables that get put together to make recommendations for you are:

1. Where exactly you are going within the country (what region you will be in)
2. How long you are there (your length of time on the ground)
3. What you will be doing when you are there (are you in the business meetings the whole time or trekking through the jungle?)
4. Your medical history and the previous vaccines you’ve already had if any (if you have allergies, what medications you are currently taking, even over-the-counter medications)
5. Your tolerance for the side effects of certain kinds of vaccines and medications (like some anti-malarials and specialty vaccines)

All these factors come into play when determining what vaccines & prescriptions you would need for your trip.

We will also discuss with you all the current outbreaks happening in the areas you will be, things to watch out for while you are overseas, and what to be aware of and how to protect yourself against common illnesses.

Ideally we’d like to you between 4-6 weeks before you travel, hopefully no less that 2 weeks before you travel, simply because it usually takes 10-14 days before most vaccines are fully effective within your system and with certain prescriptions for malaria, you may need to start them 2 weeks before you land in the country . We are able to see you in a shorter time-frame if needed as well adn can usually get you scheduled in one of our offices within a few days of when you call.

I hope this answers many of your questions about why it’s important to be seen by a Travel Medicine Specialist before you make a trip across borders. Please feel free to call us should you have other concerns or questions at: (303)442-8728 or (719) 387-5528.

Hello World!

Welcome to Passport Health Colorado/Wyoming’s Blog! This is an area where we would truly enjoy to share your stories and your photos from your trips! If you have a story of any kind to share, whether it be funny, sad or just touches your heart, we want to hear it and share it!

We are also going to implement a “Photo of the Week” Contest in which submissions from our clients will be taken and once a week, a photo will be selected. Whomever the photo belongs to will receive a $10 gift certificate to Amazon.com!

Please feel free to email your stories, your photos and your websites to: community@passporthealthco.com

We will also share travel updates, health outbreaks and other news pertinent to international travel here so we welcome you to come back often!