May 17, 2013 By Sarah Kohl, MD Leave a Comment

How to Apply Permethrin Insect Repellent to Your Clothing

Permethrin clothing treatment is the product which simplifies insect precautions: if you are visiting anywhere in the world where you need protection from mosquitoes, ticks, or other biting insects apply permethrin to your clothes prior to travel to provide the highest degree of protection. Peremthrin treated clothing is the best-kept secret of adventure travelers.

It is easy to use and safe for everyone, even babies.

You have two choices of how to apply permethrin to your clothing: spray or soak.

Personally I prefer the soak, it’s easy, lasts for 6 washings, covers evenly and costs less. The soak is available from Sawyer and is often called military wash.

Not sure how to use permethrin soak?

Simply follow the 5 steps below and you are good to go:

Step One.

Select the clothing you wish to make insect repellent. The type of fiber does not matter. I prefer clothing that can be worn several ways and covers the most skin.

Examples include zip-off pants (which now come in attractive styles for women) and lightweight long sleeved shits that can be rolled up as needed. However, any piece of clothing can be made insect repellent.

If you choose garments that cover the most of your skin you will need to apply less DEET or Picardin to your skin as less skin will be exposed.

Step Two.

Place 4-5 items of clothing place on top of each other and fold in half or thirds cross-wise.

Roll up the clothes and tie with the string included in the kit. If you have large or thick pieces of clothing, such as jeans, you will need to reduce the number of items so that the rolled clothes will fit in the bag.

Step Three.

Open the bag carefully. I found that the bag included in the Sawyer military wash tends to tear at the zipper seal if you are too ‘enthusiastic’ while opening the bag. Pour in the permethrin and add water as directed by the label.

Step Four.

Place the clothing into the bag. Swish the repellent solution around and allow the clothing to soak it up. Don’t worry about the clothes in the middle of the roll; the liquid gets there over time.

Leave in a place away from children and pets for at least two hours. This allows the permethrin to bond with the clothing fibers.

Step Five.

After two or more hours remove clothing from plastic bag. Don’t forget to wear the plastic gloves provided to protect your hands when touching the wet clothing. Hang to dry on plastic hangers. Now your clothes are ready to repel insects for up to 6 washings!

It’s really that simple.

As a bonus you can hang your treated clothing around your room. It will provide some insect protection. After all, it’s not doing anything folded up in your suitcase.

What is Bird Flu H7N9?

Should Travelers Worry?

The bird flu is back in the news, but there is a new twist: the chickens which are the likely source of the illness are not sick.

Over 125 people have been sickened and 26 have died throughout eastern China. All this has travelers wondering what is bird flu and how can travelers avoid it?

What is bird flu H7N9?

Bird flu is a viral repiratory infection of birds which sometimes infect people. We are not exactly sure how this new H7N9 strain infects people, but experts think that close contact with poultry is how most people become sick.

New Discovery

In mid-March 2013, in the same section of Shanghai, two men were hospitalized with severe pneumonia and quickly died. The astute doctors thought this was odd so they collected samples that were quickly sent off to a special laboratory that monitors for emergence of new diseases.

New technology allowed the laboratory to quickly identity the exact genetic sequence of this new strain of bird flu, including the mutation that caused the virus to become aggressive. They were surprised to learn that H7N9 was the problem since prior to this event it had never caused infection in humans. Scientists were also able to determine that this strain of bird flu can be treated with oseltamivir (Tamiflu).

Where did the H7N9 bird flu come from?

Experts were suspicious that the strain was transmitted from domestic birds, but they didn’t know which types of birds or what advice to give to people.

After careful sleuthing, scientists have determined that many of the people infected with H7N9 strain of bird flu had been to live animal markets within 10 days of becoming ill. However, since the animals on the farms and in the markets appeared well it wasn’t apparent how people actually caught the infection. Scientist literally swabbed the throats of chickens, ducks, quail, and pigeons in the markets. That is how they discovered that local chickens and pigeons were the suspected source of the new H7N9 bird flu.

This is good news because it can be contained by closing the live poultry markets, vaccinating poultry, and culling the flocks. In addition infected carrier pigeons which may have contributed to the spread of bird flu have been grounded–all bird races have been canceled in Beijing indefinitely and pigeon owners have been instructed to keep their birds in cages.

It is not surprising that bird flu is spread from chickens to humans; what is new is this particular strain seems to be more aggressive in it’s ability to affect humans. An unusually high number of people infect have died (about 20%). In fact there is suspicion that limited human-to-human transmission has occurred in close family members of people sickened with H7N9.

Fortunately, No sustained human-to-human transmission has occurred. In other words, an outbreak cased by spread between people has not happened. This is good news for travelers.

What should travelers do about bird flu?

How can travelers to China best protect themselves from bird flu?

Avoid direct contact with animals and their droppings.

Do not touch animals (live or dead).
Do not visit live animal markets in China.

Wash your hands often.

Keep your hands away from your face, and wash them frequently.
Carry and use hand sanitizer since it can be difficult to find places to wash up when traveling.
Cough into a tissue or your elbow, this avoids contaminating your hands with germs.

Eat only well-cooked food.

Only eat meats which are no longer pink.
Eggs should be fully cooked (not runny).
Avoid eating chicken since it can be difficult to be sure it was thoroughly cooked by simply looking at your food. In reality, this may be difficult due to language barriers and the propensity to use chicken parts in many dishes to provide flavor.

See your doctor if you are ill.

If you become ill with a cough, fever, etc within 10 days of visiting China see you doctor.
Cover your nose and mouth with a mask until seen by your doctor to prevent any possible spread of disease.
Rapid flu tests may not detect Influenza A(H7N9). If you become ill with a respiratory illness after return from China you should discuss with your doctor whether to begin antiviral medications while awaiting test results from a specialty lab.

Travelers leaving China should be aware they may have difficulty visiting other countries if they are sick. You may be subject to surveillance for illness and denied entry if thought to be ill with fever and/or respiratory symptoms. Your local travel medicine doctor can assist you in sorting out the health regulations.

Many people are worried by the frequent media updates regarding bird flu H7N9. You should realize that the increased media coverage of this outbreak is due to increased information from the Chinese government, and not an increase imminent danger to you, the traveler. This is due, in part, to the increase in transparency by the Chinese government who is providing frequent, informative press releases. It is refreshing a departure from the secrecy in the handling of the 2003 SARS outbreak for which the Chinese government was widely criticized.

Bottom line: you don’t need to be alarmed by all the media attention to bird flu, but be grateful that the international authorities are working together and sharing what information is known about this outbreak.

The risk to travelers, at this point in time is small, as long as you avoid contact with poultry, you should be able to proceed wth your travel plans.

Should Insect Repellents Be Worn in the UK?

For anyone that travels regularly, you’ve no doubt got yourself a few set questions to ask about your intended destination. Some of those questions must be about the local climate; will you need shots? What sort of insects do they have? Will you need to take some sort of repellent?

The short answer is that wherever you travel in the world, if there are insects, some sort of repellent will always have a role to play – even in the UK.

Why Insect Repellent Should be Worn in the UK

Now you’ll be forgiven for thinking that because the UK simply does not have the diversity of insects that you would find in other parts of the world, even warmer climates of Europe, that insect repellent is not required.

On the contrary; there are a multitude of annoying critters that affect humans living on the British Isles, particularly in the summer months. For example, flies, midges, ants, wasps, bees, and a whole host of other bugs are prevalent in those long warm months between June and September.

Of those mentioned, midges are particularly troublesome. As they feed on blood, they can cause all sorts problems, such as bites, soreness and itching. They are most common nearby stagnant water, along with other types of flies. So, if you’re travelling near lakes, and expanses of water, such as the Lake District or the lochs of Scotland, pay careful attention to midges and flies.

What Type Of Repellent To Choose And How Do They Work?

One of the most popular repellents is known as DEET. This stands for diethyl-meta-toluamide, which is the active ingredient in repellent. There are alternatives to DEET, such as Picaridin, and essential oils, however DEET is the most common type of repellent worldwide because it has proven to be effective.

Now depending on where you travel you will need a repellent containing more or less concentration of DEET. For example, some exotic countries with warm, humid climates and a vast array of insects will require you to wear a repellent with at least 30% DEET. For travelling around the UK, a repellent containing up to 35% % DEET will suffice, such as Ultrathon^TM from 3M^TM.

The way it works is relatively simple. DEET is a chemical that is used to repel, but not kill insects. In addition to the DEET, most repellents contain strong odours to mask the smell of your skin and blood, and thus deter insects. It’s basic science, but very effective.

How Should It Be Applied?

Its effectiveness can be enhanced or minimised depending on how the repellent is applied. For example, even the strongest stuff can have a minimal impact if it has not been applied properly.

Repellents come in two forms mainly, a spray and a lotion. The lotion can be applied straight to your skin, and should be massaged in thoroughly all over your body, particularly in areas where skin is tightest, such as the bony parts like elbows, writes, knees and ankles.

The better quality repellents need only to be applied once or twice during the day, as opposed to every couple of hours. This is far more practical for travellers who are either out on long walks, or want full protection throughout the night.

The 3M^TMUltrathon^TM insect repellent mentioned was designed for extreme environments, however, it is perfectly suited to the British climate as well. If you’re planning on hiking, trekking and spending a lot of time outdoors, don’t worry about a little sweat, this repellent is splash resistant.

Enjoy Your Travels

For whatever reason you’re visiting the UK this summer, be it a festival, a camping trip, or just to visit family or friends, be sure to take insect repellent with you, to make your stay all the more enjoyable.

This guest post was written by Clive Holtman, SEM Manager at 3M Direct.

Filed Under: Adventure Travel, Blog, Personal and Family Travel

March 31, 2013 By Sarah Kohl, MD 1 Comment

A Guide to Symptoms of Altitude Sickness in Travelers

“We don’t usually get cures in this business,” said my cardiologist, but I am cured!

And as a bonus, the symptoms of altitude sickness bother me less too.

I love the outdoors: hiking, skiing, camping etc. It is our ‘go to’ family vacation, a time where we can relax, spend uninterrupted time together enjoying nature’s beauty. In fact, we always have one signature outdoors vacation every year accompanied by our dear friends Karen, Mike and their sons.

All my life I have struggled with altitude sickness. Headaches, shortness of breath and nausea are the norm for me for the first few days anytime I start sleeping above 9000ft (2700 meters) However, in the last few years I noticed the symptoms had worsened which I attributed to being out of shape. A recent ski trip to Utah showed me otherwise.

Symptoms of Altitude Sickness in Travelers.

Altitude sickness is the name given to a constellation of symptoms which occur when you travel above 9000ft suddenly, such as by car or airplane. Your body has a hard time adapting to the lower oxygen content, you breath faster setting off a series of physiologic reactions in your body which result in headache, nausea, shortness of breath, dizziness, insomnia, and fatigue. Sometimes this can progress to a severe form with brain swelling (HACE) and fluid build-up in your lungs (HAPE). Not everyone is susceptible to altitude sickness, there seems to be a genetic pre-disposition to it.

If you were to travel to altitude slowly you would not develop symptoms of altitude sickness as your body would adapt along the way. Symptoms develop when you ascend quickly, such as by car or plane.

How to Adapt to High Altitude

There are several ways you can help your body adapt to the altitude.

Rest and go slow the first few days at altitude.
Avoid alcohol, caffeine, and certain prescription medications.
Acetaminophen or ibuprofen can help with the inevitable headache.
It is important to drink lots of fluids to avoid dehydration and eat even if you are not hungry.
Medication such as acetazolamide (Diamox) is often recommended for the first few days to help your body adjust to altitude.
If you have a concurrent upper respiratory infection (a ‘cold’) your symptoms may be worse than otherwise expected.
People with severe symptoms or worsening symptoms will need to descend.

Pre-existing Health Problems

Certain people should not go to altitude due to underlying health conditions. People who have sickle cell disease or trait can precipitate a crisis in the low oxygen setting of high altitude. Likewise people with polycythemia (too many red blood cells) can suffer blood clots at altitude. In addition, certain heart or lung conditions make going to altitude very risky and make the symptoms of altitude sickness far worse. Often times people with certain heart conditions don’t know they have them until they get into trouble at altitude.

And this was my case, but I didn’t know it.

Acetazolamide

I always found acetazolamide very helpful and was glad to put up with the tingling hands and feet it causes. Over the years it became less effective. I experienced worsening shortness of breath and fatigue, often unable to keep up with my fellow skiers.

Through a series of very unfortunate events my cardiologist determined that a small hole in my heart was causing me a lot of trouble. I was born with a cardiac condition (PFO) that makes traveling to altitude very risky. He advised me to give up my high altitude travels and learn to love adventures at sea level. Needless to say I was not happy but understood he was right.

As fate would have it, he also arranged for my cure.

After a few years of trying to manage my condition with medications, it became obvious that the hole would have to be closed. Dr. Smith snaked a snazzy spring-loaded device into the hole and closed the problem for good.

After getting the go-ahead I scheduled a trip to Utah to ski in the Little Cottonwood Canyon (10,000 ft) and found I could ski myself silly. This sudden improvement occurred with no change in preparation or exercise routine. My previous difficulty with altitude sickness was actually a mild condition made much worse by a cardiac problem–which is now gone.

And that is why I am smiling.

Now that I am able to comfortably go to altitude, with minimal headache and fatigue for the first few days, I am busily planning more vacations at altitude.

I think I’ll start with a visit to Machu Picchu.

Filed Under: Adventure Travel, Blog, Personal and Family Travel Tagged With: Personal and Family Travel

March 31, 2013 By Sarah Kohl, MD Leave a Comment

Do You Need Vaccines for Punta Cana, the Dominican Republic?

Ahhh the mid-winter get away…Sun, sand, vaccines. Vaccines, malaria.…Really? The beaches and resorts in the Dominican Republic are so lovely it’s hard to believe you need to protect yourself from infectious diseases while enjoying the tropical breezes. However, a quick check with the CDC confirms you will need a few vaccines along with protection from malaria, dengue, and cholera while visiting the Dominican Republic, even in the resort areas.

Note: This post contains general comments and is not a substitute for medical advice, diagnosis, or treatment. Visit your local travel medicine provider for advice specific to your individual health.

Which vaccines are recommended for the Dominican Republic?

Routine Vaccines

All children and adults should be current on their routine vaccines, including a recent Tdap, flu vaccine, and a complete MMR series. You should also get protected from chickenpoxeither through vaccination or a prior case of chickenpox.

Many adults also need a pneumonia vaccine; travelers who smoke, have asthma, diabetes, other chronic health problems, or are over age 65 need protection with a pneumonia vaccine.

Travel vaccines

Hepatitis A vaccine is recommended for all travelers to the Dominican Republic.

You may want to consider typhoid vaccine if you will be leaving the resorts for more rustic eateries or visiting local residents.

Hepatitis B is recommend for prolonged stays, those who may need health care while in the Dominican Republic. People who anticipate contact with body secretions such as tattooing, dental work, or new sexual partners should also get protected.

Rabies vaccine is rarely, if ever, needed for travel to the resorts, your travel medicine provider can discuss whether this is right for you.

You Need Other Protective Measures Besides Vaccines

Many travelers are surprised to find out the CDC recommends protection from malaria in most of the Dominican Republic, including the coastal resorts (yes, even Punta Cana)

Your travel medicine provider can help you select insect repellents and anti-malaria medication to suit you.
Remember, your anti-malarial medications are taken before you leave, while you are there, and for certain period of time after you return.
To prevent malaria you will need to apply your insect repellent during the late afternoon and evening.

Dengue is also spread by mosquitoes. The only way to prevent dengue is wear effective insect repellents during the day. Personally I prefer 20% Picardin as it is odorless and doesn’t harm the synthetic fabrics found in bathing suits.

Discuss how to prevent traveler’s diarrhea (TD) with your doctor. TD is always caused by eating or drinking contaminated food and water. It is less common in the resorts in the Dominican Republic than is in the more rustic areas of the island. Careful hand washing and attention to detail when selecting food and beverages minimizes your chance of suffering from TD.

Cholera is a severe bacterial intestinal infection which is spread by contaminated water, both fresh water and salt water. It originated in neighboring Haiti, and has on occasion sickened tourists. One particularly nasty outbreak was associated with eating shrimp at a wedding. Again, mindful food and beverage choices minimizes your chance of contracting this.

Remember, risky behaviors are risky everywhere. Resist the urge to get a new tattoo or piercing. And always use safer sex practices, I don’t want you coming home with new viruses (HIV) or other hard to treat problems.

Accidents. All this discussion about infections belies the fact that your biggest health risk is the automobile, same as it is in the USA. Look both ways before you cross the street and buckle up when you are in the car. Better yet, take a break from the car with a walk on the beach or take a nap under the palm trees.

A relaxing getaway to the Dominican Republic can be just the thing to chase away the winter blahs. A few simple protective measures can make the difference between lovely memories of a tropical vacation and vivid memories of an unpleasant infection. Your local travel medicine provider is happy to help you prepare for a relaxing, memorable vacation in the sun.

Filed Under: Blog, Personal and Family Travel, Students Abroad, vaccines Tagged With: Personal and Family Travel, Students and Groups Abroad

March 31, 2013 By Sarah Kohl, MD Leave a Comment

Surprising facts about Schistosomiasis in Travelers

Which parasite can you catch simply by swimming in fresh water? It can make you sick now or in 25 years. Oh, and did I mention it can go right through your unblemished skin without your knowing about it? Yuck!

International travelers need to learn about the parasitic worm Schistosomiasis so they can protect themselves and get treated before it causes problems.

Location. Location. Location.

Just as in real estate, location matters. Schistosomiasis is found in many areas outside the USA frequented by travelers: Africa, the Middle East, China, Indonesia, South East Asia, Central and South America, and the Caribbean. Surprisingly some areas in the Dominican Republic have Shistosomiasis, however the largest infestations are in Africa.

Your travel medicine provider can help you determine your risk of exposure.

In southern and sub-Saharan Africa ALL fresh water lakes, rivers, and streams are presumed infected.

Ignore the water sport concessions seen around Lake Victoria, Lake Malawi and the Nile River. These waters are notorious for infecting travelers, with over 80% of people testing positive after only one exposure.

Saltwater and properly chlorinated swimming pools do not transmit Schsitosomiasis.

Fresh Water, Snails, and Humans: A Complex Lifecycle

Schistosomiasis, also known as bilharzia, has five different species. It is important to know there are 5 species when selecting how to best test travelers for possible infection with ‘Schisto’

Each of the 5 varieties has a similar complex lifecycle that involves living both in a freshwater snail and in a human host.

The parasite has several life forms. The infection-cycle begins when the cercariae form leaves its snail host and gets out into fresh water (ponds, streams, lakes). When your skin comes in contact with the infected water the cercariae penetrate your intact skin and over weeks spread throughout your body via the blood stream. The worms then mature and migrate to areas of the body where they cause trouble (liver, bladder, intestines, and cervix) There they lay eggs which get passed back into fresh water in areas of poor sanitation. The eggs hatch in fresh water, infect the snail allowing the cycle to start all over again.

You May Not Initially Have Symptoms

Travelers who are infected may or may not have symptoms when initially infected, but left untreated the disease can produce chronic, debilitating health problems.

Symptoms result from inflammation caused by the worms and eggs in the parts of the body where they lodge.

Occasionally a rash may appear within hours or a week of infection.

Early symptoms can appear within 2-10 weeks. These are non-specific symptoms such as fever, chills, fatigue, headache, muscle ache, diarrhea and respiratory symptoms.

Left untreated for years, the chronic inflammation can lead to permanent damage of the liver, spleen, lungs, intestines, bladder, and cervix. In some cases it can go on to cause cancer or increased susceptibility to HIV. Often the chronic inflammatory changes are very difficult or near-impossible to treat.

You Need to Get Tested

All travelers who have had exposure to water potentially infected with Schistosomias should be tested for infection regardless of whether they have experienced symptoms.

Testing is important because people who are infected may not have symptoms early on but can suffer devastating consequences of chronic inflammatory changes and blockages of vital structures years later.

Travelers have a low likelihood of excreting eggs in urine or stool; they will need to get a blood test. The blood test screens for antibodies to Schistosomiasis.

Blood testing should be delayed for 8-12 weeks after exposure since it takes that long if you are infected to develop a positive reaction to the test. (12 weeks after exposure is preferred)

Additionally, testing for Schistosomiasis is difficult as many commercial labs do not offer a test for Schistosomiasis antibodies.

Labs which do offer testing for Schistosomiasis often only offer blood tests for one of the five varieties of Schistosomiasis. Your doctor may need to contact the CDC to arrange for the more comprehensive FAST-ELISA/Immuno-blot. There is a team of parasite specialists at the CDC who can assist your doctor in arranging proper testing.

Early testing is helpful in identifying who needs to be treated, even in the absence of symptoms. Early treatment of infected persons with praziquantal prevents the late consequences of Schistosomiasis.

Some travelers advocate brisk toweling off and use of 50% DEET at the time of exposure to prevent infection. These preventive measures are unproven; the CDC recommends follow up blood testing after exposure, even if the towel/DEET technique is used.

Avoid. Test. Treat.

Avoiding infected waters is your best defense against Schistosomiasis. You won’t get infected if you don’t swim, wade, or bathe in contaminated waters. Your travel medicine provider can help you determine if infected waters are a problem at your destination.

If you are exposed to infected water, get tested. Many travelers who test positive do not experience symptoms at the time of infection.

If you test positive, get treated. An antibiotic is available which will kill any live worms thereby preventing the late (and devastating) consequences of Schistosomiasis.

The CDC has experts available to assist your doctor in evaluating and treating for Schistosomiasis.

Travelers interested in Schistosomiasis may also enjoy:

Filed Under: Adventure Travel, Blog, Personal and Family Travel, Students Abroad

March 31, 2013 By Sarah Kohl, MD 1 Comment

7 Ways Travelers Can Prevent a Bed Bug Infestation

Recent news reports may have you wary of bringing home more than souvenirs and wonderful memories from your travels. In a joint statement, the Centers for Disease Control and Prevention and the Environmental Protective Agency reported a dramatic rise in bed bug infestation in the United States. Currently, bed bugs can be found in every state. Contrary to the popular notion, a bed bug infestation has nothing to do with cleanliness. They are parasites that feed on blood, so they can occur anywhere people sleep or spend a good amount of time. Although they might not present a serious health risk, they can be extremely annoying and difficult to remove once an infestation takes place. To help prevent this costly nuisance, follow these 7 ways to avoid getting bed bugs when traveling.

First Learn how to spot bed bugs, then prevent them from coming home in your luggage. You know what they say……an ounce of prevention is worth a pound of cure.

1. How to spot bed bugs in hotel rooms:

Inspect your surroundings as soon as you arrive and know what to look for. Bed bugs are flat, reddish brown in color, look like apple seeds, and range from one to seven millimeters long. Signs of a bed bug infestation include leftover bug shells from molting, rust-colored spots of fecal matter on mattresses or furniture, bedbugs in the folds of sheets and mattresses, and a sweet musty odor. Use a flashlight to check the headboard, sheets, pillows, walls, and any dark place they could hide.

2. How to spot bed bugs on your luggage:

Inspect your luggage. Bed bugs often get from one place to another by hitchhiking on your travel bags. They tend to hide in the seams and crevices of your bags as well as your clothes inside. It is possible they relocated from one person’s baggage on the plane and are now resting comfortably on yours. So make sure you inspect your luggage carefully looking for the same signs on your luggage as you would your hotel room.

3. How to spot bed bugs using the internet:

Before you book your stay, check on-line travel reviews for reports of bed bug infestation. Many travel sites allow customers to review lodging and accommodations. Most likely, unhappy travelers will pass on their stories of encountering bed bugs. Use this knowledge to your own benefit to help keep you from also having an unfortunate encounter with this most unwanted parasite.

4. Prevent bed bugs from coming home in your luggage:

At your place of stay, keep your belongings away from the bed, furniture and walls. Use your luggage rack to hold your suitcase. You could also consider keeping your luggage in the bathroom or dry bathtub with the light on. Bed bugs will most likely be hiding in dark places within the bedroom closer to their potential host.

5. Neem oil keeps bed bugs out of luggage:

Consider a natural insecticide like neem oil for your hotel room. Gently mist the bed and its surroundings with a neem oil spray. Bed bugs will mistakenly ingest it and die. Neem oil is a safe and environmentally friendly way to keep bed bugs at bay.

6. Prevent bed bugs from getting into your house:

To prevent a transfer to your home, think about unpacking your luggage in the garage for safe measure. You don’t want bed bugs to find new shelter within your house, so keep bags outside until you are sure none have traveled back home with you.

7.Use your dryer to kill any hidden bed bugs in clothes:

For additional assurance, place your clothes (clean and dirty) in the dryer as soon as you arrive home. Dry them on the high setting (at least 120 degrees Fahrenheit) for at least 15 minutes. This should successfully kill any bed bugs and their eggs.

These seven tips to avoid getting bed bugs while traveling can go a long way in helping you reduce your risk of being bitten or even worse, transporting these unpleasant parasites to your home. For more advice, visit the CDC’s website on bedbug prevention.

If you enjoyed learning how to spot bed bugs and preventing them from coming home in your luggae you may also enjoy:

Share your experiences with bed bugs. How did you avoid them? How did you get rid of them?

Filed Under: Blog, Business Travel, Personal and Family Travel Tagged With: Business Travel, Personal and Family Travel

March 31, 2013 By Sarah Kohl, MD Leave a Comment

What Everybody Ought to Know About Vaccines Before International Travel.

Travel vaccines. Are you confident you know which ones you need before international travel?

Just imagine how anxious you will feel if you are preparing to board a plane when you suddenly discover that there are certain vaccines you should have gotten prior to your trip. A great trip without proper preparation is like riding in a car without seatbelts, you feel great until you crash.

How can you find out which vaccines you need when traveling abroad?

You will need different vaccines depending upon your destination, what you will be doing there, and your underlying health.
The CDC has information about which vaccines are needed for which country.
Your travel medicine specialist is best able to answer the question about which vaccines are recommended for you based on your itinerary and health.
It’s a good idea to schedule your visit early since many vaccines need 4-6 weeks to become fully protective.

Which vaccines are required for international travel?

Governments and the World Health Organization (WHO) establish vaccine requirements. Currently only two are required for some destinations: yellow fever and meningitis. From time to time temporary requirements are put into place, such as flu vaccine for World Cup Soccer.

Just because a government does not require it for entry into a country does not mean it is not recommended; required only means a law or policy requires it.

What if I am pregnant and traveling abroad?

Surprisingly, some vaccines are actually recommended for pregnant women if international travel is unavoidable. Of course you will want to discuss your travel plans and selection of vaccines with your doctor. Vaccines to consider include:

Influenza. The flu vaccine protects you and your baby during pregnancy and even after birth!
Hepatitis A. This illness causes many problems for pregnant women, even miscarriages. Prevent it with vaccine or immunoglobulin.
Hepatitis B and Tetanus. These vaccines should be reviewed with your doctor.

Other vaccines are used under certain circumstances for pregnant women including Typhoid, Meningitis, Polio, Japanese Encephalitis, Pneumococcal, and Rabies.

Currently live virus vaccines are discouraged; an exception is the yellow fever vaccine which can be given to pregnant women if international travel to areas with yellow fever cannot be delayed until after delivery.

Is getting a lot of vaccines at the same time harmful?

No. Most vaccines can be given at the same time. You may experience temporary discomfort, but your body’s immune system is more than capable of handling it. In fact, most vaccines show 5-7 antigens (the things you make antibodies against) to your body’s immune system while the common cold shows 135+ antigens to your body’s immune system.

What if I am not sure if I have had a vaccine before?

It is not harmful to receive extra doses of vaccines, so it is better to make sure you are properly immunized than taking a chance at being under-immunized. If you are having trouble keeping track of all your vaccines I recommend theTraveling Well App; it is a convenient way keep track of all your routine and travel vaccines in one handy place, your phone.

Your Turn:

Have you ever traveled without proper vaccination? Have you worried about getting sick while traveling? What do you think would help to prevent illness while traveling? I invite you to leave your thoughts below.

Filed Under: Blog, Business Travel, Personal and Family Travel, Students Abroad, vaccines Tagged With: Business Travel, Personal and Family Travel, Students and Groups Abroad

March 31, 2013 By Sarah Kohl, MD 1 Comment

How Can Travelers Protect Themselves from Dengue Fever?

Dengue infection is exploding worldwide and the international traveler is vulnerable. Dengue fever is present in most Latin American and Asian countries. Alarming increases in in all populated areas from major cities to small towns in the past few years makes Dengue fever a serious concern for the international traveler.

Never heard of Dengue fever? It is a miserable viral infection characterized by severe headaches, muscle aches, fever and malaise. Your body can hurt so badly that it can take over 15 minutes just to put your clothes on in the morning. In some cases it goes on to produce internal oozing (plasma leakage) and other life-threatening complications.

Experts aren’t exactly sure why, but they do agree the number of cases is exploding. Countries such as Brazil and Peru are reporting dramatic increases in the number of infections in 2011. Your chance of infection increases 4-fold if you travel during the rainy season.

Know the Enemy.

Dengue is a flavivirus spread by mosquitoes. There are 4 varieties (serotypes) of Dengue. Infection with one serotype does not provide protection against the others; in fact, oddly enough, infection with one serotype makes it more likely that you will have a serious complication with infections from the other serotypes.

Treatment consists of supportive care, such as rest and acetaminophen; there is no cure, medication or vaccine available for Dengue infection.

In order to avoid Dengue infection you need to know how it is spread. A tiny mosquito which prefers to bite during the day transmits Dengue. The mosquito acquires the virus by biting an infected person, thereafter it spreads the virus by biting other people. This mosquito prefers to live in cities and towns; it breeds in small puddles or collections of water, such as a flowerpots or tires. The mosquito lives in temperate climates: Latin America, Asia, India, Africa and the Pacific Islands.

Bottom line for the traveler: this mosquito bites during the day and lives exactly where you will be traveling.

The Best Defense is a Good Offense.

A vaccine against dengue infection has been in the works for a while. Current estimates indicate it may be ready for clinical use by 2015.

In the meantime, if you prevent mosquito bites you can prevent Dengue infection. Only 3 insect repellents have been proven effective, and one of these has to be applied every 2 hours making it impractical.

Which insect repellents should you use?

Insect repellents containing 20% Picardin or 35% DEET. You will need to check the label.
Both are effective and come in formulations that last 11-12 hours making them easy to use.
Apply before going out for the day. Reapply according to the instructions on the bottle.
If you are using suntan lotion, apply it first and the insect repellent on top.
Combination insect repellents and suntan lotion do not contain a reliable insect repellent. So they are not recommended.

Dengue is a nasty infection with a worldwide distribution. The preferred habitat of the mosquito makes it likely that both the business traveler and casual traveler can become infected. Diligent use of insect repellents is the best way to prevent being infected.

In the near future a vaccine should become available, providing additional protection for the traveler.

photo courtesy of o5com.

Do International Travelers Need to Worry About Bird Flu?

International travelers often worry about their risk of contracting avian (bird) flu. Did you know there are many types of bird flu but only one type that affects humans?

Bird flu affects wild and domestic birds (chickens and ducks). Migrating wild birds spread avian influenza (bird flu) around the globe. One type, H5N1, has become aggressive, and can be spread from birds to humans. It has killed several hundred people who work with or near flocks of birds. Most cases have been in Southeast Asia. Avian influenza does not spread from human to human.

Bird or Avian influenza is not the same as seasonal influenza.

Seasonal flu is spread from person to person via coughing or touching contaminated hands to your face. Seasonal flu varies from an uncomfortable 2-week illness in some to a potentially fatal illness in those with underlying illness (asthma, diabetes, COPD, etc.), the very young or the very old.

Your yearly flu vaccine prevents seasonal flu. International travelers should get their annual flu vaccine; after all do you really have time to be sick for two weeks while you travel?

And no, you can’t get flu from the flu shot; the shot is manufactured with killed virus and is incapable of causing the flu.

Currently there is not a vaccine for bird flu. People affected with avian influenza are treated with antiviral medications such as oseltamivir (Tamiflu).

International travelers will not contract avian influenza from properly cooked poultry.

Most travelers won’t be exposed to bird flu, especially if you avoid poultry farms, areas with reports of sick and dying birds, or markets where live poultry is sold.

Travelers going abroad who will have significant exposure to birds, such as people working in agriculture or veterinarians, should discuss with their doctors what to do in the event they get sick. One possibility is taking a course of oseltamivir with them ‘just in case’ you need it. Identifying a doctor nearby at your destination is also a good idea. Additionally you will want to get your annual seasonal flu vaccine to prevent avian flu from mixing with seasonal flu to produce a new avian influenza that could be transmitted person to person.

So get your flu shot, cover your mouth when you cough or sneeze, and wash your hands often. That will keep seasonal flu away, the exact type of flu a traveler should worry about.

photo by Ella Mullins

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The Best Defense is a Good Offense.

Bird or Avian influenza is not the same as seasonal influenza.

Most travelers won’t be exposed to bird flu, especially if you avoid poultry farms, areas with reports of sick and dying birds, or markets where live poultry is sold.

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