ROUTINE & TRAVEL

We manage a full service clinic which provides advice and medical care prior to international travel. Our staff will review the necessary interventions prior to your travel, as well as general health and safety guidelines pertinent to each country you are planning to visit. Appropriate vaccinations and medication prescriptions are generally provided at the time of your initial consultation.

We maintain membership in the International Society of Travel Medicine and the National Foundation for Infectious Disease.

---

Adults should have received their three-part primary immunization series of tetanus and diphtheria as a child. A booster dose (Td) is required every 10 years. Swelling or inflammation at the injection site may occur.

A one time booster dose of IPV (inactivated polio vaccine) is recommended for immunized adults who are at risk of exposure to wild-type polio viruses because of foreign travel or who work as health care providers. Unimmunized adults who are at risk because of travel or occupation should receive a primary series of IPV. The polio vaccine is not routinely recommended for adults over 18 years of age.

Adults born before 1957 are usually considered immune but proof of immunity may be considered necessary for health care workers. Adults born in 1957 or later need one dose of MMR vaccine if there is no proof of immunity or documentation of a dose of MMR given on or after the 1st birthday. Adults in high risk groups, such as health care workers, students entering college, and international travelers may need a second dose. top

This vaccine is recommended for adults without a prior history of chickenpox or the immunization. A blood test can determine whether an individual has prior immunity. If required, all adults need two doses, the second 4-8 weeks after the first. No boosters are recommended. It should be avoided in children and teenagers receiving aspirin, and aspirin should not be administered to children or teenagers for 6 weeks following administration. top

The influenza vaccine is recommended for all adults who want protection against influenza. The vaccine is highly recommended for all persons over the age of 50, persons with frequent infections or those with chronic health conditions. The vaccine, which is changed each year, should be taken annually in the autumn. The optimal time is from October to mid-November. It is also recommended for international travelers and health care providers. top

The pneumococcal vaccine is recommended for patients over the age of 65, as well as patients under that age with specific diseases or conditions indicating a greater than normal risk for pneumococcal disease. This includes those with chronic respiratory or cardiac diseases, diabetes, immunologic disorders, sickle-cell disease, and those who have had surgical removal of the spleen. A booster dose after six years is currently recommended for those patients in the high risk groups. top

The hepatitis B vaccine is recommended for all sexually active non-monogamous adults, household and sexual contacts of hepatitis B carriers, users of illicit injectable drugs, and health care and public safety workers whose work involves exposure to human blood. The vaccine is a three-dose series, with the second dose one month after the first and the third dose six months after the first dose. A booster dose is not currently recommended. For those planning a prolonged stay in areas where hepatitis B is quite prevalent, vaccination is recommended. These areas include: sub-Saharan Africa, the Balkans, the Middle East, China, Southeast Asia, Korea, Indonesia, South Pacific Islands, central Brazil, Haiti, and the Dominican Republic. If time is pressing an accelerated schedule is possible. For those exposed either sexually or by blood products, a post exposure treatment is available (HBIG). It should be administered within 24-48 hours. top

Routine immunizations, especially tetanus/diphtheria, influenza, and polio, should be updated before international travel. Common vaccinations for travel are listed below. Influenza is present during our summer months in the Southern Hemisphere. top

The yellow fever vaccination is recommended for persons traveling to or living in areas where yellow fever infection occurs. A valid International Certificate of Vaccination is a requirement for entry into certain countries where yellow fever occurs, or for entry into certain countries if the traveler is arriving from an area where yellow fever occurs. The certificate is valid for 10 years, beginning 10 days after primary immunization or immediately after revaccination. Booster doses are recommended every 10 years. top

The meningococcal meningitis vaccination is recommended for travelers who visit areas recognized as having epidemic meningococcal disease. It is required for pilgrims to Mecca, Saudia Arabia for the annual Hajj. Because of the increased incidence in dormitory living, many colleges suggest that the meningococcal vaccine be considered. The single vaccination provides protection for 3 years. top

The typhoid vaccine is recommended for travelers to areas where there is a recognized risk of exposure to Salmonella typhi, the organism that causes typhoid fever. It is transmitted by contaminated food and water. An oral and an injectable vaccine are available. The oral typhoid vaccine consists of 4 doses taken at two day intervals. It needs to be refrigerated to retain full potency. The Typhoid Vi vaccine is a single injection. Both vaccines have a low incidence of side effects. The oral vaccine must not be given to people with decreased immunity. A Booster of the injectable is recommended every two years. A Booster of the oral is recommended every five years. top

The hepatitis A vaccine is recommended for travelers going to countries with a high prevalence of Hepatitis A, such as those located in Central or South America, the Caribbean, Mexico, Asia, Africa and Southern or Eastern Europe. A second dose is given 6-12 months after the first dose. The vaccine offers full protection two weeks after the first dose for approximately one year. A Booster dose is not currently recommended. top

The Twinrix vaccine is a combination of Hepatitis A + Hepatitis B. It is a three dose series with a second dose one month after the first and the third six months after the first dose. A Booster dose is not currently recommended. top

In many areas of the world rabies is still common. Transmission usually occurs through the bite of a carnivorous animal. Rarely infection results from contamination with saliva. Recently, in the United States and elsewhere, bat bites or exposure to bat infested caves have transmitted the disease. For those anticipating animal exposure in areas known to have rabies the vaccine should be considered. After any exposure that might cause rabies, an immediate post-exposure treatment series is required. top

Malaria is caused by an infection transmitted by the Anopheles mosquito. It occurs predominantly in tropical and subtropical regions of Africa, Asia, Central and South America, and Oceania. Some countries with both urban and rural malaria may not have any malaria in major cities most frequently visited by tourists. Most malaria is now resistant to the older medication, chloroquine (Aralen), but generally sensitive to mefloquine (Lariam) and atovaquone/proguanil (Malarone). Lariam is given once a week beginning one week prior to arrival and continuing for four weeks after departure. Lariam cannot be used in those with a history of serious psychiatric illness or epilepsy. It also cannot be used with certain medications. Malarone is taken daily beginning two days prior to entry into the risk area and continuing for seven days after departure from the risk area. Malarone should not be taken in conjunction with tetracycline, reglan, or rifampin. All travelers to countries with malaria should seek prompt attention for fever while traveling and for up to three years after return. Lariam resistance is common at the Thai-Cambodian and Thai-Myanmar borders and in Western Cambodia. For these areas Malarone or Doxycycline can be taken. Doxycycline can cause a reaction in the sun and therefore sun block is important, as well as protective clothing. The major human defense against malaria is avoiding exposure to mosquitoes. This includes sleeping inside screened areas, wearing clothing that covers the arms and legs, avoiding outdoor activities in the evening when the mosquitoes are most active. and using mosquito repellent. The most effective repellents contain DEET. A long-acting formulation is Ultrathon. Other recommended available insect repellents are Deet-Plus, Repel and Deep Woods Off. High concentrations of DEET may cause severe skin rash, and are not recommended for children or pregnant women. Insecticides containing permethrin may be sprayed in living or sleeping areas at night and use of mosquito nets impregnated with permethrin will further improve protection from malaria. top

HPV (Gardasil) is a vaccine that helps protect young women against some diseases caused by the human papillomavirus, including cervical cancer. HPV is recommended for girls and women 9 through 26 years of age. The schedule is three doses at intervals of 0, 2 and 6 months.top

Zostavax (Shingles) vaccine is recommended for adults 60 years of age and older with a history of chicken pox. It is a single dose live vaccine which substantially reduces the risk of developing shingles. It is not indicated for those who are immunocompromised, or for those with a history of shingles. It is not a treatment for shingles. Complete information on Zostavax can be found here.  top

In areas with poor hygiene, it is important to avoid foods that have not been personally peeled, and tap water, including ice. This is, of course, very difficult and, in spite of all efforts, bacterial infections causing diarrhea are common. Lomotil or Imodium are an effective treatment for most diarrhea. Ciprofloxacin (Cipro) 500 mg, in a single dose is often used to treat the infection in adults. If the diarrhea is severe or associated with a fever or bloody stools, ciprofloxacin (500 mg twice a day for seven days) is recommended. Adequate fluid replacement is mandatory. Bismuth subsalicylate (Pepto-Bismol) can also prevent diarrhea in travelers who take two tablets four times daily. top

Altitude illness is characterized by headache, shortness of breath, and light-headedness. Risk factors would include: fast ascent (greater than 3,000 feet per day), altitude greater than 6,000 feet, strenuous activity at high altitude, and a previous history of altitude illness. The best prevention of altitude illness is a slow ascent. Overexertion during the first few days and excess dietary salt should be avoided. Acetazolamide (Diamox) is often effective in preventing altitude illness. It is usually taken at a dose of 500 mg per day, beginning 1-2 days before ascent and continuing daily until 2 days after reaching maximum altitude. Altitude illness can occasionally be very severe and may require prompt medical attention. Acetazolamide should not be used by those who are allergic to sulfa drugs or those with liver or kidney disease. top