Posted by: mkirschmd | June 13, 2010

New Site for Travelogue!

The Travelogue Blog lives on at another site. 

Please bookmark us at

Although the blog has a new look, we will still bring you up-to-date and practical information on how to stay healthy and safe during your trip abroad.   Your comments and feedback are always welcome.

Posted by: mkirschmd | May 23, 2010

FDA Now Says Rotavirus Vaccines Safe

Travelers expect that travel vaccinations are safe and pure.   No one would willingly accept – or prescribe – a travel vaccine that is contaminated.  Yet, the Food and Drug Administration (FDA) has just reassured the public and the medical community that both ‘contaminated’ vaccines for rotavirus are safe.  Sound scary? 

FDA Initially Halted Rotarix

Currently there are two vaccines against rotavirus, Rotarix and Rotateq.   This past March, the FDA discovered that Rotarix vaccine contained fragments of a pig virus.  The agency advised against using this vaccine and recommended Rotateq instead, which was assumed to be pure.  Weeks later, Rotateq was also found to contain pig virus.  It is a mystery how this contamination occurred.

 FDA Clears Both Vaccines

The FDA has now declared that both vaccines are safe, and should be administered to prevent rotavirus infection.  The FDA advised that there is no evidence that pig virus within the vaccine can harm humans.  Rotavirus vaccines have prevented millions of cases of gastroenterititis, a disease with diarrhea that can cause severe dehydration.  The disease is particularly deadly to children in the developing world.  Experts predict that rotavirus vaccines can save millions of lives over the next decade.

Just this year, scientists reported hard evidence that these vaccines are highly effective.  Should international travelers receive this vaccines?  Discuss this with your travel doctor.

International travelers may need a variety of travel vaccines before departure.  Should travelers be concerned about the quality of these vaccinations?  Travelers should relax.  Vaccines are subjected to the highest standards of quality control.  While every vaccine or medication has some risk, these risks are much less than the risk of not receiving a recommended vaccine.  Nothing is 100% pure.  Even Ivory Soap, for those of us old enough to recall their commercials, is only 99.44% pure. 

Perhaps, we should avoid the term ‘contaminated’ which can spook travelers.  Let’s use the phrase ‘inert ingredients’ instead.  Let’s keep this issue in perspective. I would swallow some inert pig virus any day of the week if it might spare me from the thrill and excitement of acute gastroenteritis.  How bad is this disease?  I’m a gastroenterologist; I should know.

Posted by: mkirschmd | May 13, 2010

Breaking News! Vaccines Work!

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Vaccinations represent one of medicine’s scientific triumphs, saving millions of lives every year.  They are safe, effective and often inexpensive.  A medical journal, the Journal of Infectious Diseases, has just reported that since the rotavirus vaccine was introduced here in 2006, hospitalizations for gastroenteritis declined significantly.  While it is hardly shocking that the vaccine works, scientists were surprised how effective the vaccine truly is,

Two major studies published this year already demonstrated that the vaccine saves lives abroad.   Now, we have evidence that the vaccine’s benefit is both foreign and domestic.  For example, the recent study estimates that the vaccine prevented 55,000 hospitalizations in America in 2008, nothing to ‘sneeze’ at!  

Rotavirus is a concern to international travelers because the virus is present throughout the world, particularly in developing countries in Africa, South America and Southeast Asia.  The disease is highly contagious. The virus is a common cause of gastroenteritis, an acute illness characterized by nausea, vomiting and diarrhea.  A one word description of the illness is ‘miserable‘.

When you meet with your travel doctor to discuss travel vaccinations and other health and safety advice, find out if rotavirus is a common guest at your destinations.  While your physician may not advise the rotatvirus vaccine, there are common sense steps you can take to reduce your risk of contracting the disease.

It’s much more pleasant to read about gastroenteritis here on the Travelogue than to experience it personally.  Trust me; I’m a doctor.

Posted by: mkirschmd | April 26, 2010

Are Travel Vaccinations ‘for the Birds’?

Hopefully, all Americans who are advised to receive the seasonal flu and H1N1 (formerly known as swine flu) vaccines, have done so.  There is another flu virus that is a potential threat to international travelers.  Is ‘Bird Flu’ on your itinerary?

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What is ‘Bird Flu’?

Avian Influenza H5N1, or bird flu, typically infects birds and poultry.  However, international travelers are at risk of contracting the disease, which has a high mortality rate.  International travelers should consult with a travel physicians for advice on how to reduce your risk.   Unlike hepatitis, typhoid, meningitis and yellow fever, there is no commercially available avian flu vaccine/ Resistance to typical anti-flu medications is common. Most human cases of the disease occur from contact with live infected birds and poultry, or their droppings.  Human to human transmission is rare. 

 Where are the ‘High Risk’ Regions?

A particularly severe strain of bird flu has been reported in Asia, Africa, Europe and the Middle East, which has infected humans.  Since last year, bird flu outbreaks have been reported in Cambodia, China, Egypt, Vietnam and Indonesia.  Just this month, Egyptian health authorities reported a fatal case of bird flu in an 18 year-old female, who had contact with infected poultry.

What Precautions Should Travelers Take?

  • Avoid poultry farms and contact with live animal markets.  Do not regard these sites as ‘petting zoos’.
  • Wash hands with soap and water regularly
  • Use alcohol based sanitizers if soap and water are not available.
  • Make sure that all poultry and eggs are thoroughly cooked.  If the eggs are runny, then cry ‘fowl’!
  • All surfaces that have been in contact with raw poultry, such as utensils and cutting boards, should be scrubbed clean with soap and hot water.
  • Do not bring home feather products for souvenirs from high risk regions. Buy a postcard instead.
  • If a traveler develops flu-like symptoms in a high risk bird flu region, seek medical attention. 

Many diseases abroad can be prevented by effective travel vaccinations.  Other diseases, such as malaria, traveler’s diarrhea, norovirus and bird flu have no available travel vaccines.   This means that travelers need other strategies to stay safe to make sure that bird flu is kept securely in its cage.

Posted by: mkirschmd | April 14, 2010

Do I Need Travel Vaccinations for Ireland?

This post could have been titled, When Irish Eyes Ain’t Smilin’.  Find out why.

170px-Four-leaf_clover[1]COPYRIGHT Ireland, the land of luck and leprechauns, has always been a popular destination for travelers. This past year, international travelers to this lush island experienced exposure to an infection that is rarely seen in developed countries. There was an outbreak of mumps virus in Ireland that affected over 800 college students throughout the country. England and Wales also reported a spike in their infection rate compared to the prior year.

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Here’s the part of the story that international travelers need to pay close attention to. Twenty-five percent of the mumps cases were never vaccinated and 29% did not receive the recommended two doses of mumps vaccine, based on available data from the patients. These students may be academic scholars, but they get a grade of F on Preventive Medicine 101.

When international travelers meet weeks before departure with their travel doctors, they discuss how to prevent various exotic diseases such as yellow fever, malaria and typhoid fever. This is also an excellent opportunity to verify that you are up to date on all of your routine immunizations, such as mumps, diphtheria and tetanus.

As your travel doctor will advise you, no vaccine offers 100% protection. In April 2009, four American university students, 2 of whom recently traveled to Ireland, are believed to have had mumps infections. All four of them had been properly vaccinated.

On the domestic front, New York and New Jersey reported a mumps outbreak a just a few months ago, reinforcing the need for everyone to be up-to-date with routine vaccinations.

So, if you’re off to Ireland soon, and desire a mumps-free excursion, don’t rely upon the ‘luck of the Irish’. Review your vaccination history with your travel doctor. You may need other travel vaccines for Ireland, besides routine vaccinations.  If you do need a mumps vaccine, since it is only 80% effective, bring a four leaf clover along, just in case.

Posted by: mkirschmd | March 31, 2010

FDA Says No to Jet Lag Drug

Travelogue readers were previously alerted to a new drug being promoted for jet lag.  While jet lag is not a serious threat to international travelers, such as malaria or yellow fever, it can significantly decrease the quality of your trip.  Most travel experts agree that touring foreign countries is more enjoyable when you are awake.  Similarly, corporate executives who are traveling abroad for business, agree that these meetings are more useful and productive if they are coherent and conscious during them.

 Jet lag is a disruption in the traveler’s internal clock that occurs when several time zones are crossed.  With preparation, it can be minimized. International travelers have many tools available to minimize jet lag so you will not be stuporous when you want to be sharp.

 The pharmaceutical company Cephalon was hoping that Nuvigil, which promotes alertness, would be approved for jet lag.  The company was hoping for approval as Provigil, a similar drug it manufactures, will be facing competition from generic alternatives 2 years from now.  The Food and Drug Administration (FDA) rejected approving Nuvigil for jet lag, which is probably giving Cephalon executives and stockholders acute insomnia.  There is still no FDA approved prescription medicine for jet lag.

For now, Cephalon executives will be counting sheep instead of counting dollars.

Posted by: mkirschmd | March 21, 2010

‘Dr. Mom’ Supports Travel Vaccinations

Travelogue is pleased once again to feature guest blogger, Erik McLaughlin, M.D. an experienced travel writer and an expert in travel medicine. When Erik talks, travelers listen.

Attention travelers!  Listen to Dr. Mom!  Sure, she bakes apple pie.  But, she also has good advice to keep international travelers safe abroad. So much of travel safety and preventive medicine is good old fashioned common sense.  Here are some tips to prevent illness and to avoid spreading illness to others.

There are several simple steps that can minimize your risk of getting sick abroad.  Most of these words of medical wisdom are known to mothers and grandmothers across the country.  Even though these medical ‘experts’ never went to medical school, the tips that follow are good medicine, not ‘old wives tales’.

  • Wash your hands often using soap and water.
  • Use alcohol based sanitizers if soap and water is not available.
  • If you have the misfortune of being ill, then cover your cough!
  • Cough or sneeze into your sleeve, not your hands.  Can you figure out why?
  • Used tissues should be promptly discarded and not saved as a trip memento.
  • If a trip companion or acquaintance appears ill, then keep your distance.
  • If you think you have a ‘bug’, then keep away from others.
  • If you have a fever, consider enjoying some solitude in your hotel room to protect others from becoming ill.

Although I am a practicing physician, I can’t improve on ‘Dr. Mom’s’ advice.  Common sense abroad is your most safety strategy.  This tool will not only mimimize your risk of contracting and spreading illness, but will also keep you safe on the road and on the street.  As of yet, there is no travel vaccine against ‘bad judgment’, so travelers will need to remain vigilant and responsible.  If you find yourself in a dicey situation, then just consider, WWMD?   Asking yourself, What Would Mom Do, will show you a path to safer ground. 

All of us at Travel Clinics of America wish you a safe journey.  We encourage you to consult with one of our trained doctors in your area before your trip to give you travel safety advice and any necessary travel vaccinations.   Your mom would want you to do this.

One person can make a difference.  Millions of people working together can change the world.

A fabulous campaign called MassiveGood opens tomorrow at the United Nations in New York City.  Travelers will now have the opportunity to donate $2 when they book an airline ticket, rent a car or pay for hotel accomodations.  The money will go Unitaid, a charitable organization founded in 2006 that already receives hundreds of millions of dollars from donations, taxes and airline surcharges in several other countries.  Now, Americans will have a chance to participate in a global effort to combat 3 deadly diseases – AIDS, malaria and tuberculosis.

What if every traveler clicked on the MassiveGood icon when they were booking tickets?  Since there are about 2 billion annual air travelers, MassiveGood could produce MassiveCash to prevent and relieve suffering throughout the world. 

All of us at Travel Clinics of America hope that this phenomenal program will go ‘viral’ in the traveling community.  Two dollars won’t make a difference to each individual traveler, but collectively it can make all the difference in the world.

Posted by: mkirschmd | March 3, 2010

Is there a Vaccine for Chikungunya Fever?

Chikungunya is a:

(1) Native American ceremony

(2) An ancient language

(3) High tribal official

(4) A viral disease

I’m a doctor, and until I started learning about travel medicine, I would not have known that Chikungunya is a viral disease. Like malaria, Japanese encephalitis and yellow fever, it is transmitted by mosquitoes. This illness generates concern from doctors and international travelers because there is no protective vaccination or any effective treatment of the disease. Even though most readers here have never heard of this disease, millions of people in Asia and Africa are infected with the virus.

There is an acute phase of the illness, characterized by high fever, headache, nausea, vomiting, fatigue and a skin rash, and a chronic form that has debilitating arthritis that can last months or even years.  Fortunately, most people recover.

Scientists have just announced the results of exciting research on developing a vaccine against Chikungunya fever. Monkeys received an experimental vaccine and did not become ill when exposed to the virus. These results were so promising, that scientists expect to begin human trials of the vaccine. If successful, this would prevent suffering in millions of people throughout the world.

Since there is no vaccine or treatment, international travelers need to avoid mosquitoes. Precautions are similar to those for other mosquito-borne illnesses.

200px-Aedes_aegypt Chikungunyai_biting_human[1]

  • Use insect repellents with DEET
  • Wear long sleeves and long pants, preferably treated with mosquito repellent
  • Avoid or eliminate standing water
  • No open windows

While there is no vaccine yet, you can still protect yourself. Discuss your itinerary with your travel doctor, especially if Asia or Africa are your destinations. Chikungunya is probably an unfamiliar disease to you; let’s keep it that way.

Posted by: mkirschmd | February 24, 2010

A Meningitis Tragedy – Get Vaccinated!

Tragically, an Ohio university student, whose home is just a town away from mine, died last week from bacterial meningitis. The loss of a teenager to a disease is heartbreaking, particularly when there is a safe and effective meningitis vaccine available. I still remember medical school lectures where professors warned us that bacterial meningitis can kill a person in hours. They showed us slides (there was no power point back then) of the characteristic skin rash of meningitis, and admonished us never to forget it. I haven’t.

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Although the CDC advises meningitis vaccination for college students living in dorms, Ohio does not require this. In fact, in Ohio only 38% of teenagers have received the meningitis vaccine, below the national average. Health experts strongly urge that all college freshman be vaccinated prior to arriving at school. An Ohio bill was introduced to mandate meningitis vaccination for college students, but it has not moved forward in the legislature. Most states, in fact, do not require meningitis vaccination for college students. We don’t need a law in order for us to do the right thing.

Vaccinations are one of the greatest triumphs of modern medicine. They prevent terrible diseases with very low risk and expense. Meningitis is a threat both here and abroad. International travelers to the ‘meningitis belt’ in Africa, for example, should discuss this vaccine with their travel doctor.

If you are traveling abroad, meet with a travel doctor weeks before departure. In addition to necessary travel vaccinations, you will receive important travel safety advice.

Of course, there is no law that forces international travelers, or any of us, to receive the meningitis vaccine, or other important travel vaccinations. Does there have to be?

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