Posted by: mkirschmd | February 18, 2010

Vancouver Olympics – No Medals for Officials

Vancouver is captivating the world, even though the iconic show ‘American Idol’ on the Fox network had more viewers than the Olympic snow and ice competition on NBC, earlier this week. Fox and ‘Idol’ get the gold.

Medals are pouring in for the Americans. So far, they have won 14 medals in Vancouver. Yesterday, American athletes astonished the world by winning 6 medals in a single day – an Olympic tour de force. No American team has ever achieved this in the Winter Games.

Another Olympic record may have been achieved earlier this week when officials made errors in 2 Olympic events. This was an embarrassment to the International Biathlon Union, who is responsible for these officials. On Tuesday, in a womens 10 km race, an official delayed the start of 3 athletes, all of whom had late starts. But wait, there’s more. Two male biathlon athletes were sent off too early on their race. After the fact, the athletes’ times were adjusted, but this is a clumsy correction to mistakes that should never happen. The U.S. Biathlon director filed a protest.

The athletes train for years aspiring for perfection. They deserve officials who can, at least, start a race on time. So far, no medals for these guys.

All of us at Travel Clinics of America wish the athletes, the Vancouver spectators and even the officials,  a safe and thrilling experience.

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Posted by: mkirschmd | February 14, 2010

The H1N1 Vaccine, Who Needs It?

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. He is a physician member of Travel Clinics of America.

Travel is exciting.  It puts into close contact with new people, new locations, new foods and new cultures.  This is one of the reasons why we all enjoy traveling so much!  However, when one has contact with new areas and new people, there is also a chance to be exposed to new illnesses.  Savvy travelers have consulted with travel doctors for various special travel vaccinations to stay safe on their trip abroad or foreign adventure.  Some travelers require malaria medicine, and others require vaccines against exotic illnesses.

This year, because of the H1N1 pandemic, flu shots have become an important issue for international travelers. 

Influenza vaccines are one of the most important tools to prevent the spread of flu.  Most people should be receiving their annual influenza vaccine to help prevent seasonal flu.  In contrast, the H1N1 vaccine is currently advised for certain ‘high risk’ groups of people and is not advised for general use.  Currently, the Centers for Disease Control (CDC) advises that the following initial target groups of people receive the H1N1 vaccine:

  • people who live with or provide care for infants younger than 6 months (e.g., parents, siblings, and day care providers)
  • health care and emergency medical services personnel
  • people 6 months through 24 years of age (especially those with higher risk for influenza-related complications like children younger than 5 years and those who have high risk medical conditions)
  • people 25 years through 64 years of age who have certain medical conditions that put them at higher risk for influenza-related complications.

Once the target groups have been immunized against H1N1, vaccines should be given to the general population from ages 25-64 years of age.  Unlike the yearly seasonal flu, healthy persons over the age of 65 are at less risk of H1N1 than those under age 65 and are advised to receive their H1N1 vaccine after the 25-64 year old age group has been vaccinated.

Should international travelers receive the H1N1 vaccine? There is limited data to support general vaccination of travelers.  However, should a traveler fall into one of the target groups mentioned above for receiving H1N1 vaccine, then they should be vaccinated. Meet with your travel doctor several weeks before your trip to discuss anti-viral medications if symptoms of influenza strike while you are abroad.  These medications have been shown to decrease symptoms of the flu, especially if taken within the first 48 hours of the illness.

Over 50 million Americans have contracted H1N1 so far.  Do you want to be on this list?

Posted by: mkirschmd | February 8, 2010

Should International Travelers Receive the Rotavirus Vaccine?

Electron micrograph of rotaviruses.   The name of the virus is taken from the Latin word for wheel, rota, because of the circular appearance of the virus under the electron microscope.

Rotavirus is a very sneaky germ.  Like many viruses, it is highly contagious and is a plague in the developing world.  There is no treatment, but the disease can be prevented by a safe and effective rotavirus vaccine. 

 How Serious is Rotavirus? 

The disease kills 500,000 young children in Africa and Asia every year.   Consider how staggering these this loss of life is compared with the tragic loss of over 5000 Americans in the wars in Iraq and Afghanistan.   Unlike other diarrheal illnesses, improving sanitation does not reduce the risk or rotavirus infection.   Rotavirus is a health issue in the United States also.  Each year, about 600,000 infected people are seen in the U.S. by doctors and emergency rooms.  There are hospitalizations and fatalities also.

Can Rotavirus be Prevented?

Vaccination is key and is about 75% effective.   A broad immunization program in the third world would save hundreds of thousands of lives every year.  PATH, a global health advocacy group estimates that an effective vaccination strategy could save 2.5 million people by the year 2025.   Even if their data is optimistic, vaccination would still save millions of lives.   

Does the Rotavirus Vaccine Really Work?

Yes. Currently, there are 2 rotavirus vaccines available that are given to infants in the United States routinely.  Unfortunately, the countries that need these vaccines most desperately are not receiving them because of cost and logistical obstacles.  We now have proof that rotavirus vaccines save lives.  The prestigious New England Journal of Medicine published 2 major studies in the January 28, 2010 issue that clearly showed that a rotavirus vaccination program in Mexico and Africa saved children.  The World Health Organization now recommends that rotavirus vaccine be administered routinely throughout the world. 

Should International Travelers Be Vaccinated?

International travelers are not advised to receive rotavirus vaccine, although you should be up-to-date on your routine vaccinations.  However, when you meet with your travel doctor, you will discuss disease trends, including rotavirus, in your destinations.   Since this virus is contagious, there are precautions you can take to reduce your risk of contracting it.   There’s no cure like prevention.

Posted by: mkirschmd | February 2, 2010

Is the Vancouver Winter Olympics Safe?

Millions of eyes will soon be on Vancouver, British Columbia to witness the 21st Winter Olympic Games, which opens on February 12th. The Paralympic Games will follow on March 14th. I was in Vancouver this past summer and construction for the games was already underway. It promises to be a spectacular competition. There will be speed skating, snowboarding, ski jumping, ice hockey, luge racing and other frozen delights.

There will be huge crowds converging on Vancouver to spectate the events. Large crowds can create another competition that is not part of the official Olympic schedule. Germs can spread through a crowd quickly like a brushfire, infecting thousands of people. For those who will be visiting, have you trained properly for the unofficial Olympic competition of Germs vs The Crowd?

The H1N1 (swine flu) virus or the seasonal flu virus do not tickets to get front row seats in Vancouver. In fact, they can occupy any seat at every event. For those procrastinators who have not yet been vaccinated, there is still time to get protected before you depart to Canada.  Get the H1N1 and flu vaccines STAT!

Here are some common sense travel health and safety recommendations.

• Make sure you are up-to-date on routine vaccinations.
• Wear warm clothing including hats and gloves as hypothermia and frostbite can occur in the Canadian winter climate.
• Bring hand sanitizer and wash your hands with soap and water frequently.
• Apply proper sunscreen to exposed skin. Yes, you can get sunburn in the winter.
• Have a plan in place for contacting a local physician in the event you become ill.
• Verify if your medical insurance covers you in Canada.
• Take precautions to mimimize jet lag.
• Avoid contact with any ill individual.
• If you become ill, cover your mouth and nose with a tissue when you cough or sneeze. Then, wash or sanitize your hands immediately. To the extent you can avoid close contact with others, you will be performing a noble public health service.

The Olympic Torch Ceremony is less than 2 weeks away. The Winter Games will be exciting to watch on TV and will be an incredible thrill to witness in person. For those lucky enough to be in Vancouver, be cautious about the invisible competitors who may be stalking you and hoping for a victory. Make sure that they never make it to the winner’s circle.

Let the games begin!

Posted by: mkirschmd | January 25, 2010

Don’t Volunteer to Help Haiti!

Haiti is crying out for help. The world is shocked and saddened by the suffering and devastation from an earthquake that struck the island without mercy. Governments and ordinary citizens from the four corners of the globe have sent armed forces, medical personnel, blankets and supplies, volunteers, disaster relief experts, cash and prayers.

Americans have responded with abounding generosity to help ease the unimaginable suffering in our impoverished southern neighbor.

We Want to Help

Many folks have offered to put their personal lives aside to travel to Port-au-Prince to volunteer. They are examples of America at its best, and we all admire them.

They want to help with relief efforts, delivering supplies, unloading medical equipment, feeding the hungry and trying to bring some measure of hope into a very dark country. Many are ready to travel there, but are not sure what their task will be. They assume that an extra pair of arm and legs will be put to good use.

What Help Do the Experts Need?

Relief experts are urging ordinary people not to book plane tickets to Haiti. Good intentions are not enough to make traveling to Haiti a good idea. Those who are determined to volunteer should do so only as part of an organized relief effort. Volunteers may not be adequately prepared and trained for:

  • A harsh environment with a destroyed infrastructure
  • Questionable security
  • Inadequate resources
  • Health risks

Haiti needs personnel who are trained in disaster relief. Governments and various nongovernmental organizations (NGOs) have a roster of medical and technical experts that were quickly mobilized and dispatched. These professionals have done this before and know what they are doing.

James J. James, a physician and public health expert, recently expressed to a physician audience a caveat to those who want to volunteer in Haiti.

“Volunteers must be part of the solution, not the problem.”

What Should We Do?

For most of us, making a cash donation to a reputable organization is what we should do. These organizations are professionals and know where the funds are best needed. They would rather have us send cash than ship flashlights and shoes, which may not be a priority need at the moment. For those of us who simply must make a personal trip to Haiti, first contact a relief organization who can decide how you can best contribute to their team. Your next phone call should be to a travel doctor because you may need travel vaccinations for Hepatitis A, Hepatitis B and typhoid, and other important travel safety advice.

Here are 3 suggestions of organizations that would welcome your generous donations.

American Red Cross

Doctors Without Borders

Mercy Corps

This is not amateur-hour. Leave it to the professionals.

Posted by: mkirschmd | January 21, 2010

Do Travelers Need the H1N1 Vaccine?

Travelogue is pleased to feature guest blogger, Erik McLaughlin, M.D. an experienced travel writer and an expert in travel medicine. When Erik talks, travelers listen. He is a physician member of Travel Clinics of America.

Most people who are not living in a cave have heard about the H1N1 virus (formerly known as swine flu). This strain of influenza exists throughout the world and has been classified as a pandemic. The H1N1 virus is an important issue for international travelers. Travel doctors have been following international trends of H1N1 infections closely, so they can advise their travelers if this vaccine is necessary.

Should international travelers receive an H1N1 vaccine? Does the regular, or seasonal flu shot, protect against H1N1?

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Flu Background

The cause of the common “seasonal” flu is viruses. There are literally hundreds of strains of influenza that can cause seasonal flu, which typically strikes us each winter. The seasonal flu is the common ‘flu’ and is often known as a ‘cold’. The symptoms include runny nose, fever, chills, cough and muscle aches.

These strains of seasonal influenza have similar genetic make-up that changes slightly as the viruses migrate during flu season. In contrast, H1N1 influenza is a specific type of influenza that is genetically different from other influenza strains. This is why the regular ‘flu shot’ won’t protect against H1N1 disease.

 Flu Vaccine Background

There are two flu vaccines available now. The first is the seasonal influenza vaccine, or ‘flu shot’ against the common strains of ‘flu’. The second is the H1N1 vaccine that specifically targets the H1N1 virus, but has little or no effect on seasonal flu. Unfortunately, receiving one vaccine does little to protect against the other virus. This is why physicians often recommend both vaccines to many patients.

You should consult with a travel doctor several weeks before departure. Your physician will review specific details about you and your itinerary and will advise you if the H1N1 vaccine should be administered. Of course, there may be many other travel vaccinations that are also recommended.

Whether you’re traveling abroad or staying stateside, talk to your doctor about these important vaccines to keep you healthy. As a physician, I can guarantee that it’s much better to get flu shots than it is to get the flu.

Posted by: mkirschmd | January 16, 2010

Is Yellow Fever Vaccine Safe?

Receiving a ‘live virus vaccine’ sounds scary.  Who wouldn’t think twice about receiving a travel vaccination that contained a live virus?  Relax, scientists and the pharmaceutical companies know what they are doing.  In fact, a milestone experiment in vaccination from the 18th century, used a live virus.  

Edward Jenner, observed in England that milkmaids who had developed the disease cowpox did not develop the more serious illness of smallpox.  In a bold experiment in 1796, he inoculated a young boy with cowpox fluid, and then exposed the child to smallpox several weeks later.  The boy remained well.  Such an experiment would not be permitted today, but Jenner’s pioneering work has benefitted humanity to this very day.  Trivia enthusiasts should know that the term vaccine is derived from the Latin word vaca, for cow. 

Yellow fever vaccine, a safe and effective live virus vaccine, is administered to millions of people today.  This does not make healthy people sick because the virus has been altered so that it cannot cause disease.  Side effects are rare. Xcellerex, a vaccine development company has just announced exciting research that they are testing a new yellow fever vaccine that does not include live virus.  If successful, this will permit yellow fever vaccination to travelers who cannot receive the traditional live vaccine.  Travel doctors will not give live virus vaccines to pregnant women, patients with impaired immune systems from illness or medications or to those with a severe egg allergies.

Yellow fever, common in African and South America, is spread by mosquitoes.  It can cause serious illness to international travelers.  Vaccination is critical as there is no treatment for this disease.   Some countries require yellow fever vaccination before entry, but it’s not your protection they’re concerned about.

Live virus vaccines are part of the bedrock of standard medical practice.  Examples of live virus vaccines include:

  • Measles
  • Mumps
  • Rubella
  • Oral Polio Vaccine
  • Chickenpox

Talk to your travel doctor about yellow fever vaccine and other important travel vaccinations.  Don’t worry about receiving a live virus vaccine.  The real worry should be contracting the disease.  Safe travels!

Posted by: mkirschmd | January 9, 2010

Breakthrough Drug for Jet Lag?

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Could this be the end of travelers pandiculating in the streets?  Relax parents, this term is Rated G and means yawning and stretching.  This is a family blog.

At present, there is no F.D.A. (Food and Drug Administration) approved drug against jet lag, but that may change soon. The pharmaceutical company Cephalon is seeking FDA approval of their drug Nuvigil for jet lag. This would give travelers an option to reduce the effect of jet lag, which is more intense when traveling eastward across several time zones.

Jet lag can set travelers back a few days, if they don’t adequately prepare for the time zone change. If you have jet lag on a short trip, then you might miss most of it as you may be asleep and awake at the wrong times. If you are a business traveler on a 2 day trip packed with business meetings and sales calls, then you don’t want jet lag on your itinerary. A safe drug that really worked could be useful here.

Of course, there is a ‘behind the scenes story’ here, as reported in The New York Times. Nuvigil, already approved for other sleep disturbances, has a patent which expires in 2024. Cephalon is aiming for Nuvigil to take on the role of a closely related drug, Provigil, which will face competition from generics in 2012. The company would benefit if current or potential Provigil users, would take Nuvigil instead. And, with an official jet lag indication from the F.D.A., pharmaceutical representatives would be permitted to market the drug to nearly any physician, rather than only to sleep specialists.

Will physicians prescribe Nuvigil, a prescription medicine with potential side effects, for a benign condition like jet lag, particularly when there are safe available techniques?

Travel doctors typically recommend many risk free strategies to minimize jet lag:

  • Avoid caffeine for a few days prior to departure.
  • Stay well hydrated during your flight
  • Sleep during flight when it’s bedtime at your destination
  • Adjust your sleeping and waking times a few days before departure so your pre-departure schedule will mimic your destination time zone.
  • Adjust to the new time zone on arrival. No midday naps!
  • Consider melatonin supplements, not proven but used by many travelers.

What is our opinion? We’re skeptical that Nuvigil will be a magic bullet to transform travelers from stupor into a razor sharp state of alertness. Let’s see what the F.D.A. has to say about it. We will be following and will keep you posted.

Could Nuvigil be used for Blog Lag, a condition where the reader nods off in the middle of a blog post? Perhaps, we should contact Cephalon and begin some preliminary discussions.  Safe travels to all.

Posted by: mkirschmd | January 7, 2010

Getting H1N1 Immunity: Two Surefire Methods

My wife and I are both immune to H1N1.  Here’s how we did it.

  • I received the H1N1 vaccine
  • She got sick with H1N1 disease

Both of these methods are effective.  Which method would you prefer?   As a physician, I recommend the H1N1 vaccination strategy, but the choice is yours.  The public health authorities and the pharmaceutical companies have performed incredibly well in understanding the H1N1 virus, and translating scientific knowledge into a safe and effective H1N1 vaccine.   And, they did it in time. 

Of course, the government had some missteps.  This is to be expected when you are aiming at a moving target.  If the Feds didn’t respond with sufficient resources and attention, and the H1N1 pandemic caused a plague across America, then the country would not forgive them, particularly with the memory of the government’s response to Hurricane Katrina, just a few years ago.  The error of overreacting to a perceived crisis is much easier to forgive, as money is wasted instead of lives. 

How did the press do with H1N1?  Did they accurately report H1N1 facts or did they contribute to the national hysteria?  We’d like to know your opinion.  Exercise your right to vote in the following poll.  And, feel free to leave a comment.

Posted by: mkirschmd | January 4, 2010

Do You Need a Travel Vaccine for Measles?

 Measles is for Kids, Right?

Think again.   It can strike adults, particularly those who are not immune and are traveling to at risk regions.  Although measles in America is uncommon, since we vaccinate routinely here, in many parts of the world, measles is alive and well.  There are 10 million cases of measles worldwide every year, with nearly 200,000 fatalties.  Nearly 90% of measles cases in the U.S. are linked to a traveler entering this country.  International travelers must review their routine vaccinations history with their travel doctors to verify if they are immune to measles. 

Am I Immune to Measles?

There are only 2 surefire methods that a person can develop immunity to measles.

  • Receive the proper measles vaccination
  • Recover from measles infection 

Most of us would prefer the first method.   Last month, a California woman returned from abroad where she contracted a confirmed case of measles.  This concerned local health officials who publicized various locations and stores she visited to warn the public of this potential measles exposure.  Measles is a highly contagious virus and has increased risk for unvaccinated infants, pregnant women and individuals who have impaired immunity.

Where in the World is Measles?

Measles is present in many countries, including developed nations in Asia and Europe, including England and Wales.   Folks traveling to London or to a Welsh castle may not consider these to be destinations that may require a travel vaccine.  This is why advice and education from a trained travel physician is so important.  Parts of Africa, South America, India and Southeast Asia are also higher risk regions for measles because of lower vaccination rates of these populations.

When you are discussing  travel vaccinations with your travel doctor, you may need a measles vaccine if immunity against this virus is in doubt.  Vaccination will protect you against the infection and will protect the rest of us when you come home.

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