Travel in Good Health – Part 2 of 3

25 07 2014

All the prep and stress of getting out your front door is over. Now it’s fun, sun, and bugs.

Wait. What?

Oh yes, wherever your journeys take you, you can be sure that pesky critters will be flying or crawling around, biting, stinging and more…so much more.

Some bugs carry certain diseases, such as West Nile virus, malaria, dengue and others. Whether you’re in Napa Valley, the Sahara or the Alps, there are steps you can take to avoid infection.

  • Use an insect repellent on exposed skin to repel mosquitoes, ticks, fleas and other arthropods. EPA-registered repellents include products containing DEET (N,N-diethylmetatoluamide) and picaridin (KBR 3023). DEET concentrations of 30% to 50% are effective for several hours. Picaridin, available at 7% and 15 % concentrations, needs more frequent application.
  • DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. There are DEET-free solutions available, but check with the pediatrician for a final recommendation. Protection against mosquito bites is the goal.
  • When using sunscreen, apply sunscreen first and then repellent. Repellent should be washed off at the end of the day before going to bed. Put repellent only on exposed skin and/or clothing and don’t apply repellent to open or irritated skin. Don’t let children handle the repellent. Rather than spraying it directly on children, adults should apply it to their own hands then rub it on the children. Don’t get it near a child’s mouth, eyes or hands and don’t use much around a child’s ears.
  • Wear long-sleeved shirts which should be tucked in, long pants, and hats to cover exposed skin. When you visit areas with ticks and fleas, wear boots, not sandals, and tuck your pants into your socks.
  • Inspect your body and clothing for ticks during outdoor activity and at the end of the day. Wear light-colored or white clothing so ticks can be more easily seen. Removing ticks right away can prevent some infections.
  • Apply permethrin-containing (e.g., Permanone) or other insect repellents to clothing, shoes, tents, mosquito nets, and other gear for greater protection. Permethrin is not labeled for use directly on skin. Check label for use around children. Most repellent is generally removed from clothing and gear by a single washing, but permethrin-treated clothing is effective for up to 5 washings.
  • Be aware that mosquitoes that transmit malaria are most active during twilight periods (dawn and dusk or in the evening). Stay in air-conditioned or well-screened housing, and/ or sleep under an insecticide-treated bed net. Bed nets should be tucked under mattresses and can be sprayed with a repellent if not already treated with an insecticide.
  • Keep baby carriers covered with a mosquito net.
  • Daytime biters include mosquitoes that transmit dengue and chikungunya viruses, and sand flies that transmit leishmaniasis.

Don’t forget to come back for Part 3, where we talk about more fun times for traveling parents.

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Travel in Good Health – Part 1 of 3

24 07 2014

[Editor’s note: We posted this a few years ago, but find the info timely, so what the heck, we’re running it again! Parts 2 and 3 run 25 and 26 July.]

Traveling with children, no matter their age, can be a joyful, tiring, exciting, and exhausting endeavor. Traveling with children who get sick on the trip is just plain exhausting and, sometimes, exciting in a way that we don’t want to experience.

Although dealing with illness in the midst of a family trip isn’t ideal, you can take steps to prevent illness before traveling and equip yourself with supplies to make the treatment of illness easier and more comforting.

Prevention is key, and no one does that better than the CDC. This article captures some tips for traveling families from CDC’s website, and a few other places.

If anyone in your travel group has an existing condition that may affect his or her health, it’s important to discuss travel health safety with a healthcare provider.

If you’re traveling outside the United States and you love detail, download a copy of CDC’s Yellow Book . It’s written for healthcare providers, but many people find it useful. Wherever you’re traveling, these suggestions may help you and yours avoid infectious diseases on the road.

There are steps you can take prior to departure that will protect you and your kids, and many things you can do while traveling. First, the pre-departure list:

Time Zones and Rest

If you’re changing time zones, spend a few days just before travel adjusting your sleep/wake periods to match the destination’s time zones. When you arrive, get out during the sunny periods so that you body realizes it’s time to be awake. Good sleep is critical to good health. Make sure everyone gets lots of rest a few days before and then during the trip.

Vaccinations

You and your kids should be up-to-date on currently recommended vaccines in the U.S.

If you’re traveling outside the United States, you need to check the destination country for recommended vaccines for you and your children, and if you have special health concerns, you need to determine which vaccines to get and which you should not have. Not all vaccines recommended for international travel are licensed for children.

Health Notices

If you’re traveling outside the U.S., read the CDC’s Health Notices first to get the latest updates on infectious diseases in various areas of the world. What you learn may affect your travel plans.

First Aid Kits

Prepare a first aid kit for the trip or purchase one from a commercial vendor. This is a sample list, as not all destinations require the same things.

  • 1% hydrocortisone cream
  • Ace wrap
  • Acetaminophen, aspirin, ibuprofen, or other medication for pain or fever
  • Address and phone numbers of area hospitals or clinics
  • Adhesive bandages
  • Aloe gel for sunburns
  • Antacid
  • Anti-anxiety medication
  • Antibacterial hand wipes (including child-safe) or alcohol-based hand sanitizer containing at least 60% alcohol
  • Antibacterial soap
  • Antibiotic for general use or travelers’ diarrhea (azithromycin, cefixime)
  • Antidiarrheal medication (e.g., bismuth subsalicylate, loperamide)
  • Antifungal and antibacterial ointments or creams
  • Antihistamine (such as Benadryl)
  • Antimalarial medications, if applicable
  • Anti-motion sickness medication
  • Commercial suture/syringe kits (to be used by local health-care provider with a letter from your prescribing physician on letterhead stationery)
  • Cotton-tipped applicators (such as Q-tips)
  • Cough suppressant/expectorant
  • Decongestant, alone or in combination with antihistamine
  • Diaper rash ointment
  • Digital thermometer
  • Epinephrine auto-injector (e.g., EpiPen), especially if anyone has a history of severe allergic reaction. Also available in smaller-dose package for children.
  • First aid quick reference card
  • Gauze
  • Ground sheet (water- and insect-proof)
  • High-altitude preventive medication
  • Insect repellent containing DEET (up to 50%)
  • Latex condoms
  • Laxative (mild)
  • Lice treatment (topical)
  • Lubricating eye drops
  • Malaria prophylaxis and standby treatment, as required by itinerary
  • Medications that the child has used in the past year
  • Moleskin for blisters
  • Mosquito netting, if applicable
  • Oral rehydration solution (ORS) packets
  • Personal prescription medications in their original containers (carry copies of all prescriptions, including the generic names for medications, and a note from the prescribing physician on letterhead stationery for controlled substances and injectable medications)
  • Safe water
  • Scabies topical ointment
  • Sedative (mild) or other sleep aid
  • Snacks
  • Sunscreen (preferably SPF 15 or greater)
  • Throat lozenges
  • Tweezers
  • Water purification tablets

Discuss with your family’s pediatrician any special needs your children might have that require you to prepare beyond this basic list. Also, your pediatrician may be able to give you sample sizes of antibiotics and other meds that may be useful for your kit.

Health Insurance

Before traveling, check your health insurance policy to see what it pays for. It will probable reimburse you for most of the cost of emergency medical care abroad, excluding any deductible or co-payment. For non-emergency care overseas, you may be covered, but check with your health plan about this before you leave home. Failure to get authorization may mean denial of reimbursement.

Travel Regulations

Check travel regulations and carry what you can onboard the plane, particularly prescription medication. Put the rest in your checked baggage. Put your first aid kit in a fanny pack or backpack that you take with you everywhere you go. There’s no sense bringing the kit if you don’t have it when you need it.

Now that you’ve done your pre-departure prep, stay tuned for Part 2 for some tips on problems you may encounter on the road.

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Summer + Mosquitoes = Dengue Fever?

13 05 2014

The dengue fever virus is the most common virus that mosquitoes transmit and infects about 100 million people worldwide every year, killing about 25,000. In spite of this frequency, though, the United States, with the exception of Puerto Rico, has been mostly dengue-free for decades—until 2009.

image by infidelic

That year, a woman in New York turned up with a dengue infection, having just returned from a trip to the Florida Keys. Her case was the first of a handful that led public officials to conduct a survey of the Key West population. To their shock, they found that about 5% of residents, or about 1000 people, showed evidence of dengue exposure in 2009.

The mosquito that carries the virus occurs in warm areas of the country, including Florida and Texas, and indeed, isolated cases of dengue have cropped up a few times since the 1980s along the Texas–Mexico border. But the cases in 2009 and more in 2010 have authorities concerned that dengue now has achieved an intractable foothold on the continental United States.

Work on a vaccine against dengue is ongoing, but in the meantime, the only preventive is to avoid the bug that carries the virus: the mosquito.

Wearing repellent when in areas where they occur is one tactic. Another is removing breeding places, such as any containers with standing water. The precautions apply wherever you’re going, whether to areas where dengue is already endemic or where it is emerging. The CDC provides regular updates for travelers, including a page specific to the Florida cases.

Dengue fever can hit hard or harder, depending on the symptom severity. The “mild” version of the disease can involve a high fever, a rash, severe headache and pain behind the eyes, and nausea and vomiting.  Given that these symptoms are largely nonspecific, if you see your doctor about them and have traveled in a place where dengue fever occurs, be sure to mention it. A more severe form of dengue fever is dengue hemorrhagic fever, which begins much like the “mild” form but then progresses to symptoms that can include nosebleed and signs of bleeding under the skin, known as petechiae.  This form of dengue can be fatal.

The most severe manifestation of the disease, dengue shock syndrome, includes the symptoms of the milder forms along with severe abdominal pain, disorientation, heavy bleeding, and the sudden drop in blood pressure that signals deadly shock.  Onset is typically four to seven days after exposure, and the mild form usually lasts only a week, while the more severe forms can involve either a progressive worsening or a sudden worsening following an apparent improvement.

Oddly enough, having dengue fever once does not mean you’re safe from it. Indeed, some studies indicate that a second bout of dengue fever often can be worse than the first, with a greater risk of progressing to the hemorrhagic form.





Airplane Cabins and Your Health

30 08 2012

Do you remember SARS (Severe Acute Respiratory Syndrome)? It popped up in China in 2002 and spread to more than 25 countries before we could blink.

PKIDs landed a group of disease prevention educators in China just as the world became aware of this outbreak that would rapidly become an epidemic. It was coincidence, of course. The trip had been planned for months.

But, our proximity to the SARS outbreak was a reminder to us of how efficient air travel is at spreading germs.

In 2009, there were 2.5 billion airline passengers and that number is expected to increase to 3.3 billion by 2014. That’s a lot of sneezing, coughing, and just plain touching of armrests, overheads, and other surfaces going on in small spaces.

Dr. Alexandra Mangili and Dr. Mark Gendreau wrote a piece for the Lancet in 2005 that talks about the mechanics of disease transmission in an airplane. It’s very good, if you have a few minutes to read it.

They explain air flow patterns and how much air is recirculated (50% and that’s through filters). Turns out, air does not flow the length of the plane, but rather in sections or pockets along the width of the plane. Still an efficient method of disease transmission for airborne and large droplet transmission, but not the only way germs are spread onboard.

According to the article, the most common infections on aircraft have been via the fecal-oral route through contaminated food, although that has diminished in the last few years, possibly due to prepackaged food products and more care in the prepping and handling of food.

Mosquitos, a common vector for diseases such as dengue and malaria, often hitch rides on airplanes. Mangili and Gendreau point out that, “Many cases of malaria occurring in and around airports all over the world in people who had not travelled to endemic areas, known as airport malaria, is evidence that malaria-carrying mosquitoes can be imported on aircraft.”

The cabins of airplanes cannot be thoroughly disinfected between flights. Many times, a plane lands, passengers disembark, and more passengers are seated within 30 minutes. Think of all the droplets of goo left behind that the cleaning crew cannot remove, and the many surfaces that can’t be disinfected.

Keeping one’s hands clean throughout the flight will go a long way toward preventing transmission, and staying up-to-date on your vaccinations for your home country and your destination. As for masks, the authors say, “Although masks play a crucial part in infection control in health care settings, their use is unproven in disease control within the aircraft cabin.” But they do recommend masking and isolating someone suspected of having SARS.

The CDC has quite a bit more to say about air travel and travelers’ health in general, if you’re looking for more details.

How do you prevent infections during air travel? What do you do to protect yourself? We’d love to hear! Please share your tips in the comment section.

By Trish Parnell
Image courtesy of WHO





Why You Have to Vaccinate

7 05 2012

In 2000, public health workers slapped high fives and declared measles eliminated in the U.S. This meant that the disease wasn’t being passed person-to-person in this country.

In 2011, we had 222 cases of measles in the U.S.—a 15-year high.

Most of the 222 infected individuals were either unvaccinated or their vaccination status was unknown.

How did this happen? The answer is, almost all of the infections were imported. They came from U.S. residents returning from trips outside the country, or from visitors from foreign lands. The travelers carried the germ and, in some cases, infected others once they arrived.

Almost half of these cases came from countries with easy access to vaccines; the WHO European Region. The rub is, there are some Europeans who choose not to vaccinate themselves or their children, and the same is true in this country.

When a disease is floating around a community, it finds those who are unprotected and boom, we have disease outbreaks.

Most of the time, most of the diseases that are vaccine-preventable are not going to kill a child. They might not hospitalize him, or even make him feel really bad.

But, no one can say which disease will harm which child, and how much harm it will cause.

Kids do die from measles and chickenpox and other vaccine-preventable diseases. Or they don’t die and they only lose a limb, or their hearing, or they just need a liver transplant. Or any number of other health problems may occur that are still better than dying.

But like I said, no one can say how one child will be affected by one disease. So when I answer the phone here at PKIDs, and a parent on the other end asks if they really need to vaccinate their child against XYZ disease, I don’t have a problem telling them: you really do.

By Trish Parnell

Image courtesy of Vox efx





Spring Break!

19 03 2012

Health tips from our friends at CDC:

Going to another country for spring break? Follow these tips to reduce your risk of illness or injury abroad.

Spring break means an escape from the daily grind. For high school and college students, it can be a rite of passage or an annual tradition. This is your time. It is all about you, and YOU are in charge of your health, safety, and well-being.

Getting ready for spring break is more than just picking a destination.

While you’re choosing among an exotic island getaway, a ski vacation, or just a short ride down the highway, follow these steps to ensure you have a healthy and safe spring break trip.

For those Going Abroad

Vaccination before vacation. Before you go abroad, find out about vaccines and any health concerns at your destination. Check with the local health department or a travel medicine specialist 6 to 8 weeks before you leave the United States.

It’s still flu season, and vaccines are the most important tool we have for preventing the flu. Talk with your doctor about getting a flu shot.

Travel health insurance. Consider health insurance if you’re traveling outside the United States, because your regular carrier might not cover expenses. Coverage for emergency medical evacuation can be useful, particularly if you do extreme sports, such as mountain climbing or heli-skiing.

Active vacations. Whether your sport is ice climbing or reef diving, depend on reliable outfitters for success. When making reservations, ask questions to make sure you will be with properly trained guides and will be using well-maintained equipment. Don’t take chances that might cause injuries—or worse.

You are what you eat. Tempted to indulge in the local cuisine? Food can be the best or the worst part of your international trip. In developing countries, eat only food that has been fully cooked and served hot. Avoid eating fresh vegetables and fruits, unless you can peel them yourself. Drink only bottled, sealed beverages, and steer clear of ice—it was probably made with tap water.

Is it worth the risk? The phrase “what happens on spring break stays on spring break” can imply that it is okay—even expected—to engage in risky behaviors that you would not normally consider in your daily life, but you should take your healthy behaviors on vacation with you:

  • Use latex condoms if you have sex (see Sexually Transmitted Diseases).
  • To prevent infections such as HIV and hepatitis B, don’t get tattoos or piercings.
  • Drink alcohol responsibly and be sure to have a designated driver.
  • Remember the basics of safe driving: wear seatbelts, maintain the speed limit, and avoid distractions such as talking on the phone or texting while driving. (Using a cell phone while driving is illegal in many countries.)

Travel wise. Here are a few other reminders to ensure smart traveling:

  • Wear sunscreen. Avoid overexposure to the sun by wearing protective clothing and limit time in the sun during the hottest part of the day, 10 am–4 pm.
  • Swim in safe places. Before jumping in, ask about bacterial contamination, water depth, and other hazards, such as sharp rocks or coral, riptides, and dangerous sea animals.
  • Pack smart and remember that prevention can be travel-sized. Carry your own stash of first-aid supplies and medications. Insect repellent and antidiarrheal medicine are musts.

Politics, politics. The US Department of State website, www.travel.state.gov, helps travelers gauge the political climate of unstable countries.

You have been busy, you have worked hard, so now relax and have a good time—you deserve it!

More Information:
CDC Travelers’ Health





Nurse Mary Beth and Travel

20 06 2007

Nurse Mary Beth tells us ways to keep the kids healthy when traveling.

www.pkids.org

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Right-click here to download podcast (6 MB, 12 min)