Waterfalls in Iguacu Parana, Brazil



“Yellow fever continues to take its toll on those who are not vaccinated.

It causes more than 200,000 illnesses and 30,000 deaths worldwide among unvaccinated populations.”


Terry Parsons R.N.-C



International travelers tend to plan their trips based on activities: Napa and Sonoma for wine country touring, Costa Rica for ecotourism, and Lyon to experience dégustation gastronomique. What if you could do them all in one country?...



A doctor friend, Harold, called me one afternoon at the office. “My daughter, Anna, is about to leave for Colombia with her fiancèe and they are flying to rural Columbia where the embassy says it is dangerous to travel. What should I tell my daughter?”...



Q- After receiving immunizations for international travel, will I be able to donate blood?

Q- I am traveling to a country where the Yellow Fever vaccine is required. Are you authorized to give the vaccine? Do you have it available in all your offices?

Q- I had the flu shot in October and I am traveling this summer to Brazil. Why is the influenza vaccination recommended?


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travel medicine most dreadful pest
Walter Reed was referring to the Aegypti mosquito as “this most dreadful pest of humanity” in a letter to his wife in 1900. He had recently discovered that the Aegypti mosquito was the vector of transmission for yellow fever. Soon after his breakthrough discovery, mosquito eradication and sanitation efforts began with remarkable results. Yellow Fever, a disease that once took so many lives has been controlled in the U.S. Yellow fever, although not the threat that it once was, continues to take its toll in illness and death in many parts of the world. A traveler’s risk of acquiring yellow fever is determined by immunization status, geographic location, season, exposure, activity, and the local rate of virus transmission. Fatality rates are greater than 50% in non-immune travelers.

Female Aedes aegypti mosquito
Photo by: James Gathany,Center for Disease Control and Prevention
In 2008 Paraguay has had 22 cases and 7 deaths and Brazil has had 48 cases and 25 deaths. The government of Brazil is recommending that all travelers to all areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Minas Gerais, Pará, Rondônia, Roraima, Tocantins, and the following states: northwest and west Bahia, central and west Paraná, southwest Piauí, northwest and west central Rio Grande do Sul, far west Santa Catarina, and north and west São Paulo obtain the yellow fever vaccine prior to travel. Visitors to the interior of South America are at an increased risk to become victims of yellow fever where costal regions are currently outside of the endemic zone.


In Brazil, transmission risk increases from January to March which is their rainy season. Yellow Fever is a life threatening viral infection. The incubation period ranges from three to six days.


Andes Mountains, Venezuela

Initial symptoms, fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting usually subside in three or four days. One in six persons will enter a second toxic period characterized by recurrent fever, vomiting listlessness, jaundice, organ system failure and hemorrhage. About 50% of patients who enter the toxic phase die within 10 to 14 days. Since there is no specific treatment for yellow fever, care is based on relief of symptoms.

Steps to prevent yellow fever include appropriate use of insect repellents, protective clothing and vaccination. To avoid mosquito bites when outside wear long sleeved clothing and long pants. For extra protection treat clothing with the insecticide permethrin.

   Chile--Photo Courtesy of Destination 360







Obtain the yellow fever vaccine at least ten days prior to entering a yellow fever zone. The yellow fever vaccine is an injectable, attenuated, live virus, thimerosal free vaccine. Mild reactions to the vaccine are generally headache, myalgia and a low grade fever. If you are receiving the yellow fever vaccine for the first time, are younger than 9 months or older than 65 years you may be at greater risk for complications. Yellow fever is the only internationally regulated immunization.
Proof of yellow fever immunization may be officially required as a condition for entry to some countries, including many that have no yellow fever transmission themselves. They may require a certificate of vaccination from travelers arriving from areas or countries with risk of yellow fever transmission. Proof of vaccination, a completed International Certificate of Vaccination, signed and validated with the center’s stamp is valid 10 days after vaccination and for a subsequent period of 10 years.

Terry Parsons R.N.-C
Executive Director, Passport Health

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International travelers tend to plan their trips based on activities:
Napa and Sonoma for wine country touring, Costa Rica for ecotourism, and Lyon to experience dégustation gastronomique. What if you could do them all in one country?

In our first E-zine edition of Hot Travel Destinations, we will discover some of the hidden jewels Peru has to offer. If you have traveled to Peru only to go to Machu Picchu, good for you; but you might be missing a lot. If you are a wine lover, you owe it to yourself to visit the place where the oldest vines were planted in the new world: Ica.


Grape Vineyard- Ica, Peru



Paracas National Park

Ica is better known for Pisco, which is both a brandy and the port from which this libation was exported to Spain in the 1500s. A brandy is simply a distilled wine, so it makes sense that Pisco is made from distilling fermented white grape wine. While you are tasting Pisco and wine you will be, literally, in an oasis surrounded by what has been called the world’s driest desert: a narrow desert fringe that stretches for more than 1,400 miles along Peru’s central pacific coast. The fertile valleys would not exist were it not for roaring rivers descending from the slopes of the Andes. In Ica, Peru’s wine country, these valleys create the perfect microclimate for grape growing.

Every year in March, the grape harvest is celebrated in Ica during the National Vintage Festival. Festivities include wine and grape tasting, a floats parade, marching bands, and commercial and hand craft exhibitions. Several winery tours are available, but don’t forget to check out Vista Alegre Winery which is the one of the oldest in Peru, and is presently the largest producer of Pisco.
To whet your appetite for adventure, you may wish to visit Paracas, which in Quechua literally means “raining sands.”

Paracas is just a hop from Pisco and it’s home to the Paracas National Reserve, a World Heritage National Site. The stark contrast between the dessert topology and the sea provides breathtaking vistas which come to life with thousands of wild resident and migratory birds including flamencos, red-legged cormorants, Humboldt penguins, and Inca terns. On your way back, check out the Regional Museum of Ica, one of the best regional museums in the country.

Within its realm you will find a variety of archeological pieces such as pottery and textiles from the Nazca and Paracas cultures that developed in the area. If you want to get some exercise you can trek Cerro Blanco (the highest sand dune in the world) or explore the surrounding dessert dunes. Ica is also home to the world renowned Nazca Lines.

You can now fly directly out of Pisco and over the Nazca Lines in charter flights.
These lines can only be seen from the air but the amazing designs are still as intriguing today as they were when they were first discovered. The area encompassing the Nazca Lines is about 800 square miles and some of the largest designs are over 900 feet long.



Nazca Lines
On your return trip to Lima, make sure you plan at least one great dinner before flying back home. Lima has some of the best restaurants you will find in South America –and Pisco is not too far behind-- revitalized by a recent gastronomic renaissance, traditional ingredients are carefully mélanged using classic culinary techniques that elevate the dishes to levels comparable to Michelin 3-star restaurants. You will be amazed as you taste the most flavorful seafood dishes like Ceviche: white Corvina fish or a mixture of fish and other seafood, marinated with lemon, coriander, Peruvian yellow chili and garlic.

PLEASE NOTE: Ceviche is served raw. Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of food borne illness. Only consider dining at reputable establishments that have been inspected by the Peruvian Department of Health. The best way to prevent food borne illnesses is to avoid raw meats altogether. Unless you know exactly where the fish came from and how it was handled, you are at risk.

This refreshing and ever-evolving dish that inspires chefs to try different approaches and variations on a simple, yet tantalizing dish is available throughout the Peruvian coast. If you are looking for a truly memorable experience, you should try La Rosa Nautica (The Nautical Rose) right on the ocean of Lima. When I say “on” the ocean, that is precisely what I mean. Perhaps the best restaurant in Peru, La Rosa Nautica floats on the ocean and it is accessible only after you reach the end a long pier. Inside you will have a spectacular 360 view of the ocean and the coast. Try a Peruvian classic, Aji de Gallina: a delectably creamy, chicken- based dish cooked with walnuts and parmesan that is similar to a good korma and is an absolute classic, a must have dish.



Pisco Sour

The safest way to enjoy a Pisco Sour is at home, where you know where your water, ice and other ingredients are coming from. Below is a classic recipe. I prefer to use a blender and make a larger batch. This allows for the egg white to really fluff up and it makes your presentation better. Remember to always use fresh lime juice.

• 2 fl oz (8 parts) Pisco
• 1 fl oz (4 parts) Lime juice
• 3/4 fl oz (3 parts) Simple syrup
• 1 Egg white
• 1 dash Bitters

Preparation: Shake hard or blend with ice and strain into glass. The bitters are an aromatic garnish topping the finished drink, put on top of pisco sour foam.

PLEASE NOTE: Contaminated water or ice may carry pathogens that cause illness. Only consider beverages from reputable dining establishments that have been inspected by the Peruvian Department of Health. Only consume bottled water and make sure that ice used for drinks is made from bottled water as well. If you can not confirm the source of the water, you are at risk.


Jorge Eduardo Castillo
Passport Health

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Red Cross Helicopter

Q: After receiving immunizations for international travel will I be able to donate blood?

A:
The American Red Cross’s guidelines for blood donation eligibility are as follows:

After immunization for Influenza, Hepatitis A, Typhoid (injectable), Tetanus, Meningitis, HPV (Gardasil) or Polio (injectable), blood donation is acceptable immediately.

MMR (Rubeola, Mumps, Rubella), Chicken Pox or Shingles, wait four weeks after immunization.

Red Measles (Rubeola), Mumps, Polio (oral), Typhoid (oral), and Yellow Fever, wait two weeks after immunization.

Hepatitis B, wait seven days after immunization.

Smallpox vaccination without complications, wait eight weeks and two weeks after resolution of complications.

If you have traveled outside of the US to an area where malaria is found, wait twelve months after returning.

If you have been treated for malaria you must wait three years.
Q: I am traveling to a country where the Yellow Fever vaccine is required. Are you authorized to give the vaccine? Do you have it available in all your offices?

A:
Yes there are adequate supplies of the Yellow Fever vaccine at our locations. All 170 Passport Health locations are state certified to administer the Yellow Fever vaccine.



Q: I had the flu shot in October and I am traveling this summer to Brazil. Why is the influenza vaccination recommended?

A:
The flu shot is only effective for the season in which it was given. Your October immunization will have lost it’s effectiveness in three to six months. In the southern hemisphere the influenza disease circulates from April to September.

In the central latitudes, where Brazil is located, the influenza disease circulates throughout the year. Passport Health carries at least four injectable vaccines for influenza and one nasally administered preparation for protection.



















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Passport Health

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A doctor friend, Harold, called me one afternoon at the office.
“My daughter, Anna, and her fiancée are about to leave for rural Colombia where the embassy says it is dangerous to travel. What should I tell my daughter?” I needed more details:

"When is she planning to leave? Where is she planning to travel? What did the Embassy personnel say? Tell me a little about your daughter and her fiancée."

Harold said, "They are leaving from Argentina and will fly to Bogota, Colombia and then to a little town near the Ecuadorian border. She and her fiancée plan to drive to Pitalito , a mountainous road trip, in a rental car to visit friends. Anna has lived in Latin America, speaks fluent Argentine Spanish and her fiancée grew up around the town to be visited."



Bogota, Colombia









Bogota, Colombia

I wrote Harold the following letter:

Harold, I spoke to Monica Ortiz at OSAC/State. While she sounds a note of caution, she says that it is very unlikely that flying into Bogota and driving in daytime to Pitalito is a real risk. She suggests that Anna register at the US Embassy (can be done on line at www.travel.state.gov) and contact local authorities about any immediate developments, risks or advisories.

She points out that there have been a number of FARC, Revolutionary Armed Forces (Fuerzas Armadas Revolucionarias de Colombia) related incidents reported in this area. Anna and her fiance’e speak Spanish and know the area so they are less likely to be targeted for kidnapping. Daytime travel is not likely to be interrupted by FARC roadblocks.

You may wish to inquire further at Private Intel. I would certainly advise that Anna have travel and evacuation insurance. We have partnered with some of the best organizations like International SOS.There is also a company that will get you home to the USA from any point on the globe under circumstances like that of your daughter: Global Rescue.

Let me know how Anna fairs.

Peter V Savage
Passport Health


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