China has a tuberculosis (TB) problem, one that generates a million new cases each year. Despite fewer cases, the disease remains a significant problem for much of the country.

Tuberculosis infections have declined each year since the 1990s. The prevalence per 100,000 population decreased from 215 in 1990 to 68 in 2014. This is due to government outreach and the help of global health organizations. But, many suffer from TB and an alarming number of these cases are drug-resistant.

China has the most cases of multi-drug-resistant tuberculosis in the world. Many of these patients go undiagnosed. This creates an increased risk of infection to others living in or traveling to the country.

Many people in China infected by TB come from poor socioeconomic groups in rural areas. Public healthcare is less than ideal in these regions. Often patients do not know they are carriers or cannot afford the treatments they need.

Tuberculosis is a bacterial infection that attacks the lungs. According to the Centers for Disease Control, the most common symptoms are:

• A bad cough lasting three weeks or longer
• Chest pain
• Coughing up blood or sputum (mucus from deep in the lungs)
• Weakness or fatigue
• Other symptoms include weight loss, loss of appetite, chills, fever and night sweats

TB only spreads through the air, via infected air droplets, and not by shaking hands or sharing food. Whenever an infected person coughs, sneezes, or speaks, anyone standing nearby may become infected.

Not everyone infected by tuberculosis becomes sick right away. There are two forms of the disease: latent TB disease and TB disease. Those with latent TB are not infectious and may have no symptoms. Their body was able to isolate the bacteria and prevent it from growing. But, the bacteria lies dormant in the body and can become active at any time.

Latent tuberculosis infection is a problem in China and many other countries. Travelers are at increased risk of coming in contact with infected persons than they are at home.

This is why testing for TB is so crucial. You may have latent TB and not know it, especially if you have traveled to areas where the disease is endemic.

There are two diagnostic tests used to identify TB bacteria:

• Skin test (also known as the PPD test)
• Blood test

TB testing will not identify the type of infection, only whether you are infected. X-rays or other testing may be necessary if tests come back positive. Treatment usually starts immediately with oral medications. It can take up to a year to overcome TB.

Tuberculosis vaccination is common in some countries but is not available in the U.S.. The vaccine is not always effective in adults and can interfere TB testing. The CDC does not recommend its use.

There are ways you can protect yourself from this disease. Prevention is key to minimizing the risks of contracting TB. The CDC recommends travelers do the following to avoid TB:

• Avoid exposing yourself to people with active TB, especially in warm, small rooms.
• If you work in healthcare settings, wear a face mask to avoid breathing in the bacteria.
• If you expect long-term exposure to victims of TB, receive a TB test upon your return.

To learn more about TB, see our tuberculosis testing page.

Are you planning on traveling to China or another country with endemic tuberculosis? Or, have you recently returned a from a TB-endemic area?

Protect your health by making an appointment with a travel health specialist today. Visit a Passport Health clinic to receive more information about TB or for testing. Book your appointment today by calling or schedule online now.

Let us know what you think about the continuing problem of TB disease in China. Comment below, on Facebook or via Twitter.

Seeing the world is one of the most amazing experiences a person can have. From Europe to Australia, the globe is full of absolute must see destinations that people will plan for years to visit. But, one simple thing can ruin a trip before it even starts: losing your passport.

While losing a passport at home can make travel planning difficult, there are ways to easily overcome this issue. Passport expediting services like those that Passport Health offers, can help you get a passport in 24-hours if needed – much faster than the 3-8 weeks the government normally takes to issue a new passport. But, what do you do if you lose your passport while abroad?

A lost passport will often mean the end of a trip. While the temporary passport an embassy or consulate give you will help you get home, it won’t let you into other countries. That’s where a secondary passport can come in handy.

[Read more…]

A vacation in Thailand, hiking the Inca trail or a business trip to Rio: every trip has a different level of risk. Unfortunately, no trip is without risk. Even a short excursion to your local grocery store could end poorly. But, there are ways to manage the risks.

Understanding the Risks of Travel

The first step to planning any trip, whether we are doing it consciously or not, is assessing the risks. Would you think of booking a flight to Damascus for vacation in 2016? Probably not, due to the current risks associated with traveling to Syria.

A recent article in Stratfor looked at the myth of ‘total security,’ or the idea that a location can be totally secure. The author pointed out a key, very interesting fact about travel. People tend to fixate on highly publicized events.

The 2015 and 2016 terrorist attacks in Europe show this to be accurate. Tourism to Europe fell, and many questioned whether it was safe to travel to the continent at all. But, understanding the risk can give us a better idea of the true situation.

Fires, natural disasters, accidents and disease kill far more people each year than terrorist attacks and homicides. One quote from the article sums this up nicely:

The bottom line is that there is no such thing as absolute safety and security. And since more people die from household accidents every year than from terrorism or criminal homicide, holing up inside your home is no guarantee of safety.

Mitigating Travel Risks

Once we understand that there are risks to traveling, we need to find ways to mitigate them. Let’s use Brazil as an example. The primary risks associated with travel to Brazil are:

• Crime– Petty theft is fairly common in tourist areas, but ‘hard’ crime occurs in many outlying regions.
  

• Disease– Zika may have made headlines, but a variety of other infections are present including yellow fever, malaria, dengue fever, typhoid and hepatitis.
  

• Political unrest– Protests have become more common in Brazil, especially during important events.

Now that we ‘know’ the risks, how can we mitigate them? The first step would be to learn more. In the case of crime, the U.S. State Department is a good resource as it offers country-specific web pages that discuss what to do in case something happens. It also discusses what to do in case of political unrest.

For disease, Passport Health has a wide range of resources to help educate about the potential risks in Brazil (and other countries) including vaccination pages, Brazil-specific pages and even information on how to get your visa for Brazil. By using these resources, you can learn more about the risks, and then start taking steps to mitigate them.

In the case of crime and political unrest, the key is to avoid potential trouble spots and then take certain precautions, like not wearing flashy clothing. But, you can’t always avoid infection.

This is what vaccinations and other preventative measures are for. Through vaccination and items like antimalarials or mosquito nets, diseases can be often be prevented and trips can become even more enjoyable.

Change Your Mindset

Education and vaccination can only go so far in protecting you from risks. A change of mind needs to happen as well.

You may not be used to putting on mosquito repellent every time you go out, or looking in the opposite direction for a car in England. But, such behavioral changes could save your life.

The Stratfor article told the story of an American teacher in Libya who decided to go running every morning and was killed. While running isn’t usually a risky activity, it can be if you are in an unsafe area. Remember this when you travel.

If you are worried about risks during your trip, do what you can to avoid them. Learn about which risks may be present, take steps to mitigate them, and be sure to keep them in mind as you go. No place is 100 percent safe, not even your home. Do what you can to make your journey as safe as possible.

To learn more about travel medicine and how it can reduce risks and protect you as you travel, see our travel medicine portal.

No matter what stage you are at in your trip planning process, be sure to contact Passport Health about what you need to stay safe. Our travel medicine specialists will make sure you have everything you need to stay safe as you travel. Call or book online to schedule your appointment today.

What do you do to prevent travel risks? Post your answer in the comments below or Facebook or Twitter.

Thinking of Thailand invokes images of blue waters, sparkling beaches and tropical drinks while watching the sunset. Who doesn’t dream of relaxing on a stunning beach in Thailand and snorkeling through the azure waters? However, make sure you are well protected before your exotic adventure. Vaccinations for Thailand can help ensure your good health during your trip and upon your return home.

Which Vaccines Do I Need for Thailand?

Vaccination recommendations vary based on itinerary. If you are traveling to Thailand for business or pleasure you may need certain vaccinations, but an aid worker, for example, will likely need many more. The Centers for Disease Control and Prevention and World Health Organization recommend you receive these vaccines:

• Typhoid– Food and water in Thailand have been known to carry typhoid. Be careful with what you eat and drink, and make sure you are vaccinated.
• Japanese Encephalitis– This vaccine is very important for many travelers to the region. Japanese encephalitis is a mosquito-borne disease, meaning you could catch it at any time. Take proper precautions against mosquitoes in general, and speak with a travel health specialist about the vaccine.
• Hepatitis A– Another food and waterborne disease, hepatitis A affects many each year. Make sure you are up to date on this immunization.
• Hepatitis B– Transmitted through contaminated needles, blood products and sex, hepatitis B can be a serious risk. Vaccination is key to preventing the disease.
• Rabies– While not a common disease in Thailand, the rabies vaccine is recommened for some travelers who may have contact with wild animals.

For more information on these vaccines or to find out where to schedule a travel consultation at your local Passport Health clinic, give us a call at or book online today.

Which Other Diseases Are Present In Thailand?

Sometimes there aren’t vaccinations to protect against some diseases. Though Thailand is a magical place, these diseases can be present:

• Malaria– The CDC recommends antimalarial medication for some itineraries. Talk with a travel health specialist to learn if this applies to you.
• Dengue Fever– This mosquito-borne disease is present in Thailand, so be sure to use netting and mosquito repellents when possible.
• Zika Virus cases have been reported in Thailand. Pregnant women may want to consider postponing a trip. Precautions against mosquitoes are recommended for all travelers.
• Traveler’s Diarrhea is the most common illness to afflict international travelers, and traveler’s diarrhea can be caused by a variety of factors. To avoid it, be sure to watch what and where you eat, and avoid unfiltered water or ice cubes. Remedies like DiaResQ can help treat diarrhea if it occurs.
• Bed Bugs– While this may seem odd, bed bugs are in issue in Thailand, according to the CDC. If you suspect there are bed bugs where you are staying, contact the manager or landlord.

To learn more about these infections, see their respective pages. If you are planning a trip to Thailand, schedule your appointment with a Passport Health travel health specialist today by calling or booking online now.

What Else Should I Know Before Leaving For Thailand?

With amazing beaches and fantastic sights like Wat Chaiwatthanaram, Thailand is a ‘must visit’ for many international travelers. But, there is some more prep work need to help you get ready for your trip.

Be sure to have your itinerary finalized before you go. Having this ready will help you be better prepared for what you’re planning on doing and keep you safe. Thailand is a generally safe country, but some places off the beaten path require caution.

Also, don’t forget to have your passport ready. While Thailand doesn’t require a visa for stays under 30 days, you will need to have at least six months’ validity left on your passport. If you need any help or have any questions about renewing your passport, please feel free to reach out to Passport Health’s Passport and Visa Expediting Service for help. Our representatives can be reached by calling 1-844-366-8472 or contact us online now.

Six weeks before your scheduled departure date for Thailand, make a visit to a Passport Health travel health specialist. We will review your medical history, provide the vaccinations and preventive medications you need, and give you advice to help keep you healthy before, during, and after your trip. Call us at or book your appointment online and start protecting yourself today.

Do you have any travel tips for Thailand? Share them with the Passport Health community in the comments below, on Facebook or via Twitter.

Imagine a plague that infected millions in just a year, killing as many as 5,000 people per day. For the Eastern Roman (Byzantine) Empire, this nightmare was a reality. Beginning in about 541 CE, the Plague of Justinian swept through Europe, killing up to a quarter of the Eastern Mediterranean population and possibly as much as 10 percent of the world’s population.

What Was The Plague of Justinian?

Despite the catchy name, the Plague of Justinian was identified as the bubonic plague, otherwise known for its 14th Century cousin, “The Black Death.” The disease earned its name from Justinian, the ruler of the Byzantine Empire at the time. It also has a double meaning, as Justinian’s handling of the crisis was almost its own form of infection.

As farmers and other workers were dying by the thousands, Justinian was unable to complete many of the projects he had started and began to raise taxes and change the tax code.

Procopius, a scholar of the time, explained:

“When pestilence swept through the whole known world and notably the Roman Empire, wiping out most of the farming community and of necessity leaving a trail of desolation in its wake, Justinian showed no mercy towards the ruined freeholders. Even then, he did not refrain from demanding the annual tax, not only the amount at which he assessed each individual, but also the amount for which his deceased neighbors were liable.”

What Were the Symptoms of the Plague?

We don’t know the exact symptoms of the Plague of Justinian. The current symptoms for bubonic plague include:

• Fever
• Headache
• Chills
• Swollen or tender lymph nodes
• Abdominal pain
• Gangrene

Procopius described victims suffering from these and also other symptoms including:

• Delusions
• Nightmares
• Comas

He even said some would die almost immediately after the onset of symptoms. However, we don’t know how accurate his reporting was. Procopius said the plague was killing 10,000 people every day, but modern estimates put the daily death toll to closer to 5,000.

How and Where Did the Plague Spread?

Like the modern bubonic plague, scientists believe the Plague of Justinian spread through fleas. Studies indicate the plague may have originated in China or India and was then transported to the fertile valleys of Egypt through trade routes. In 541, the Egyptian port of Pelusium was the first city to document cases, and, by 542, cases were seen as far north as England.

Due to the nature of ancient records, we don’t know the full extent of the disease’s spread. We know the Mediterranean region was the hardest hit, but anecdotal evidence indicates some cases occurred in England, Germany and other northern regions.

What Effects Did the Plague Have?

Justinian wasn’t just a leader; he was also a conqueror. By 542, he had reconquered most of the Roman Empire’s previous domain and was hoping to solidify his rule. The plague made this all but impossible as farmers, soldiers and other key members of society fell ill and died from the disease.

By 568, Justinian’s empire began to crumble as the Lombards invaded Northern Italy, and, within a few generations, enemies were at the gates. Byzantium remained a power through 1453, but it would never be as large as it had been before the plague.

Could The Plague of Justinian Resurface?

Just as with many other ancient diseases, this question has been under investigation for years. A study conducted by Northern Arizona University found the Plague of Justinian came from a now extinct form of Y. pestis or bubonic plague. So in short, it is still around. But, we are unlikely to see anything like Justinian’s Plague or the Black Death in modern times.

“We’ve greatly improved hygiene since the times of the great pandemics,” said one researcher. “The other thing is we not have antibiotics, and plague is susceptible to every antibiotic.”

To learn more about bubonic plague, see the CDC portal. To learn more about other eradicated, or nearly eradicated diseases, see our polio and measles, mumps and rubella pages.

If you are planning a trip, especially one where you may come in contact with rodents, book an appointment at your local Passport Health by calling or booking online today.

What are your thoughts on this terrible plague? Let us know in the comments below, on Facebook or Twitter.