Volcano Erupts in Indonesia

The volcanic eruption of Mount Kelud in Indonesia on Friday, February 14, 2014 sheds light upon the issue of the impacts of Mother Nature during travel. Although volcanic activity and earthquakes should not be a surprise due to Indonesia being located in the “Pacific Ring of Fire” where such activity often occurs, the volcano had not erupted since 2007. In December, Chapparrastique volcano in El Salvador also gained worldwide attention when it erupted after over 37 years of inactivity.

The eruption prompted the Indonesian government to raise its eruption alert to its highest level. This eruption has taken 3 lives due to falling debris and smoke inhalation, and over 75,000 residents within a 6 mile radius were ordered to evacuate, calling on military assistance to relocate residents to shelters. Seven airports were closed due to the amount of volcanic ash in the atmosphere and the threat this poses to jet engines compromising safety conditions, suspending travel plans for many.

Protecting You and Your Family During a Volcanic Eruption

When preparing for travel, you may have thought of everything that you need to pack and your itinerary, and still encounter a few surprises along the way. But what do you do when the totally unforeseen occurs, such as a volcano eruption? The Center for Disease Control advises that the best thing to do if you should encounter a volcanic eruption is to follow the advice of local officials. They will be able to provide you with important information, including evacuation details, if needed.

The CDC also provides the following tips if you are faced with this situation:

• If lava is headed towards you, leave the area immediately. Follow evacuation instructions immediately after being warned of imminent danger. When able to do so, evacuate in a vehicle rather than walking, keeping all doors and windows closed. Be aware of the road and any hazardous driving conditions or obstacles. If you are able to, drive your vehicle across the path of danger, and if not, drive away from danger.
• If you are indoors, protect yourself from ash and smoke by closing all windows and doors, and any other entry points for outside air, such as fireplaces or woodstove dampers. Fans, heating and air conditioning should not be used. Remember to also protect pets and livestock by bringing them indoors.
• If you are outdoors, seek an indoor shelter. If caught in rockfall or other falling debris, tuck into a ball and always protect your head. Move up-slop as quickly as possible if you are near a stream or river since rising water and possible mudflows are likely in lower-lying areas. If your eyes, nose, and throat become irritated from volcanic gases and fumes, these symptoms should subside as you immediately relocate to another area. If these symptoms persist, seek medical attention as soon as possible.

The presence of ashfall alone poses its own threat. When faced with ashfall, you should:

• Close all doors and windows and stay inside.
• Wear long-sleeved shirts and pants.
• Protect your eyes with goggles while inside. If ashfall is continuous, your indoor shelter is put at risk after a few hours due to a possible roof collapse caused by the weight of ash, and could possibly block air intakes. If ashfall lasts for more than a few hours, listen to evacuation advice from authorities.
• Remember that exposure to ash can cause harm to your respiratory tract and your health. When outdoors or cleaning ash that has accumulated indoors, an air purifying respirator may be considered, such as an N-95 respirator which is commonly available at hardware stores. All directions should be followed for proper use and maximum protection. A dust mask may be used as a last resort, but they do not offer as much protection as a particulate respirator, such as the N-95. Please note that a particulate respirator does not filter toxic gases and vapors. It is important that all trips outdoors are not for extended periods of time while dust and ash is falling.
• If you have to drive, driving in heavy ashfall should be avoided since the ash can clog engines and stall vehicles. All windows and doors should be closed, and air conditioning should not be used since it will draw in outside air and ash.

For more details on these recent volcanic eruptions and volcano preparedness, please see the listed sources below.

Sources:
https://www.cnn.com/2014/02/13/world/asia/indonesia-volcano-eruption-evacuation/
https://www.cnn.com/2013/12/29/world/americas/el-salvador-chaparrastique-volcano-erupts/index.html
https://www.bt.cdc.gov/disasters/volcanoes/during.asp
https://www.redcross.org/prepare/disaster/volcano

Going on a Cruise as a Disabled Passenger

As cruise vacations grow more popular, cruise lines are making a dedicated effort to accommodate disabled passengers. Ships are being outfitted with cabins that can fit wheelchairs, support bars and medical equipment. No matter what your situation, it is now easier than ever to enjoy fresh sea air and exotic locations. Here are seven tips for disabled persons who want to go on a cruise:

1. Make Sure You’re Fit to Travel

Before you even book your cruise trip, you should consult with a travel health specialist to assess whether or not it is safe for you to travel. He or she will give you a thorough consultation and listen to your concerns. You may need to arrange for vaccinations as well as travel insurance that can cover any medical attention you may need while on your trip.

2. Get in Touch with a Travel Agent

Once you have been cleared to go on a cruise, you should contact a travel agent, especially one who specializes in making plans that are tailored to unique situations. He or she can help you find a cruise that will provide you with a great experience no matter what your personal situation is. Relying on the expert knowledge of a travel agent can allow for a great cruise experience with as little hassle as possible.

3. Find a Cruise Line that Suits Your Needs

Some of the best cruise lines for disabled passengers are Holland America, Royal Caribbean and NCL. You should check to see if the whole ship is accessible and what plans are made for areas that may not be accessible to you. Your travel agent will be able to advise you on what cruise line and itinerary will be best for you, and you can make an informed decision from there. Don’t be afraid to ask questions!

4. Be Firm about Requesting a Cabin with Disabled Access

Travel agents are very understanding about the needs of potential passengers, so you shouldn’t be ashamed or scared to request a cabin that will accommodate your medical needs. Once you have made your booking, double-check to make sure that your assigned cabin is exactly what you requested, and don’t be afraid to get in touch if a mistake has been made.

5. Bring Extra Medications and Medical Supplies

If you have any medications or supplies that you rely on in your day-to-day life, make sure that you bring an extra amount with you for the cruise. Talk to your travel health specialist before your trip and get a prescription that covers your journey if necessary. This is extremely important as some countries that you will be visiting may not fill a U.S. prescription.

6. Carry a Ship’s Map with You

Once you are onboard, ask for a ship’s map from the staff and carry it with you at all times. You can rely on the map to navigate through accessible and non-accessible areas. Don’t be afraid to ask for a staff member to act as your guide if you need it.

7. Ask about Shore Excursions

While the cruise ship itself will be equipped to handle passengers with various disabilities, some of the ports and shore excursions might not be. For example, some towns and regions might not have wheelchair ramps. If you want to take part in an excursion or visit a location listed on the cruise, you should check with the ship’s staff to see how your needs can be accommodated during the short trip. By asking in advance, alternative arrangements can be made for you so that you do not miss out on any part of your vacation!

Cruises: A Great Way to Relax and Recharge

Thankfully, cruises are becoming progressively more accessible to those with disabilities. With a bit of extra planning, you can fully enjoy a cruise vacation and not miss out on a second of fun! After all, everyone deserves a vacation and the chance to relax and recharge.

Sources
Article from Cruise Critic
CDC Article on Cruise Ship Travel
CDC Page on Traveling with a Disability

Shingles and the Risk for Heart Attack and Stroke

Shingles (Herpes zoster) is caused by the same virus that causes chickenpox (varicella). People tend to contract chickenpox when they are children. This initial infection causes painful rashes, blisters and can lead to significant scarring if proper care is not given. However, the infection never leaves the body, even after the outward symptoms subside.

Anyone who contracted chickenpox as a child is at risk of developing shingles later on in life, especially after they reach the age of 50. Shingles often starts with pain and tingling in the area of the body where a rash will later develop. The condition is often accompanied by fever, chills and headache. The rash itself can persist for seven to 10 days, and the affected person is usually back to normal in two to four weeks. However, in severe cases, shingles can affect the eyes, leading to blindness.

A recent British study published in the journal Neurology has demonstrated that there is a link between shingles and an elevated risk of heart attack or stroke. Subjects were followed for over six years after they developed shingles. The risk of having a stroke was not significantly increased in the overall group, but the chances of subjects experiencing a transient ischemic attack (TIA) or “mini-stroke” increased by 15 percent. The risk of heart attacks in the larger group was raised by 10 percent.

The biggest increase in risk was among those who developed shingles before the age of 40. Subjects in this group faced a 74 percent increase in the risk of having a stroke. This is because the shingles virus seems to be able to spread and affect the cerebral arteries, which can lead to strokes. The researchers who performed the study have recommended that anyone who develops shingles before the age of 40 be closely monitored for strokes or heart attacks by their health specialist. They have also suggested that more adequate prevention against shingles could be provided to people under the age of 60. This newly published research confirms that shingles is indeed a serious health risk and should be addressed through vaccination as soon as possible.

What Can Be Done to Prevent Shingles?

The best prevention for shingles is through vaccination. The vaccine is usually given to people over the age of 60, but there is FDA approval for the use of this vaccine for those between the ages of 50 and 59. The final decision on vaccination lies with you and your health specialist. You should get the shingles vaccination even if you have developed shingles in the past as you could still be at risk in the future.

Most people do not experience any side effects from the shingles vaccine, but others may notice a small rash or blister at the injection site. People with allergies to either gelatin or neomycin, an antibiotic, should not get the shingles vaccine. Anyone who is HIV positive, suffers from leukemia or lymphoma, or who is otherwise immuno-compromised should also avoid getting the vaccine. If you are experiencing an active shingles infection, then you will not be able to receive the vaccine. In addition, pregnant women should not receive the shingles vaccine.

Where Can I Get a Shingles Vaccine?

If you are concerned about the long-term consequences you may face if you contract shingles, you may want to visit a travel health specialist as soon as possible. He or she will be able to provide you with a full medical exam and administer the shingles vaccine if you meet the criteria for immunization.

Sources
CDC Information Page on Shingles Vaccination
CNN Health Article on the Link Between Shingles and Heart Attack Risk
Medical News Today on Shingles-Associated Risks
Milvax Shingles Information
New York Times Article on Recent Findings

Chinese New Year – a Time of Happiness and Good Luck

Chinese New Year is fast approaching, and millions of people from around the world will be making the journey to the Chinese mainland, Hong Kong and Macau in order to join in on the celebrations. If you are thinking of visiting the region to celebrate the Year of the Horse, then you should take the following advice into consideration so that you stay healthy throughout your travels.

1Schedule a Visit with a Travel Health Specialist

You should take the time to schedule an appointment with a travel health specialist at least one month before you embark on your trip to China. The specialist can provide you with a comprehensive travel consultation and a discussion about your medical history to make sure that you are fit to travel. This meeting should be scheduled well in advance just in case you need to make follow-up visits for vaccinations prior to your departure.

2Make Sure Your Vaccinations are Up to Date

Your travel health specialist can provide you with vaccinations that are recommended for traveling to China. You may also be given anti-malarial medication to take with you as well as prophylactic antibiotics for unexpected illness. Your travel health specialist will give you exact instructions that are tailored for your health and travel situation.

3Exercise Caution When Eating and Drinking

Family meals and street food stall delicacies are a major draw to Chinese New Year, but travelers should be very careful about what they choose to eat and drink. Avoid eating any raw or under-cooked eggs and poultry. Do not eat fruits or vegetables that you cannot peel or sterilize. Drink sealed and bottled water from reputable companies if you are concerned about tap water. In addition, you may want to bring along a water purification kit if you are going to be visiting regions with questionable water sanitation facilities. You should also bring along over-the-counter anti-diarrhea medicines in case you become unwell from anything you eat.

4Practice Good Handwashing Techniques

One of the best ways to stay healthy is to make sure that you wash your hands thoroughly as often as possible. Be sure to use clean running water and lots of soap. Lather your hands, fingers and wrists for as long as it takes for you to sing “Happy Birthday” twice. Rinse your hands well and use a clean paper towel to dry them. If you find yourself without soap and water, you can use an alcohol-based hand sanitizer that is at least 60 percent alcohol.

5Stay Safe, Even if You Become Ill

If you do become sick while visiting China for the New Year, then you should try to get in touch with a doctor as soon as possible. In the meantime, cover your nose and mouth in order to avoid spreading illness to others. If you have a fever, difficulty breathing, or you cannot keep down water, then you should contact a doctor immediately. Some major cities may have Western medical facilities, but if you are in a rural area, then you may have to travel a long distance in order to get adequate help.

Happy New Year!

By taking the appropriate steps to safeguard your health during your travels, you can ensure the best possible chance to enjoy each of the 15 days of the Lunar New Year celebrations in China. Gong Xi Fa Cai! Happy New Year!

Sources
CDC announcement on the Lunar New Year
Passport Health USA travel advice for China
CNN article on the Chinese New Year
CDC page on their work in China
CDC travel advice for China

According to a new study by the World Health Organization (WHO), the 2009 H1N1 flu pandemic may have been responsible for up to 203,000 deaths. When deaths due to flu-related complications such as cardiac and respiratory issues are added in, the total could go up to nearly 400,000 fatalities. This is a steep rise from the original laboratory reported number of deaths of 18,449. While this flu pandemic was nowhere near as lethal as other strains of the virus, particularly that seen during the 1918-1919 flu season that resulted in over 50 million global deaths, the impact of the 2009 flu pandemic now stands at 10 times the original estimate. Moreover, the new study demonstrated that the infection and death rates varied greatly based on demographics and geography.

Indeed, one of the key take home points of the new study is that even a global pandemic can have great heterogeneity in terms of its deadly impact. For example, the Americas were impacted much more heavily than Europe or Australia, causing great difficulty for the WHO as it tried to craft a global response. Indeed, the impact of the disease varied greatly even within regions; for example, Argentina was hit very hard, while the impact in Chile was far less. Some have proposed that exposure to past disease strains that were similar to the 2009 strain may have had a preventative effect, whereby past exposure almost acted like a vaccine to the new disease. Most experts agree that quality of care was not a sufficient explanation for differences in impact, but the disease was more deadly in countries in which it peaked during cold weather months.

Additionally, the 2009 pandemic took an especially heavy toll on children, young adults, and pregnant women. Approximately, 80% of deaths from the 2009 H1N1 pandemic were in people younger than 65 years old, a sharp contrast to the typical influenza epidemic in which 80-90% of deaths occur in people over 65. Therefore, in terms of years-of-life-lost, the 2009 pandemic had a much greater impact than a typical flu season.
In short, experts are still trying to determine the exact reasons the disease took a deadly toll on certain regions and age groups. However, the additional data will be integral to improving public health response to future pandemics and to build out better influenza monitoring systems that take these key variations in disease impact into account.

In the United States, the flu season tends to begin in October and can continue into the springtime. If the news about the high death toll from the 2009 pandemic has concerned you, remember that it is not too late to get your flu shot, the best preventative measure you can take.

Sources
https://www.npr.org/blogs/health/2013/11/26/247379604/2009-flu-pandemic-was-10-times-more-deadly-than-previously-thought
https://www.nytimes.com/2013/11/27/health/who-revises-estimate-of-swine-flu-deaths.html?hpw&rref=health&_r=3&
https://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001558