In The News Leptospirosis in Peru CDC Outbreak Notice – May 11, 2012 What Is the Current Situation? Flooding has caused an outbreak of leptospirosis in Peru, especially in the Loreto region. This is the worst flooding seen in this area for over 20 years. Peru has reported more than 300 cases and 3 deaths associated with leptospirosis thus far in 2012. Health authorities have alerted people to take precautions against the infection. What Is Leptospirosis? Leptospirosis is a disease that is spread by animal urine. People become infected with the disease when they come in contact with body fluids of infected animals or in contact with water, soil, or food contaminated with infected urine. Leptospirosis is a hazard for many people who work outdoors or with animals. The disease has also been associated with swimming, wading, kayaking, and rafting in contaminated lakes and rivers. Symptoms include high fever, headache, chills, muscle aches, vomiting, jaundice (yellow eyes and skin), red eyes, abdominal pain, diarrhea, and rash. Some people do not experience symptoms. This disease can cause kidney or liver failure and/or meningitis (swelling of the tissue covering the brain). Without treatment, recovery can take several months. Leptospirosis occurs throughout the world, especially in regions with flooding. Leptospirosis occurs more often in tropical areas. Urban areas lacking sanitation may also have a higher risk of leptospirosis. How Can Travelers Protect Themselves? No vaccine is available to prevent leptospirosis. Travelers to areas with flooding can take the following steps to prevent the disease: •Avoid swallowing flood waters or water from lakes, rivers, and swamps. Wear protective clothing, especially footwear, if you are wading in flood waters or other areas that might be contaminated. •Avoid wading in flooded areas, especially if you have any cuts or abrasions. •Avoid contact with environments contaminated with animal urine. •Talk to your health care provider about taking medicine to help prevent leptospirosis. Be sure to tell your health care provider about all your planned activities. Read More>> Dominican Republic Probe Possible Cholera Outbreak SANTO DOMINGO, Dominican Republic (AP) — Health officials are investigating what could be a new cholera outbreak in the northern Dominican Republic, where one woman died and more than 200 people have sought medical attention, Health Minister Bautista Rojas said Thursday. He cautioned that only six of the more than 200 cases have been confirmed as cholera, including that of a 64-year-old woman who died on Wednesday. The remaining patients exhibit cholera symptoms but are awaiting confirmation through lab tests, he said. The outbreak occurred in the northern town of Tamboril, where heavy rains damaged water and sewer pipes earlier this month. Bautista said the outbreak is under control, and government officials said they are disinfecting potable water with the maximum amount of chlorine allowed. The first cholera outbreak in the Dominican Republic occurred in late 2010 with more than 22,500 cases and 163 deaths reported. The number of cases had been dwindling since August 2011. The neighboring country of Haiti, where the outbreak originated, is still struggling with cholera, which has killed more than 7,000 people and sickened 530,000 more, according to Haitian health officials. Ghana introduces 2 new vaccines; 2nd African Vaccination Week launched Ghanian First Lady, H.E Dr Ernestina Naadu Mills Accra, 26 April 2012 – Ghana today made history as the first African country to simultaneously introduce pneumococcal and rotavirus vaccines in its national immunization programme in a bid to fight pneumonia and diarrheoal diseases, each of which accounts for approximately 10 per cent of under-five deaths in the country. Ghanaian First Lady, H. E. Dr Ernestina Naadu Mills, said at a ceremony in Accra marking the introduction of the two life-saving vaccines: “I am happy to announce that vaccines against pneumonia will from today be available at all health centres and hospitals. Children will be given three doses of the vaccine at 6, 10 and 14 weeks of age. Also, rotavirus vaccines will be administered to children aged 6 and 10 weeks.” The First Lady was joined at the launch by WHO Deputy Director-General, Dr Anarfi Asamoah-Baah; the Coordinator of the WHO Inter-Country Support Team for West Africa, Dr. O. Walker, representing the WHO Regional Director for Africa, Dr Luis Sambo; the Chief Executive Officer of the GAVI Alliance, Dr Seth Berkley; Ghana’s Health Minister Mr. Alban Bagbin; UNICEF Country Representative in Ghana Dr Iyabode Olusanmi, among other international guests. In his remarks, WHO Deputy Director-General, Dr Asamoah-Baah, praised Ghana’s “bold” decision to introduce the two vaccines at the same time and spoke of the phenomenal progress Ghana had made over the years in immunization coverage – from a national coverage of 4% with just one antigen in 1985 to a national coverage of 90% with nine antigens in 2012. He attributed this progress to the commitment of the government of Ghana; the leadership and vision of the country’s health ministry; the dedication of its country’s health workers, particularly nurses, and the facilitative role of partners and the country’s women and mothers. On his part, the Chief Executive Officer of GAVI, Dr Berkley said: “Ghana has taken the lead…it has taken a bold and courageous decision and today’s simultaneous launch marks yet another ambitious and encouraging step to make life-saving vaccines rapidly and efficiently available to children who need them wherever thy may be born. The world is watching as Ghana has set an example for everyone else”. Launch of the second African Vaccination Week The occasion of the introduction of the vaccines also served as the platform for the official launch of the second African Vaccination Week which is being observed from 23 to 28 April 2012 under the theme “An unimmunized child is one too many. Give polio the final push.” Launching the Week, Dr Walker, representing WHO Regional Director for Africa, said “As one of the most efficient, cost-effective public health interventions, vaccinations are critical to the attainment of the Millennium Development Goals. Further improvements in coverage, expansion of resource pools and large-scale introduction of new vaccines targeting an increasing number of infectious diseases are needed to sustain the gains.” He drew attention to the focus of the observance of the second African Vaccination Week: interrupting wild polio transmission, through strengthening national immunization programmes and increasing vaccination coverage as well as accelerating the uptake of new and existing vaccines. He also pointed out that emphasis should be put on prioritizing service provision for hard-to-reach areas with selected high impact child survival packages. He added that the second African Vaccination Week was a unique opportunity to raise awareness on the value and importance of vaccination; mobilize human, financial, material and other resources, and implement a variety of activities aimed at improving child survival and primary health care interventions in the region. The first ever World Immunization Week, being celebrated from to 21 to 28 April 2012, unites countries across the globe for a week of vaccination campaigns, public education and information sharing. World Malaria Day-Malaria Risk for Travellers April 25, 2012 marks this year’s World Malaria Day. The Public Health Agency of Canada (PHAC) reminds travellers that there is risk of malaria transmission in many tropical countries around the world. Malaria is a serious and occasionally fatal disease. It is caused by a parasite which is spread to humans by infected mosquitoes. There is no vaccine available against malaria. All travellers are at risk if going to a destination where malaria occurs. Travellers can reduce their risk by following four principles of malaria prevention, called the “ABCD” of malaria: be Aware of malaria risks and symptoms know how to prevent mosquito Bites take anti-malarial drugs or “Chemoprophylaxis”, if appropriate seek medical help early for Diagnosis, if malaria-like symptoms develop Where is Malaria a Concern? Globally, there are over 100 countries or areas at risk of malaria transmission. Malaria risk can change based on season (rainy/dry), location (rural/urban), and altitude. If travelling to any of these areas, you may be at risk: Most of sub-Saharan Africa and limited areas in Northern Africa (most malaria cases and deaths occur in sub-Saharan Africa). Large areas of South Asia, Southeast Asia, and some parts of East Asia. Areas in South and Central America as well as the Caribbean, including parts of Mexico, the Dominican Republic and Haiti. Limited areas in the Middle East, as well as limited parts of Europe. Papua New Guinea and in parts of other small islands in the Oceania region. The following table shows regions of risk for malaria among popular Canadian tourist destinations: Countries with Malaria Risk* in the Top 50 Destinations** among Canadian Travellers (other than the USA) Country Risk of Malaria * Risk of malaria according to: World Health Organization (WHO). International travel and health: Situation as on January 1 2011. Geneva: WHO, 2011 & The Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian Recommendations for the Prevention and Treatment of Malaria in International Travellers. Canada Communicable Disease Report (CCDR) vol 35S1, 2009; WHO- International travel and health updates. Greece- Malaria. Accessed November 11, 2011. Retrieved from: http://www.who.int/ith/updates/20111111/en/index.html ** Top 50 destinations among Canadian travellers according to: Statistics Canada. Characteristics of International Travelers: Custom Extraction Commissioned by the Public Health Agency of Canada, 2010. Argentina Limited risk in rural areas along the borders with Bolivia and Paraguay. Bahamas Risk on Great Exuma Island only. Brazil Moderate to high risk in certain areas of the country. China (mainland) Risk varies within certain areas of the country and during certain seasons; no risk in urban areas. Costa Rica Risk in the province of Limón, mostly in the canton of Matina. No risk in Limón city and little to no risk in other cantons of the country. Dominican Republic Risk is highest in the provinces bordering Haiti. There is little to no risk in other areas of the country. Ecuador Risk exists below 1500m. Moderate risk in the coastal provinces. No risk in Guayaquil, Quito and other cities of the inter-Andean region. Greece Very limited risk exists in villages of the Evrotas delta area of Lakonia district. There is no risk in tourist areas. Guatemala Risk exists below 1500m and varies within certain areas of the country. No risk in Guatemala City, Antigua or Lake Atitlán. India Risk exists throughout the year in the whole country in areas below 2000m. Jamaica Very limited risk in Kingston area only. Malaysia Risk varies within rural areas of the country. No risk in urban and costal areas. Mexico Risk in some rural areas not often visited by travellers. No risk along the United States-Mexico border or in the major resorts along the Pacific and Gulf/Caribbean coasts. Philippines Risk in rural areas and islands below 600m with the exception of several provinces. No risk in Manila and other urban areas. Peru Risk exists throughout the year within rural areas below 2000m. Highest risk areas include regions of Ayacucho, Junín, Loreto, Madre de Dios, Piura, San Martin and Tumbes. South Africa Risk within certain eastern provinces, including Kruger National Park. No risk in major cities. South Korea Limited risk in rural northern areas. Thailand Risk in rural areas bordering Cambodia, Laos, and Myanmar (Burma). No risk in cities (i.e.: Bangkok, Chiang Mai, Pattaya) and the main tourist resorts of Phuket island. Turkey Risk limited to the southeastern part of the country during certain seasons. No risk in the main tourist areas in the west and southwest of the country. Countries with no Malaria Risk* in the Top 50 Destinations** among Canadian Travellers (other than the USA) Australia, Austria, Barbados, Belgium, Bermuda, Croatia, Cuba, Czech Republic, Denmark, Egypt (U.A.R), France, Germany, Hong Kong, Hungary, Israel, Italy, Japan, Netherlands Antilles, New Zealand, Norway, Portugal, Puerto Rico, Republic of Ireland, Singapore, Spain, Sweden, Switzerland, Taiwan (R.O.C.), The Netherlands, Trinidad & Tobago, and the United Kingdom. * Risk of malaria according to: World Health Organization (WHO). International travel and health: Situation as on January 1 2011. Geneva: WHO, 2011 & The Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian Recommendations for the Prevention and Treatment of Malaria in International Travellers. Canada Communicable Disease Report (CCDR) vol 35S1, 2009; WHO- International travel and health updates. Greece- Malaria. Accessed November 11, 2011. Retrieved from: http://www.who.int/ith/updates/20111111/en/index.html ** Top 50 destinations among Canadian travellers according to: Statistics Canada. Characteristics of International Travelers: Custom Extraction Commissioned by the Public Health Agency of Canada, 2010. A complete list of countries (PDF) and a map of the areas where malaria transmission occurs are available from the World Health Organization (WHO). Recommendations Consult a doctor, nurse or health care provider, or visit a travel health clinic preferably six weeks before you travel. It is recommended that travellers: Protect themselves from mosquito bites Discuss the benefits of taking antimalarial medication with a health care provider before departure Discuss your risks with a health care provider, preferably six weeks before travel, to determine whether to take antimalarial medication and which one to take. Antimalarial medication is very effective but is not 100% effective in preventing the disease; therefore, travellers should always follow protective measures to avoid mosquito bites. Recommended antimalarial medication for regions with risk of malaria can be found at the following: CATMAT – Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers WHO – Malaria Situation by Country (PDF) Know the symptoms of malaria and see a health care provider if they develop. Seek medical attention immediately if a fever arises during or after travel (for up to three months or longer) to regions at risk of malaria. Be sure to tell your health care provider that you have travelled to a region where malaria is present. Gates Pledges $363 million to Fight Neglected Tropical Diseases By Madison Park Less than a week after the the Bill & Melinda Gates Foundation announced it would give $750 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the foundation has pledged $363 million to target neglected tropical diseases over five years. The Gates Foundation, along with 13 pharmaceutical companies, the World Bank, other global health organizations and the governments of the U.S., U.K. and United Arab Emirates, announced the effort Monday. It’s called the London Declaration on Neglected Diseases. The goal is to eliminate 10 neglected tropical diseases by the end of the decade by expanding the drug donations, providing about $785 million to support research and development, and efforts to address treatment. The diseases include Guinea worm, lymphatic filariasis (elephantiasis), blinding trachoma (an infectious eye disease), sleeping sickness and leprosy, soil-transmitted helminthes (intestinal worms), schistosomiasis (parasitic infection), river blindness, Chagas disease (parasitic disease) and visceral leishmaniasis (sandfly infection). The 13 pharmaceutical companies have signed on to donate an average of 1.4 billion treatments, such as tablets to treat elephantiasis, donations to treat sleeping sickness, and drugs to treat worm infection. In the past, drug companies have been accused of ignoring tropical diseases in favor of developing drugs targeted towards first-world health problems. The participating drug companies are: AstraZeneca, Abbott, Bayer HealthCare AG, Bristol-Myers Squibb, Eisai, Gilead, GlaxoSmithKline, Johnson & Johnson, Merck, MSD, Novartis, Pfizer and Sanofi. “Our members and researchers around the world applaud this unprecedented level of international cooperation to improve the lives of the 1.4 billion people around the world who are disabled, blinded and suffer needlessly from neglected tropical diseases,” according to a statement released by American Society of Tropical Medicine and Hygiene. As part of the effort against neglected diseases, the Gates foundation has pledged $23.3 million toward eradicating Guinea worm. The foundation named after Microsoft co-founder Bill Gates and his wife, has invested more than $100 million in the effort to eradicate Guinea worm disease. Guinea worm is a debilitating disease which is only in three countries. If eradicated, the Guinea worm disease would become the second disease wiped out by mankind. The first is smallpox. The Bill & Melinda Gates Foundation, Sheikh Khalifa bin Zayed Al Nahyan, president of the United Arab Emirates and the Children’s Investment Fund Foundation will together contribute $40 million to end Guinea worm disease by 2015, the Carter Center, based in Atlanta, Georgia, announced Monday. Former U.S. President Jimmy Carter and the Carter Center have led public health efforts tackling neglected diseases most Americans have never heard of. The Carter Center began its campaign to get rid of the Guinea worm in 1986 and have come closer each year to eradicating the disease. The disease remains in three sub-Saharan African countries: Mali, Ethiopia and Southern Sudan. In Sudan, a war is waged to eradicate the ‘fiery serpent’ Unlike smallpox, the Guinea worm disease is not fatal. But there is no treatment for it and there’s no vaccine to prevent infection either, according to the Centers for Disease Control and Prevention. This disease can, however, cause permanent disabilities to people, crippling their livelihood and local economies. The key to eradicating the disease is access to clean water and changes in people’s behavior because the parasitic Guinea worm lives in stagnant water. When a person drinks the contaminated water, the worm grows inside its human host for a year until it emerges through the skin, causing great pain and in some cases, infections. Measles cases on the rise in Spain By Bryan Cohen Measles Measles cases in Spain rose from 173 cases in 2010 to close to 2,000 cases last year, leading to a pediatrician group’s request to move the vaccination period three months earlier. The Vaccination Advice Committee of the Spanish Pediatric Association has suggested moving the measles, mumps and rubella vaccine forward, giving the first dose to children at 12 months as opposed to 15 months, Euro Weekly News reports. The committee reached this decision because many of the cases detected have been in children between 12 and 15 months of age who have yet to develop the antibodies to fight the extremely contagious disease. The committee recommended moving the second dose to age two, instead of waiting until between the ages of three and six years old. There were 30,000 cases of measles in Europe in 2011, which killed eight people in total. While there were 2,000 registered cases detected in Spain, the true figure is probably closer to 3,000, according to Euro Weekly News. There may have been as many as 2,000 cases in Seville alone, due to many gypsy families with unvaccinated children. Experts said that the rise in the number of cases is the result of vaccination levels that have dropped to 85 percent, while the ideal rate to prevent a disease from spreading is 95 percent or above. Measles infects more than 10 million children each year and kills 120,000 people annually worldwide. Yellow Fever in Brazil Current Situation Yellow fever is a risk for travelers to most areas of Brazil, except coastal regions. During 2009, an outbreak of yellow fever, including a number of deaths, occurred in parts of southeastern Brazil that had not been affected by yellow fever for many years. In response, the Brazil Ministry of Health has gradually expanded the list of municipalities for which yellow fever vaccination is recommended in the four southeastern states of São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul. Globally, yellow fever occurs in sub-Saharan Africa and tropical South America and is spread to people through the bite of infected mosquitoes. Symptoms can include sudden onset of fever, chills, headache, backache, nausea, and vomiting. Yellow Fever Risk Areas in Brazil Currently, Brazil and CDC recommend yellow fever vaccination for travelers to the following states: •All areas of Acre, Amapá, Amazonas, Distrito Federal (including the capital city of Brasília), Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Rondônia, Roraima, and Tocantins. •Other designated areas of the following states: Bahia, Paraná, Piauí, Rio Grande do Sul, Santa Catarina, and São Paulo. Vaccination is also recommended for travelers visiting Iguassu Falls. •Vaccination is NOT recommended for travel to the following coastal cities: Rio de Janeiro, São Paulo, Salvador, Recife, and Fortaleza. Refer to the updated 2011 Brazil Ministry of Health yellow fever vaccination map (PDF) to see the states where yellow fever vaccine is recommended. To determine if yellow fever vaccination is recommended for a specific municipality in Brazil, you may consult the following list of yellow fever vaccine recommendations, organized by municipality and state (PDF). To more easily use this list of Brazilian municipalities, which contains terms in Portuguese, see the following legend for English translations. Recommendations for US Travelers Vaccine Brazil currently does not require yellow fever vaccination for entrance into the country. However, travelers are strongly urged to get the yellow fever vaccine before traveling to an area of Brazil with risk of yellow fever virus transmission. (See Yellow Fever Risk Areas in Brazil above.) For additional information, see CDC yellow fever vaccination recommendations and requirements for Brazil. Protection from Mosquito Bites Since yellow fever is spread by the bite of an infected mosquito, travelers are also reminded to take steps to prevent mosquito bites: •When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. Always apply sunscreen before applying insect repellent. ◦Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), oil of lemon eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent. ◦In general, repellents protect longer against mosquito bites when they have a higher concentration (%) of the active ingredient. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often just 1-2 hours. ◦The American Academy of Pediatrics approves the use of repellents with up to 30% DEET on children over 2 months old. ◦Protect babies less than 2 months old by using a carrier draped with mosquito netting with an elastic edge for a tight fit. ◦For more information about the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” section in Traveling Safely with Infants and Children in CDC Health Information for International Travel 2010 and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use. ◦For more information on the use of insect repellents, visit Mosquito and Tick Protection. •Wear loose, long-sleeved shirts and long pants when outdoors. •Spray clothing with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: Don’t use permethrin on skin.) Visit the Brazil destination page on the CDC Travelers’ Health website for information about other steps to take to ensure a safe and healthy trip to Brazil. Clinic Gives Travelers ‘Passport’ for Safe Trips By Aisling Maki Nurse practitioner, Tonya Parson’s mother returned home last year from a Mexican getaway carrying an unwanted souvenir – a parasite that had taken up residence in her liver. “We’re filling a large gap here in Western Tennessee. And being here allows us to serve the entire region, including Mississippi and Arkansas.” –Mario Parson, Marketing Director, Passport Health “At first, we thought it was jetlag,” Parson said. “We thought she was tired from the trip, but it went on and on.” The healthy, active 60-year-old was constantly plagued by high fevers, weakness and anemia, and although she was treated with blood transfusions and antibiotics, the problem went undiagnosed for months. It was eventually determined that a parasite acquired during international travel had consumed nearly 80 percent of the woman’s liver, leaving her housebound and with a drain in place for more than three months. “I started researching how I could have prevented this because I am a clinician,” said Parson, who worked for 12 years in the intensive care unit at Saint Francis Hospital. “Why didn’t I protect her before she went? Maybe I couldn’t have prevented it, but maybe it wouldn’t have been as bad as it was where she lost months of her life to this illness.” Her mother made a full recovery, but the experience motivated Parson to do some research, leading her to discover Baltimore-based Passport Health, which claims to be the largest provider of travel medical services in the country. The original Baltimore location was opened in 1994 by registered nurse Fran Lessans, who had noticed, despite increasing amounts of travel to underdeveloped nations, a lack of comprehensive, readily available travel medical and immunization services. Parson noticed that despite Memphis being home to a number of corporate headquarters as well as a departure point for missionaries traveling abroad, the city’s nearest Passport Health location was a three-hour drive away in Nashville. Parson and her husband, Mario, decided to bring those services here, and they recently celebrated the grand opening of the Memphis branch of Passport Health at 4515 Poplar Ave. In the two months the business has been open, Parson, who leads a staff of four as executive director, said it’s already served clients that include missionaries, physicians, leisure travelers, business travelers, students and military personnel preparing for deployment. Client travel destinations have included Afghanistan, Argentina, Brazil, Chile, China, the Dominican Republic, Haiti and Romania. “We’re filling a large gap here in Western Tennessee,” said Mario Parson, who serves as marketing director for the clinic. “And being here allows us to serve the entire region, including Mississippi and Arkansas.” And Tonya Parson said although some vaccinations can be obtained at the health department and through primary care physicians, other facilities typically carry neither the breadth of vaccines and medications nor the specialized education component offered by Passport Health. The company carries all medications in house – and is a certified provider for vaccines such as yellow fever, meningitis, and Hepatitis A and B. The company said it’s the sole private provider of anthrax vaccine in the U.S and has even been called upon to develop outreach programs to deal with bioterrorism response and military preparedness. “We don’t just medicate and vaccinate: we educate,” said Parson, explaining that the company accesses electronic medical records updated daily with information from the Centers for Disease Control, the World Health Organization and the Immunization Action Coalition. Passport Health clients are provided with personalized packets containing comprehensive information about the country and specific region to which they’re traveling. Parson said the company also travels to businesses to educate and vaccinate onsite, and maintains several national contracts with corporations such as Microsoft, UPS and JPMorgan Chase & Co. “Again, it’s hard to believe our area had not been serviced by anybody,” Parson said Travel-Related Infectious Diseases By: Jessica Grogan, MDNews.com The CDC says that approximately 1–5% of people receive medical attention upon returning to the U.S. That number increases to 8% for travelers who visited developing countries. A patient who presents in the emergency room with chills, fever or a headache is not commonly thought to have malaria, dengue fever or typhoid fever, but with people taking more vacations to exotic locations or developing countries, hospital staff need to be on the lookout for a more serious condition than the flu, as those symptoms might suggest. The most common medical complaints from travelers returning to the U.S. include GI illnesses (10%), skin lesions and rashes (8%), respiratory infections (5–13%) and fever (3%). The GeoSentinel Surveillance Network studied data from March 1997 through March 2006 from 24,920 travelers and found that 28% of them sought medical attention because they had a fever. Up to 26% of those travelers ended up in the hospital. Malaria, typhoid, dengue, hepatitis A, invasive bacterial diarrhea and rickettsial infections are the most common illnesses associated with a fever that travelers contract. Travel-related illnesses are occurring with more frequency because many travelers do not receive pre-travel care, such as vaccinations, if they are visiting a high-risk area. If a patient scheduled a visit with his or her doctor a few months before taking a trip, the physician could administer appropriate vaccinations and discuss other measures that should be taken before leaving the country. A majority of travel-related diseases occur within 12 weeks of the traveler’s return to the country. Often,] patients who present with a fever, nausea, body aches or rashes may not think it’s important to mention recent travel unless they are specifically questioned about it. As patients travel more often and to more exotic places, the list of possible illnesses must grow. Through appropriate testing, similarly manifesting illnesses can be differentiated from each other. Hand, Foot and Mouth Disease in Vietnam What is the current situation? The Vietnamese Ministry of Health has confirmed an outbreak of hand, foot and mouth disease (HFMD) attributed to enterovirus 71 (EV71). The outbreak is concentrated in the southern part of the country, but cases have been reported from all regions. Cities and provinces with the highest HFMD number of deaths are Ho Chi Minh City, Dong Nai, Binh Duong, Long An, Ba Ria-Vung Tau, Bac Lieu, Dong Tap, Tien Giang, and Quang Ngai. As of mid-October 2011, Vietnam had reported 80,000 cases of HFMD and 137 deaths. As in other outbreaks of EV71 HFMD reported in Southeast Asia since 1997, a small proportion of children with the disease have developed severe, often fatal complications, including encephalitis (swelling of the brain). What is HFMD? HFMD is a common illness that usually affects infants and young children. However, older children and adults can also become infected. HFMD can be caused by several different viruses. Symptoms of HFMD include fever, painful blister-like sores in the mouth, and a skin rash. HFMD is spread from person to person by direct contact with the viruses that cause this disease. These viruses can be found in saliva, nasal secretions, blister fluid, and feces of the infected persons. The viruses also may be spread when an infected person touches objects and surfaces that are then touched by others. How can travelers protect themselves? You can protect yourself from HFMD by practicing healthy personal hygiene. •Wash your hands often with soap and water, especially before you eat, after you cough or sneeze, and after you go to the bathroom or change a baby’s diaper. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). Consider packing alcohol-based hand gel in your carry-on luggage to ensure you have it when needed. •Disinfect dirty surfaces and soiled items. •Avoid close contact such as kissing, hugging, or sharing eating utensils or cups with people with HFMD. There is currently no vaccine to protect against the viruses that cause HFMD. The personal hygiene measures described above are the best protection. There is no specific treatment for HFMD. However, some things can be done to relieve symptoms, such as •Taking over-the-counter medications to relieve pain and fever. (Caution: Aspirin should not be given to children.) •Using mouthwashes or sprays that numb mouth pain If a person develops mouth sores, staying hydrated is important. An ill person who cannot swallow enough liquids to stay hydrated should see a doctor. Fluids may need to be given through the veins. Information for Health Care Providers The current outbreak in Vietnam has been attributed to EV71. HFMD is one of many infections that cause mouth sores. If laboratory diagnosis is required, throat swabs or stool specimens may be tested for enteroviruses. Contact your local or state health department to find laboratory resources in your area. Winter Travel Health Tips Introduction Winter is a season in which majority of people get cold, flu or other infections. Injuries are also common for this period of year. It is obvious that there is even greater possibility for certain medical conditions to occur if someone is traveling during winter months. How to Deal with Possible Obstacles The exposure to infective agents increases as during traveling people get into mutual contact more often. Even the trains, airplanes and boats are excellent sources of these vicious agents. It is common knowledge that immune system is functioning less effectively in winter months comparing to any other time of year. Still, this does not have to be an obstacle if someone wants to travel abroad right in the middle of the winter. The easiest way to avoid certain health conditions is to take proper measures. Before traveling it is best to see a doctor who will exam you. This way he/ she will be able to establish possible onset of some infection that can impede in your vacation. Additionally, the one who is traveling might receive adequate vaccines that will prevent possible infections. This especially refers to seasonal flu vaccines. Furthermore, according to the country one is traveling to a doctor may recommend additional immunization or taking of certain medications that will protect from the diseases that are endemic in the country one is traveling to. Proper diet counts as well. It is common that people have to get used to new cuisines and change their standardized dietary regimes. Still in all the countries all over the world fresh fruit and vegetables are highly available and one should not hesitate to buy them. But it is very important that these products are properly washed to avoid possible infestations. Speaking of hygiene proper body hygiene can prevent possible digestion of parasites and prevent certain intestinal infections. The jet lag is common if one is heading for distant countries. This is why proper rest and plenty of sleep in important at the arrival so that a person can back to normal rhythm. This will help in energy preservation and one will be fresh enough to go sightseeing and do other sorts of activities. Additional problem may be the change in climate especially if the temperature is way too high or lower than in home town. These temperature changes can lead to certain medical conditions. Proper wardrobe is necessary and one should keep in mind to change clothes on time. If the vacation is in mountains or in cold areas people should be careful and avoid excessive exposure to cold temperatures as they can lead to hypothermia and even frost bites. Every person should think of possible health conditions that can happen during vacation. This is why a small first aid kit is essential whenever one is traveling. Painkillers, antacids, antihistamines are only a few of medications that has to be at hand.