International Travel Health Clinic Newsletter
May/June 2012
Located in the Claremont Village, Hendricks Pharmacy is your local independent pharmacy. We accept most insurance plans and offer
FREE delivery. We also have a solution for you if you need help remembering to order you medications; it's the AUTOREFILL system.
Hendricks Pharmacy also has an International Travel Health Clinic headed by our certified travel pharmacist, Dr. Karl Hess. The clinic is
providing this newsletter as a way to keep you up-to-date on the latest travel news and to answer questions that are frequently asked by
our patients. In addition, our travel clinic also provides comprehensive pre-travel consultations, during which, we will review your travel
plans as well as your medical and vaccination history to determine the best pre-travel recommendations for you. This is extremely
important to ensure that you are properly protected from various diseases and to give you peace of mind, allowing you to enjoy and make
the most of your trip. Our personalized consultations will include all necessary vaccines as well as medications for malaria, altitude
sickness, and traveler’s diarrhea. We will also include specific travel advisories associated with your destination.
To set up your personalized consultation today, please fill out our pre-travel form online at www.HendricksPharmacy.com or
call us at (909) 624-1611 or email us at Travel@HendricksPharmacy.com. You can also find us on Twitter @HendricksTravel.
International Health Regulations Update 1,2,3
What are the International Health Regulations?
International Health Regulations (IHR) composed by 194 State Parties and the World
Health Organization (WHO). Together they have been implementing global rules to
enhance national, regional and global public health security.
Vaccination Requirement for Travel
Some countries require proof of yellow fever vaccination for entry. Travelers are
required to carry a valid International Certificate of Vaccination if they have previously
been to a yellow fever endemic area. The certificate is valid for 10 years and becomes
valid 10 days after vaccination.
Recent Updates
Many countries have updated their requirement to include airport layovers in countries
at risk for yellow fever. In some cases, the layover will only be considered if it is greater
than 12 hours.
Country Requirement Updates
South Africa now states that their requirement applies to travelers arriving from Zambia,
Tanzania, Eritrea, Sao Tome and Principe, and Somalia. This is in addition to the usual
countries listed by WHO as having risk of yellow fever transmission and includes airport
layovers in such countries. New yellow fever vaccination requirements: Kyrgyzstan,
Mayotte. Countries whose yellow fever vaccination requirements have been dropped:
Reunion, South Sudan.
For a list of all countries and their requirements, go to:
New Clinic Services5,6,7,8
,2,3
Post-Travel Consultation
About 15-70% of travelers returning to the
US develop a travel-related illness.
Common symptoms include fever (~3%),
stomach illness (10%), rash (8%), and
respiratory infections (5-13%) that may
occur during travel or weeks to years after
returning. These symptoms may indicate a
potential infection and may worsen existing
medical conditions if present.
What do we do?
We provide a 15-minute phone interview
scheduled approximately one month after
arriving back to the US. We will help
screen for any health problems that might
have occurred during your travels and
make recommendations for treatment or
referrals to your health care provider based
on information provided.
http://www.who.int/ith/chapters/ith2012en_annexes.pdf
Focus on Vaccines: FLuMist Quadrivalent® Influenza Vaccine 3,4
What is the FluMist Quadrivalent Influenza vaccine?
FluMist Quadrivalent is the first live, intranasal, quadrivalent influenza vaccine. FluMist Quadrivalent contains 4 strains (2 type A and 2 type B
influenza viruses) which may help provide broad protection against circulating influenza. FluMist Quadrivalent vaccine will be available for the
2013-2014 Flu Season.
Who should get the FluMist Qudrivalent vaccine?
It can be used in children, adolescents, and adults ages 2 through 49.
Who should NOT get the FluMist Qudrivalent vaccine?
Anyone who has ever had a severe allergic reaction to eggs, gentamicin, gelatin, and/or arginine
Anyone who has ever had a life-threatening reaction to a prior influenza vaccine
Children under 2 or adults over 49 years of age
Anyone with a chronic medical condition such as diabetes or asthma
What are the common adverse effects?
Common side effects include runny or stuffy nose, sore throat and fever.
Safety and effectiveness of FluMist Quadrivalent compared to FluMist Trivalent
Current studies have demonstrated similar immune responses and side effect events in both groups
Hendricks Pharmacy International Travel Health Clinic Newsletter
Websites for Current Outbreaks
For information on recent outbreaks and travel alerts throughout
the world, visit these websites:
http://wwwnc.cdc.gov/travel/
http://www.promedmail.org
http://www.istm.org/WebForms/NonIstmLinks/Outbreak_News.aspx
http://www.who.int/csr/outbreaknetwork/en/index.html
Fact or Fiction?
18, 19
People traveling for extended periods of time may be at an
increased risk for Deep Vein Thrombosis.
FACT: Deep Vein Thrombosis (DVT) occurs when a blood clot
forms in a large vein. If part of the clot breaks off and travels to the
lungs, this is called a Pulmonary Embolism (PE), which can be fatal.
The American College of Chest Physicians (ACCP) states that
individuals traveling for more than 8-10 hours, whether by air, bus,
train or car are more susceptible to DVT due to limited mobility and
restricted blood flow.
Someone with a family history or personal history of a blood
clot is more likely to get a blood clot while traveling.
FACT: For travelers on flights of 8 hours or more who have an
increased risk for DVT/PE, the ACCP recommends frequent
ambulation, calf muscle stretching, or sitting in an aisle seat if
possible.
Getting up occasionally, walking around, and stretching your
legs while you sit do NOT help prevent DVT.
FICTION: All of these are helpful strategies to avoid a blood clot
during travel, especially for those with a family or personal history of
Deep Vein Thrombosis. In addition, the guidelines suggest against
the use of aspirin or anticoagulant therapy to prevent DVT/PE in
long-distance travelers. For travelers who are considered to be at
particularly high risk for DVT/PE, the use of antithrombotic agents
should be considered on an individual basis because the adverse
effects may outweigh the benefits.
References
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Facts – Malaria Prophylaxis 10,11,12,14
Chloroquine is generally the drug of choice in Central America. Other drug
options that are also effective against the malaria causing protozoa, P.
falciparum, include mefloquine, Malarone® (atovaquone/proguanil), or
doxycycline. Primaquine may also be used in certain circumstances.
Monday
If the region
of learning
travel is known
be chloroquine-resistant, Malarone® is
Today
we are
abouttodinosaurs.
often preferable because it can be stopped within 7 days of returning from
Tuesday
the malarious area and has minimal side effects. Other options include
Today
we are
learning about pets.
mefloquine
or doxycycline
Wednesday
Primaquine is used for malaria prevention in two ways. First is primary
Today we are learning about the solar system.
prophylaxis in areas with predominantly P. vivax, for 7 days after leaving the
Thursday
malarious area. Secondly, it is used for Presumptive Antirelapse Therapy
(terminal
also
knowntrip
as to
PART.
When used for PART,
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weprophylaxis),
are going on
a field
the zoo.
primaquine is given for 14 days after leaving the malarious area. Before
Friday
primaquine is used however, a blood test to rule out G6PD deficiency MUST
Today
we have a special guest from the fire department to
be done!
tell us about fire safety.
Resistance to Mefloquine has been documented in SE Asia, therefore, this
medication should be avoided if traveling to Myanmar (Burma), Cambodia,
Laos, Thailand, and/or Vietnam.
Have more questions? Contact our Travel Health Clinic at
travel@hendrickspharmacy.com or at 909-624-1611
Quick Travel Tips - Advice for Safe and
Healthy Travel for Students! 9, 13, 15, 16, 17
Preparation Before Travel Is Key!
Check with your physician to make sure you are in adequate health for
travel.
Make any necessary precautions for routine vaccinations and learn about
any country/region specific vaccines that you may need.
Write down phone numbers and other pertinent information about the US
Embassies at http://www.usembassy.gov/
Before you leave, enroll with the Smart Traveler Enrollment Program
(http://travelregistration.state.gov/ibrs/ui/) so that the Department of State
can better assist you in an emergency.
Lastly, be sure to make an appointment with a doctor familiar with travel
health and medicine, such as our International Travel Clinic, at least 4-6
weeks prior to leaving!
CDC: Yellow Fever, 2012. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.htm. Accessed on April 27, 2012.
WHO's 2012 edition of International Travel and Health
http://www.who.int/ihr/en/ Accessed on April 30, 2012.
FluMist Quadrivalent (Influenza Vaccine Live, Intranasal) Package Insert.
FluMist Quadrivalent (Website) https://www.flumistquadrivalent.com/
PubMed Health. Pulmonary tuberculosis. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001141/ Accessed on April 23, 2012
CDC: Tuberculosis (TB), 2011. http://www.cdc.gov/tb/topic/basics/default.htm. Accessed on April 23, 2012
CDC. Tuberculosis Testing and diagnosis. http://www.cdc.gov/tb/topic/testing/default.htm Accessed on April 23, 2012
CDC. Post-Travel Evaluation. Yellow Book Chapter 5. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-5-post-travel-evaluation/general-approach-to-the-returned-traveler.htm. Accessed Mar 23, 2012.
CDC. Malaria. Yellow Book Chapter 3. http://wwwnc.cdc.gov/travel/yellowbook/2012/ chapter-3-infectious-diseases-related-to-travel/malaria.htm>. Accessed on April 26, 2012.
Vaccines. National Institute of Allergy and Infectious Diseases. http://www.niaid. nih.gov/topics/vaccines/understanding/pages/typesvaccines.aspx#live>. Accessed on April 26, 2012.
CDC. Altitude Sickness. Yellow Book Chapter 2. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/altitude-illness.htm April 26, 2012.
CDC. Food/Water Precautions. Yellow Book Chapter 2. http://wwwnc.cdc.gov/travel /yellowbook/2012/chapter-2-the-pre-travel-consultation/food-and-water-precautions.htm. Accessed April 26, 2012.
CDC. Vaccinations. Yellow Book. http://wwwnc.cdc.gov/travel/page/vaccinations .htm#scheduled>. Accessed April 26, 2012.
CDC. Advice for Safe and Healthy Travel for Students. http://www.cdc.gov/Features/StudyAbroad/ Accessed April 28, 2012
CDC. Know What to Do if You Become Sick or Injured on Your Trip. Yellow Book. http://wwwnc.cdc. gov/travel/page/sick-during-trip.htm. Accessed on April 28, 2012.
CDC. Pack Smart. Yellow Book. http://wwwnc.cdc.gov/travel/page/pack-smart.htm>. Accessed April 26, 2012.
CDC. Deep Vein Thrombosis and Pulmonary Embolism. Chapter 2. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/deep-vein-thrombosis-and-pulmonary-embolism.htm
ACCP CHEST Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. chestjournal.chestpubs.org 374S. Accessed May 1, 2012.