Medical documents for your trip

I made a post over at www.MatadorTravel.com about important documents that travelers should carry with them and was just asked to re-post that item overe here:

http://www.flickr.com/photos/18789396@N00/144251306/When I am getting ready for a trip and have finally made it to the packing stage, I am usually very, very excited!  My packing routine usually consists of a few beers, some Bob Marley and most all of my personal belongings spread out like a “yard sale”, all over my bed.  I even have packing lists, checking off important items such as electricity converters, passport, batteries, phone charger, etc.  Some things I forget to bring, such as when I was recently in Washington, DC and had to find a black belt to match my clothes for an unexpected invitation to a formal and important business dinner, in about 30 minutes.  Some things should never be forgotten and those are documents and records related to your personal health and medical care.

In my job, I see a lot of sick people.  Having access to their medical records and history are very important and help speed up the process of seeking medical care.  I wanted to make a list of things travelers should carry with them, related to their medical history and conditions…

A LIST OF ALL MEDICATIONS CURRENTLY TAKEN

This should include the medication names, doses and frequency you take them.  Also, a copy of your prescription should be included, in case you lose your supply and need to arrange for more.  A translation of tis list into the local language might also be a good idea.  Don’t forget to include any herbal, over-the-counter or suppliments you may be taking.

IMMUNIZATION HISTORY

This is important, especially if you are traveling in areas know for diseases such as Yellow Fever or participating in a special event that has requirements, such as Hajj.  The World Health Organization offers a card for recording immunizations and is required for documentation of a yellow fever vaccine.

A LIST OF ALL CURRENT MEDICAL CONDITIONS 

This can be particularly helpful in providing history about yourself, in a quick and easy manner.  List all your medical conditions, including basics such as allergies and prior surgery.  To make it even better, consider adding a note about your history with the illness, such as frequency of hospitalizations, treatments and severity.  Again, this would be a good thing to translate into the local language.

EKG

Patients with a history of cardiac problems should carry a copy of their latest EKG with them.  Comparision of one EKG to another is a vital tool in helping diagnose chest pain, and if you find youself hospitalized in a far-away-land, you’ll be very glad you have this.

MEDICAL INSURANCE CARD

Don’t forget to bring your medical insurance card, from home.  If you purchased medical insurance for your trip, bring your policy card and a list of contact information for your provider.

YOUR HOME DOCTOR’S CONTACTS

Taking the time to write down your personal doctor’s name, location and contact information can be very helpful, especially when trying to get medication refills or medical records. 

 

One other nice trick that I have used in the past is to scan these documents and email them, to yourself.  This allows you to have a paper copy, in your bag and a e-copy that can be printed out from virtually any internet site on the planet.  This can be very useful if you lose your originals.

Paking for your trip should be a fun experience and I actually enjoy packing, for the most part.  Next time your are getting ready to go and making sure your iPOD charger is packed, take a second to think about getting together a few papers about your personal health.  Keep these with your passport and hopefully, shred them when you get home, because you never needed them!

Lost vaccine records

Hi,
Thanks for putting together your website. It’s very informative! I have a quick question I’m hoping you can help me with. I’m about to do some long-term travel either in Eastern Europe or Latin America or perhaps both. My problem is that I really don’t know my adult vaccination history (I’m 38). I noticed that you mention a blood test that can tell if you’ve been immunized against Hepatatis B. Are there other tests that can tell what other vaccines I’ve had?
Thanks in advance,
Ed

Thanks for the kind words, first off! This is a very common problem and easy to take care of. Either the records got lost, misplaced or destroyed, some people don’t have copies of their childhood immunization records. 

Blood titers can be drawn by your doctor and can tell if you have immunity to a certain disease, either through exposure to the illness or a vaccine. Some common disease titers include:
Hepatitis A and B
Varicella (chicken pox)
Rubella
Measles
Mumps

There are others on the list, as well as these. If you are unsure of your “level of protection” with respect to a certain disease, before you get the vaccine, check your titer. It may save you an un-necessary shot!

AdventureDoc

Measles Cases in Italy

Eurosurveillance Weekly Release features an article on an Italian Student that was the center of a measles outbreak in the Piemont Region of Northern Italy.

From September to November 2007, a total of 46 cases were linked by contact with the 17 year old girl. The student returned from an international study trip in Cambridge, England immediately prior to appearence of symptoms. She flew with 54 classmates and toured London, as well. The dates fo her trip were Spetember 2nd through 15th. She developed fever 2 days after return to Italy, and rash 2 days after fever. She was un-vaccinated. Two other students on the trip were also un-vaccinated and developed symptoms similiar to the girl.

The siblings of the 17 year old girl, also unvaccinated, developed symptoms of fever and rash 10 days after their sister’s return. Both siblings developed symptoms on October 1st and were vaccinated on October 3rd. However, they had already become symptomatic.

By November 19th, a total of 33 cases were reported, mostly by young adults, who lived in the town of or attended classes with the original case (17 year old girl).

Outbreak measures were initiated and vaccinizations issued to unimmunized persons. The cases were reported to the EU to allow further tracking.

Adventure Doc

DesertUSA.com Survival Article

I grew up in Southern Arizona, the center of the Sonoran Desert. For people not used to the heat down there, it can be overwhelming. A really cool website, called DesertUSA.com, has an article by Felice Prage about “Surviving in the Sonoran Desert“.

The article contains loads of good information from sun protection and safe desert travel to special survival gear for deserts. I really liked it!

I have a page on Hot Climates over at AdventureDoc.org

Sri Lanka Viral Fever Spreading

TamilNet has an article about a febrile illness that is spreading accross Sri Lanka. The Jaffna Hospital has been overwhelmed with nearly 700 patients.

Sri Lanka has a history of Chikungunya virus outbreaks, especially this rainy time of year. Chikungunya is a viral illness spread from the bite of an infected mosquito. Similiar to Dengue fever, chikungunya is considered less severe and self-limiting.

Dominican Leptospirosis Outbreak

In the wake of flooding from Tropical Storm Noel,  last month, there is a outbreak of leptospirosis in the Dominican Republic. The article, from Reuter’s also went to to say that there has been 25 deaths and almost 200 illnesses.

Leptospirosis is a spirocheate that is most commonly acquired through skin contact with infected fresh water. Animals such as rats carry the disease and shed the infective organism in their urine. The usual method of infection is the hiker or forest walker, with a few cuts on their legs, gets splashed or wades in standing fresh water and acquires the infection. Symptoms include fever, headache, jaundice and leg pains. This infection may progress to a fatal meningitis/encephalopathy, if untreated. Treatment is with an antibiotic (penicillin) and there is some literature to suggest prophylaxis with weekly doses of doxycycline.

To learn more about leptospirosis visit the adventure doc leptopsirosis page

Pet Related Infections Article

A very good article on Pet Related Infections can be found at the American Family Physician website (Am Fam Physician 2007;76:1314-22). The article, written by an MD and two vets, covers zoonosis very well. Most of the illness are not specific to household pets and have application to wild animals and travelers, as well.  This is a very informative and well written piece that deserves to be read by any person who treats people in contact with animals.

The authors are: PETER M. RABINOWITZ, MD, MPH, ZIMRA GORDON, DVM, MPH and LYNDA ODOFIN, DVM, MSPH.

Adventure Doc

Antarctic Cruise Ship Rescue

A cruise ship in the antarctic ran into some trouble and is sinking according to this article from the AP.

Apparently, there is a hole the size of a fist and some hull damage, causing the passangers to have to be evacuated. All passengers are safe and accounted for, according to the coast guard.

The incident took place near the South Shetland Islands, on the vessel named “Explorer”. Rescue teams from Norfolk, Virgina and Argentina responded to the call for help.

The saga is over, hopefully. MSNBC has a good article covering the evacuation and safe recovery of cruisers. MSNBC Article.

Read more about cruise ships and health at sea on the Cruise Ship Medicine page over at AdventureDoc.org

Dengue Updates

The good people at ProMed Mail has just sent out some new info on Dengue activity. For the “hard core” out there, you can get all the info form the above link. Here’s a brief summary on where they are saying the problems are:

Martinique, Carribean
Still in the apparent midst of their Dengue epidemic, the island nation of 430,000 people have a total of 6,400 suspected cases, this year. A few fatalities due to Dengue Hemorrhagic Fever (DHF) have also been reported.

Belize
A total of 80 confirmed cases here, with most of them being in Belize City or Corozal District. The government is encouraging citizens to help decrease the mosquito population by eliminating standing water and potential breeding sites.

Costa Rica
24,000 new cases, this year. Puntarenas and Limon seem to be the host spots, in the country. Also, there are 250 reported cases of DHF.

Vietnam
80,000 new cases this year with the provinces of Dong Thap, Tien Giang, and An Giang leading the number of reports.

Karachi, Pakistan
After being a little shy about sharing information on new cases, Karachi hospitals have started talking. 534 new cases this year and a bit of a problem with correct diagnosis, it seems. There is some speculation of under-reporting the number of new cases due to problems with their testing methods.

If all this bug and infection talk got you interested, check out more on Dengue Fever over at: Adventure Doc Dengue Page

Stoked!

I know it is not a technological miracle that I was able to link the newly started blog and the website, but I am pretty damn proud of myself. I am not the best in the wordl, when it comes to websites and publishing, etc. Well, just visit the site, and you’ll see.

I am glad I can finally make some “on the fly” posts about updates, outbreaks and other stuff that is is little more dynamic. I only update the website one per week and sometimes, that is not enough. Day job…what can you do?

I spent part of the day drooling over the new Wilderness Medicine Conference and being pissed I can’t go. I also saw some pretty cool field gear over at this site NARescue.com. They have some pretty decent looking trauma kits, airways, packs and diagnostic kits. Definately worth a look.

I also read a pretty good article about “Aircraft Cabin Air Recirculation and Symptoms of the Common Cold”. The study looked at the main factor of recycled air in the cabins of commercial airliners and its risk factor for catching a cold. The article basically said there was no increased risk of catching a cold while flying, commercially. I got the article from JAMA July 24/31, 2002 Vol. 288 No. 4. I always thought I seemed to get sick from commercial air travel. I guess not.

I am getting ready to work on the section of the website for “wilderness and remote orthopedic care”. Where to begin? How detailed to go? Ahhh, who cares, nobody reads this anyway.

Malaria Vaccine shows promise

Glaxo experimental malaria vaccine works in babies
Wed 17 Oct 2007, 16:00 GMT
Reuters Africa

By Ben Hirschler

LONDON, Oct 17 (Reuters) – African babies — the group most at risk of dying from malaria — may be protected against the mosquito-borne disease by an experimental vaccine, researchers said on Wednesday.

The finding clears the way for final-stage testing of GlaxoSmithKine Plc’s shot and increases the chance that the world will have a usable vaccine within five years.

Malaria kills one person every 30 seconds, most of them young African children. Doctors believe a vaccine, given as part of routine infant immunisation, is the best hope in fighting the disease.

A clinical trial in Mozambique of 214 infants aged 10 to 18 weeks found the vaccine was safe and reduced new infections by 65 percent over a three-month period after treatment. Clinical illness was cut by 35 percent over six months.

Although such efficacy rates are not as good as for some childhood vaccinations, experts believe the huge burden of malaria means the new shot can still save millions of lives.

“This is a very major breakthrough,” lead investigator Dr Pedro Alonso of the University of Barcelona told reporters in a conference call.

“These tantalising and unprecedented results further strengthen the vision that a vaccine may contribute to the reduction of the intolerable burden of disease and death caused by malaria.”

ONE MILLION DEATHS A YEAR

Malaria, caused by a parasite carried by mosquitoes, kills more than 1 million people every year and makes 300 million seriously ill.

The latest findings, published online in the Lancet, are broadly in line with a 45 percent reduction in new infections reported in 2004 when Glaxo’s vaccine, known as Mosquirix or RTS,S/AS02, was given to children aged 1- to 4-years old.

Mosquirix will now go into a large-scale Phase III trial in the second half of 2008, involving 16,000 infants and young children in seven African countries.

If all goes well, the vaccine — which is the most advanced of a number in development — will be submitted for regulatory approval in 2011, suggesting it could be commercially available in 2012.

Glaxo has promised to sell Mosquirix at low prices in developing countries. The exact price will be negotiated with purchasers, who are likely to be multilateral groups who would cover the cost on behalf of countries where malaria is endemic.

Glaxo has spent $300 million developing Mosquirix and expects to spend another $50 million to $100 million in future.

But the trials programme is also being financed by the nonprofit PATH Malaria Vaccine Initiative, helped by a $107 million grant from the Bill & Melinda Gates Foundation.

Mosquirix — which is given in three doses — targets just one stage in the malaria parasite’s life cycle and its success has surprised some scientists, given the complexity of the disease.

The fact that it works suggests an improved vaccine, targeting multiple elements in the life cycle, might be even more effective.

http://africa.reuters.com/wire/news/usnL17759798.html

Link to Story

Adventure Doc Malaria page

Think before you swim…This is Schistosome country

Schistosomes

Basics: Also known as Bilharziasis. This Trematode/blood fluke infection may lead to portal hypertension, liver fibrosis or bladder cancers, depending on location and length of infection. Eggs enter a freshwater pool, mature in snails and then become free swimming. They directly penetrate skin when it contacts infected water. Two species have a preference for mesenteric veins (Schistosoma Mansoni and S. Japonicium). Schistosoma Hematobium is generally found in the bladder.

Location: S. Mansoni is seen in Africa, South America and parts of Caribbean. S. Hematobium is found in Africa and Middle East. S. Japonicium is found mainly in China and Phillipines.

Transmission/Incubation: Transmitted by direct contact with infected water, allowing penetration of free-swimming cercariae. Eggs are deposited in water from infected person’s urine or feces.

Prevention: Avoidance of infected water, wearing of waterproof boots if wading, topical application of a 70% alcohol solution immediately after contact with infected water and vigorous drying

Diagnosis: Demonstration of eggs in Kato fecal smear or in urine. Urine filtration often facilitates demonstration. Various attempts are underway to have a rapid antigen analysis card for either blood or urine.

Treatment: Praziquantel single dose of 40mg/kg for S. Mansoni and S. Japonicium. A 60mg/kg dose may be used for S. Hematobium.

These are blood flukes and have two sexes, male and female. These parasites like to live in the bladder or mesenteric veins of the abdomen. There are several types of Schistosomiasis: Schistosoma Mansoni and S. Japonicium like to live in the mesenteric veins of the abdomen. Schistosoma Haematobium likes to live in the bladder.
These parasites clog the veins or bladder that they live in.

The life cycle of this parasite requires a snail to mature within. The eggs are passed from an infected individual, either in feces or urine. These eggs hatch miracidae (baby schistosomes) that mature within a snail, that lives in the water. Once they grow up a bit, they leave the snail and swim freely in the fresh water. These are known as cercariae (teenage schistosomes). These bad guys directly penetrate your skin while you are swimming or wading in the water.

To keep this from happening, wear waterproof boots while wading in the water. If you contact the water, vigorously dry skin and immediately rinse your body off with 70% alcohol solution after drying off, to kill the cercariae before they penetrate. This illness is found in Africa, Saudi Arabian peninsula, South America, the Middle East and some Caribbean islands. S. Mekongi and S. Intercalatum are two addition species worth mentioning. Katayama fever (systemic manifestation) is rare, but may occur 3-5 weeks after primary exposure.

Iodine or Chlorine may be used to disinfect water prior to bathing, laundry or drinking. Ensure 3-4 hours for treatment, prior to use.

Visit the Adventure Doc page for more info about this:
AdventureDoc Helminthes

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