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Ticks 'Tis the season to be aware!

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Ticks 'Tis the season to be aware!

The Zika virus has been dominating the health news headlines recently, distracting us from remembering that we are now in the Lyme disease season. The Zika virus can be devastating to a fetus, but otherwise it generally causes mild symptoms and (except for rare cases of Guillian-Barre syndrome) resolves without treatment. Lyme disease is much more serious and is growing more rampant in its normal hotspots across the US; It is also endemic throughout Europe and much of Russia. If you engage in hiking, camping, or similar outdoor activities in wooded regions of endemic areas, or do a lot of gardening, you must take measures...

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Essential Travel Safety Tips—Know before you go!

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Essential Travel Safety Tips—Know before you go!

  There are two pieces of advice I give to all travelers in my Clinic: 1) Don't get bitten by mosquitoes, ticks, or flies. Get insect repellent! 2) Wear your seat belt—if there is one!  Car accidents are the number one killer of healthy Americans abroad.  You can have a heart attack anywhere, but driving—or crossing the street—in many countries can be lethal Things to know before you go  • Dogs are the most common source of rabies in the developing world although bites or scratches from any mammal can transmit the virus. Travelers should avoid contact with animals! They must...

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Reassuring News on Zika and the Olympics

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Reassuring News on Zika and the Olympics

The World Health Organization (WHO) says there is a "very low risk" of Zika virus spreading globally as a result of holding the Olympics in Brazil. There is no need to move the Olympics from Rio de Janeiro, or to postpone or cancel them, WHO experts said. The WHO reaffirmed earlier advice against imposing any travel or trade restrictions on areas affected by the virus, which is spread by mosquitoes. Zika has been linked to birth defects. The Olympics will be held in August. The WHO has already declared Zika a global public health emergency. It has advised pregnant women...

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Aedes aegypti: The Mosquito that transmits Zika (and Dengue and Chikungunya)

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Aedes aegypti: The Mosquito that transmits Zika (and Dengue and Chikungunya)

Aedes aegypti is a mosquito that can spread dengue fever, Chikungunya fever and yellow fever, as well as the Zika Virus. While there is a vaccine against yellow fever, none are available against dengue fever, chikungunya fever or the Zika virus. You must apply an insect repellent during daylight hours to prevent these diseases. Figure 1: A female Aedes aegypti taking a blood meal Aedes aegypti is a day-biting mosquito and is most active for approximately two hours after sunrise and several hours before sunset. The mosquitoes rest indoors, in closets and other dark places. Outside, they rest where it is cool and shaded. Only the female mosquitoes...

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You should worry more about this disease than Zika

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You should worry more about this disease than Zika

Like the Zika virus, chikungunya fever is caused by a virus transmitted by daytime-biting mosquitoes. There is no vaccine. The only prevention is insect-bite protection. If you are going to a country with Zika virus, and you're not pregnant, and especially have a young family, you should be much more worried about this disease! Chikungunya fever is a rapid-onset disease, characterized by high fever, intense weakness, severe joint and muscle pain, headache, and rash. The abrupt onset of fever follows a mean incubation period of 3 days; when fever is present, the body temperature is usually higher than 39°C Soon after the onset of...

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Dangerous Cities You Should Never Visit Alone

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Dangerous Cities You Should Never Visit Alone

Here's the top 10 list. It's surprising how many cities in the US are deemed unsafe. (I think that's basically an escalating inner city poverty issue.) I also remember when New York was considered dangerous (hard to imagine now). The article advises never to travel alone, implying to have another person with you, but in my experience, just one other person may not be enough to scare off a theft, mugging, or worse, because more than one assailant may confront you. I recommend being in a group of 3 or more persons if going around by foot in any of these places...

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Cancel the Brazil Olympic Games?

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Cancel the Brazil Olympic Games?

Here's a provocative article published in the Harvard Public Health Review. Should the Games be cancelled because of the risk of spreading the Zika Virus worldwide? I think its probably too late to cancel the games, from a logistical standpoint. It's not possible to predict the consequences of proceeding with the Olympics; there are too many variables in play. An intensive campaign to eliminate mosquito breeding areas of standing water, combined with application of mosquito repellent, could make a big difference. As for the risk of accelerating the worldwide spread of the Zika virus, it's important to remember that the Zika...

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Zika virus report from Bora Bora

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Zika virus report from Bora Bora

I have been in Bora Bora (French Polynesia) for the past week, and concerned about the presence of Zika virus as well as dengue fever. To date, the largest ZIKa virus outbreak occurred in French Polynesia during 2013–2014. The outbreak spread to other Pacific Islands and then to Brazil in 2015. These viruses are transmitted by daytime-biting mosquitoes. There are no vaccines. Zika virus (but not dengue) causes mild disease unless it infects a fetus, in which case microcephaly and mental retardation can result. Here's my quick assessment: I think there is very little risk of being bitten and getting either disease...

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Another Way to Use Permethrin

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Another Way to Use Permethrin

Some travelers report nighttime mosquito bites despite spraying their room with insecticide and/or permethrin. If you are asleep, mosquitoes can bite your exposed face and neck. What to do? I suggest treating your pillow case and the foldover top of your bedsheet with permethrin. This involves bringing a permethrin pump spray with you on your next trip to any tropical area where there is the risk of malaria. (Pump spray only if flying to your destination, otherwise an aerosol spray is OK). On arrival in your room, spray the pillow cases and the top of your bedsheet and allow 2 hours for...

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Zika Virus Review Article from the New England Journal of Medicine

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Zika Virus Review Article from the New England Journal of Medicine

Here's an excellent article from the NEJM that provides the very latest information about the Zika Virus. You can see how widespread it has become.  Remember that the Zika Virus is transmitted by daytime-biting mosquitoes and that the only prevention is the application of insect repellent to your skin; I also advise treating your clothes with permethrin fabric insecticide.  Important: Although Zika Virus infection is often mild, a Zika-caused death has just been reported from Puerto Rico. This death was caused by bleeding from low platelets in the patient's blood. Also, Zika can cause the Guillain-Barré Syndrome, an ascending paralysis...

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Consumer Reports: Zika Virus Prevention Advice: How Good Is It?

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Consumer Reports: Zika Virus Prevention Advice: How Good Is It?

In their May 2016 newsletter "On Health" ConsumerReports tested a number of insect repellents "That Best Protect Against Zika." Their top-rated pick was Sawyer 20% Picaridin (a non-DEET repellent). OFF! Deepwoods VIII (25% DEET) was also recommended. These repellents provided about 8 hours of protection. The travel medicine community recommends using at least 30% DEET repellent when traveling to areas where there are serious insect-transmitted diseases. Ironically, when West Nile Virus came to the US 15 years ago, CR rated Ultrathon (33% DEET) the most effective (12 hours of protection). which is 4 hours longer acting than any of the repellents in the current study....

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MIT, MGH and Scurvy

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MIT, MGH and Scurvy

Remember Matt Damon in Good Will Hunting? He's a mathematical genius but, because of personal problems, was working as a night janitor at MIT. He anonymously solved a mathematical proof that was left on a blackboard by the math professor as a challenge for his students. Flabbergasted that the solution suddenly appeared on the blackboard, but who did it? Anyway, Damon's character's intellect is mind-blowing, but sometimes a solution to a complex problem does not require a genius IQ, but instead relies on simple pattern recognition and taking a basic history of events. If only experts would remember this. For example,...

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Free-Roaming Dogs: Facts to Know.

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Free-Roaming Dogs: Facts to Know.

There are about one billion dogs in the world, and only about one-quarter are pets. The rest? Some are neighborhood dogs, recognized and perhaps given handouts by people who live in a certain area. Sometimes they are adopted by people. Others may feed and breed on their own, but spend nights at the homes of people. Others are pure scavengers, living mostly off garbage. The number of dogs that can survive in a city or a neighborhood or at a dump is determined by the available garbage. it is calculated that in the tropics it takes about 100 people to produce enough...

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DEET repellents: Are they safe for infants and pregnant women?

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DEET repellents: Are they safe for infants and pregnant women?

The answer is Yes! ----When used as directed. Read the label on any DEET-containing insect repellent and you'll find warnings about not putting it on cuts or under clothing; not getting it in your eyes or mouth; not ingesting it. Interestingly, there is no age limitation warning, and no directions on how much you can apply, e,g., only so much repellent should be applied to a certain area of skin. The American Academy of Pediatrics recommends not putting DEET on an infant under age 2 months, but this is only a recommendation, not supported by any study showing harm, such as...

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CDC says the Zika virus linked to more birth defects and is coming farther north.

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CDC says the Zika virus linked to more birth defects and is coming farther north.

The CDC is now saying that the Zika virus has been linked to a broader array of birth defects throughout a longer period of pregnancy, including premature birth and blindness in addition to the smaller brain size caused by microcephaly. The potential geographic range of the mosquitoes transmitting the virus also reaches farther northward, with the Aedes aegypti species present in all or part of 30 states, not just 12. And it can be spread sexually, causing the CDC to update its guidance to couples. How to prevent Zika virus infection.

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