Tuesday, June 28, 2011

CDC urges pregnant women to get whooping cough vaccine

CDC- Pregnant women should be vaccinated against the whooping cough, an advisory panel for the Centers for Disease Control and Prevention said Wednesday. It recommended that the vaccination be given in the late second or third trimester.

The endorsement was a change from the panel's previous recommendation to wait until immediately after women give birth.

In addition, the panel also recommended that teens and adults in close contact with newborns receive a single dose of the vaccine if they had not received it previously, in order to form a "cocoon" of immunity to protect newborns until they're old enough to be fully vaccinated themselves.

The panel also voted to recommend that a vaccine against meningitis, which is a life-threatening bacterial infection, be given to high-risk infants when they are only 9 months old.

The advantage to vaccinating pregnant women against whooping cough, which is also known as pertussis, is that they may pass the antibodies against the disease to the fetus so that it has some protection upon birth, said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine. In addition, the woman would be protected for a longer period, Schaffner said.

Whooping cough Infants younger than 6 months are most at risk of dying from pertussis and receive vaccinations at the ages of 2, 4 and 6 months through the diphtheria, tetanus and pertussis (DtaP) series of shots. But some infants develop the condition before their shots.

Doctors want to "cocoon" infants by vaccinating the adults around them who might transmit the disease, Dr. Edgar Marcuse, professor of pediatrics at the University of Washington School of Medicine, said in an interview yesterday.

The recommendations won't help unless adults actually get their vaccinations, said Dr. Paul Offit, a pediatric infectious disease expert at the Children's Hospital of Philadelphia. In an outbreak last year of 10,000 cases in California, resulting in 10 infant deaths, only 6 percent of adults living with children were vaccinated, Offit said.

After reviewing evidence, the panel concluded the vaccine was safe to give during the later months of pregnancy. However, there was some concern that vaccinating mothers could interfere with how newborn babies respond to the vaccinations.

Pertussis is a bacterial infection of the respiratory tract that causes severe coughing, according to the National Network for Immunization Information. The coughing makes it difficult to breathe, and a "whooping" sound is sometimes heard when the child tries to breathe.

Passport Health carries the Tetanus, Diphtheria and Pertussis vaccine nation-wide.  

Thursday, June 16, 2011

Weather Changes May Predict Cholera Outbreaks

The good news and the bad news of epidemic predictions
By Joel N. Shurkin, ISNS Contributor

(ISNS)—Scientists working with data from the cholera-plagued Tanzanian archipelago of Zanzibar have found that even a slight variation in temperature or rainfall could herald an epidemic.
That’s both good news and bad news.
The good news is that by monitoring the weather and changes in the climate, epidemiologists may be able to predict the arrival of a disease epidemic up to four months in advance, early enough to make maximum use of vaccines.

The bad news is that with global warming, it is likely cholera epidemics will increase in frequency, and with the climate and rain patterns changing, epidemics could be even more frequent. It’s happening already—recent epidemics in Haiti and Cameroon indicate a resurgent disease.

Cholera is a particularly ghastly disorder caused by the Vibrio cholerae bacteria and is transmitted through drinking water contaminated by human feces. Its main symptom is violent, severe diarrhea, followed by dehydration. In some recorded epidemics, the death rate for infected individuals can be as high as 50 percent. For some patients, the time between feeling healthy and death can be as little as 24 hours.
Cholera originated in the Indian subcontinent and is a disease usually found in developing areas of the world. It arrived in Europe in the early 19th century, reaching pandemic proportions several times.

The relationship between weather, seasons and cholera is long-established. Sea surface height, sea surface temperature and the concentration of chlorophyll in the ocean have already been shown to be predictive in earlier studies in India and Bangladesh.

Researchers from the International Vaccine Institute in Seoul, South Korea, went back to disease and environmental records in Zanzibar between 2003-08. Reporting in the June issue of the American Journal of Tropical Medicine and Hygiene they studied rainfall totals in Zanzibar, high and low temperatures, humidity, and sea surface temperatures. Similar techniques have been successfully used to plot malaria and dengue fever.

They found that a one degree Celsius increase in the average monthly minimum temperature was a sign that the number of cholera cases would double within four months. Further, a 7.8 inch increase in monthly rainfall totals was predictive of a substantial increase in cases within two months.

Giving vaccines to a population that may already have been infected is less effective than vaccinating them before infection, so being able to get ready for an outbreak would save lives.

An epidemic now underway in Yaounde, the capital city of Cameroon, has been blamed on unusual heavy rains coming well before their normal time. The researchers think that is a good example of environmentally driven disease.

The 2010 earthquake in Haiti also triggered cholera. More than 300,000 people have been sickened and 5,000 died. The rainy season is about to start, and the researchers fear an explosion of the disease.

While the study from Zanzibar is useful it would be more useful if it could be extrapolated to other areas, and so far it cannot, said David Sack, professor of international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Sack studies cholera in Bangladesh. He said that the disease comes in March in the south of that country, October and November in the north, and year round in Dacca, the capital city—all this in a country the size of Florida.

So what is true in Zanzibar may not be true in Nigeria. But the seasonality of the disease is well-established and more extreme summers may cause more grief.

"Climatologists predict a 1.4-5.8 C (2.5-10.435-42 F) degree rise in mean temperature over the next 100 years," the vaccine researchers wrote. "Increased sea temperatures and levels associated with global warming intuitively suggest the possibility of increased cholera incidence in many resource-poor regions of the world."

Passport Health, the largest doctor recommended provider of travel medical services and vaccines, not only administers and prescribes immunizations and medications, but also counsels international travelers on water and food precautions for non-vaccine preventable diseases such as cholera.
Make an appointment today to speak with a Travel Medicine Specialist at Passport Health.

Call 1.888.499.PASS (7277)

Monday, June 13, 2011

Know your limits while traveling

We are so excited to have Marcello Arrambide as our guest blogger today.  He is not only a fantastic travel blogger, but a very gifted photographer.  (Be sure to check out his bio at the end!)  Please enjoy his accounts of knowing (and testing) his limits in South America.  We look forward to more posts from you Marcello!

Know Your Limits While Traveling

by: Marcello Arrambide

When you are traveling around the world there are many things that you need to consider.  Its not just about vaccinations and trying to save money everywhere you go.  When you travel you have to know your limits in every respect.  I tested my limits on my trip to Paraguay.  The capital city of Asuncion is commonly known as one of the cheapest capitals in the world.  I tested my limits at the $3 dollar all you can eat pork dish at a local eatery and at the Brazilian Favela (ghetto) that I found shortly after.  I personally like the unknown and my first thought was to walk right into the favela.

I pondered it for a minute whether it would be very dangerous but I figured it wouldn't be as bad as the places I have been in the United States or even in other countries in South America.  (When I was seeing some of the Argentina tourist attractions in Buenos Aires I accidentally drove into the part of the city where tourist reportedly get kidnapped!  When I went to Carnival this year in Brazil, I walked through one of the worst part of the cities as well--- at dark!)  I figured walking into the front of a ghetto with kids running around shouldn't be a problem.
 aerial view of the Brazilian favela in Paraguay

One of the unique things about Paraguay is that the poorest part of the city rests a few feet away from the Presidential palace.  The history museum (that you shouldn't visit) is right on the cliff where favela can be seen.  In the opposite direction you can view a small neighborhood where they live out of boats that sit on stilts on the beach.  Seeing the favela and how the other side lives in Paraguay is almost unmistakable.

After I decided to enter, a man was walking out and approached me.  He advised that I really REALLY did not want to enter the favela since its one of the most dangerous parts of the city.  I later asked a few Paraguayan friends about that area and they told me that the police don't even enter that zone because its  so dangerous.  Sometimes we want to be adventurous and experience new things but we also have to know our limits.  Accidents will happen but when something doesn't feel right you should move on and forget about it, there will always be another adventure around the corner.

Marcello Arrambide is a long term traveler that has been living overseas much of his life.  He shares his travel tips, experiences, and travel advice on his travel blog: WanderingTrader.com.  He currently is living in Colombia finishing his tour of South America and will be heading to Kenya in August.

Thursday, June 9, 2011

Dengue Fever is Resurfacing in Peru

In Heart Of Amazon, A Natural Lab To Study Diseases

by Dan Charles - NPR

It's summer and mosquitoes are back. We mostly consider these insects merely annoying, but they also can transmit disease, such as West Nile virus. In fact, in parts of Latin America and Asia — and even, to a lesser extent, in the U.S. — mosquito-borne diseases are growing more common.

The city of Iquitos, Peru, in the heart of the Amazon rain forest, has become a giant, open-air laboratory to study the spread of one such disease: dengue fever. Scientists are also using this city-size experiment to find out what works best to stop it. The program is sponsored by the U.S. Navy's Medical Research Unit 6.

Every morning, a dozen young men go door to door down sun-baked streets in Iquitos that are sometimes paved, sometimes just dirt, carrying out a mosquito census. Two by two, they knock on doors. The people who answer the knock don't seem surprised, and almost all of them invite the mosquito hunters inside.

Inside, walls of rough wooden planks divide the space into rooms; clothing is piled on tables. "This is a really good example of ideal resting sites [for mosquitoes]," says Amy Morrison, who leads the medical research unit here in Iquitos. She's also field director for the Mosquito Research Laboratory of the University of California, Davis.

One mosquito hunter pokes around in dark corners with a miniature vacuum cleaner that traps insects in a wire mesh cage. His partner counts water containers in the backyard where mosquitoes could lay their eggs.

And in one corner, the mosquito hunters find their quarry: tiny specks in a bucket of water. To the untrained eye, they just look like bits of dirt. But they're actually mosquito larvae. "I'd probably miss it, too," Morrison admits.

This bucket was in the bathroom, placed to catch water from a roof leak. "That's a very common practice here," says Morrison. But it's also a perfect spot for one particular species of mosquito — Aedes aegypti — to lay its eggs. This is also the primary species of mosquito that spreads dengue fever.

"What's fascinating to me about aegypti is it's probably the mosquito that's most closely associated with human beings, and the most adapted to human beings," says Morrison. It's a kind of unwelcome house pet. No other mosquito species is quite so comfortable laying its eggs inside people's homes. It thrives in tropical cities. And more than most mosquitoes, the female of this species has a particular taste for blood.

A Front-Row Seat To The 'Re-Invasion' Of Dengue

Curiously, this mosquito was not always found in Peru. Half a century ago, public health officials unleashed chemical insecticides on Aedes aegypti and actually wiped it out in large parts of Latin America. By the late 1970s, it was gone from all of Peru. As a result, dengue fever disappeared, too.

But it survived elsewhere — in nearby Venezuela, for instance. Scientists now say the species could not, realistically, be eradicated. Ten years later, inevitably, it found its way back to Peru and other parts of Latin America. The first city in Peru where it resurfaced was Iquitos.

The dengue virus soon followed. Since the U.S. Navy already had a research laboratory in Iquitos, researchers there had a front row seat to watch the "re-invasion" of dengue. It's become one of the world's main centers for studying the virus and the mosquito that spreads it.

Along with the mosquito census, teams of nurses monitor people who live in selected neighborhoods. They go door to door to see who is running a fever. Hundreds of people give blood samples every six months. All this information gets recorded in a computerized map of the city. It's a snapshot — actually, more like a movie — of the virus's migration through the city.

Morrison and her co-workers are hoping it will help them understand the spread of mosquito-borne disease anywhere, including in the U.S.

Roger Nasci, who's in charge of research on mosquito-borne diseases at the U.S. Centers for Disease Control and Prevention, says such diseases certainly can erupt in this country.

"Not only could it happen here; it has happened here," he says. "We had yellow fever epidemics in the United States as recently as 100 years ago; we had dengue epidemics as recently as 50 or 60 years ago."

Controlling The Mosquito

Those epidemics have almost been forgotten. They largely ended when people erected effective barriers between themselves and the insects, such as window screens and air conditioning. But West Nile virus was a reminder that mosquito-borne diseases still can be a threat. In just a few years, West Nile spread from New York to California. Persistent cases of dengue now are found in a few areas of the U.S. as well.

More Mosquitoes

Nasci says others could follow. For instance, there's Chikungunya virus, which has spread from East Africa to South Asia. Recently, a traveler from India brought it to Italy, and mosquitoes there picked it up and started spreading it.

"We have infected travelers coming to the U.S. with both dengue and Chikungunya virus that could hypothetically and very easily set up a similar kind of transmission cycle," Nasci says.

The experience in Iquitos shows how difficult it is to shut down such a transmission cycle once it is well-established. Spraying campaigns that the city carries out do have an impact, but they don't prevent dengue entirely. Morrison admits that the mosquito is a really tough adversary.

"I always say, we keep discovering things that turn out to be sort of bad news to the overall goal, which is to find more clever, interesting ways to combat the mosquito, or control the mosquito," she says.

But even though the mosquito probably can't be wiped out in Latin America, Morrison is convinced that it can be controlled well enough to prevent really big outbreaks — such as one that swept through Iquitos earlier this year.

During that outbreak, almost 1,000 feverish patients filled the regional hospital. Dr. Stalin Vilcaromero says temporary cots lined the hospital's stairwells and hallways. And these patients didn't have ordinary dengue, which usually means a week or so of misery but little more — they had the really dangerous form of the disease: dengue hemorrhagic fever.

This is much more common when a person gets reinfected a second time with another strain of the virus. At least two dozen people died; many more might have, if they had not come to the hospital.

On this evening, only two dengue patients remain in the hospital. One of them, Javier Almindo Garcia, still cannot walk. In his case, the dengue infection set off another illness, a neurological condition called Guillain-Barre syndrome.

Almindo Garcia says he doesn't know where he might have encountered the mosquito that infected him with the virus. "I have no idea. It just suddenly hit me," he says.

Full Article from NPR

Tuesday, June 7, 2011

Want to Cut Down your Future Health Care Cost? Act Now and Get Vaccinated!

Vaccines are a cost-effective way to reduce health risks, but they are often overlooked by adults.

Many family practitioners do not check their adult patients’ immunization history on a routine basis. Hence, most patients are not urged to stay on top of their routine immunizations.

Unlike vaccines for infants and children, most adult vaccines generally aren't stocked by primary care doctors, with the exceptions of influenza and pneumonia shots, which usually are covered under preventive care. For other vaccinations, patients often must pay out of pocket until they meet a health plan's deductible, or pay upfront and seek reimbursement.

Medical experts recommend an annual flu shot and a TdaP (tetanus-diphtheria-pertussis) booster every 10 years for everyone over 18. Many people know that, but still don't get those shots.

There are eight other vaccines recommended for many adults, depending on age, sex, current health and whether they had or were vaccinated against certain diseases as a child. Here's a chance to get up to speed. Passport Health, the leader of travel medical services and immunizations in the U.S. carries all vaccinations from the flu shot to more exotic vaccines such as yellow fever.

Here's what's recommended by the federal government, listed by the Centers for Disease Control and Prevention:


Influenza, Can trigger dangerous pneumonia. One dose a year now recommended for all adults. Besides injections, a nasal spray vaccine (Flu Mist) is available for healthy adults, except pregnant women.

Tetanus/diphtheria/whooping cough (pertussis). Generally, one dose every 10 years; when vaccine status is unknown, as soon as possible for women who have just given birth and anyone caring for patients or infants.


Chicken pox (varicella), Two doses from age 19 up, or a booster shot if you've had one shot. Generally not needed if you were infected with chickenpox as a child.

Hepatitis A, Liver infection caused by contact with contaminated food, water, stool or blood. Two doses from age 19 up, mainly for: injection-drug users, men who have sex with men, patients with chronic liver disease or taking clotting-factor medicines, those traveling to or working in countries where hepatitis A is common.

Hepatitis B, Liver infection spread mainly by sex with an infected person and sharing of contaminated implements (drug, tattoo or acupuncture needles; toothbrushes, razors, nail clippers). Three doses from age 19 up.

Hepatitis A and B combination

Human papilloma virus. Spread by sexual contact, it can cause vaginal, anal and mouth cancers and genital warts. Three shots needed over six months. Best before initial sexual activity. Gardasil is approved for females and males aged 9-26.

Measles/mumps/rubella (German measles). One or two shots from 19 through 49, then a booster, for anyone born after 1956, unless they have lab tests showing immunity from prior infection or vaccination. Second dose is needed after four weeks if exposed to a measles or mumps outbreak. Rubella protection is particularly needed before pregnancy.

Meningococcal disease. Causes bacterial meningitis and bloodstream infections, which are uncommon but can Kill or disable quickly. Two-dose series recommended mainly for new college students, military recruits, people without a healthy spleen.

Pneumococcal disease. Causes painful ear and sinus infections, pneumonia, bacterial meningitis and blood stream infections. One dose from age 65 up if immunity isn't certain, or one or two doses from age 19 through 64, then a booster dose. Mainly for smokers, nursing home residents, people with lung or heart disease, diabetes, HIV and other immune conditions, liver diseases, alcoholism, or damaged or removed spleen.

Shingles (herpes zoster). One dose from age 60 up to prevent shingles, a painful, blistering skin rash caused by the chicken pox virus.

It's difficult to quantify how much money one might save by getting vaccines but some of these infections can bring very high medical expenses and leave people too sick to work.

For example, treatment for a yearlong outbreak of shingles pain easily exceeds $5,000, and serious complications requiring hospitalization can add another $20,000. Removal of precancerous lesions that might be prevented by the HPV shot can run well over $700, and treatment would cost far more if cancer developed.

The U.S. Centers for Disease Control and Prevention recently called new vaccines one of the top public health achievements of the last decade. It cited record lows in the number of reported cases of hepatitis A, hepatitis B and chicken pox, along with the introduction of multiple-strain pneumococcal vaccines.


CDC schedule with detailed recommendations for who should get vaccines