Archive for April, 2009

Before You Say “Pandemic”, Consider the Source

Wednesday, April 29th, 2009 by Frank Gillingham, MD
who4

World Health Organization

As quickly as swine flu is popping up around the globe, “news” about swine flu is being consumed at an even faster pace.  If you ever played Whisper Down the Lane, you know that information often changes as it passes from person to person. With the advent of social networks such as Twitter, basic facts can morph into panicky fiction as quickly as a text message is transmitted.

It is at times like these that we need to carefully search out credible sources of information. Let’s take a moment to look at two authoritative sources of international health news and the arbiters of the term “pandemic”: the United Nations World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC).

In an effort to provide meaningful and consistent characterization of flu outbreaks, both the WHO and the CDC have formulated rating systems.  The WHO rates the severity of an outbreak of a new contagion using a six-phase system ranging from no-risk (Level 1) to pandemic (Level 6):

1.       No animal virus has caused human infection

2.       An animal influenza virus has caused at least one human to become ill

3.       An animal influenza virus has caused sporadic cases or small clusters of people to become ill, but there is no sustained human to human transmission (current level of avian or “bird’ flu worldwide)

4.       Verified human-to-human transmission of enough volume to cause community level  outbreaks (such as the swine flu outbreak at the school in Queens, New York)

5.       Human-to-human spread into at least two countries in close proximity without a known host travelling from one country to another (Tourists who return home from Mexico and become ill do not meet this test)

6.      Community level outbreaks on at least two continents (Pandemic)

Don’t even try to “tweet” this important information on Twitter.

Once a pandemic has been declared by the WHO, the CDC uses a “Pandemic  Severity Index” to rate flu outbreaks based on the number of anticipated deaths.  Category 1 outbreaks have an expected death toll limited to less than 90,000, while category 5 puts the number at almost 2 million.  The CDC developed this system in response to the Avian Flu threat in 2007 in order to standardize the level  response taken by  public health agencies around the U.S. and the world. 

Word is just in that the WHO has raised its pandemic alert to Level 5. Let’s keep the WHO criteria firmly in mind as the contagion spreads. There are 36,000 deaths in the U.S. each year from flu complications, and we have a long way to go to reach Category 2.

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More News from the Swine Flu Epicenter

Wednesday, April 29th, 2009 by Carol Foley

tamifluThe CDC has recommended Tamiflu® and Relenza® for treatment of the swine influenza virus . As is often the case in any type of outbreak, there are numerous conflicting reports arising concerning the availability of the necessary medications.

One of our physician advisors, who is based at a Mexico City hospital, has provided us with the latest information on the treatment available for swine flu.

For those already infected, both Tamiflu and Relenza are available in the main hospitals and are believed to be effective for treating swine flu. Tamiflu is not available commercially but has been stockpiled by the government in adequate supplies and is being dispensed with a physician’s prescription under government supervision at large hospitals. We have learned that Tamiflu is starting to appear in pharmacies in Mexico City.  Relenza has been commercially available in Mexico but demand may exceed supply.   We will provide updated information as it becomes available. 

There have also been reports that thousands of people are flooding the hospitals in Mexico City and are being turned away by police. Our physician advisor reports this is NOT TRUE. The main hospitals in the city are accepting anyone who needs treatment. In fact, they are encouraging people to come to the hospital for proper medical care, ideally within the first 24 hours of recognizing symptoms of swine flu.

We will stay in contact with our physician advisor in Mexico and will post any newsworthy updates.

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On the Front Lines in Mexico

Tuesday, April 28th, 2009 by Laura Hilton

mexico428092After 24 surreal hours on the ground in Mexico, I’m on my way back out of the country. I had arrived in Monterrey yesterday for a conference of Mexican Hospitals, but the conference has been canceled due to the swine flu outbreak.

 

Here are my observations from my quick stay:

 

The mood and behavior of people has changed dramatically from yesterday; when I first arrived, only a few people were wearing masks. Today, well over half the people are wearing masks. If they don’t have masks on, they’re using bandanas and t-shirts over their mouth and nose. I’d estimate that 80 percent of the people in the Monterrey airport were wearing masks. On the street, not as many people are wearing masks. A lot of people aren’t wearing the masks properly, but they seem comforted by the fact that they have them or their bandanas perched on their head or around their neck.

 

The city seems like a set for a disaster movie with everyone wearing masks and avoiding crowds.  It certainly seemed to me that the onslaught of information from reporters all over the globe has put the local citizens on edge.

 

I know there have been some reports that the Mexican government has been a little slow to act in this emergency, but at least one local seemed pleased with the response. My driver from the airport said that the Mexican government has been very open in its communication, and he didn’t think that past administrations would have been as forthright.

 

One of the funniest observations goes into group psychology – during the normally uncomfortable period of lining up and boarding a plane, everyone was even a little more unsettled than usual brought on by the close proximity of strangers all wearing masks.  Of course, once on the plane, despite the quarters being even more confined, everyone seemed to let out a deep breath of relief.  In this case, most of us were probably just happy to be leaving Mexico behind.

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Swine Flu Outbreak: More Answers Needed

Tuesday, April 28th, 2009 by Frank Gillingham, MD

swineflumexico428Not since the panic of 1976, when a Fort Dix, New Jersey soldier died and four of his fellow recruits became ill, has there been such attention paid to swine flu.  The 1976 “outbreak” triggered a massive effort from the US government to immunize the entire population. The pandemic never materialized despite only 24 per cent of the population receiving the vaccine, and some criticized our government for making much ado about nothing.  Moreover, there were over 500 cases of Guillain Barre Syndrome attributed directly to the vaccination.  Are we currently heading down the same path, or is there good reason to be concerned about an emerging epidemic?

Each year, anywhere from 250,000 to 500,000 people die worldwide as a result of influenza. So what is so different about the swine flu? In 1976, scientists were very concerned because the swine flu isolated from the Fort Dix soldiers closely resembled the flu strain responsible for the pandemic of 1918 that killed countless victims worldwide. Unlike the human influenza A strains that circulate each year, and for which the World Health Organization develops annual vaccines, the swine flu’s primary host is the pig, and is an unknown entity without a “track record” of virulence. As such, epidemiologists do not know what to expect. Generally speaking, new flu viruses are harder for the immune system to defend against, so they can reproduce rapidly and overwhelm the body’s defenses. Ironically, the body can even overreact to a new virus- the so called “cytokine storm”- which may lead to grave illness or death.

The seriousness of the current swine flu from Mexico has yet to be determined.  Several dozen cases have been reported in five states over the past few days, but no one is yet critically ill.  On the other hand, there are already over 140 deaths reported in Mexico from (presumably) the same strain.   History does not help us. In 2007, there was a little publicized outbreak of swine flu in the Philippines that resulted only in mild illness. There were also about a dozen cases of swine flu reported in the United States between 2005 and 2009 – none of them lethal.

A pandemic has three features- the ability to spread rapidly among humans, the ability to cause serious illness in a high percentage of those infected, and novelty in the world of flu viruses.  So far, the Mexican swine flu has proven to only have one of these features- it is a strain not previously identified. We will be watching (and posting) as this story unfolds.

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Outbreak in Africa’s Meningitis Belt Means Travelers Need Immunization

Friday, April 24th, 2009 by Frank Gillingham, MD

High season is nearing the end in the annual battle against meningitis in many countries of equatorial Africa. According to the Centers for Disease Control , there have been over 25,000 suspected cases so far this year in an area that stretches from Mali and Senegal in the west to Ethiopia and Eritrea in the east. Nigeria and Niger have been especially hard hit. The high season for infections runs from December through June.

If you aren’t immunized, it isn’t safe to visit these countries at this time.

Forgive me this pause for a little education – Meningitis is an inflammation of the meninges – the thin lining of the brain and spinal cord. Symptoms may include severe headache, a stiff neck, fever, vomiting, a marked sensitivity to light, and delirium.  It is most commonly caused by the Neisseria meningiditis bacteria. Despite early and adequate treatment, 5-10% of patients die, usually within 24-36 hours.  Those who recover may experience brain damage, with hearing loss and/or learning disabilities in 10-20% of survivors.  The infection is spread by breathing in the small droplets of fluid from the sneezing or coughing of those affected. In short, it spreads quickly and it’s devastating.

http://gamapserver.who.int/mapLibrary/Files/Maps/Global_MeningitTravelers to the so called “meningitis belt” MUST be immunized.  Fortunately, the two commercial vaccines available in the United States (MPSV4 or Menomune and MCV4 or MenactraT) provide protection against the most common types of infection.  Students who are immunized against meningitis in preparation for dormitory living in the U.S.  typically receive these vaccines, but they should check with their physician to make sure they are protected.  Those traveling through  or living in the meningitis belt should adopt strategies for avoiding the illness such as staying away from large gatherings, refraining from sharing drinking and eating utensils, and seeking medical attention at the first sign of a headache, fever, stiff neck, or purplish rash. 

The CDC has a website for frequently asked questions about meningitis and the World Health Organization provides useful information on its website.  Though there is no guarantee that vaccinations will eliminate your chance of contracting the infection, they are safe, effective and highly recommended.

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China: New Healthcare Frontier, or Just Following In Our Footsteps?

Wednesday, April 15th, 2009 by Laura Hilton

As we read recently in the Wall Street Journal Health Blog, the U.S. is not the only country grappling with healthcare reform.

CB050932China is dealing with healthcare challenges that come with the reality of having a billion citizens. It will be fascinating to watch as China continues to move beyond the history of peasant farmers playing the role of Barefoot Doctor to try to provide healthcare to the hundreds of millions of Chinese living in its ginormous rural territory. 

International health insurers are jockeying for position in China focusing on the upper echelon of the market – wealthy urban Chinese.  Our sources indicate that the Chinese are hoping to leverage deals with international insurance giants to facilitate healthcare delivery to the rural population. 

China’s cities offer better healthcare operations; there are hospitals operated by the Ministry of Health as well as a growing number of private facilities, many of which are operated as joint ventures between Western and Asian companies.  The best of these facilities offer care at an international standard, with a substantial price tag to match.  Although the history of these joint ventures only goes back about 15 years, there are numerous indications that they are susceptible to the twin evils that plague the U.S. healthcare system (which we discussed recently) – overutilization and overcharging. These trends also extend to the Ministry of Health hospitals, where physicians are encouraged to prescribe high-tech diagnostics and the new prescription drugs through a bonus system. 

It looks like the U.S. is not the only country struggling to find the right mix of incentives to provide the best care at the best price.

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Window on a World of Giving: Medical Projects Reach the Neediest

Wednesday, April 8th, 2009 by Laura Hilton

intldoctorPart of our focus on healthy travel is to build an appreciation for the doctors and hospitals around the world that make special efforts to treat sick and injured travelers.  Well, it turns out that many of these healthcare providers also go out of their way to care for some of the neediest people on the planet. We opened a window on this activity when we introduced some of the doctors and hospitals that work most closely with us to an organization called Global Giving , a philanthropic network dedicated to supporting grass roots programs worldwide.

Through Global Giving, our community of doctors and hospitals applies HTH-funded donations to the philanthropic projects of their choice.  The funds support a diverse range of healthcare projects worldwide – equipment for a hospital in Haiti, mosquito nets for families in East Africa and immunizations for children in the Philippines, just to name a few. 

Over the years, I have learned that despite their busy practices, many of the doctors and hospitals we work with have initiated and nurtured a wide variety of philanthropic projects.  Many provide care free of charge to uninsured local patients who can’t afford it-the CIWEC Clinic in Kathmandu provides free rabies treatment, Dr. Marcos Pacheco e Silva provides dental care free of charge to patients with Down’s Syndrome, HIV and Hepatitis C at the University of São Paulo, and the Dubai Bone and Joint Center founded The Emirates Arthritis Foundation  which raises funds for arthritis patients in need.  In partnership with the Cardiac Children Foundation of Thailand (CCF), Bumrungrad Hospital has given life-saving heart surgery free of charge to 276 children since 2004. 

Others, like Dr. Paul Zakowich, our Regional Physician Advisor in Singapore, help lead medical relief missions to Cambodia and Laos, while the CURE International  hospital in the Dominican Republic regularly receives orthopedic surgeons from the United States to perform life-changing operations on young local patients.  Physicians at the Central Health Medical Practice in Hong Kong  provide medical care to orphans in China.  One of my favorite projects is headed by Dr. Tim Meade in Lusaka, whose organization “Tiny Tim and Friends“ provides medical care and support to HIV-positive orphans and other vulnerable children in Zambia.  Sometimes, projects are on a larger scale:  the renowned University College of London Hospitals  has developed a long-term program to exchange staff and expertise with a sister institution in Kampala, Uganda.

It’s our plan to use this space to describe these initiatives in more detail.  We hope that by promoting wider appreciation of these efforts, we will encourage greater participation and investment in improving the lives of the neediest around the world.

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ADHD (and other mental health conditions) around the Globe

Thursday, April 2nd, 2009 by Carol Foley

rxpad6College years bring opportunities to explore the world. Young adults are adept at traveling light, but today many carry the weight of living with a mental health condition. They may be traveling with Attention Deficit Hyperactivity Disorder (ADHD) or a more serious condition, or, as often happens, a new condition might emerge when an adolescent leaves home for the first time (for reasons Vikram Tarugu cites  in The Real World: Recognizing Illness in Young Adults).

Early diagnosis and treatment of mental health conditions is crucial, so it’s important for students abroad or hoping to go abroad to discuss any suspected symptoms with a mental health professional.  Fortunately, the latest medications and therapies enable diagnosed young people to go pretty much wherever they want without fear and with the blessing of school officials. Coming forward to seek treatment won’t disqualify students from a study abroad program, but it will help ensure that steps are taken to arrange proper treatment and support in the host country.

Finding the right practitioner can be a challenge; in many cultures, physicians are not accustomed to prescribing medications for mental health conditions. Even in a western European country such as Germany, a search may need to be undertaken to find a doctor that will provide care consistent with a treatment plan prescribed in the U.S.

And there are other hurdles as well. Psychiatric medications are typically controlled substances and bringing them across an international border may be illegal. For example, the common ADHD drug Adderall is banned in China, Argentina, the United Arab Emirates and the countries of Western Europe.

Even when legal, medications often vary by brand name and dosage, so getting a prescription filled or refilled can be problematic.  There are tools to help travelers figure these things out, but it’s obviously better to know about them before setting off on your journey. For example, at HTH Worldwide, we have an online and mobile translation tool that finds generic and brand equivalents for over 350 commonly prescribed medications.

Careful preparation may not always be enough because symptoms may first arise upon reaching the destination and may be misinterpreted as culture shock, stress or anxiety. We’ll talk more about that in future postings but in the meantime, remember the importance of self-awareness.   If these conditions persist, they may be symptoms of a larger problem that could be diagnosed and treated by qualified professionals nearby before the situation gets severe.

Certainly, increased understanding and advanced treatment methods have made world travel easier for students. But barriers remain. We have still miles to go to raise awareness of what it takes to keep students healthy while traveling.

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April Fools’ Day

Wednesday, April 1st, 2009 by Angelo Masciantonio

aprilfoolWe’ve tackled some serious issues so far here on HealthyTravelBlog, and we’ll continue to talk about that. But, today, in honor of April Fools’ Day, we wanted to point out that sometimes, travel is just flat out wacky.

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