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About :

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

Measles on the Rise

Monday, February 6th, 2012 by

Last Thursday, U.S. health officials reported that after a full decade of decline, Europe and Africa reported an increase in the number of measles cases in 2010.  Because of concerted immunization efforts in those areas, total cases declined from more than 853,000 in 2000 to nearly 278,000 in 2008, and remained stable in 2009. However, the number increased in 2010 to almost 340,000 — a jump of over 21%.  Worldwide, measles remains a very serious problem, with over 20 million cases and 197,000 deaths each year.  Over half of the cases and deaths are in India and China.

The somewhat alarming rise in the number of cases is felt partly due to an increasing reluctance on the part of many parents to have their children immunized against measles. Indeed, in what most physicians feel is a gross misrepresentation of the dangers, claims of severe reactions, including autism, have been used by some parents as an excuse to forego the measles vaccination for their children. In truth, the incidence of serious side effects is very rare.  Most children experience only mild local discomfort, fever, and rash. 

On the other hand, complications from measles such as ear infections (10%), pneumonia (5%) and brain damage from subacute sclerosing panencephalitis — an inflammation of the brain that can lead to convulsions, and leave the victim deaf or mentally retarded (0.1%) are much more common than unwelcome side effects of the vaccine.  Parents of unimmunized children reap the benefits of having the vast majority of the remaining pediatric population immunized, particularly in the United States.  This “free ride” has its limitations, especially for those traveling abroad

In January, four members of an unimmunized family from Kansas who had recently traveled to an undisclosed location overseas, were diagnosed with measles.  Two other cases in unvaccinated persons were reported in the same community one week later. Measles is very contagious and is characterized by high fever, cough, a runny nose, redness in the eyes and a characteristic pink rash that spreads from the face to the feet.

Health officials worldwide are concerned that the efforts to eradicate measles will be stymied if parents continue to resist having their children immunized. Since the measles vaccine is almost always given in combination with mumps and rubella (German measles), these illnesses are likely to see an increase as well.  Although the incidence of measles remains extremely low in the United States, parents with unprotected children going abroad, particularly to areas where the measles virus remains prevalent, should be aware of the risks involved.

Photo by Gates Foundation.

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Bird Flu Research Suspended

Tuesday, January 24th, 2012 by

This week, research scientists from the University of Wisconsin and Erasmus University in the Netherlands announced that they were suspending research on new, more contagious bird flu strains for at least the next 60 days.  The announcement was in response to growing concerns that the genetically engineered strains already developed by these virologists could get into the hands of bioterrorists and cause an unprecedented worldwide epidemic.

With a mortality rate approaching 60%, infection with the bird flu virus ranks as one of the most damaging strains of all time. The virus seems to be particularly harmful to otherwise healthy, young people who have limited immunity to other influenza A viruses.  Human-to-human spread is almost unheard of, with the vast majority of cases on record attributable to very close contact with infected poultry.  Scientists announced last month that they had genetically engineered strains that were readily transmissible among humans. 

There is currently no vaccine for the bird flu, and only two medications — oseltamivir and zanamivir — have been shown to be effective in treating the infection.  Symptoms include the typical constellation of fever, muscle aches, runny nose, headache, and cough.  Patients who develop eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other complications are at greatest risk of succumbing to the infection. 

Epidemiologists all over the globe are watching carefully for strains of bird flu that evolve naturally to spread more easily from person to person.   For more information about influenza pandemics, see Flu.gov.

Photo by uafcde.

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Polio and Politics

Monday, January 23rd, 2012 by

Just as India celebrated a full year without a single new case of polio this month, Afghanistan and Pakistan officials released data that showed nearly a threefold increase in polio cases in 2011.  Although the total numbers were rather small — 76 (up from 25 in 2010) in Afghanistan and 192 (up from 80 in 2010) in Pakistan — the dramatic increase was particularly disheartening because both countries were so close to eradication.  Indeed, polio is considered endemic in only three countries in the world, with Nigeria the other still reporting new cases each year.

Politicians were quick to place the blame.  President Hamid Karzai of Afghanistan blamed the Taliban. “Those who stand in the way of vaccination are the true enemies of our children’s future,” he said, calling on “the armed opposition to allow the vaccination teams to help save children against the lifetime paralysis.” Taliban leaders fought back, citing no change in their policy of allowing immunization teams to freely travel through territories they occupy.  “It is not for Karzai to ask us to attack or not to attack someone,” said the Taliban’s southern Afghanistan spokesman, Qari Yousaf Ahmadi.

Health officials appear to have their own view, citing many new cases in parts of Afghanistan where polio was seldom seen in the past. Historically, polio cases have been prevalent in the Pashtun belt of the southern region.  In 2011, cases were spread by refugees fleeing the war torn South for other parts of Afghanistan. Muhammed Taufiq Mashal, the director of preventive medicine in the Afghan Ministry of Public Health, blames much of the polio increase on infiltration from neighboring Pakistan.  This allegation has been confirmed by World Health Organization scientists who showed that the genetic sequence of many viruses isolated in Afghanistan match those from Pakistan.

Naqibullah Faieq, a member of the Afghan Parliament, said, “This health issue is nonpolitical, nonmilitary. We want both the government and the Taliban to not use the issue of vaccination in their speeches.”  Members of the World Health Organization responsible for tracking the incidence of polio agree.  Dr. Bruce Aylward, the polio coordinator for the World Health Organization, believes that the efforts to eliminate polio from Afghanistan and Pakistan will only be successful if vaccination efforts remain unimpeded by opposing political groups.

Smallpox was eliminated in 1977.  Will polio be next?

Photo from The Global Polio Eradication Initiative

 

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Breathing Easier? New Stricter Air Pollution Standards for Beijing

Thursday, January 12th, 2012 by

In response to international criticism, with much of it coming from the United States, the Chinese government announced on Friday that it would initiate stricter air pollution standards for Beijing by the end of the month.  Residents of Beijing, foreigners and natives alike, have long complained that the Chinese government routinely understates the severity of the problem, with many relying on the United States embassy’s official figures instead. 

Under the more “U.S. like” standards, Beijing officials will begin reporting on the level of tiny floating particles — 2.5 micrometers in diameter or less, known as PM 2.5 — that doctors warn can more easily settle in the lungs and cause respiratory problems and other illnesses.  As we reported earlier, China has only reported on the levels of much larger particles—10 micrometers or more. 

Liu Xianshu, the director of the city’s equivalent of the Environmental Protection Agency, said that they would start reporting the readings of the PM 2.5 at the start of the Chinese New Year, which falls on January 23rd.  This appears to be a reversal from a statement last month made by Environment Minister Zhou Shengxian that the government agency would not begin using stricter standards until 2016. 

HTH Worldwide, sponsor of Healthy Travel Blog, processes dozens of allergy and respiratory related claims from travelers to Beijing, many of whom had no prior history of either type of illness.  Ear, nose and throat specialists in Beijing appear to do a very brisk business removing nasal polyps and expanding sinus cavities of those afflicted with conditions aggravated by heavy pollutants, while pulmonologists are quite busy taking care of asthmatics and those with chronic lung disease who struggle with frequent exacerbations.  HTH consultants in China routinely advise those with severe seasonal allergies and lung conditions to have adequate medications for their trip to Beijing.

Photo by egorgrebnev.

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Genetically Engineered Bird Flu?

Thursday, December 22nd, 2011 by

In an unprecedented move, the U.S. Government announced on Tuesday that it had not only sponsored research to figure out how the deadly bird flu virus might mutate to become a bigger threat to humans, but also implored two institutions who met with some success not to publish details of their findings. The concern, according to Dr. Anthony Fauci of the National Institute of Health, was that the information would get in the hands of bioterrorists

Both Erasmus Medical Center in the Netherlands and University of Wisconsin researchers agreed to eliminate specifics in their upcoming reports.  Biosecurity advisers to the government recommended that the journals Science and Nature publish only the general discoveries, not the full blueprint for these man-made strains. 

Characterizing it as a “watershed moment”, the editor in chief of Science, Dr. Bruce Alberts, added that his staff encouraged the U.S. government to establish a mechanism whereby credentialed international researchers could get information on these lab bred strains- especially in bird flu-prone countries like China and Indonesia.  He added “it’s believed to be the first time this kind of secrecy has been sought from legitimate public health research.” 

H5N1 has been responsible for isolated outbreaks primarily in chickens in a number of countries over the past ten years. Rarely does it infect people who have been in close contact with infected poultry, with the outbreaks primarily in Southeast Asia. It is known to have sickened only 600 people in the past decade, but the mortality rate is almost 60%, making it the deadliest influenza on record. These statistics demand that every threat be handled aggressively. For instance, earlier this week Hong Kong officials called for the culling of 17,000 chickens after a chicken carcass tested positive for H5N1. Additionally, they have banned imports and the sale of live chickens for three weeks and have raised the city’s flu alert system to serious.

The new H5N1 strains genetically engineered separately by Erasmus and Wisconsin researchers are spread easily among ferrets, which transmit the influenza virus in a manner very similar to humans.

Most scientists agree that the bird flu virus may someday mutate without the help of human scientists and cause a major, deadly pandemic.  The research community is very concerned that genetically engineered bird flu strains, developed in good faith by experts, may either escape from the lab or fall into the hands of bioterrorists.  Dr. D.A. Henderson of the Center for Biosecurity of the University of Pittsburgh Medical Center commented “Influenza is certainly a unique beast in its capability to spread. The question is how we can assure experiments like this really aren’t done in ways that the organism is apt to escape.”

Photo by karlequin.

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Global AIDS Update

Wednesday, November 30th, 2011 by

The World Health Organization announced today that for the first time since the AIDS virus was discovered almost thirty years ago, there has been a worldwide decrease in the number of new cases.  The remarkable drop of over 15% in the last decade can be attributed to increased education on the use of condoms, and improved access to medical services and medications, according to Gottfried Hirnschall, director of WHO’s HIV department in Geneva. 

The announcement was made today, just one day prior to World AIDS Day, and highlighted an even more impressive statistic that the death rate from AIDS related illnesses had decreased 22% over the past five years. Hirnschall added “it has taken the world 10 years to achieve this level of momentum. There is now a very real possibility of getting ahead of the epidemic. But this can only be achieved by both sustaining and accelerating this momentum over the next decade and beyond.”

Despite the good news, Paul De Lay, deputy executive director of UNAIDS, warns “gains made to date are being threatened by a decline in resources for AIDS”.  Indeed, problems with the global economy threaten government expenditure on AIDS research and treatment. There also continues to be a significant gap in the treatment options in developed countries as opposed to those considered third world.  For instance, in vitro fertilization using washed sperm from AIDS infected males has virtually eliminated the transmission of AIDS to newborns with mothers who are HIV negative, but whose fathers are infected.  On the other hand, the WHO report suggests that more than half of the people who need antiretroviral therapy in low- and middle-income countries are still unable to access it. Many of them do not even know that they have HIV.

In addition, not every part of the world has seen a decrease in the number of AIDS cases. In striking contrast to the overall 15% worldwide decrease, Eastern Europe and the former Soviet bloc countries have seen a 250% increase in the number of AIDS cases in the past ten years. The Middle East and North Africa also logged a record number of new cases last year. 

Travelers overseas should keep in mind that casual, unprotected sexual encounters still pose a measureable risk for contracting the AIDS virus.  Though no longer headlines, the AIDS epidemic remains just that… a worldwide epidemic.

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Get Immunized: Bacterial Meningitis

Tuesday, November 29th, 2011 by

Once one of the most feared contagious illnesses among college students and the military, the incidence of bacterial meningitis due to the Neisseria meningitidis strain has dropped significantly since the introduction of the Menactra meningitis vaccine (MCV4) in 2005.  The American College Health Association, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics now strongly recommend that all children under the age of 19 receive the Menactra vaccine according to the following schedule:

  • 11 to 15 year-olds should be vaccinated routinely with a booster dose given at 16-18 years of age.
  • Those 15 years old and higher receiving the vaccine for the first time do not need a booster dose.

Bacterial meningitis may also be caused by other bacterial strains such as Haemophilis and Pneumococcus.  The Haemophilis vaccine (Hib), which has been available for over thirty years and is routinely given to infants, confers reasonable protection against this form of meningitis, while the efficacy of the pneumococcal vaccine (PCV7) in preventing meningitis is less clear. 

Nonetheless, the untimely death of two study abroad students last week is a sober reminder that bacterial meningitis still occurs. Symptoms of bacterial meningitis include fever, severe headache, neck stiffness, nausea and vomiting, rash, and in severe cases confusion and seizures.  The diagnosis is made by examining fluid removed from the spinal canal (spinal tap), while early treatment with the appropriate intravenous antibiotics is essential to avoid long term sequela or death.  Anyone who is experiencing any combination of these symptoms should seek medical care immediately, and anyone who has not received the HIB and Menactra vaccines according to the recommended schedule (including boosters), should make sure these immunizations are made current prior to travel. 

Bacterial meningitis is spread by kissing, sharing utensils and drinking glasses, living in close quarters such as a dormitory or summer camp, and smoking or being exposed to smoke. Being run down, stressed and/or fatigued also increases the risk of infection.  Although not as contagious as the common cold, the mechanism of spread is similar.  Those who have been exposed, and are not properly immunized, may need prophylactic antibiotics such as rifampin or ciprofloxacin after consultation with a medical professional.

Meningitis may also be caused by viruses and other pathogens such as fungi, protozoa and tuberculosis.  Viral meningitis is common, but the symptoms are not as severe and usually require only supportive treatment.  Viral meningitis rarely has any long term effects.   Other types of meningitis are much less common and generally attack only those who are immunocompromised by AIDs or chemotherapy. 

Although there are certain parts of the world, such as the “meningitis belt” of sub Saharan Africa, where bacterial strains that can cause meningitis are commonly found, no part of our planet is free from risk.  HTH Worldwide encourages all travelers to make sure they are properly immunized against bacterial meningitis, and to seek medical help immediately for suspicious symptoms or for known exposure to someone who has been diagnosed with bacterial meningitis.

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The Global Freshwater Shortage

Friday, October 28th, 2011 by

On October 18th the Pacific Institute, a non government organization based in Oakland, California that focuses on global water issues, released the 7th edition of The World’s Water, perhaps the most comprehensive analysis of global water challenges and solutions.  According to the report, this past year has seen a dramatic growth in the number of regions of the world that are moving towards “peak water”, or the state where fresh water replenishment fails to keep up with demand.

In recent years, several South Pacific islands have seen their groundwater reserves became salinized and undrinkable as sea levels rose.  Last month, the tiny nation island of Tavula (population 11,000) was placed in crisis mode, as the rainwater upon which they depended became inadequate. Officials from Australia and New Zealand came to the rescue, providing desalination equipment and rehydration packs. 

Indeed, even Australia has experienced severe drought and water shortages over the past few years.  Some scientists attribute the loss of fresh rain water to global warming, and cite Australia as a country whose environment could be changed permanently if the water shortage continues.  ”Climate-change impacts on water resources continue to appear in the form of growing influence on the severity and intensity of extreme events,” says Peter Gleick, one of the foremost water experts in the U.S. and head of the Pacific Institute.

 Mismanagement of freshwater has long been a problem in many sub Saharan African companies, with many of the two million deaths each year from preventable water related diseases such as cholera and salmonella occurring in that part of the world.  Even the United States cannot escape it.  A severe water shortage in Texas this summer has placed some of the driest regions of the State in danger of reaching the “peak water” mark. 

There is little question that going forward, every region on the planet is going to need to use water much more efficiently than we do now.  By the end of 2011, the world’s population is expected to exceed the 7 billion mark, and everyone needs fresh water. Gleick adds “New thinking about solutions and sustainable water planning and management, better data, case studies and efforts to raise awareness, are all needed.”

In some cases, water may be in good supply, but it may need to be purified before drinking. Water supply is a topic that should always be included in pre-travel research.

Photo by DJ-Dwayne.

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Healthy International Recipes

Friday, August 26th, 2011 by

My wife got a good chuckle when she heard I was going to write a blog article on healthy international cuisine.  After all, I am not exactly Julia Child around our house, as my version of a self prepared healthy meal is steak, Rice-a-Roni (the butter and herb version), and tossed salad with ranch dressing.   I reminded her, however, that I was quite good at scouring the internet for fresh ideas, and even offered (she refused) to make one or two of the dishes pulled from my research. 

 While most are familiar with healthy dietary choices at home, travelers to other countries are often faced with a plethora of unfamiliar food choices without any understanding of what is healthy and what is not.  Eating out is unhealthy to begin with, as most establishments provide large portions, heavily salted and filled with fat derived calories.  Restaurants in foreign countries are no exception, so it behooves the international traveler to plan plenty of home cooked meals, if possible. 

Here are a few websites that feature some wonderful recipes, broken down by region and/or type of food.  The list is quite short, but should give the international cuisine novice committed to eating healthy a good start:

Heart and Stroke Foundation- Recipes from Around the World

Healthy Latin American Favorites

World Health Circle of International Cooking

International Vegetarian Union- Especially for Vegans

Healthy Salads with an International Flavor

Fermented Grains For the Die Hards

Bon Appétit!

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World Humanitarian Day

Friday, August 19th, 2011 by

Today, August 19th, marks World Humanitarian Day, an annual celebration of those selfless people around the world who volunteer their time and talents to help relieve the pain and suffering of those less fortunate.  The United Nations recognizes this day as an opportunity for

  1. the public to learn more about the humanitarian community, what aid workers do and the challenges they face;
  2. nongovernmental and international bodies and UN agencies to demonstrate their humanitarian activities; and
  3. recognizing those who have died or been injured in the course of their humanitarian work.

HTH Worldwide would like to thank the many volunteers who continue to give of themselves at a time when concerns over the world’s economy, tensions in the Middle East, and domestic political upheaval grab the headlines, while crises such as the famine and cholera epidemic in Somalia and the protracted recovery in Haiti go largely unnoticed.  Those who make these enormous humanitarian efforts possible, seldom seek the limelight.  Rather, they quietly personify the uniquely human spirit of giving just for the sake of helping others.

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