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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 .

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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Flu Vaccine Unchanged but Annual Immunization Required

Wednesday, August 10th, 2011 by

Each year in mid winter, the World Health Organization (WHO) selects the influenza strains that will be used to develop the vaccine for the following flu season.  The viruses are chosen based on which viruses are prevalent, how they are spreading, and how well the previous season’s vaccine might protect against any that have been newly identified.

This year the WHO Vaccine Composition Committee has picked the same virus strains that were used to develop the influenza vaccine for 2010-2011.  Consequently, the seasonal vaccine for the 2011-2012 season provides protection against the (H1N1)-like virus (swine flu), the (H3N2)-like virus, and the B/Brisbane/60/2008-like virus.

The WHO decision does not mean that those who received the vaccine last year should not be immunized again. Immunity to influenza viruses declines over time and may be too low to provide protection after a year has passed.

Travelers should note that the flu vaccine does not protect against Avian flu, as recent reports of deaths from the Avian flu in Cambodia  remind us. Mortality rates as high as 85% for the Avian flu have been reported in Southeast Asia this year, and only two antiviral medications oseltamavir (Tamiflu®) and zanamavir (Relenza) are useful for H5N1 avian influenza.  The more widely used antivirals, amantadine and rimantidine, are of no help.  Avoiding direct contact with poultry in this region affords the only real protection against the H5N1 flu strain. 

For the latest on flu outbreaks around the world, Travelers should turn to the WHO’s Global Alert and Response Network.

Photo by Sanofi Pasteur.

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Ancient Disease a New Problem in Hong Kong

Tuesday, June 28th, 2011 by

Hong Kong’s recent reporting of the deaths of two children from scarlet fever is a serious reminder that infectious diseases still pose a great risk in many parts of the world, even in places that have evolved from third world status.   

The death of a seven year old in May and was the first casualty of scarlet fever in ten years. When the second death (a five year old) occurred on June 21st, officials grew increasingly concerned.  Both children deteriorated very quickly from two different antibiotic-resistant strains of scarlet fever, according to Kwok-yung Yuen, head of Hong Kong University’s microbiology department, who sequenced samples taken from the current outbreak. One of the two strains appears to be more dominant, and has undergone a genetic mutation that increases its ability to spread. 

Scarlet fever, also known as scarlatina, is rarely seen by physicians in the developed world.  Most medical students in the United States would likely miss the diagnosis despite its classic presentation- fever, sore throat, a sandpaper rash and bright tongue. The widespread use of penicillin during the 20th century virtually wiped out the infection, but overuse of both penicillin and other antibiotics such as erythromycin and clindamycin have allowed bacteria such as the streptococcus strains responsible for scarlet fever to develop resistance. Fortunately, penicillin has thus far weathered the storm and is still effective against the bug, a fact that is very surprising to Mark Walker, a microbiologist and strep expert who heads the Australian Infectious Disease Research Center. “We’re very lucky. We still have a treatment we can use.”  

 “Germs outsmarting antibiotics is a cause of lots of nightmares,” said Dr. Edward Kaplan, who heads a World Health Organization research center at the University of Minnesota that focuses on the streptococcus germ. “The fact that we still have penicillin is something we all get down on our knees and say prayers about each night.” 

Along with the nearly 550 cases of scarlet fever reported this year, which is already double Hong Kong’s annual number, there are over 9,000 cases in mainland China.  Although resistance to alternative antibiotics used by those allergic to penicillin is not new, the severe toxicity and ease of spread of the new strains seen this year is what concerns health officials the most. As the development of vaccines is years away, controlling the spread of the illness and the judicious use of antibiotics is now the top priority. 

Those traveling with children are advised to research their destination for any reported outbreaks of infectious disease.

Photo from choa.org.

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FDA Regulations Call for Broad Spectrum Sun Protection

Thursday, June 16th, 2011 by

After decades of debate, the FDA has finally released guidelines for sunscreen products that will help protect consumers against both sunburn — caused by ultraviolet B rays, and skin cancer and aging — caused by more dangerous ultraviolet A rays.  The guidelines also set limits on acceptable sun protection factor (SPF) levels.

New regulations will require manufacturers to specifically address whether or not their products block both UVA and UVB rays.  The new buzzword from the FDA is “broad spectrum” to describe sunscreen that blocks both.  They also require manufacturers to market sunscreens with a SPF rating of at least 15, but less than 50, unless they have data to substantiate a higher number.   ”These changes to sunscreen labels are an important part of helping consumers have the information they need so they can choose the right sun protection for themselves and their families,” said Dr. Janet Woodcock, director of FDA’s drug division. The majority of consumers are not aware that most sunscreens on the market today are designed to only prevent sunburn by blocking out UVB rays, while affording little to no protection against UVA rays.  The FDA is hoping that this will soon change.

Malignant melanoma, the most deadly form of skin cancer, is diagnosed each year in over 65,000 Americans, resulting in almost 9,000 deaths.  Dermatologists recommend that in order to prevent melanoma and the other ravaging effects of exposure, sunbathing enthusiasts should apply a sunscreen that is “broad spectrum” and with a SPF of 30 or greater every two hours.  The FDA is also banning sunscreen claims such as “sweatproof” and/or “waterproof”, which the agency says are “exaggerations of performance.”

Starting in 2012, if a sunscreen product does not protect against both UVA and UVB rays, or if the sun protection factor is below 15, then it must have a disclaimer which reads “This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”  In order to be compliant, some manufacturers, such as Coppertone and Neutrogena, already have labels that read “broad spectrum UVA and UVB protection.”

Whether you’re spending the day at the beach or taking a ten minute walk in the sun, take the necessary precautions to protect your skin.

Photo by sgt fun.

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E. coli Detective Work Produces No Answers

Tuesday, June 7th, 2011 by

Although it has been over a month since the first case of enterohemorrhagic E. coli was reported in Germany, officials in that country have yet to identify the source of the outbreak.  Although both Spanish cucumbers and sprouts grown by German farmers have been implicated, further tests have failed to substantiate initial claims.  The inability to positively identify the source of the bacteria is rapidly becoming a source of embarrassment for the country.

German officials acknowledge that time is not on their side, as the number of new cases appears to be on the decline, and testing produce several weeks after the initial outbreak may no longer be helpful.  Dr. Guenael Rodier, an epidemiologist at the World Health Organization, told the Associated Press on Tuesday that the contaminated vegetables have likely disappeared from the market and it will be difficult to link patients to produce so long after they first became infected. He added, “If we don’t know the likely culprit in a week’s time, we may never know the cause.”

Despite the fact that the source remains elusive, there is little question that vegetables are the culprit and that washing and peeling all fruits and vegetables is the only sure way to prevent food-borne illness.

Photo by shawnleishman.

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E. coli: Search for the Source Continues

Monday, June 6th, 2011 by

Scientists continue to work to identify the source of the new deadly strain of E. coli bacteria that has infected over 2,200 people in 12 European countries. “This is a unique strain that has never been isolated from patients before,” Hilde Kruse, a food safety expert at WHO, told The Associated Press.  The new strain has “various characteristics that make it more virulent and toxin-producing” than the many E. coli strains people naturally carry in their intestines.

Despite speculation over the weekend that the outbreak could be traced to a German bean sprout farm, the search for the source continues.  German authorities on Sunday issued a warning against eating any sprouts and repeated earlier warnings against eating tomatoes, cucumbers and lettuce.  The WHO is recommending the usual precautions to avoid illnesses that are transmitted by raw food — wash hands before eating or cooking and wash and peel all fruits and vegetables, especially if eaten raw.

HTB will continue to monitor what is turning out to be the worst outbreak of E. coli-related illness in eleven years, and already the third-largest involving E. coli in recent world history.

Photo by agrilifetoday.

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