As if budget woes are not enough, last month the State of California officially declared a statewide whooping cough epidemic.  With recorded cases 400 percent higher than last year, including almost 1000 cases in 2010 with five infant deaths, state officials now believe that California is headed for the highest incidence of  pertussis, commonly known as whooping cough, in over 50 years.

California is not alone. The CDC notes that the number of reported cases in the United States tripled between 2002 and 2004.  Although still a far cry from the 175,000 annual cases diagnosed prior to the introduction of the vaccine, the incidence of whooping cough reported annually in the last decade still represents an alarming increase from the less than 3,000 yearly cases in the 1980s.

The dramatic rise in whooping cough is not limited to the United States.  The World Health Organization estimates there were over 17.6 million cases of whooping cough and 300,000 deaths last year alone, making this easily preventable disease one of the world’s leading causes of illness and death. The greatest increase has been in wealthier countries with widespread immunization programs.  The rarity of the illness, coupled with concerns about side effects of the vaccine and the use of vaccines with poor efficacy (Canada, Sweden), has led to an increase in the number of inadequately immunized, or unimmunized children, in developed countries.  In addition, the whooping cough vaccine does not confer lifelong immunity, which means that adults immunized in childhood are susceptible to the illness.  Indeed, almost 25% of whooping cough cases in Europe and the United States are now reported in adults.

Whooping cough is seldom more than a mild inconvenience in those over 10, who may experience prolonged upper respiratory symptoms (runny nose, fever, persistent unproductive cough), but rarely have more serious consequences. Nonetheless, the presence of the B. pertussis infection in adolescents and adults who may transmit the bacteria to infants has led healthcare providers to promote booster immunizations after childhood.  However, booster shots have been approved for adults in only a handful of countries (Canada, France, Germany and the United States), which means that there remains a tremendous reservoir of unprotected adults around the globe, even in developed countries. To compound matters further, there is newly emerging evidence that some strains of the bacteria that cause whooping cough have developed resistance to the newer (acellular) version of the vaccine

Fortunately, the CDC now recommends that anyone traveling outside of the United States receive the DTaP (which includes pertussis protection) vaccine prior to travel. Some resistance notwithstanding, compliance should minimize the risk of contracting the illness overseas and passing it on to susceptible infants who tend to suffer more devastating clinical consequences.

Last week  Healthy Travel Blog was recognized as one of the Best Health and Lifestyle Travel Blogs by Iglu Cruises.com.  One of the leading online travel agencies serving the UK and Canada, Iglu bestows its award on sites that help travelers maintain good health and lifestyle practices while on the road, whether for business or pleasure. Iglu’s staff noted that “Each and every one of our award winners are experts at collating and conveying the information you need to succeed, from insightful articles to innovative health tips and a great deal more.”

We think we’re in good company and encourage you to visit the sites of the other winners: Globorati, The NuNomad, ArtTrav, A Luxury Travel Blog, and Health Conscious Travel.

Please continue to check in for updates on news, trends, issues and solutions relating to healthy travel!

Fees for U.S. Passports increase substantially in less than a week.  Currently, adult fees for the standard Passport Book are $100 for a new one and $75 for renewals.  These fees rise to $135 and $110, respectively.  For children the increases are also large.  Current fees are $85 for new passports or renewals; this will go up to $105.

Some other fees are also going up or are being charged for the first time – additional pages for your book used to be free but are now $82, and the file search fee has gone up from $60 to $150.  The file search is required when an applicant is unable to present proof of citizenship.

All of the details can be found at the U.S. Department of State’s web site – new fees and current rates.

We put together a simple chart to highlight the changes (see below). 

The State Department’s main page for passports can answer all of your questions about passports – when you need one, how to get one fast, what to do when you lose one, etc.  Get prepared for your next fun, international trip and save some money by doing it this week!

The two main labor unions in Greece, representing three million workers, are striking in major cities and ports today. The strikes are in response to the opening day of the financial reforms debates in the Parliament.  These debates are expected to last at least a week, so it’s possible the turmoil outside will continue at least that long.

Unfortunately, this coincides with the beginning of the busiest travel months – July and August – and will negatively impact Greek tourism which generates 15 – 20% of the national income.

Tourists and visitors to Greece are being disrupted and displaced by the protest rallies in Athens and the demonstration at the country’s main port, Piraeus, where unionists are stopping passengers from boarding the ferries and blocking the departure of some ships.  In an effort to minimize the chaos, police are ordering people away from the port.

In addition to water transportation being made difficult, the strikes have resulted in disruptions to the airports, roads and railways.  International train service was suspended as were domestic flights. Most international flights are ok. The local trains and bus schedules have been suspended for most of the day with restricted services available to allow demonstrators to attend the rallies.

Public services have been shut down which means that the hospitals are running on emergency staffing.

Additionally, journalists are on strike so all today’s newscasts were cancelled and newspapers are not being printed. Ironically, those in Greece may have to get the local news from an international source. Where would you turn for information if you were in the midst of chaos on your vacation? We hope mPassport.com, but you let us know!

Photo by: apas

While most were unaware of it, June 14^th was “World Blood Donor Day”, celebrated internationally to encourage those eligible to donate blood at least once a year.  Indeed, although 95% of Americans either receive blood during their lifetime, or know someone who has, only about 8% of Americans currently donate blood.  The requirements are fairly simple: be 16 or older, weigh at least 110 pounds, and enjoy good health.  Apart from doing the right thing, donating blood includes free screening for infectious diseases such as HIV and hepatitis.

The need for “good” blood around the world is critical.  The World Health Organization (WHO) makes a strong statement on blood transfusion safety and places the responsibility for enforcing it on the health administrators around the globe to “galvanize entire communities towards regular and non-remunerated blood donations.”  Just yesterday, one of our clients in China inquired about the reliability of blood in that country.  In fact, some of the blood collected in China may still be contaminated with the HIV virus.  Over the past twenty years, hundreds of cases with dozens of deaths have been traced to blood collected from those in China willing to sell their blood.  Following a government ban on imported blood products in the mid 1980s, literally thousands of blood and plasma collection stations popped up in China offering remuneration for donors. 

These unregulated centers used an unusual method of collecting blood and then reinfusing donors with pooled red blood cells after the plasma had been removed.  The technique was practiced in order to speed recovery following donation but is thought to have infected hundreds of thousands of donors and those who received blood transfusions.  Although Chinese authorities have endeavored to ban this practice and close illegal blood donation stations, the problem has not gone away.  A report published in 2007 claimed that China’s blood supply is still not being properly monitored for HIV.  The demand for blood products is growing, and the supply is short which “creates an economic incentive for hospitals to rely on illegal, untested blood donations.”

China is not alone.  The World Health Organization estimates that 5 – 10% of all HIV infections in Africa occur as a result of unsafe blood transfusions.  In addition, countless thousands are infected with hepatitis and/or malaria due to the lack of proper screening.  The organization “Safe Blood for Africa” is attempting to correct the problem by encouraging voluntary blood donations from adequately screened applicants and discouraging facilities from using untested blood.

The United States, Canada, Japan, France and a host of other developed countries experienced similar problems with contaminated blood from for-profit centers in the late 1970s and early 1980s before adequate screening for HIV and hepatitis was available.  We can only hope that emerging countries learn quickly from the experience of others.  In the meantime, the international traveler must be aware that significant risks still exist from getting blood products in many parts of the world.

Back in January we told you about Cephalon’s submission of their sleep disorder drug, Nuvigil, to be approved as a treatment for jet lag by the FDA.  The FDA has completed its review, but they have not approved the application because of questions pertaining to some of the data submitted.  Cephalon is already following up with the FDA to clarify the points in question and we’ll continue to track its progress through the process.

It is the phone call every parent of a child abroad is horrified to receive: “Mom, Dad, please help me!” followed by a concealed voice making monetary demands for the safe return of the kidnapped child.  In years past, this usually meant that the child had indeed been abducted and was being held for ransom.  In recent years, however, many of these calls are placed by “virtual kidnappers” who may be nowhere near the alleged victim.

One of the consequences of the “information age” and social media such as Facebook and My Space is the widespread availability of names, addresses and phone numbers.  The resourceful virtual kidnapper is someone who collects data on prospective victims who have shared details online about upcoming adventures such as a trip down the Amazon, a hike to Machu Picchu, or an African Safari — all places where cell phone reception is spotty or nonexistent, creating the conditions for scams to go undetected.

The calls to the families of the “virtual victims” convey a sense of urgency — that the victim will be executed within the hour unless funds are transferred to a foreign bank account, for instance.  Since the family has no way to determine the veracity of the kidnapping, payment is made.  Sophisticated virtual kidnappers go to great lengths to “fake out” the families of their victims by pretending to be the victims themselves — speaking in short, frantic sentences that are muffled by “poor cell phone reception.”

Because cell phone coverage has grown ever wider– even the remote jungles of sub-Saharan Africa are often reachable today — many virtual kidnappers do not limit their victims to those whose cell phone reception is marginal.  Instead, perpetrators contact prospective victims and tell them that their phones should be turned off for an hour or two for servicing.  The virtual kidnappers take advantage of the window to make their calls back home.

The problem has become so severe in Mexico that the country’s government has set up a hot line for victims of virtual extortion.  The U.S. State Department, in its section on travel precautions for Central and South American countries such as Mexico, Venezuela and Peru www.travel.state.gov/ suggests that families of victims should:  1) not reveal any personal information over the phone, 2) insist on speaking with the victim to corroborate his/her identity and 3) contact the nearest US Embassy or consulate.  Although the temptation to respond immediately to demands is very high, most “virtual kidnappers” will abandon their efforts within an hour or two if payment is not received.

Here are a few imperatives to avoid becoming a victim of “virtual kidnapping”: 

Register with the State Department prior to travel

• Verify cell phone reception at all proposed locations on the itinerary
• Do NOT turn off a cell phone at any time- claims that a phone must be disconnected for servicing are universally false
• Do NOT share any information about an upcoming trip on line
• Maintain regular contact with family and loved ones back home 
• Establish a code word to be used to verify any kidnapping claims
• Never travel alone, particularly in Latin America, Africa and the mid East where both real and virtual kidnappings are epidemic 

Tomorrow marks the 42^nd anniversary of the Department of Transportation’s first day of operation.  And today marks the announcement of the recipients of the 3^rd annual Dotty Awards – the annual recognition of those travelers you hope to avoid on your travels.  Enjoy reading about these “winners” and feel free to share with us your own out-of-the-ordinary experiences!

Two stories concerning mosquitoes caught my attention recently.  In the age-old “bad news, good news” tradition, it goes like this:

“The bad news is that if you drink beer, mosquitoes are more attracted to you and may bite you and give you malaria.  The good news is that scientists have developed a mosquito that could, in theory, vaccinate you against malaria with each bite.”

The first study, Beer Consumption Increases Human Attractiveness to Malaria Mosquitoes, was conducted in Burkina Faso by a team of researchers led by Thierry Lefèvre from Emory University and published by PLoS ONE, an interactive open-access journal.  It concluded that “beer consumption consistently increased volunteers’ attractiveness to mosquitoes.”  The researchers believe that the alcohol in the local beer causes the increased attractiveness; however, further studies are necessary to eliminate other possibilities.  I saw that the local beer is fairly low in alcohol content and wondered what the curve would look like as the strength varied.  Is it a linear relationship, or would it yield an upside-down “U” shape?  If the latter, one could stick to more toxic drinks (although this flies in the face of the researchers who also noted that alcohol consumption has other negative health effects and can lower one’s ability to defend against parasites and other threats to the immune system).  I was lucky enough to learn about the African drink, dawa, from my wife (it was a huge hit on our wedding night).  Dawa means “medicine” or “magical potion” in Swahili and is a much stronger drink than the local beer in Burkina Faso, so perhaps they already know about the shape of the curve.

The second study, Flying vaccinator; a transgenic mosquito delivers a Leishmania vaccine via blood feeding, was published in the April 2010 issue of Insect Molecular Biology and conducted by Associate Professor Shigeto Yoshida and his research team from Jichi Medical University. Unfortunately, there are ethical issues with using wild mosquitoes (are there domesticated ones?) to transmit a vaccine.  How would the pharmas get paid for it, for example?  Oh, yeah, that is not an ethical issue so much as an economical one.  In all seriousness, it does sound like this idea may be years away if it ever gets off the ground (no pun intended).  The mere fact that they did successfully use the mosquito’s saliva to deliver the payload, however, does hold promise for other therapies in the future.

Malaria is a very serious problem worldwide, affecting hundreds of millions of people each year and killing millions, mostly sub-Saharan children.  If you took the time to read this, please think about helping to stop this disease and perhaps contributing to a worthy organization.  It is money well spent. Also, if you are traveling to areas where malaria is a risk, learn about which preventive medicine is right for you and make sure that you take it.

Tourism has exploded in the Central Asia region.  The exquisite mountains, closed for many years to the West, now attract growing numbers of foreign visitors who are drawn by their natural and unspoiled beauty.  Government officials, hungry for the revenue that tourism generates, are fearful of international scandal.  As a result, there is little transparency when it comes to disclosing failures in infrastructure, including health care systems.

The announcement this week by authorities in Uzbekistan that at least 14 children had died and that another 133 are infected with HIV from contaminated medical equipment is a sober reminder that health care in underdeveloped countries remains perilous. Reports of similar incidents in Kazakhstan and Kyrgyzstan, should make anyone travelling to the former Eastern Soviet bloc wary of the medical treatment they might receive.

Complicating matters further, the government of Uzbekistan is widely believed to have covered up reports in 2007 that HIV contaminated needles and syringes were used to immunize toddlers in the city of Namangan.  Indeed, the details only came to light this week when news broke that 12 doctors and nurses at two hospitals in the city were convicted of using contaminated equipment.  Moreover, Uzbek activist Maxim Popov, who distributed brochures saying condoms and disposable syringes could help prevent HIV, was convicted of corrupting minors by promoting homosexuality, prostitution and drug use. He was sentenced to seven years in jail.

The United Nations says Uzbekistan has one of the world’s fastest-rising HIV infection rates. About 16,000 cases of HIV/AIDS were reported in 2009 — more than an eleven-fold increase from 1,400 cases in 2001, a World Health Organization report said.  Not all of the increase can be attributed to transmission through contaminated needles, however, as the rate of illegal drug use and sexually transmitted diseases has skyrocketed in recent years. 

American tourists must prepare before travelling to Central Asia. As in many underdeveloped regions of the world, most health care remains substandard.  However, risks may be minimized with the proper vetting of medical providers – hospitals and doctors – prior to departure. If you are heading for Tashkent, Almaty or Dusanbe, ask your travel health plan or assistance company for a contingency plan.