Microsoft word - pre-travel health information.doc
Vaccine requirements will vary according to your individual itinerary. All
immunizations described below can be given at the same time and in combination. Vaccines administered within the last month may interfere with vaccines administered today. Reactions to modern vaccines are unusual so administration of multiple vaccines at a single sitting is preferable. No contraindications to athletic activity or alcohol after any vaccine. ٱ
Hepatitis A--Acquired orally (from contaminated food/water) in areas where
sanitation is poor. Hepatitis A is the most common serious illness acquired by travelers. A single dose provides high-level protection good for at least a year and perhaps longer. A booster dose administered 6-1 2 months later will confer long-term immunity which is likely lifelong. Side effects-local soreness, rare fever. ٱ
Hepatitis B—Transmitted by blood and body fluids so is recommended for long-
term travelers (increased risk of encountering contaminated medical/dental instruments) and those in certain high-risk groups such as health workers or adventure travelers. Administered at 0,1, and 6 months with a 50-60% chance of protection after 2 doses but 3 doses are required to be assuredly protected. Accelerated regimens of 1) 0, 1, and 2 months, or alternatively 2) 0, 1, and 3 weeks offer good short-term protection but necessitate a 4th dose at 1 2 months. Side effects-sore arm only. ٱ
Hepatitis A/B (Twinrix®)—A cor vaccine which is administered at 0, 1,
6months. After 2 doses spaced by 1 month, there is adequate protection against Hepatitis A with a 50-60% chance of protection against Hepatitis B. An accelerated regimen of 0, 1, and 3 weeks offers good short-term protection but necessitates a 4th dose at 1 2 months. Side-effects-local soreness, rare fever. ٱ
Immune Globulin—Temporary Hepatitis A protection, but not available in the
US anymore. No vaccine against Hepatitis C or E has yet been developed. ٱ
Tetanus/diphtheria--The tetanus component protects against the bacteria which
causes lockjaw when a cut or wound gets dirty or contaminated. Diphtheria is prevalent in the developing world. Boosters required every 1 0 years (but suggested at 5 year intervals for some people) for all adults regardless of your future travel plans. With no proper immunization history you will need a complete primary series of 3 injections. Side effects- local pain at injection site is common. ٱ
Typhoid--Typhoid fever is a severe bacterial illness acquired from food/water in
areas with poor sanitation. Two vaccines are available. 1) Typhim Vi injectable killed vaccine. Single dose. Boosters-2-3 years. Side effects-mild sore arm. 2) Oral vaccine. 4 doses of live attenuated bacteria in capsule form (must be refrigerated) that must be taken as 1 capsule every 2nd day until finished. Take on an empty stomach, at least 1 hour before or 3 hours after eating. Booster-every 5 years. Typhoid Vaccine USP, the old crude vaccine, which caused at least 25% of people to have violent reactions is no longer made.
Polio--Still present in a few developing countries in Africa and the Indian sub
continent. Even those properly immunized previously against polio may need a booster of injectable killed vaccine. BOosters necessary just once in your entire adult life. ٱ
Yellow Fever--Yellow fever is a severe or fatal mosquito-borne viral illness
common in many parts of South America and Africa. Must(by law) be given at least 1 0 days prior to entering an infected country. Some uninfected countries require certificates from individuals arriving from/via an infected country. Boosters-required every 1 0 years. Potential side effects-flu-like symptoms 5-7 days later. Vaccine contains egg, allergic reactions occur in 1 in 200,000 vaccinees. Severe reactions with multi-organ failure occur in approximately 1 in 400,000 vacinees and may be more common in those over age 70. ٱ
Measles--Measles, a potentially serious disease is common in developing
countries and transmitted via the respiratory route. Persons born prior to 1 957 are considered immune. Other persons over 1 years of age should have had 2 documented doses of live measles vaccine during their life. Boosters-none after 2 doses. Potential side effects-mild fever beginning at day 6 and lasting 1-2 days. ٱ
Meningococcal--Bacterial meningitis caused by the meningococcus bacteria is
epidemic in much of sub-Saharan Africa. Also required for Hajjis. Transmitted by respiratory droplets. Boosters-every 3 years. Side effects-local arm pain ٱ
Cholera--Vaccination no longer recommended nor required by the World Health
Organization for any country. The vaccine is not available in the US at present. ٱ
Rabies--Highly prevalent in Africa, India, Thailand, and Latin America but risk
to individual travelers is low. Recommended for longer itineraries, adventure travel, rural travel, and children. Administered at 0, 7, and 21-28 days. No routine boosters recommended. After a bite or a skin-penetrating scratch by a potentially rabid animal, 2 doses of a cell- culture vaccine (international brand; not local preparation) spaced by 3 days, are still necessary. Without .pre-travel vaccination, treatment requires immediate rabies immune globulin (expensive, very hard to find overseas) and then ‘5 doses of vaccine over 28 days. ٱ
Influenza—Respiratory infections are very common in travelers. Influenza
vaccine protects against influenza virus as well as respiratory viral illness in general and decreases the risk of you being labeled as SARS if you return with a respiratory illness. Influenza is a year-round illness in the tropics. Indicated for healthy travelers simply desiring protection in addition to older individuals and those with chronic illnesses. Single dose with boosters once/year. Healthy individuals under age 50 may receive the new and well-tolerated intranasal vaccine instead of the injection. UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366 TRAVELERS’ DIARRHEA PREVENTION The most common health problem during stays in developing countries is traveler’s diarrhea. Although the risk varies somewhat by country you can minimize, although not completely eliminate, your chances of developing this problem by being very diligent in what you eat and drink. Even in the most expensive and luxurious of hotels the water, as well as many of the foods, are simply not safe. Most precautions are simple common sense: Drink -Boiled water is safest. Must be heated to a bubbling boil for 1 minute. -Water, even in 5-star American- or European owned luxury hotels, is never assuredly safe. This includes the water in your room or restaurant pitcher which they vehemently insist has been boiled. -If available, bottled water (carbonated or uncarbonated) that has a tamper proof top and that you open yourself (or is opened in front of you) is almost always safe. -If you have access to an electrical outlet or cooking facilities you can boil water yourself. Immersible electric coils are compact to pack. -Carbonated soft drinks (open them yourself), beer, hot tea or hot coffee are generally safe. Containers or glasses may be dirty, drink from the bottle (after you have wiped the opening) -Avoid fruit juices not directly from the can or box, they may be diluted with contaminated water -If you are going out for the day where facilities are unknown or inadequate carry some drinking water with you. -Ice (1 cube in 1 drink can destroy a vacation) is never safe. First class travelers can make safe ice cubes using bottled water and the freezer tray in their mini-bar. -Purification tablets and filter devices work well but are not as effective as boiling. Devices utilizing iodinated resins may pose a health hazard to children, pregnant women and those with thyroid disease. Food -If possible eat only at larger restaurants catering to an international crowd or at places known to other foreigners to be reasonably safe. -No matter how luxurious and clean looking the restaurant (including the kinds mentioned above) never eat raw vegetables (i.e. salad). Only eat fruit that you cut open or peel yourself. -Never eat dairy products unless they are imported or clearly pasteurized.
-Make sure all meat, fish and fowl is well cooked and served hot. -Shellfish are often contaminated in the US. This is doubly true abroad. -Never, never eat even a tidbit from a street stall. -Avoid creamy sauces and deserts which have been sitting at room temperature for long periods such as on buffet tables. TREATMENT Despite all precautions travelers diarrhea may still occur. This most often results from the ingestion of bacteria in contaminated food and water. Common symptoms include frequent watery stools, vomiting, and severe cramps, which is sometimes accompanied by a moderate fever. Even without treatment this type of diarrhea is self-limited and usually lasts from 5-7 days. The following measures may be implemented as the situation dictates: Fluids-If the diarrhea is watery and moderately heavy, drink hot tea with sugar, light soups, rice water, and eat salty crackers to stay hydrated. Travelers diarrhea is rarely dehydrating but oral rehydration solution packets should be carried for trips to remote areas. Antimotility drugs (Loperamide; Imodium AD is one brand)-For symptomatic relief as needed (see Medication Information sheet) to decrease stool frequency and relieve cramps. May be curative by itself. It is especially handy when a long car, bus, plane or train trip must be made. Antibiotics-The duration of bacterial diarrhea can be shortened by beginning the antibiotic prescribed for you by your Travelers’ Clinic physician. See the Medication Information sheet for instructions. Loperamide may be continued at the same time. Bacterial diarrhea usually subsides within 24 hours but it may take up to 2 days. Do not take the antibiotics if you have nausea and/or vomiting without any diarrhea. Avoid anti- diarrhea drugs sold over-the-counter in pharmacies overseas--some of them are very dangerous. If you have a high fever with your diarrhea that lasts for more than 2 days despite antibiotics or if you have blood or pus in your stools that persist this is a sign of more serious illness--consult a reputable physician as soon as possible. ٱ Oral Rehydration salts (ORS; Ceralyte)--Most travelers diarrhea is non- dehydrating and salty crackers and fluids suffice. Carry for travel with children, to areas away from medical care where a dehydrating illness might be devastating, or in those with underlying medical problems. ORS/Ceralyte come in packets to be mixed in a liter of water. UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366
ٱ Pepto-Bismol (original pink formulation)--moderately effective for treatment of diarrhea. Moderately effective for diarrhea prevention but large doses must be taken--2 tablets or 2 tablespoonfuls 4-6 times/day. Side effects--black tongue, black stool, ringing in the ears. Altitude Sickness ٱ Acetozolamide (Diamox)--For prevention of altitude illness, take 250 mg twice a day beginning the morning of the day before ascent and continuing through the day after ascent. Some diuretic effect so don’t take right before bed. Makes all carbonated beverages (soda, beer) taste horrible; this is temporary. If tingling around mouth or in fingers/toes occurs, cut dose to half a tablet twice a day. If altitude symptoms persist beyond the day after ascent, continue to take one tablet each evening. Jet Lag ٱ Zolpidem (Ambien)--To sleep at appropriate destination time-zone sleeping time when the body is jet-lagged and cannot fall asleep. Use for up to 2 or 3 nights at each end of trip. Sedatives are no longer recommended on airplane flights due to the risk of blood clots in the legs during prolonged immobility. Take one 10-mg tablet when absolutely ready for sleep (rapid onset of action). Short half-life, no residual effect in the morning. Resist temptation to sleep during the day the first few days at destination, will decrease ability to sleep at night and prolong the adjustment cycle. UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366 Sex and the Traveler or Casual Travel Sex (CTS) CTS is Surprisingly Common Even in the AIDS Era
• 1 41 of 756 (1 9%) consecutive patients seen for any reason at the London Hospital
for Tropical Diseases had had a new sexual partner during their last trip abroad.
• 1 5% of Americans in the Lima, Peru airport had had-a new partner while in Peru.
• Other studies report CTS in from 4-25% of all travelers.
• Female travelers are almost as likely as males to report CTS. • CTS and its accompanying problems are so prevalent that strategies for its prevention
has become a leading area of research in travel medicine.
Why Do People Who Should Know Better Have CTS?
• The “sun, sand, new people, new places” aura of travel loosens inhibitions.
• The normal social and moral constraints of everyday life at home seem far, far away • ALCOHOL, ALCOHOL, ALCOHOL Why is CTS Risky?
• AIDS and sexually transmitted diseases are epidemic in the US and are even more so
• CTS with a fellow traveler is still as risky as casual sex at home. • CTS with a local resident may have risks for HIV far higher than that in the US.
• Sexually transmitted diseases not familiar to most American doctors can be acquired
Will I be Safe if I Carry Condoms?
• • condoms are always a good idea but they slip or break 3-5% of the time; up to 50% of
the professional sex workers in many tropical destinations are HIV positive.
• Practical issues, combined with the usual overlay of alcohol, can prevent even those
people with the best of intentions from using the condom during the time CTS actually occurs.
Blood Borne Diseases
• HIV and hepatitis B & C may be transmitted through blood, blood products, and
contaminated surgical or dental instruments. These may be required following accidents or trauma.
• Consider carrying a needle and suture kit for high risk areas. If possible, defer
medical treatment and travel to a facility where safety can be assured.
• Tattooing and body piercing carry similar risks for HIV and hepatitis.
UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366
Malaria is the most common serious infection in the world. Malaria in previously unexposed individuals, like travelers, is a severe illness which can become potentially life-threatening if not recognized and treated in a timely manner. It is present in at least some parts of almost every tropical country and is the most serious risk faced by travelers to these areas. Your Travelers Clinic physician will let you know if you are at risk of malaria on your particular trip. There is no malaria vaccine. Studies have shown that many of the several hundred US civilians who acquire malaria abroad each year were not taking appropriate preventive medications or precautions in order to prevent malaria. How can I catch malaria? Malaria, a parasite which lives and multiplies in the blood, is acquired through the bite of certain mosquitoes (anopheles) that only bite between dusk and dawn. Malaria is highly infectious. A brief exposure--riding in an open train at night or spending a few evening hours visiting in a malarious rural area- constitute a significant enough risk for infection that the institution of full (up to 5 weeks) preventive measures is mandated. Generally larger urban areas, even in heavily infected countries, are malaria free; the cities of Africa and India, however, are an exception to this rule. Because symptoms usually start from 8 to 35 days after being bitten by the infected mosquito you may already be back home before you get sick. If you develop fever of kind within 2 months of travel to a malarious area you must contact a knowledgeable physician at once. How can I protect myself? Avoid exposure-Because malaria parasites are becoming more and more resistant to available drugs, avoiding mosquito exposure during feeding hours (dusk to dawn) is more important than ever. Some suggestions: -stay indoors as much as possible after dark -cover up exposed skin after dark -use DEET containing insect repellent (minimum 30%) liberally on exposed skin -after dark -sleep in well-screened areas or under mosquito netting -use knockdown insect sprays or mosquito coils in sleeping areas (done by most good hotels in affected areas). -treat clothing and/or bednet with permethrin (catalog in nurses office) Preventive drugs-Unfortunately, no single drug will provide optimal protection against malaria in all parts of the world. Your UAB Travelers Clinic physician will give you a prescription for preventive drugs individualized to your particular itinerary and your medical history. The frequency with which you musttake the different possible medications varies, so read the instructions on your travel Medications sheet carefully. Not only must you take your medications faithfully during your stay but also for the
prescribed period of time after leaving the malarious area in order to eradicate incubating parasites. How can I tell if I have malaria? Because of drug resistance in some areas you still may have a chance of getting malaria despite faithful adherence to your preventive drug regimen. Symptoms of malaria often include violent shaking chills (lasting up to 1 hour), high fever, muscle aches, headache, nausea and vomiting but can be very non-specific and mimic common gastrointestinal, respiratory or urinary infections. Many other tropical illnesses have non-specific symptoms similar to malaria. If you think you have even a chance of having malaria, it is mandatory that you see a physician as soon as possible so that a diagnostic blood smear may be done. Malaria is quite easy to treat if caught early, but serious complications (including brain involvement) may arise if the infection is given time to affect vital organs. Treatment of drug resistant malaria is complex and the drugs used have potentially serious side effects if used incorrectly. The UAB Travelers Clinic utilizes the latest information and your prescription reflects the standard of care in the United States. In the course of your travel you will meet people who are on many different malaria preventive drugs. This results from the lack of availability of hard scientific information on antimalarial drug effectiveness for every individual country in the world and on the unavailability -of certain more expensive drugs overseas. Therefore, approaches to malaria prevention may differ even among experts. In fact, the Centers for Disease Control in the US and the World Health Organization often disagree on their respective recommendations for many countries. Several approaches work well-the important thing is to take your drugs faithfully. UAB Travelers’ Health Clinic Birmingham, Alabama 205 731-9366 MEDICATION INFORMATION
Certain medications need to be taken on a regular schedule while others need to be started only when certain situations arise. MALARIA DRUGS ٱ Atovaquone/Proguanil (Malarone)--A drug of choice for prevention of malaria in most parts of the world. As effective as older drugs mefloquine or doxycycline with less potential for side effects. Requires daily dosing (compared to once/week for mefloquine). An expensive drug for long-term use, so most advantageous for short-term trips (2 weeks or less) because it only needs to be taken for 7 days after the last exposure. For longer stay travelers, an alternative if Mefloquine can’t be taken. Adults take 1 tablet (250/100 mg) per day with a meal beginning 1 day prior to arrival in the malarious area (may not coincide with first overseas destination) and for 7 days after the last exposure. If you miss a day do not double up on the next day. Children take from 1 to 4 pediatric tablets (62.5/25 mg) per day depending on weight. Side effects--gastrointestinal discomfort but at a rate equal to placebo in trials. Unsafe in pregnancy. ٱ Mefloquine (Lariam, Larium, or generic Mefioquine now available from Geneva Pharmaceuticals)--A drug of choice for prevention of malaria in most of the world. Take 1 tablet (250 mg) once a week always on the same day. Start 2 Sundays (easiest day to remember) before your first entry into the malarious area (may not coincide with first overseas destination) and each Sunday while exposed. Take the pills for 4 weeks after you get back home in order to suppress parasites which are still incubating during this time. If you forget a dose, take the pills later in the week but then go back to the regular day immediately thereafter. if you forget a week completely do i double up the following week. Side effects: occasional-mild stomach upset (always take mefloquine with a meal), insomnia, anxiety, vivid dreams. Mild side-effect like vivid dreams usually only last a day or two with each dose and often disappear with use beyond 2 months. Malaria is a potentially fatal infection, the benefit of this drug far outweighs the inconvenience of the relatively minor side effects that occur in a small percentage of people. As with many other drugs for serious diseases, up to 5% experience intolerable side effects and need to switch to another drug. Rarely-i in 1 3,000 incidence of significant nervous system toxicity. Mefioquine cannot be mixed with certain heart or anti seizure medications. Not to be use in those with active depression or recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, or other major psychiatric disorder Mefloquine should be used with caution in patients with previous history of depression. If psychiatric symptoms occur during prophylactic use, they may be prodromal to a more serious event and the drug should be discontinued and an alternative medication substituted. Safe in pregnancy and in children. if mefloquine has been taken within the previous month, do not take a drug called Halfan (halofantrine) which is commonly given overseas to patients with undiagnosed fever (potentially fatal cardiac interaction).
ٱ Doxycycline--Effective drug of choice for prevention of malaria in all parts of the world; good alternative to Malarorte or mefloquine. Take 1 tablet (1 00 mg) once/day. Start 1-2 days prior to entering the malarious area and for 4 weeks after last exposure. Side effects-gastric irritation if taken on an empty stomach, candidal vaginitis (all women to carry self-treatment single dose of Fluconazole 1 50 mg tablet); fungal skin rash in groin or on feet. Not for children under 8 or in pregnancy. ٱ Chioroquine (Aralen)--For prevention of malaria in limited parts of the world. Take500 mg (1 tablet) once a week beginning the Sunday prior to first malarious exposure and for 4 weeks after last exposure. Side effects occasional mild stomach upset (taken with meals; itchiness in blacks). ٱ Proguanil (Paludrine), Maloprim, Deltaprim--Poorly effective antirnalarials sold in Africa. Not obtainable in the USA. Avoid using. Diarrhea Drugs ٱ Loperamide (over the counter as Imodium AD and others). To control symptoms of acute diarrhea or intestinal cramping. Take two 2mg tablets at onset of diarrhea and then 1 tablet up to 4 times a day. Do not take if you have blood or pus in the stools or if fever lasts more than 48 hours. ٱ Levofloxacin (Levaquin)--An antibiotic which will shorten the course of diarrhea due to almost all bacteria that cause travelers diarrhea. One tablet (500 mg) once/day starting if the Loperamide has failed to work within 2 hours of the first dose of loperamide. Take for 3 days total if diarrhea resolves quickly and for 5 days if diarrhea takes more than 24 hours to resolve. Loperamide may be continued at the same time. Not approved for children but safe in those over age 2. Unsafe in pregnancy. Not effective against parasites like ameba and giardia but parasites cause less than 5% of all travelers diarrhea. Other quinolones (ciprofloxacin, ofloxacin, or norfloxacin) are equally effective but require twice a day dosing. Levaquin, 500 mg/day for 7 days, is also effective for upper respiratory infections like bronchitis or sinusitis and for some skin infections. ٱ Azithromycin (Zithromax)--An antibiotic which will shorten the course of diarrhea due to almost all bacteria that cause travelers diarrhea. Not as much experience as with quinolone antibiotics described above. Useful in quinolone allergic patients, pregnant women, and children who don’t want to take quinolones. Useful for quinolone-resistant Campylobacter diarrhea, an increasing problem in a few countries in South and Southeast Asia. Take one 500 mg tablet/day for 3 days as per instructions on the Azithromycin Tn Pak. Packing for Travel to Developing Countries MEDICALLY ESSENTIAL: Medications prescribed by Travelers Health Clinic physician Ibuprofen, acetominophen, or similar anti-inflammatory Disinfectant for skin cuts & wounds Bandages, gauze, band-aids, tweezers Neosporin (or similar) antibiotic ointment Sun block Sun hat DEET based insect repellent (minimum 30%) (may damage plastic watch crystals, contact lenses, etc) Cold/flu medication (to contain pseudoephedrine as one ingredient) Antihistamine (i.e. Claritin, Chlortrimeton, Benadryl) Plastic water bottle or flask All above items to be carried in your hand luggage MEDICALLY NECESSARY IF APPLICABLE: Over-supply of regular prescription drugs Copy of important prescriptions using generic names Nasal decongestant spray Oil of wintergreen (for toothache) and/or emergency dental kit Antifungal skin creme (Lotrimin) & foot powder (e.g. Tinactin) Heating coil (to boil water) Iodine tablets or hand-filter (to treat water if no electricity) Oral rehydration packets (for travel to remote areas) Motion sickness pills (eg Bonine) or Scopolamine patches Cough syrup or tablets Thermometer Sunburn cream Insect sting kit (Epi-pen) if history of sting allergy Ipecac (if traveling with small children) PRACTICAL ITEMS Mosquito bed net Permethrin insect spray or liquid to impregnate clothes AIDS free certificate (for long term visitors, students or workers) Swiss army knife Sunglasses, spare eyeglasses, copy of eye prescription Sewing kit Small flashlight Knockdown insect spray Kleenex
paper (turn over)
Commercial AIDS prevention Kit (needles, syringes, IV infusion tubing) Photocopy of passport front page, airline ticket, important phone numbers (i.e. US embassy, personal MD), credit card data. Trip disruption insurance (should include medical evacuation coverage) Pre-travel dental check-up Pre-signed consent form for medical treatment to minor children left at home SAFETY AND CRIME AVOIDANCE
• Make sure at least one other person knows your whereabouts and expected schedule
• Use extra caution in crowded subways, train stations, elevators, tourist sites, market
places, and festivals, and avoid marginal areas of cities.
• Use only “registered” taxis, preferably radio taxis. • Avoid visible signs of wealth in dress or jewelry.
• Be constantly attentive to surroundings and be wary of any stranger who engages you
in any form of conversation or touches you in any way no matter how accidental the contact may appear to be.
• Carry only a photocopy of your passport face page and legal entry stamp; leave the
actual passport in a hotel safe or at your residence.
• Wear your hand bag across your chest to prevent it from being snatched.
• Familiarize yourself with common local scams and distraction techniques.
• If you are confronted, give up your valuables. Money and passports can be replaced;
SAFETY IN THE HOTEL
• Keep your hotel door locked at all times.
• Look for fire safety instructions in your hotel room.
• Familiarize yourself with escape routes upon arrival. • Keep valuables in the room safe or the hotel safe.
• SAFETY WHEN YOU DRIVE
• Try to drive with windows closed. • Keep car doors locked at all times.
• Avoid driving at night or alone, and never drive or ride by car or bus outside urban
• Never drive a motorcycle or scooter abroad.
• If available, long-stay and business travelers should arrange a locally purchased
mobile phone to be in the vehicle whenever traveling.
UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366 RESOURCES CDC International Health Requirements and Recommendations Authoritative general information by region of the world, but may not be detailed enough for specific individual itineraries within a specific country. Faxback information 1 -888-CDC FAXX. <www.cdc.gov/travel/> International Travel and Health. Vaccination Requirements and Health Advice. From the World Health Organization. <www.who.int/ith/> Shorelands Travel Health On-Line. Consumer oriented site with good country specific information. <www.tripprep .com>. US State Department. Automated travel advisories with reference to disturbed or disrupted areas. Provides phone numbers of US embassies and consulates in areas you will visit. Assistance with information and liaison re: family members caught in disrupted areas, or those with medical and legal problems. http://travel.state.gov/ IAMAT-International Association for Medical Assistance to Travelers. Provides a compact booklet with names and numbers of English speaking physicians listed geographically who meet certain professional standards and who abide by a set fee schedule. 71 6 754 4883 <www.iamat.org> . Medic Alert Foundation-Metal disks with your medical problem engraved and an emergency phone number. 1-888-633 4298. <www.medicalert.org> Travel Medicine, Inc. International Travel Health Guide. Consumer oriented book-- updated annually. Practical information with addresses of suppliers. 800 872-8633 <www.travmed.com>. Permethrin, mosquito nets, ORS, AIDS prevention kits, water purification supplies available by phone or internet: Travel accessories and gadgets, health related and not. Magellan’s Catalogue 800 962- 4943. <www Chinook Medical Gear, Inc. 800 766 1 365 <www.chinookmed.com>. Evacuation Insurance. Multiple vendors. International SOS Assistance is a primary medical assistance company (not merely an insurance broker) that has its own emergency centers worldwide. 800 523 8930 <www.internationalsos.com> UAB Travelers Health Clinic Birmingham, Alabama 205 731-9366 UAB Travelers Health Clinic On-call 24 hours for travelers becoming ill during or after travel Post-Travel • Routine or urgent appointments for post-travel fever, diarrhea, rashes, or other
• Screening for tropical pathogens in returned long-stay travelers 205 731-9366 (office hours) 205 934 3411 (Page operator for after hours urgent problems; ask for Travelers Clinic doctor on-call) During Travel Existing Travelers Clinic patients may contact us from abroad for advice to the extent possible by long-distance communication. 205 934 1630 (day) 205 934 5600 (fax) 205 934 3411 (off hours) [email protected] (e-mail; not attended 24 hours)
UAB is a recognized center of excellence for tropical and parasitic disease. Our
physicians are board certified in infectious diseases and with special expertise in tropical medicine. They each spend 1-2 months each year teaching and seeing patients in the tropics. The Gorgas Course in Clinical Tropical Medicine (see www.gorgas.org) organized every year by our physicians is the leading overseas opportunity for other US physicians to be trained in tropical diseases.
INSURANCE WILL COVER ILL RETURNED TRAVELERS. INSURANCE MAY NOT COVER SCREENING FOR WELL RETURNED TRAVELERS.
LA TOXICITE DES CHAMPIGNONS Par René PIOT SOCIETE MYCOLOGIQUE DE VILLEFRANCHE-SUR-SAONE I – Généralités II – Syndromes à incubation longue (issue souvent fatale) II 1 – Phalloïdien (phallotoxines – phallolysine - amatoxine) Dose mortelle : 0.1 mg/kg, soit 7 mg pour un individu de 70 kgs (contenus dans 50 grammes de champignons). II 2 – Orellanien
Mobilgrease XHP 220 serie smeervetten zijn lithium-complex smeervetten bedoeld voor een verlengde service met een breed toepassingsgebied en in uiteenlopende bedrijfsomstandigheden. Deze smeervetten overtreffen conventionele smeervetten door het gebruik van onze gepatenteerde toonaangevende lithium-complex productietechnologie. Deze smeervetten zijn ontwikkeld om uitmuntende hoge temperatuur pres