By: JulieF,
on 9/29/2015
Are you planning a trip to Brazil, Cambodia, The Dominican Republic, Haiti, or another destination that requires immunizations in advance of your arrival? Are you a health care worker, about to travel to a destination currently dealing with an epidemic or outbreak?
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By: Julia Callaway,
on 8/2/2014
With the Ebola virus in the news recently, you may be wondering what actions you can take to reduce the risk of contracting and spreading the deadly disease. Expert Peter C. Doherty provides valuable pointers on the best ways to stay safe and healthy in this excerpt from Pandemics: What Everyone Needs to Know answering: Is there anything that I can do personally to limit the possibility of a dangerous pandemic?
While pandemics are by their nature unpredictable, there are some things worth considering when it comes to the issue of personal safety and responsibility. The first point is to be a safe international traveler so that you don’t bring some nasty infection home with you. Protect yourself and you protect others. Though taking the available vaccines won’t prevent infection with some novel pathogen, it will contribute toward ensuring that you enjoy a successful vacation or business trip, and it should also put you in a “think bugs” mind-set. If, for instance, you are off to Africa for a wildlife safari, make an appointment at a travel clinic (or with your primary care physician) two to three months ahead of time to check your vaccine status and, if needed, receive booster shots to ensure that your antibody levels are high. Anyone who is visiting a developing country should make sure that he or she has indeed received the standard immunizations of childhood. Adolescents and young adults are much more likely to suffer severe consequences if, for instance, they contract commonplace infections like measles or mumps that have, because of herd immunity, become so unusual in Western countries that a minority of parents reject the collective responsibility of vaccinating their kids. If you’re younger and your parents are (or were) into alternative lifestyles, it may be wise to ask them very directly about your personal immunization history.
It’s also likely that, even if you were vaccinated early on, your level of immunity will have declined greatly and you will benefit from further challenge. Both possibilities will be covered if you go to a comprehensive travel clinic, as the doctors and nurses there will insist that you receive these shots (or a booster) if you don’t have a documented recent history. Any vaccination schedule should ideally be completed at least 3 to 4 weeks ahead of boarding your flight, the time needed for the full development of immunity. But this is one situation where “better late than never” applies. Should it have slipped your mind until the last minute, you should be vaccinated nevertheless. Even if you’ve never had that particular vaccine before, some level of protection could be there within 5 to 10 days, and a boosted, existing response will cut in more quickly. A travel clinic will also sell you a Gastro (gastroenteritis, not gastronomy) kit containing antibiotics to counter traveler’s diarrhea (generally a result of low-grade E. coli infection), something to decrease intestinal/gastric motility (Imodium), and sachets of salts to restore an appropriate fluid balance.
For the elderly, be aware of the decline in immunity that happens with age. You may not respond to vaccines as well as those who are younger, and you will be at greater risk from any novel infection. Depending on your proposed itinerary, it may also be essential to take anti-malarial drugs, which generally have to be started well ahead of arrival. Malaria is not the only mosquito-borne threat in tropical countries, so carry a good supply of insect repellant. In general, think about when and where you travel. Avoiding the hot, wet season in the tropics may be a good idea, both from the aspect that too much rain can limit access to interesting sites and because more standing water means more mosquitoes. Wearing long trousers, long-sleeved shirts, and shoes and socks helps to protect against being bitten (both by insects and by snakes), while also minimizing skin damage due to higher UV levels. Then, before you make your plans and again prior to embarking, check the relevant websites at the CDC, the WHO, and your own Department of Foreign Affairs (Department of State in the United States) for travel alerts. Especially if they’re off to Asia, many of my medical infectious disease colleagues travel with one or other of the antiviral drugs (Relenza and Tamiflu) that work against all known influenza strains. These require a prescription, but they’re worth having at home anyway in case there is a flu pandemic. If that happens, the word will be out that influenza is raging and stocks in the pharmacies and drugstores will disappear very quickly. But don’t rely on self-diagnosis if you took your Tamiflu with you to some exotic place; see a doctor. What you may think is flu could be malaria.
For those who may be sexually active with a previously unknown partner, carry prophylactics (condoms) and behave as responsibly as possible. Excess alcohol intake increases the likelihood that we will do something stupid. Dirty needles must be avoided, but don’t inject drugs under any circumstances. Blood-borne infections with persistently circulating viruses (HIV and hepatitis B and C) are major risks, while insect-transmitted pathogens (dengue, Chikungunya, Japanese B encephalitis) can also be in the human circulation for 5–10 days. Apart from that, being caught with illegal drugs can land you in terrible trouble, particularly in some Southeast Asian nations. No matter what passport you carry, you are subject to the laws of the country. Be aware that rabies may be endemic and that animal bites in general can be dangerous.
Can you really trust a tattooist to use sterile needles? Even if the needles are clean, what about the inks? How can they be sterilized to ensure that they are not, as has been known to occur, contaminated with Mycobacterium chelonae, the cause of a nasty skin infection? And that was in the United States, not in some exotic location where there may be much nastier bugs around.
Peter C. Doherty is Chairman of the Department of Immunology at St. Jude’s Children’s Research Hospital, and a Laureate Professor of Microbiology and Immunology at the University of Melbourne. He is the author of Pandemics: What Everyone Needs to Know, The Beginner’s Guide to Winning the Nobel Prize: Advice for Young Scientists, Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World, and A Light History of Hot Air.
What Everyone Needs to Know (WENTK) series offers a balanced and authoritative primer on complex current event issues and countries. Written by leading authorities in their given fields, in a concise question-and-answer format, inquiring minds soon learn essential knowledge to engage with the issues that matter today. Starting July 2014, OUPblog will publish a WENTK blog post monthly.
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Image credit: Ebola virus particles by Thomas W. Geisbert, Boston University School of Medicine. Public Domain via Wikimedia Commons.
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By: Alice,
on 4/24/2014
Every April, when the robins sing and the trees erupt in leaves, I think of Brad — of the curtain wafting through his open window, of the sounds of his iron lung from within, of the heartache of his family. Brad and I grew up at a time when worried mothers barred their children from swimming pools, the circus, and the Fourth of July parade for fear of paralysis. It was constantly on everyone’s minds, cast a shadow over all summertime activities. In spite of the caution, Brad got polio — bad polio, which further terrorized our mothers. It still haunts me. If, somehow, he had managed to avoid the virus for a couple years until the Salk vaccine arrived, none of that — the iron lung, the shriveled limbs, the sling to hold up his head — would have happened.
In 1954, many children in my town, myself included, became “Polio Pioneers” because our parents made us participate in the massive clinical trial of the Salk vaccine. Some of us received the shot of killed virus, others received a placebo. We were proud, albeit scared, to get those jabs, to be part of a big, important experiment. Our moms and dads would have done anything to rid the country of that dreaded disease.
Because the vaccine is so effective, mothers today aren’t terrified of polio. Children in our neighborhoods aren’t growing up in iron lungs or shuffling to school in leg braces. We seem so safe. But our world is smaller than it used to be. The oceans along our coasts can’t stop a pestilence from reaching us from abroad. A polio virus infecting a child in Pakistan, Nigeria, or Afghanistan can hop a plane to New York or Los Angeles or Frankfurt or London, find an unimmunized child, and spread to other unimmunized people. Our earth is not yet free of polio.
Germs are like things that go bump in the night. They can’t been seen, they lurk in familiar places, they are sometimes very harmful, and they instill great fear—some justified, some not.
Fear of measles, like fear of polio, is justified. In the old days, one in twenty children with measles developed pneumonia, one or two in a thousand died. The vaccine changed all that in the developed world. But, measles continues to rage in underdeveloped countries. In a race for very high contagiousness, the measles virus ties the chickenpox virus (which causes another vaccine-preventable childhood infection). Both viruses can catch a breeze and fly. Or they may linger in still air for over an hour. They, too, ride airplanes. This year alone, outbreaks of measles started by imported cases have occurred in New York, California, Massachusetts, Washington, Texas, British Columbia, Italy, Germany, and Netherlands.
Fear of whooping cough (aka pertussis) is also justified. In the pediatric hospital where I work, two young children have died of this infection in the past several years and many others have suffered from the disease, which used to be called “the one-hundred day cough.” It lasts a long time and antibiotic treatment does nothing to shorten the course. Young children with pertussis may quit breathing, have seizures, or bleed into their eyes. It spreads like invisible smoke around high schools and places where people gather … and cough on each other.
On the other hand, fear of vaccines — immunizations against measles, polio, chickenpox, or whooping cough — is hard to understand. In the grand scheme of things, any of these serious infections is a much greater threat than the minimal side effects of a vaccine to prevent them. Just ask the mothers of the children who died of pertussis in my hospital. It’s true that the absolute risk of these infections in resource rich areas is small. But, for even rare infections, a 0.01% risk of disease translates into hundreds of healthy children who don’t have to be sick, or worse yet die, of a preventable infection.
In spite of the great success of vaccines, they aren’t perfect. Perfection is a tall order. Still we can do better. Fortunately, because of the work of my medical and scientific colleagues, new vaccines under development hold promise to be more effective with fewer doses, to provide increased durability of vaccine-induced immunity, and to be even freer of their already rare side effects. And, we’re creating vaccines against respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, herpes virus, and HIV, to name a few.
Brad would be proud of how far we have come in protecting our children from the horrible affliction that crippled him. He’d also be furious at our failure to vaccinate all our children. Every single one of them. He’d tell us that no child should ever be sacrificed to the ravages of polio or measles or chicken pox or whooping cough.
Janet R. Gilsdorf, MD is the Robert P. Kelch Research Professor of Pediatrics at the University of Michigan Medical School and pediatric infectious diseases physician at C. S. Mott Children’s Hospital, Ann Arbor. She is also professor of epidemiology at the University of Michigan and President-elect of the Pediatric Infectious Diseases Society. Her research focuses on developing new vaccines against Haemophilus influenzae, a bacterium that causes ear infections in children and bronchitis in older adults. She is the author of Inside/Outside: A Physician’s Journey with Breast Cancer and the novel Ten Days.
To raise awareness of World Immunization Week, the editors of Clinical Infectious Diseases, The Journal of Infectious Diseases, Open Forum Infectious Diseases, and Journal of the Pediatric Infectious Diseases Society have highlighted recent, topical articles, which have been made freely available throughout the observance week in a World Immunization Week Virtual Issue. Oxford University Press publishes The Journal of Infectious Diseases, Clinical Infectious Diseases, and Open Forum Infectious Diseases on behalf of the HIV Medicine Association and the Infectious Diseases Society of America (IDSA), and Journal of the Pediatric Infectious Diseases Society on behalf of the Pediatric Infectious Diseases Society (PIDS).
The Journal of the Pediatric Infectious Diseases Society (JPIDS), the official journal of the Pediatric Infectious Diseases Society, is dedicated to perinatal, childhood, and adolescent infectious diseases. The journal is a high-quality source of original research articles, clinical trial reports, guidelines, and topical reviews, with particular attention to the interests and needs of the global pediatric infectious diseases communities.
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