Saturday, February 16, 2008

Immunizations for going to PNG

We, as team leaders, cannot tell you exactly what you have to do to protect your health on this trip. That decision is between you and your health care provider. Because of the health risks that do exist in PNG, we strongly advise you to seek out a "travel doctor" or clinic that is familiar with international travel and current exposure potential. For example, I have been told that dengue is presently not a risk in PNG. However, your travel doctor will have more current information and may advise you differently.

Of course there is more to health care than immunizations...such as wearing sunblock and a hat and drinking plenty of water. Your physician will advise you on all of this, as well as other preventative measures.The travel clinic will want you to bring information regarding your your up-to-date list of vaccinations, medications, allergies/sensitivities and recent illnesses.

In addition, we encourage you to have a routine check with your General Practitioner, regarding your blood pressure, medications, and overall health for this trip. Let him/her know what the "travel doctor" recommended for you and see if there is an agreeance. For your information, as a measure towards preventing malaria, we are going to be purchasing bed nets to put over you and your mattress at night. We'll leave those nets with the affiliate when we leave. Also, for those of you who often donate blood, please note: You are not allowed to donate blood for 1 year after you have returned from a malarious area.Most of the following information came the CDC website: If you go to that website, there are other links mentioned that you can go to for further information.If you have ANY questions, please ask!

To have the most benefit, see a health-care provider at least 4-6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations.

Although yellow fever is not a disease risk in Papua New Guinea, the government requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. If you will be traveling to one of these countries where yellow fever is present before arriving in Papua New Guinea, this requirement must be taken into consideration.

Drugs to Prevent Malaria (antimalarial drugs)If you will be visiting a malaria risk area in Papua New Guinea, you will need to take one of the following antimalarial drugs: atovaquone/proguanil, doxycycline, or mefloquine (primaquine in special circumstances and only after G6PD testing).Note: Chloroquine is NOT an effective antimalarial drug in Papua New Guinea and should not be taken to prevent malaria in this region. Malaria risk area in Papua New Guinea: Risk throughout at altitudes below 1,800 m (<5,906>
a.. Sunblock and sunglasses for protection from harmful effects of UV sun rays.
b.. Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.

To prevent insect/mosquito bites, bring:
a.. Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
b.. Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
c.. Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.Vaccine-Preventable Diseases Vaccination or Disease Recommendations or Requirements for Vaccine-Preventable Diseases Routine Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, etc. Hepatitis A or immune globulin (IG) Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors. Hepatitis B Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map) and who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment, such as for an accident, and for all adults requesting protection from HBV infection. Typhoid Recommended for all unvaccinated people traveling to or working in Southern and Western Pacific, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Japanese encephalitis Recommended if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis, see country-specific information. (VACCINE NOT ROUTINELY RECOMMENDED)Although yellow fever is not a disease risk in Papua New Guinea, the government requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination.Update: Dengue, Tropical and Subtropical RegionsThis information is current as of today, November 01, 2007 at 16:28Updated: September 19, 2007Dengue has become one of the most common viral diseases transmitted to humans by the bite of infected mosquitoes (usually Aedes aegypti); it is the most common cause of fever in travelers returned from the Caribbean, Central America, and South Central Asia.* Symptoms of dengue include fever, severe headache, retro-orbital eye pain (pain behind the eye), joint and muscle pain, and rash. Dengue can produce a range of illness from mild to severe, as well as fatal hemorrhagic fever. Travelers are at risk for dengue infection if they travel to or reside in areas where dengue virus is transmitted; the preventive measures outlined below can reduce their risk.Dengue Risk AreasThe range of areas where dengue is located has rapidly expanded in recent years. Today it includes many tropical countries in Southeast Asia, the Indian Subcontinent, the South Pacific, the Caribbean, South and Central America, northeastern Australia, and Africa. See the Distribution of dengue maps for areas where it is present most of the time. Risk of infection is related to mosquito exposure, which can vary with the season. The mosquitoes that transmit dengue breed in man-made and natural containers, which are especially common in and around houses; therefore, dengue is common where many houses are clustered.Currently, an outbreak of dengue is being reported in French Polynesia and Palau in the South Pacific. Singapore is also experiencing an increase in dengue cases this year. As of June 30, 2007, the outbreak of dengue in Paraguay was reported to be subsiding. Other areas in South and Central America and the Caribbean, such as Brazil, Guadeloupe, Martinique, Mexico, Nicaragua, and Puerto Rico, are experiencing an increase in dengue cases in 2007.Prevention Measures for TravelersNo vaccine is available to prevent dengue, and there is no specific treatment other than therapeutic support. Travelers can reduce their risk by protecting themselves from mosquito bites: a.. Use insect repellent containing DEET or Picaridin on exposed skin. DEET concentrations of 30% to 50% are effective for several hours. Picaridin, available in 7% and 15% concentrations, must be applied more frequently. When using sunscreen, apply it before insect repellent. a.. DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. b.. Wear loose, long pants and long-sleeved shirts when outdoors. c.. Indoors, spray insecticide where the Aedes mosquito likes to linger: closets, behind curtains, and under beds. If practical, empty or cover containers containing water. d.. Air conditioned, screened rooms furnished with mosquito nets provide further protection. e.. Empty or cover containers that can collect water (e.g., uncovered barrels, flower vases, or cisterns), because mosquitoes that transmit dengue breed in standing water.Aedes mosquitoes, the principal mosquito vector, usually are active at dusk and dawn, but may feed at any time during the day, especially indoors, in shady areas, or when the weather is cloudy. Unlike malaria, dengue is often transmitted in urban as well as in rural areas.Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by: a.. Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. b.. Wearing long-sleeved shirts, long pants, and a hat outdoors. c.. Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn). d.. Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room. e.. Spraying rooms with products effective against flying insects, such as those containing pyrethroid.Additional InformationProper diagnosis of dengue is important; many other diseases may mimic dengue and health-care providers should consider dengue, malaria, and (in South Asia and countries bordering the Indian Ocean), chikungunya in the differential diagnosis of patients who have fever and a history of travel to tropical areas during the 2 weeks before symptom onset. See Dengue and Dengue Hemorrhagic Fever: Information for Health-Care Practitioners for information regarding reporting dengue cases and instructions for specimen shipping. Serum samples obtained for viral identification and serologic diagnosis can be sent through state or territorial health departments to CDC's Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, 1324 Calle CaƱada, San Juan, Puerto Rico 00920-3860; telephone, 787-706-2399; fax, 787-706-2496.You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.For detailed information about these antimalarial drugs, see Information for the Public: Prescription Drugs for Malaria.More Information About MalariaMalaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).Travelers to malaria risk-areas in Papua New Guinea, including infants, children, and former residents of Papua New Guinea, should take one of the following antimalarial drugs listed above.SymptomsMalaria symptoms may include a.. fever b.. chills c.. sweats d.. headache e.. body aches f.. nausea and vomiting g.. fatigueMalaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.Malaria symptoms can develop as early as 7 days after initial exposure in a malaria-endemic area and as late as several months after departure from a malarious area, after chemoprophylaxis has been terminated.

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