International Medicine

The trip just got real today with a visit to the International Travel Medicine and Immunization Clinic. In addition to providing the appropriate immunizations for travel all over the world, clinics like this oversee care for a variety of issues such as altitude sickness, insecticides and repellants, insurance and evacuation counseling, malaria prevention, safe eating and drinking recommendations, and traveler’s illnesses among a host of other things. These clinics provide care to adults and children and they tend to be some of the happier hospital employees that I have come across.

Given our itinerary we were given the options to get vaccinated for typhoid fever, yellow fever, rabies and Japanese encephalitis. It is assumed that travelers are already following the 2021 CDC recommended immunizations for illnesses such as covid, measles, polio, tetanus, and pertussis, among others.

Typhoid fever, also known as typhoid, is caused by a type of Salmonella bacteria. It is spread by eating or drinking food or water that is contaminated by an infected person. In addition to the typhoid vaccine, efforts to prevent the disease include providing clean drinking water, good sanitation, and hand washing. The disease can be treated with antibiotics. It is most common in India and children are most commonly affected. Each year over 12 million new cases are reported with only about 400 cases in the United States.

Yellow fever is caused by the yellow fever virus and is spread by the bite of an infected mosquito. It infects only humans, other primates, and several types of mosquitoes. It is spread primarily by Aedes aegypti, a type of mosquito commonly found in the tropical areas of South America and Africa. A safe and effective vaccine exists and some countries require vaccinations for travelers. Once a person is infected, management is symptomatic as no specific measures are effective against the virus. The disease originated in Africa and spread to the Americas starting in the 15th century with the European trafficking of slaves from sub-Saharan Africa. Since the 17th century, several major outbreaks of the disease have occurred in the Americas, Africa, and Europe. A particularly bad outbreak occurred in Philadelphia in 1793. There is a good YA book on the topic called Fever 1793 by Laurie Halse Anderson.

Rabies is caused by the rabies virus. It is spread when an infected animal bites or scratches a human or other animal. Saliva from an infected animal can also transmit rabies if the saliva comes into contact with the eyes, mouth, or nose. Globally, dogs are the most common animal involved. In the Americas, bat bites are the most common source of rabies infections in humans, and less than 5% of cases are from dogs. Early symptoms can include fever and tingling at the site of exposure followed by one or more of the following symptoms: nausea, vomiting, violent movements, uncontrolled excitement, fear of water, an inability to move parts of the body, confusion, and loss of consciousness. Once symptoms appear, the result is virtually always death. The time period between contracting the disease and the start of symptoms is from one week to more than one year (usually one to three months). The time depends on the distance the virus must travel along peripheral nerves to reach the central nervous system. In people who have been exposed to rabies, the rabies vaccine and sometimes rabies immunoglobulin are effective in preventing the disease if the person receives the treatment before the start of rabies symptoms. Rabies causes about 59,000 deaths worldwide per year with 95% occurring in Africa and Asia. It is present in more than 150 countries and on all continents, but Antarctica. A number of countries, including Australia and Japan, as well as much of Western Europe, do not have rabies among dogs. As of 2016, only fourteen people had survived a rabies infection after showing symptoms.

Japanese encephalitis is an infection of the brain caused by the Japanese encephalitis virus (JEV). JEV is generally spread by mosquitoes and occurs mostly outside of cities. The disease occurs in Southeast Asia and the Western Pacific. About 68,000 symptomatic cases occur a year.