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Fresh from the Travel Clinic--Recommendations for India

Fresh from the Travel Clinic--Recommendations for India

Oct 18th, 2005, 09:40 AM
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Fresh from the Travel Clinic--Recommendations for India

As many of you know, I am traveling in India for three weeks in starting mid December 2005. Went to the Travel Clinic today. Here is what the Infectious disease physician (a frequent India traveler) recommended:

>Hepatitis A
>Hepatitis B (not critical, but since I had two doses last year, he suggested I finish the 3rd one)
>Typhoid vaccine (oral--four doses to be taken every other day and finished at least one week before leaving for India)
>Polio Booster
>Tetanus Booster
>Malarone prescription for Malaria (30 day supply)

Antibiotics prescription: Cipro, enough for two infectious episodes.

I also asked about Rifaximin for travellers diarrhea prophyaxis. It is very new, but early clinical studies have shown efficacy in preventing travelers diarrhea. However, CVS didn't even have it in their computers yet, so they are checking with other sources for me. NOTE; Rifaximin ONLY works against non invasive E-Coli--nothing else. So, if a problem is caused by Shigella or some other pathogen, Rifaximin won't work, you *must* always have a back up antibiotic for curative purposes against other pathogens. Not many are prescribing this drug for prophylaxis yet--the jury seems still to be out. You can do your own research.

I know you are suppose to brush your teeth with bottled water, and I asked about getting water in eyes while showering and was told there is very little chance of anything happening from getting water in your eyes while showering or washing your face (since eyes are outside the alimentary canal), but obviously, one must use their head and not ask for trouble by overdoing the "water in the eyes" thing.

I asked about taking Lactobacillus before leaving and during the trip and was told "it can't hurt, but probably doesn't help"

I asked about eating yogurt in India and was told that he (personally) avoids ALL milk products--will only have it in very HOT tea drinks. However, many in this forum who have been to India have injested pasturized milk products without incident-so just being careful of the source may be the best advice.

I asked about the Pepto Bismol diarrhea prophyaxis regime of four doses (two tablets or spoonfuls each) of Pepto Bismol per day at meals and bedtime every day one travels. He said it has been shown to decrease the occurence of travelers diarrhea in clinical studies, but has some side effects that some find problematic such as a black tongue (bismuth) and ringing in the ears (from the aspirin ingredient) if taken over a long period of time(not serious side effects, just annoying)

He also suggested that if I injest something and immediately (or shortly after) get worried that it was sketchy as to freshness or cleanliness, that I should immediately take one dose of my antibiotic (in my case Cipro).

Finally, I also have plenty of Ambien for the plane and the first few nights and I am going to try "No Jet Lag" for the first time. Like the Lactobacillus, "No Jet Lag" may not help, but it can't hurt and if it has no more than placebo effect--who cares--if I "mentally" believe I have no jet lag then it works!

***DISCLAIMER***DISCLAIMER***DISCLAIMER: The above are the recommendations that were made by my physician specifically for me and where I am travelling. It is IN NO WAY meant as anything other than very general information. You need to see your own physician and review the CDC website to determine what is the best for you, your health and your travels.

***************
It was great meeting so many great people at the Boston GTG. Particular thanks to Craig, Derby and Laura for all their India tips. Also to Bob, Karen and gPanda for hosting the event. I am planning (emphasis on "planning") on a real time blog during my trip--assuming the Internet works, so I'll post a link to the blog before I go should anyone be interested in following along.
BostonHarbor is offline  
Oct 18th, 2005, 10:43 AM
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Boston:
Thanks for the info....Love the disclaimer
Aloha!
hawaiiantraveler is offline  
Oct 18th, 2005, 11:16 AM
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Thanks for your post. Overall, good advice.

The only thing I personally disagree with is taking a dose of antibiotic immediately after eating something that seems "sketchy" - it will be of little use and may encourage antibiotic resistance. But you disclaimer is excellent, and your doctor may have reasons for making that recommendation to you specifically.
Kathie is offline  
Oct 18th, 2005, 12:25 PM
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Very timely post for me, Boston! We will be traveling in India Dec 25-Jan 24 and I was just about to call the travel med dept at Kaiser to find out what we need. Now I'm better prepared.

I had heard the same about dairy products. I've always ignored that restriction in Mexico without any ill effects (although I'm quite careful about everything else). But everyone says you can't be too careful in India.

Besides Cook It, Peel It, or Don't Eat It, I also NEVER eat at buffets since I got sick in Cambodia.

Have a great trip!
Marilyn is offline  
Oct 18th, 2005, 02:03 PM
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Be cautious about seafood (especially away from the coast) and meat as well. You can do very well in India on a vegatarian diet. We are not vegetarians but after going meatless for 3/4 of our India trip we are sold on the fact that you can have a very satisfying vegetarian meal.

Our immunizations were similar to those of Patricia's (BostonHarbor). I did not get the Hep B vaccine but our doctor warned me that by traveling as frequently as we do, our chances of a hospital visit would be increased (auto accidents and the like) and thus the potential for Hep B exposure.

Patricia's excellent disclaimer applies here as well.

Looking forward to the "real time blog".
Craig is offline  
Oct 19th, 2005, 02:45 AM
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I forgot to mention the travel clinic's reference to avian flu. Although India has yet to have any cases in their bird population (that has been identified), my physician strongly instructed (not recommended--"instructed") that any traveler must stay far away from any animal/bird markets or chicken farms. It is only a matter of time--and probably a very short time, that birds in India will be involved since the disease is being carried by migrating birds.

However, he stated that the eating of chicken, if well cooked, was not a problem. But, I'm with Craig. When in India, do what most Hindus do--go vegatarian. I have a very good friend who is Indian and a Hindu Brahmin vegetarian--it is amazing how delicious her meals are. The use of spices and grains are so much more sophisticated and subtle than in our culture.

Lastly, to Kathie--you are correct to have questioned my "sketchy" remark relative to taking an antibiotic. His reference was to something really, seriously worrisome that you only noticed a really bad taste as you were swallowing. He certainly didn't mean every time you had a concern. Thanks for the correction.
BostonHarbor is offline  
Oct 19th, 2005, 04:31 AM
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I'm going to be visiting the Keoladeo Bird Sanctuary in a couple of weeks- maybe I'll hold my breath!I understand it's the winter home for lots of birds migrating from Europe.
massagediva is offline  
Oct 19th, 2005, 04:39 AM
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I think being a veg. while in India is a good idea. When we go again I will try that. I get sick every time I go so why not? Its worth a try.
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Oct 19th, 2005, 05:45 AM
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Boston, that clarification makes much more sense to me. Thanks for responding.
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Oct 19th, 2005, 06:36 PM
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MassageDiva, not to be an alarmist, but do you really need to go to a migrating bird santuary in Asia right now? Avian flu when passed from bird to human has a greater than 50% death rate--in healthy adults. Seems like a risk not worth taking. However, you probably have more than a passing interest in the santuary--maybe a professional connection, so your risk analysis might be different than mine.
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Oct 19th, 2005, 06:43 PM
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Boston H, that was interesting info about Avian Flu. I, too will be in India for 3 weeks from mid Dec. I was wondering about eating chicken. Too bad vaccinations won't be avaialble before we leave.
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Oct 19th, 2005, 11:20 PM
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I read that tamiflu & relenza are not 100% effective against avian flu.

We intend to avoid any contact (including eating) chicken, ducks, all birds, dead or alive, while we are in Asia in Nov/Dec 2005. And eating vegetarian food in India is a smart idea. Ensure you get plenty of protein from lentils, beans etc.
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Oct 20th, 2005, 03:59 AM
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RE: Avian Flu and eating eggs, chickens and fowl in infected areas (From Canadian Lung association)


"Is it safe to eat chicken, eggs and fowl (birds)?
To date, there has been no evidence that the avian flu virus can be caught by people eating contaminated food. However, people travelling to Thailand, China, Cambodia, Vietnam, South Korea, the Democratic People's Republic of Korea (North Korea), Japan, Indonesia, and Laos should take certain precautions, just in case. Travellers to these countries should not eat undercooked fowl (birds), raw eggs, or lightly cooked egg products (like runny eggs). Travelers should make sure that whatever bird and egg products they eat are well cooked all the way through."

(http://www.lung.ca/diseases/avian_flu.html)

It's official--I'm a traveling vegetarian!
BostonHarbor is offline  
Oct 20th, 2005, 05:47 AM
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Lyndie, your comment "I read that tamiflu & relenza are not 100% effective against avian flu. " is correct as far as it goes. Indeed. many of the strains of flu (not just the avian flu) show resistance to those anti-virals. Unfortunately, they have been over-used and used inappropriately so the viruses have developed resistance. The data I've read has indicated that both meds have been ineffectuve against the Avian flu. Of course the avian flu that everyone is worried about is one that does not yet exist, one that can be readily transmitted person to person. In order for that to happen, the virus will have to mutate and of course it's unknown what characteristics that virus might have (virulence, for instance).
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Oct 20th, 2005, 05:52 AM
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The cdc has a new update on the avaian flu as of 10/18/2005, as there has now been another confirmed case in Indonesia. Note that there have been no cases in Thailand since 2004.

Here are the cdc's recommendations:

During Travel to an Affected Area

Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions.
As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled.
Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked.
If you become sick with symptoms such as a fever, difficulty breathing, or cough, or with any illness that requires prompt medical attention, a U.S. consular officer can assist you in locating medical services and informing your family or friends. Inform your health care provider of any possible exposures to avian influenza. See Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad. You should defer further travel until you are free of symptoms, unless your travel is health-related.
Kathie is offline  
Oct 20th, 2005, 05:56 AM
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Note that the primary concern about the virus possibly spreading through food are the traditional Vietnamese soups that contain fresh duck blood. Sorry, I don't remember what it is called. Note that even though that has been a concern, there have been no cases of Avian flu from eating poultry or eggs (even raw duck blood). In order for an infleunza virus to infect a person, the virus must get into mucous membranes, typically in the nose or eyes.
Kathie is offline  
Oct 20th, 2005, 06:39 AM
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Let's all stay away from the Duck Blood Smoothies!
massagediva is offline  
Oct 20th, 2005, 06:55 AM
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yuck! (lol)
Kathie is offline  
Oct 20th, 2005, 05:41 PM
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Hi Kathie. Thanks for the great input.

I think people overestimate the value of antivirals like tamiflu & relenza. Is there a vaccination for avian flu? I don't think so. Maybe you can let us know.

Today I hear that a Thai gentleman passed away from eating infected chickens from a neighbour's farm. Also a shipment of pigeons from Canada arriving in Oz today, have avian flu antibodies.

Where will it end? Are we (the human race) to be wiped out by our avian friends. I'm getting rid of my budgie!

I know it's not a joke but how does one stop birds from migrating anywhere?
Lyndie is offline  
Oct 20th, 2005, 07:05 PM
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Lyndie, no, there is no vaccine for the Avian flu. They are working on one, but part of the problem is that the flu virus they need to have a vaccine against does not yet exist. If/when the virus mutates so that it can be passed person to person, it will be different from what it is now. So any vaccine developed in advance of the mutation is just an educated guess about which of the viral proteins will remain unchanged.

Unfortunately, people have all gotten stirred up about something that is still theoretical. Do you remember when there was avian flu in Hong King and there was a panic that it would mutate? By killing millions of domesticated chickens and ducks and disinfecting the poultry farms and poultry markets, it was stopped. This current avain flu is more problematic, as it is being spread by migrating birds. The only way you stop birds from migrating is to kill them. No one is suggesting that.

I haven't heard any confirmation of the rumor about a Thai man dying from it. Also, the whole issue of how it was contracted would no doubt be very unclear. As there have been no confirmed cases of transmission via eating chickens or eggs, it would be more likely that the known routes (contact with the corpses of infected chickens or their feces) are more likely candidates. I'll post more if I hear of any new developments.
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