Thursday, July 31, 2014

Prevention of contagious diseases medical information written by Gloria Poole,RN

Practical help for those traveling abroad and to help prevent disease anywhere:

In the news is the ebola outbreak in Africa that has the potential to become pandemic and that has killed about 800 people so far. I am including a link to the BBC article about that :
W.H.O. plan to curtail ebola, 31 July 2014:
I am updating this that I wrote yesterday [31 July] to add information that is available today on ebola, [virus]  from The New York Times: Quote: "The C.D.C. advised Americans to avoid all nonessential travel to the three countries hardest hit by the virus: Guinea, Sierra Leone and Liberia. The agency issued a Level 3 travel warning, reserved for grave situations. It was also used for the outbreak of the highly contagious respiratory disease SARS." And : "The virus causes high fever, vomiting, diarrhea and, in some cases, bleeding. In the current outbreak, about 60 percent of the cases have been fatal. It is transmitted by contact with bodily fluids from someone who is ill."  And :
 "There is no vaccine to prevent the illness, and no specific treatment for it, only care to try to nurse people through the worst of the fevers, bleeding and other symptoms. The only way to stop an outbreak is to isolate each infected patient, trace all their contacts, isolate the ones who get sick and repeat the process until, finally, there are no more cases." And :
"In New York, Dr. Jay Varma, the deputy commissioner for disease control at the city’s health department, said that someone at an area airport with symptoms that could be from Ebola would immediately be isolated and tested, briefly quarantined at the airport and quickly taken to a hospital where the department has standing arrangements for just such an event."

 I logged back in this afternoon 1 August, at 3:24pm to add this info :
Very good article about ebola with visuals of how it affects humans:

And also to remind all readers that hand washing is the NUMBER ONE thing they can and should do to prevent the spread of any disease. You should wash your hands with good soap for at least 5 minutes using a fingernail brush to get soap under nails and to remove debris when you come into contact with anybody's body fluids, excrement, sneezes, coughs, including your own because fingernails harbor bacteria and viruses under them. So, for any person working in any capacity with infected [with any disease ] persons handwashing is essential. Also, for diseases transmitted via droplets of moisture [such as tuberculosis] covering your nose and mouth is also essential [ the reason for wearing masks over those in the operating room and disinfecting centers]. Any time you sneeze or cough you should cover your nose and mouth with something that can either be disposed of, or washed thoroughly, to prevent the spread of "germs" from you to others.  Nurses and doctors are taught to wash their hands between patients and usually you do not see them do that because they wash up at nurse's station or restricted area.  But if you are in a situation where you do see a medical doctor, nurse, technician, technologist of any department go from one patient to another without washing hands, you should call them on it--insist they wash their hands to not spread the diseases around to others. They know to do that and get in hurry and forget. WE, who are trained in the health care disciplines, KNOW to do this and KNOW why to do it but we are all after only human.  This is critical when the diseases are infectious. Not all diseases are infectious but I have touched on some of the main points of the ones that are in the words below.  However, it is best practice to wash your hands after toileting, after putting on or off shoes, before eating or drinking, after touching another person because skin also harbors bacteria.  And it goes without saying do NOT share food or drink with infected persons. in other words, do not eat off their plate or drink from their cup. They get microscopic saliva on the rim of the cup and on their plate and it takes only a tiny amount of contaminant to infect you. So tiny in fact that you do not see it with the naked eye. That means that the virus or bacteria can only be seen under a microscope unless it has multiplied so much it is making colonies on an agar plate.

I know as Registered Nurse licensed in Missouri but whose main career was in state of Georgia, that contagious diseases have a set of practices that can help contain it, including quarantine of those infected. I am sure they need to do that in Africa and possibly burn the bodies of those who died from it to prevent contamination of mortuaries  and personnel handling them. I cannot add much to the BBC article as it shows the protective covering of health care workers to prevent contamination.

However, I am going to write here some practical advice using a medical  textbook as a reference that will help international travelers stay healthy. Three  to five million people travel from countries where they are not likely to be exposed to contagious disease, to countries where contagious diseases are common. And then they travel back, potentially exposing their family and friends and co-workers to anything they acquired that is infectious or contagious. Only a few contagious diseases have mandatory reporting of them to public health authorities. The diseases that must be reported are malaria, Lassa fever,  and African trypanosomiasis. The risk of contracting a contagious disease is not as great if a traveler is staying in a city hotel with clean drinking water. However, if staying in remote villages with spotty sanitation and non-potable drinking water, a traveler becomes a high risk of disease.

There are two recognized medical sources of information that are updated yearly to provide practical advice to international travelers:
1)  "Health Information for International Travel" published by the U.S. Public Health Service and available from the Center for Disease Control in Atlanta, GA, 30333; and
2) "Vaccination Requirements for International Travel and Advice to Travelers," published by the World Health Organization, available from WHO Publication Center, 49 Sheridan Ave, Albany, NY 12210, USA.
There are two other resources for international travelers:
1) International Association for Medical Assistance to Travelers [IAMAT] at 417 Center St. Lewistown, NY, 14092 which has info on tropical diseases & a list of English speaking medical doctors in other countries.
2) Center for Disease Control Traveler's information hotline  +1(404)3324559 and they will fax it to all regions of world.

As of the writing of the medical textbook I am using as reference, the only two legally required vaccinations to travel abroad are cholera and yellow fever. Yellow fever is endemic in Africa. And cholera is endemic in South and Central Americas. Typhoid fever is a danger for travelers since 60 percent of the cases of it occurred after international travel. The greatest risk of typhoid fever is in Peru, Chile, and the Indian sub-continent; although the risk is present in almost all developing countries. Typhoid vaccination is recommended for travelers who will stay in small villages and eat local food and drink local water. In developing countries, polio is still uncontrolled . For those who had the initial vaccinations against polio a booster vaccinate is recommended for those whose last vaccination was more than 10 years before. Also, tetanus is a worldwide problem especially in the tropics. A vaccination and or booster is recommended if traveling to those countries. Hepatitis A is an "important risk"  in many areas of the developing world. Immune globulin gives immediate resistance to Hepatitis A and is strongly recommended for travelers to the developing countries of the world. For travelers who will be in a country more than six months, in sub-Saharan Africa or Southeast Asia including China and Indonesia, North Africa, South Central Asia and Southern Europe  it is also recommended that they  be vaccinated for Hepatitis B.  Since rabies exists in many undeveloped countries, anyone who will be in presence of animals [ veterinarians, safari travelers, animal handlers, laboratory workers] should have the rabies prophylaxis which is three injections on days 0, 7, 21 and 28 before they travel. Tuberculosis is an airborne contagious disease caused by mycobacterium tuberculosis that are either inhaled or present in unpasteurized milk. The BCG vaccination is controversial and most U S experts do not recommend it but do recommend frequent skin testing for exposure to it for travelers in areas where it is known to be a problem [worldwide].

 Japanese encephalitis [abbrev JE] s a mosquito-borne encephalitis [inflammation of brain] that occurs in much of Asia including China and the tropical areas of Southeast Asia. There is a vaccination {JE-vax] manufactured by Research Foundation for Microbiological Diseases of Osaka University and distributed by Connaught Laboratories, that is a series of three injections.
Plague exists in certain rural parts of Africa, Asia, North  and South America. If any contact with rodents is a risk, then vaccination is recommended.
For travelers to New Delhi, Northern India, Sahel [sub-Sahara Africa], Saudi Arabia, Nepal, Tanzania and Burundi pre-travel vaccination for meningococcoal meningitis is recommended.

Malaria is a potentially fatal parasitic disease caused by infection of red blood cells with Plasmodium species and is usually transmitted by the anopheles mosquitoes but can be acquired from blood transfusions and intravenous drug use. Malaria is worldwide. The aim is to prevent it by sleeping in mosquito-netting during the anopheles feeding time of dusk to dawn. Travelers outside mosquito netting during those times should cover all body parts with clothing and use insect repellent. Mosquito repellent with N, N-diethylmetatoluamide [DEET] should be applied to expose skin including the face. Best to avoid night time activities in malaria prone countries. People die from malaria every year. In high risk areas, chemical prophylaxis is recommended to begin 1-2 weeks BEFORE traveling to the area and continue until four weeks after return from the area. There are six different medicines [chemicals ] used to prevent infection with malaria. 
Even with chemical prevention attempts, it is possible to contract malaria. The CDC maintains an up-to-date database on malaria and and it is available by calling +1(404) 639-1610. In seeking what chemical to use to prevent malaria, the traveler has to be assessed for risk of developing chloroquine-resistant Plasmodium falciparum [CRPF] malaria. The counties where CRPF have been reported are eastern Thailand and rural Cambodia. Travelers in those areas are advised to take with them Fansidar and to take it promptly if they develop a fever and can't get to medical care immediately. Some of the chemicals have serious side effects so a medical doctor prescribing those would need to know a complete history of any traveler.

The more minor infectious diseases international travelers can be exposed to abroad are : measles, mumps, rubella, influenza [flu] though some influenzas are deadly.

Food and water are the most common methods of introduction of infectious agents into the body.  It is best for international travelers to the developing or undeveloped world to consider all local food and drink as potentially contaminated and use extreme caution [boil water , cook food thoroughly] . Avoid eating raw fresh water fish and crustaceans. Avoid unrefrigerated creamy products and salads since leafy vegetables are hard to clean and often harbor parasites and eggs and bacteria. If purified water is not available, order beverages that require boiling water such as tea or coffee; drink bottled or canned beverages commercially available, soft drinks . Remember that ice may also be contaminated . The best thing to do is use bottled or canned drinking water and also for brushing teeth.  If you doubt the water, boil it vigorously for ten minutes and let it cool. If you see any sediment in it strain it somehow before you boil it. If you plan to be in an area where you cannot boil water, buy tincture of iodine or tetraglycine hydroperiodide tablets  before you travel and use them to disinfect water by putting 5 drops of Tincture of Iodine in a quart or liter of clean looking water and ten drops in cloudy looking water. If the water looks clean let is stand with the iodine for 30 minutes before drinking it. If the water looks cloudy let it stand several hours with the iodine before drinking it. The water purification tablets can be bought at a pharmacy or sporting goods store and you must follow the instructions with them. 
Infection with e.coli [escherichia coli bacteria] is the cause of 50 percent of diarrhea in travelers. For the general population, prophylaxis against e.coli is not recommended ; but in certain people it is recommended . Those people for whom even a mild case of dehydration would be serious [such as those taking diuretics , or with cardiovascular disease, or very young and very old] treatment to prevent infection with e.coli is recommended.

For travelers to Ethiopia and Kenya, the risk of Schistosomiasis is  a major problem. Three predominate species exist: Schistosoma mansoni; Schistosoma haematobium, and Schistosoma japonicum.
It is contracted by wading or swimming in fresh or estuary water that harbors the snail vector of the trematode parasite. It can penetrate the skin and get into the bloodstream without causing any problems at the time, then after about six months it can cause liver or urinary tract disease. To prevent this it is best to avoid rafting or swimming in fresh water in Ethiopia or Kenya.  It is treatable with the drug praziquantel [Biltricide] .

For people who have HIV+ blood there are risks of developing tuberculosis, malaria, and fungal infections and other infections are greater in international travel.

Other precautions is to avoid blood transfusions abroad since blood is not routinely screened for HIV or  Hepatitis B in many countries. And sterilization of equipment may not be adequate in undeveloped countries.

This is not an exhaustive report on the risks of contagious diseases nor on the methods to prevent them. It is only intended to provide some basic information to prompt any person planning to travel abroad to tell their doctor about it beforehand, and to educate people on some of the risks and some of the preventions and treatments that are known.

Copyright notice: since I put this in my own words I am copyrighting this . I, Gloria Poole, residing in Missouri but born in the state of Georgia, own all rights to this blog and to all content of it and it may not be transferred to anyone anywhere, nor have domains forwarded to it that do not belong to me, nor be re-published, nor printed at remote. It may be read as many times as you need too however. I do not track viewers in any way or require login or registration on any blog or site of mine. This is an effort to help improve the worlds' public health by teaching how to prevent contagious and or infectious diseases. Also, for the record: I am a white, single again, Southern Baptist Christian woman, and the natural mother of two grown daughters who are Jennifer and Leigh. I am also an artist in all mediums, a poet, author, republican, Registered Nurse licensed in Missouri, a writer, blogger, citizen journo, photographer, prolife activist and personhood amendment promoter. I have another site in this account at: and it is quite different from this site. But all sites and blogs I own and create are moral and decent and intended to better the world.

Gloria Poole, RN [and artist in all mediums] licensed in Missouri, and using as reference but not quoting the medical textbook Principles of Ambulatory Surgery edited by L. Randol Barker, John R Burton and Philip Zieve;  ch 32. I am also known on the web as : gloriapoole; gloria0817 ; gpoole0817 ; gloriapoole.RN ; gloriapooleRN at yahoo where RN is standard abbreviation for Registered Nurse;  gloria-poole ;  gloria.poole ;  artist-gloriapoole ; Gloria.Poole ; and other variations of my real, born with, legal name of Gloria Poole; at my own, private apt in Missouri; 31, July 2014 at 8:01pm. Updated by me Gloria  twice on 1 August with info on ebola from NY Times and Business Insider .