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International Travel Health Clinic Newsletter
• June/July 2012 •
Located in the Claremont Village, Hendricks Pharmacy is your local independent pharmacy. We accept most insurance plans and offer
FREE delivery. We also have a solution for you if you need help remembering to order you medications; it's the AUTOREFILL system.
Hendricks Pharmacy also has an International Travel Health Clinic headed by our certified travel pharmacist, Dr. Karl Hess. The clinic is
providing this newsletter as a way to keep you up-to-date on the latest travel news and to answer questions that are frequently asked by our
patients. In addition, our travel clinic also provides comprehensive pre-travel consultations, during which, we will review your travel plans as
well as your medical and vaccination history to determine the best pre-travel recommendations for you. This is extremely important to
ensure that you are properly protected from various diseases and to give you peace of mind, allowing you to enjoy and make the most of
your trip. Our personalized consultations will include all necessary vaccines as well as medications for malaria, altitude sickness, and
traveler’s diarrhea. We will also include specific travel advisories associated with your destination.
To set up your personalized consultation today, please fill out our pre-travel form online at www.HendricksPharmacy.com or call
us at (909) 624-1611 or email us at [email protected]. We can also be found on Twitter @HendricksTravel
New Screening Recommendations1,2
Hepatitis C Virus (HCV) Screening for All Baby Boomers
What is hepatitis C?
Hepatitis C is a common blood born infection of the liver which infects 3.2
million Americans and causes liver inflammation. Serious liver problems, such
as scarring and liver cancer may also occur years after the initial infection.
Currently, there are no vaccines available for hepatitis C.
What is the new recommendation for HCV screening?
The US Centers for Disease Control and Prevention is currently working on a
proposal to recommend one-time HCV screening in all baby boomers.
How do you screen for HCV?
A simple blood sample can be used to detect the presence of antibodies
specific for HCV. When hepatitis C infects your liver, the body responds by
making these antibodies.
Why is CDC recommending HCV testing for all baby boomers now?
Baby boomers, individuals born from 1945 through 1965, make up more than
75% of all patients with HCV. Prior to this, only at risk individuals were
recommended to test and many were not treated.
What are the benefits of testing for HCV?
Recently, breakthrough treatments for HCV (boceprevir and telaprevir)
became available and the cure rates are estimated to be about 75%. The new
medications are taken orally in conjunction to injectable HCV treatments.
Azithromycin and Sudden Death3,4,5
Recently, there have been some concerns raised over a
possible link between azithromycin and irregular rhythms of
the heart called arrhythmias. Currently, a short-term course
of azithromycin is sometimes prescribed for travelers’
diarrhea due to its ease of use, effectiveness, and limited
side effects. A recent study however showed that in patients
with pre-existing conditions such as heart failure, heart
attack, and/or stroke; azithromycin may minutely increase
the risk for death due to arrhythmia. This study reported an
increase of 2.8 times more risk for death related to
arrhythmia in those patients taking azithromycin as
compared to those that did not take any antibiotics.
However, the FDA recently announced that the current
recommendation for the use of azithromycin will remain the
same and the agency is currently reviewing the evidence for
this medication. Until further data or recommendations
become available, it may be safer to avoid azithromycin in
those individuals that have been previously diagnosed with
arrhythmia or are taking anti-arrhythmic medications such
as amiodarone, sotalol, or procainamide or are on warfarin
or Coumadin as a blood thinner. If you fall into these
groups, you may be offered other alternative medications,
which are just as effective for travelers’ diarrhea.
Focus on Vaccines: DTaP, Td, Tdap Confusion Clarification6
What is a DTaP vaccine? This is given as part of the routine childhood vaccination schedule as a five dose primary series at ages 2, 4, 6,
and 15-18 months of age and then again at 4-6 years of age. The uppercase letters (D and T) indicate that there are higher amounts of
tetanus, diphtheria, and pertussis (i.e. whooping cough) components in the vaccine compared to similar adult vaccinations.
What is a Tdap vaccine? For children aged 11 to 12 who have completed a full primary series of DTaP, a one time dose of Tdap is
recommended. It is also used as a one-time booster in patients 11 through 64 years of age who have not previously received the vaccine
and for any adult older than 65 who has not received Tdap in the past. As immunity to pertussis wanes over time, this vaccine offers
additional immunity against a severe childhood disease which adults may transmit to young children.
What is a Td vaccine? Immunity to diphtheria and tetanus also wanes over time and a booster is routinely needed every 10 years. Td
vaccine contains only tetanus and diphtheria components, but lacks the protection against pertussis (i.e. whooping cough). If you have
previously received the Tdap vaccine, then only Td is recommended every 10 years.
Hendricks Pharmacy International Travel Health Clinic Newsletter
Fact or Fiction? 11,12,13,14,15,18
1. Water filtration devices will protect against ALL water borne diseases.
FICTION: Although these devices may filter larger sized “bugs” such as bacteria or parasites, viruses are much smaller and may not
be removed by the filter. Double check the label for the exact filter size/specifications to determine the filter’s capacity and protection.
For a recommendation of water filter features check out: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travelMonday
consultation/water-disinfection-for-travelers.htm
Today we are learning about dinosaurs.
Tuesday
2. Patient’s that have already had an episode of shingles gain minimal additional benefit from receiving the vaccine.
Today we are learning about pets.
FACT: Data from a recent study suggests that the risk of shingles recurrence following a recent episode is similar between those that
Wednesday
have and have not been vaccinated. Therefore, otherwise healthy individuals
that would be candidates to receive the shingles vaccine,
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Today we are going on a field trip to the zoo.
7,8,10,12
Quick Tips!
Ask the Expert
Q:Friday
What changes has the FDA recently made to
Today we havesunscreen
a special guest
from the fire
labels?
department to tell us about fire safety.
Travel health kits should include: prescription medicines
in their original containers, antibiotic for travelers’
diarrhea, pain relievers, anti-diarrhea medicine, minimum
of 60% alcohol based hand gel, broad spectrum
sunscreen with a minimum SPF 15, insect repellent, first
aid items, and a thermometer.
In general, UVA rays cause skin aging and UVB rays cause skin
burning. Sunscreens may ONLY be labeled “broad spectrum” if
they provide protection against both UVA and UVB rays.
Insect repellants may need to be applied around the
clock. Check travel destination ahead of time to see if day
and night time insect precaution is needed. Nighttime
application of insect repellants offers protection against
mosquitoes that transmit malaria and Japanese
encephalitis and daytime application protects against
mosquitoes that transmit yellow and dengue fever.
ONLY broad-spectrum sunscreens with a minimum SPF of 15
may state that they protect against skin cancer if used as directed
with other sun protection measures.
Avoid getting beverages with ice. A single drop of
contaminated water is enough cause sickness.
Products that have SPF values >50 will be labeled “SPF 50+”
because the FDA does not have adequate data demonstrating
any additional protection above SPF 50.
Terms such as “sun block/sweat proof & waterproof” have been
replaced by “water resistant”. Products must specify whether they
protect the skin for 40 or 80 minutes of swimming or sweating.
Final verdict: The FDA recommends a broad spectrum
sunscreen with an SPF of at least 15.
137 N. Harvard Avenue
Claremont, CA 91711
http://www.hendrickspharmacy.com
137 N. Harvard Avenue
Have
question1 for
Clinic?
E-mail
them
Applyasunscreen
hourour
priorTravel
to exposure
wait 30
minutes
then to:
[email protected]
apply insect repellant (when indicated). or on Twitter
@HendricksTravel
For more information or to request an appointment,
Claremont, CA 91711
contact the clinic at
http://www.hendrickspharmacy.com
(909) 624-1611 or e-mail:
[email protected]
For more information or to request an appointment,
contact the clinic at
(909) 624-1611 or e-mail:
[email protected]
References
1. Hepatitis C FAQ for the public. http://www.cdc.gov/hepatitis/C/cFAQ.htm PubMed Health.
Accessed June 17, 2012
2. CDC proposes HCV testing for all baby boomers. Medscape.
http://www.medscape.com/viewarticle/764110?src=mp&spon=38. Accessed June 17, 2012.
3. Ray WA, Murray KT, Hall K, et al. Azithromycin and the risk of cardiovascular deaths. N Engl J
Med 2012; 366:1881-1890. http://www.nejm.org/doi/full/10.1056/NEJMoa1003833. Accessed June
8, 2012.
4. FDA Statement regarding azithromycin (Zithromax) and the risk of cardiovascular death.
http://www.fda.gov/Drugs/Drugsafety/ucm304372.htm. Accessed June 17, 2012.
5. Literature watch review- Azithromycin and the risk of cardiac death.
https://www.travax.com/scripts/main/topframeset.asp?DocID=medical. Accessed June 15, 2012
6. CDC. Tetanus vaccination. http://www.cdc.gov/vaccines/vpd-vac/tetanus/default.htmMMWR
June 6, 2008; volume 57 RR-5. Accessed October 20, 2011
7. CDC. Travel Health Kit. <http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travelconsultation/travel-health-kits.htm>. [June 2012].
8. CDC. Insect Repellant Use and Safety.>http://www.cdc.gov/ncidod/
dvbid/westnile/qa/insect_repellent.htm>. [June 2012].
9. The Skin Cancer Foundation. <http://www.skincancer.org/publications/sun-and-skinnews/summer-2011-28-2/New-FDA-Rules>. [June 2012].
10. CDC. Drinking Water.<http://www.cdc.gov/healthywater/drinking/>. [June 2012].
11. CDC. Malaria. < http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseasesrelated-to-travel/malaria.htm>. [June 2012].
12. American Mosquito Control Association. Mosquito Information: FAQs. http://www.
mosquito.org/mosquito-information /faq. aspx. [June 2012].
13.CDC. Camping, Hiking, Travel.
<http://www.cdc.gov/healthywater/drinking/travel/index.html>.[June 2012].
14. CDC. Private water systems. <http://www.cdc.gov/healthywater/drinking/private/index.html>.
[June 2012].
15. Hung Fu Tseng, Margaret Chi, Ning Smith, Stephen M. Marcy, Lina S. Sy, and Steven J.
Jacobsen Herpes Zoster Vaccine and the Incidence of Recurrent Herpes Zoster in an
Immunocompetent Elderly Population The Journal of Infectious Disease 2012 : jis334v1-jis334.
[June 2012].
16. FDA. Sun safety.
<http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/Understand
ingOver-the-CounterMedicines/ucm239463.htm>. [June 2012].
17. CDC. Protection against Mosquitoes, Ticks, & Other Insects & Arthropods.
<http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/protectionagainst-mosquitoes-ticks-and-other-insects-and-arthropods.htm>. [June 2012]
18. CDC. Water Disinfection for Travelers.
<http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/waterdisinfection-for-travelers.htm#1931>. [June 2012]