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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, Today we learning the solar but that have had a recent episode of shingles, may want to wait between 1.5 to 3are years after theabout outbreak before vaccination. system. Thursday 9,16 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]