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Welcome to Regional Medical Clinic and Black Hills Travel Medicine.  If you will be traveling, please call ASAP and ask for a travel medicine appointment.  We specialize in vaccinations including typhoid, yellow fever and rabies, and in the prevention of malaria and other travel diseases.  Your travel and vaccination questions are welcome at 718-3300.

Cloud Callout: stories Cloud Callout: travel tips South Dakota Yellow Fever Vaccination Site

Rabies Vaccination Site

  • Clinic Hours:     8 AM to 5 PM  Monday - Thursday
                                 (Friday AM by special appointment)

  • Phone:               605-718-3300

  • Fax                    605-718-3437 

     

  • Address:            Black Hills Travel Medicine
                              c/o Regional Medical Clinic
                              640 Flormann Street
                              Rapid City, SD 57701

(Located behind 8th Street Safeway Store)

Sylvia Cuka, LPN - Travel Medicine Nurse
Steven Stocks, MD - Director profile

 

Notices to Travelers
updated March 11,2010

Information for Healthcare Providers & Others Traveling to or from Haiti
 http://wwwnc.cdc.gov/travel/content/haiti-earthquake-travel.aspx

Airport Screening
Do you know what 3-1-1 means?  See  www.tsa.gov/travelers

Aviation Note - 1

  • Always keep prescription medicines in your carry-on in the original labeled container. 

  • Use the 3-1-1 rule for toiletries, cosmetics, lotions etc.

  • To allow for parking, check-in and other unforeseen delays, travelers should plan on arriving at the airport:

    • 2 hours before domestic flights
    • 3 hours before international flights

*Travelers may be denied boarding passes at check-in
when less than sufficient time remains for a security check.

Aviation Note - 2
Most airlines are charging for each checked bag.  Also, be prepared to pay for blankets, pillows and other amenities. 
Check with your airline or SeatGuru.Com (Seating, amenities & information)  

Aviation Note - 3
Travelers especially to a developing country should be thoroughly familiar with US State Department web site warnings and alerts regarding that country.
http://travel.state.gov/travel/cis_pa_tw/cis/cis_1765.html

Aviation Note - 4
If you are sick with symptoms of influenza-like illness, you should not travel. These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.

Aviation Note - 5
As of Monday, December 14, 2009, the H1N1 vaccine will be released by the South Dakota Department of Health for all South Dakotans desiring it.  This vaccine is free, though there may be an administration fee.  Check with your clinic ahead of your appointment time, as supplies are still limited.  This vaccine is highly desirable for both travelers and non-travelers because a resurgence of H1N1 infections is expected during the usual seasonal flu months of January - March 2010

Arrivals in other counters from the USA may be asked to:

  • Pass through a scanning device that checks your temperature. (The device may look like an airport metal detector, a camera, or a handheld device.)

  • Have your temperature taken with an oral or ear thermometer

  • Fill out a sheet of questions about your health

  • Review information about the symptoms of the new H1N1 flu

  • Give your address, phone number, and other contact information

  • Be quarantined for a period of time if a passenger on your flight is found to have symptoms of the new H1N1 flu

  • Contact health authorities in the country you are visiting to let them know if you become ill

If you have a fever or respiratory symptoms or are suspected to have the H1N1 flu based on screening, you may be asked to:

  • Be isolated from other people until you are well

  • Have a medical examination

  • Take a rapid flu test (which consists of a nasal swab sample)

  • Be hospitalized and given medical treatment, if you test positive for the new H1N1 flu

Many countries, including Japan and China, are screening arriving passengers for illness due to the H1N1 flu (Swine flu).

Please note that the U.S. Department of State usually cannot interfere with the rights of other countries to screen airline passengers entering or exiting their countries, nor can it influence the number of days in quarantine.
http://wwwnc.cdc.gov/travel/content/news-announcements/delays-H1N1-screening.aspx

Recommendations and guidance for clinicians in prescribing antiviral medications for treatment and prevention of influenza during the 2009-2010 season.
http://www.cdc.gov/h1n1flu/recommendations.htm

Banned Medications & Drugs
Japan-
According to Shoreland, it is illegal to bring into Japan some over-the-counter medicines commonly used in the United States, including inhalers and some cough, cold, allergy, or sinus medications. Banned ingredients include those deemed to be stimulants, such as pseudoephedrine, levmetamphetamine, and the common cough suppressant dextromethorphan.

Some U.S. prescription medications (codeine, narcotics, stimulants, and psychotropic drugs) cannot be imported into Japan, even when accompanied by a customs declaration and a copy of the prescription.  Japanese customs officials have detained travelers carrying prohibited items, sometimes for several weeks.

Travelers to Japan may bring a one-month supply of a prescription medication or a two-month supply of an over-the-counter medication so long as they don't contain the banned substances listed above. Larger supplies and/or prescriptions that contain narcotics require import certification, and application should be made several months prior to travel. 
http://japan.usembassy.gov/e/acs/tacs-medimport.html
http://www.mhlw.go.jp/english/topics/import/index.html

Zambia-
According to Shoreland, a US State Department posting on April 16, 2009 reports cases of travelers being detained by the Zambian Drug Enforcement Commission (DEC) for possession of Benadryl (diphenhydramine) and other over the counter medications that contain small quantities of diphenhydramine, which is on the Zambia's list of controlled substances.  This over-the-counter medication in the US is used for allergies, allergic reactions, and motion sickness.  Travelers have been charged with drug trafficking offenses, had their passports confiscated, and been jailed.  As a result, anyone visiting Zambia should consider leaving all non-prescription medications behind.  When traveling with prescription medications, bring a doctors prescription and ensure that the medication is in its original bottle.  Any American stopped by the DEC for possession of over-the-counter medications should contact the Embassy at 0211-250-955 as soon as possible.
http://travel.state.gov/travel/cis_pa_tw/cis/cis_1062.html

Batteries (Lithium)
DOT’s rule on lithium batteries in air travel, which took effect on January 1, 2008, prohibits carriage of spare lithium batteries in checked baggage...   If you put a portable electronic device in checked baggage, you may still do so with the batteries installed in the device.

In carry-on baggage, you may still carry any number of some types of lithium batteries, such as the ones used in cell phones and most laptop computers, provided you take measures to protect terminals. You may also carry up to two more powerful batteries, within the limits...
For details see http://safetravel.dot.gov

Chikungunya Fever
Chikungunya fever is a viral infection transmitted by the bite of mosquitoes.  It can cause mild to severe arthritis for six weeks or more.  Imported cases have occurred in a number of countries which have never previously reported chikungunya.  Travelers are advised to practice daytime and nighttime insect precautions.
http://wwwnc.cdc.gov/travel/content/outbreak-notice/chikungunya-fever.aspx

Thailand-
As of September, 29, 2009, a large outbreak of chikungunya fever has affected the country, particularly the southern region including some tourist destinations, such as Phuket. According to the Ministry of Public Health in Thailand, over 42,300 cases have been documented this year in 50 provinces. Reports from Thailand show that chikungunya virus continues to circulate throughout the country.

Malaysia-
As of September 26, 2009, the Ministry of Health in Malaysia has reported over 3,185 cases of chikungunya fever. The most affected areas are the northern provinces of Kedah, followed by Kelantan, Selangor, Perak, and Sarawak.

Réunion-
As of August 28, 2009, the French government has reported 3 confirmed cases of chikungunya fever on the island of Réunion. No deaths have been reported. All cases occurred in the Saint-Gilles-Les-Bains area, on the western side of the island. However, mosquito activity reports show that the virus is circulating throughout Réunion.

Cholera Outbreak Notice
Zimbabwe and Neighboring Countries-
From August 26 through April 2, 2009, 94,443 suspected cases and 4,127 deaths have been reported in the Zimbabwe. The worst-affected areas are the capital city of Harare (18,375 cases and 648 deaths), Mashonaland West (21,260 cases and 902 deaths) and Manicaland (12,999 cases and 544 deaths).  Cases have also been confirmed in the neighboring countries of Botswana, Mozambique, South Africa, and Zambia. Additional sources have reported cases in Angola, Burundi, Democratic Republic of Congo, Kenya, Malawi, Namibia, Nigeria, Guinea-Bissau and Togo.
wwwn.cdc.gov/travel/contentCholeraZimbabwe.aspx

Dengue Fever & Dengue Hemorrhagic Fever (DF & DHF)
 Dengue is the world's the most common arboviral disease (virus transmitted by an insect) in the world.  It is transmitted by the bite of infected mosquitoes (usually Aedes aegpyti) and the most common cause of fever in travelers returned from the Caribbean, Central America, South and Central Asia.  Many areas are reporting a rapid increase in cases since the beginning of 2009.
wwwnc.cdc.gov/travel/content/outbreak-notice/dengue-tropical-sub-tropical.aspx

Africa-
The country of Cape Verde reported its first outbreak of dengue fever.

As of October 28, 2009, over 3,000 suspected cases of dengue have been reported to the Ministry of Health in four islands: Brava, Fogo, Maio, and Santiago.

South Pacific-
Dengue is circulating widely throughout this region. Examples of outbreaks include the following:

Malaysia-
According to the Malaysia Ministry of Health as of September 26, 2009, more than 31,000 dengue cases and 71 deaths from dengue hemorrhagic fever have been reported during 2009.

Vietnam-
As of September 19, 2009, more than 57,100 cases have been reported by the World Health Organization (WHO) for 2009. Forty-four deaths have been attributed to dengue thus far in 2009.

Philippines-
As of September 5, the Western Pacific Region of the WHO has reported more than 24,000 cases of dengue and 224 deaths for 2009.

Central and South America-
Certain countries in Central and South America, including Argentina, Brazil, Bolivia, Colombia, Paraguay, and Mexico, have experienced unusually high numbers of cases of dengue and dengue hemorrhagic fever during 2009. The peak of case reports occurred during January through May. Currently reported cases of dengue are on a decline in this region; however, there is still an ongoing risk of dengue in these areas.

Middle East-
Throughout 2009, Saudi Arabia reported dengue cases in areas popular with travelers, including Jeddah and Mecca. Those planning to participate in the Hajj should take extra precautions to prevent dengue. For more information about staying safe and healthy during the Hajj, see the travel notice Health Requirements and Recommendations for Travel to Saudi Arabia during the 2009 Hajj: Information for U.S. Travelers.

To view areas where cases have been reported in previous years, see the Distribution of Dengue maps.  For more information on dengue and updates on worldwide activity, see CDC’s Dengue website and WHO’s Dengue webpage.

Hand, Foot, and Mouth Disease
Asia-
Since March 2009, a growing number of cases of hand, foot, and mouth disease (HFMD) have been reported in parts of Asia, including China, Hong Kong, Singapore, and Taiwan. HFMD is common among infants and children, and most of the recently reported cases have occurred in children.

It is very contagious and is spread through direct contact with the nose and throat secretions, saliva, blister fluid, or stool of an infected person.
http://wwwn.cdc.gov/travel/contentHandFootMouthAsia.aspx

No vaccine is available to prevent HFMD. There is no specific treatment for people who are sick with this disease other than treating symptoms, such as fever.

Travelers can take steps to prevent getting HFMD by practicing good personal hygiene and following safe food and water practices. If you are traveling to China, follow these tips to help make healthy choices:

  • Wash your hands frequently with soap and water for 20 seconds, especially before you eat, after you cough or sneeze, and after you go to the bathroom. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). Consider packing alcohol-based hand gel in your luggage to ensure you have it when needed.

  • Eat foods that are fully cooked and served hot.

  • Drink beverages that have been properly bottled and sealed (water, carbonated drinks, or sports drinks).

  • Do not put ice in drinks.

  • Eat only fruits and vegetables that you can wash and peel yourself.

  • Do not share eating utensils, such as forks, spoons, and cups.

Hepatitis A
Ethiopian-
Several cases of hepatitis A have recently been reported in children and adults linked to adoptees from Ethiopia. Hepatitis A is a liver disease caused by the hepatitis A virus. Most children under the age of 6 years do not get sick from the infection, but can spread it to older children and adults, who often become ill.
wwwn.cdc.gov/travel/contentHepAEthiopianAdoptees.aspx

On February 25, 2009, the Advisory Committee on Immunizations Practice (ACIP) recommended routine hepatitis A vaccination for all household members and other close personal contacts (e.g., regular baby-sitters) of adopted children newly arriving from countries with high or intermediate hepatitis A infection rates.  This is based on numerous episodes of hepatitis A infections occurring in family members and close contacts of adopted children brought to the US.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a4.htm

Japanese Encephalitis-New Vaccine IXIARO®
The Japanese encephalitis virus (JEV) is a mosquito bite transmitted virus which is the leading cause of encephalitis in Asia.  In March 2009, the Food and Drug Administration approved the new JE vaccine, IXIARO®, for use in persons ages 17 year of age or older.  This newer vaccine has been proven to be safe and effective.  It is given as two doses over 28 days.  However, studies have not been completed in children under 17 years of age, pregnant women or in nursing mothers. 

The older JE vaccine, JE-VAX®, has been licensed in the United States since 1992 for use in persons ages 1 year and older. However, JE-VAX® is no longer being produced, and limited supplies remain. Therefore, the CDC currently recommends that JE-VAX® only be used for children aged 1-16 years of age.

Malaria
Great Exuma Island, Bahamas-
The CDC has received an official report of a confirmed malaria case in a person who traveled to Great Exuma, Bahamas, in March 2008 and is reinstating the recommendation that travelers to Great Exuma, Bahamas take chloroquine malaria preventive medication (prophylaxis).
http://wwwn.cdc.gov/travel/contentMalariaBahamas07.aspx

Kingston, Jamaica-
The CDC recommendations for traveler antimalarial medication in Kingston, Jamaica  have been rescinded as of February 2008.
wwwn.cdc.gov/travel/contentMalariaJamaicaNewCase.aspx

Measles & Mumps Update
Unprotected travelers may be at risk for measles and mumps.  These diseases a generally thought of as childhood diseases.  They can be much more severe in adults, especially immunosuppressed adults, such as, those with certain chronic illnesses, cancer or those on immunosuppressant drugs for diseases like rheumatoid arthritis.  Measles and mumps still circulate widely in developing countries and outbreaks still occur in some developed countries. 
http://wwwn.cdc.gov/travel/yellowBookCh4-Measles.aspx
http://wwwn.cdc.gov/travel/yellowBookCh4-Mumps.aspx

Traveling adults and adolescents who are unsure of their immunity to measles or mumps should have two doses of the MMR vaccine 28 days apart or have their blood checked for antibody levels.

Measles
Measles remains a common disease in many parts of the world.  According to the World Health Organization (WHO), more than 20 million people worldwide are affected by measles each year.  Because of the risk of measles in both developed and developing countries, all international travelers should be up-to-date on immunizations, regardless of the travel destination.
 http://wwwn.cdc.gov/travel/content/in-the-news/measles.aspx

Pertussis (Whooping Cough) & Tetanus
Australia-
 Since early 2009, several areas in Australia have reported an increase in cases of pertussis. As of April 13, 2009, more than 7,000 cases have been reported across the country.
 This outbreak highlights how important it is for all international travelers to be up-to-date on routine vaccinations such as pertussis vaccine, regardless of the travel destination.
http://wwwn.cdc.gov/travel/contentPertussisAustralia.aspx

A tetanus booster is often forgotten by travelers.  This can cause difficulties when minor injuries occur, and the traveler cannot find a clinic for a tetanus booster or does not know his vaccination status.  Vaccinate before your trip, and ask for the new tetanus combination booster which contains both tetanus and acellular pertussis vaccine for whooping cough. 

Developing countries have high rates of pertussis infections putting the traveler at risk.  In addition,  the US has experienced a study increase in whooping cough or pertussis cases since 1980, in adolescents and adults.  Infected persons are highly infectious and often are not aware that their irksome, barking cough is pertussis.  Previous vaccination or infection as a child with pertussis does not give lasting immunity. Pertussis is serious and sometimes fatal to unvaccinated infants.  

In March of 2006, the CDC published it's recommendation that all adolescents age 11-18 years receive one dose of Tdap to prevent pertussis infection. 
www.cdc.gov/mmwr/PDF/rr/rr5503.pdf

In December of 2006, the CDC published it's recommendation that adults, in particular certain groups, such as physicians, nurses, dentists and other health care workers with direct patient contact, receive one dose of the newly licensed Tdap vaccine to prevent pertussis infection and outbreaks.  Family members of newborns should be vaccinated to prevent an unrecognized pertussis infection being transmitted to infants not fully vaccinated.
www.cdc.gov/mmwr/PDF/rr/rr5517.pdf

Currently, Tdap is not licensed for use in adults over 65 years of age.  Recommendations for use of Tdap among this older adult group will be available in the future.  A large number of pertussis cases are in the elderly making vaccination with Tdap in persons over 65 years of age advisable.  This is called "off-label" usage of Tdap.  The use of Tdap in older age groups is being studied in the US and elsewhere.  

Adolescents and adults are the major carriers of pertussis in the US.  All unvaccinated travelers are at risk for pertussis.  See a video clip of an infant with whooping cough at this site:
www.pertussis.com 

For details on pertussis infection (whooping cough) and pertussis vaccines click here.

Polio Update
County specific information-
wwwn.cdc.gov/travel/contentPolioOutbreaks.aspx

Q Fever
Netherlands-
The Dutch National Institute for Public Health and the Environment has reported an outbreak of Q fever in the Netherlands. As of June 10, 1,133 human cases have been reported in 2009.  Many of these are in the Noord (North) Brabant Province and southern Gelderland Province.  People can become sick with Q fever by breathing in the C. burnetii bacteria, usually through contaminated barnyard dust and soil. People can also get sick by drinking or eating unpasteurized (raw) milk and dairy products.
http://wwwn.cdc.gov/travel/content/id/1769.aspx

Rabies
Indonesia-

Update of Bali rabies fatalities
Date: Thu, 17 Dec 2009
From: ProMED-mail <promed@promed.isid.harvard.edu>

The Bali rabies outbreak human death count, according to Bali [local] media, has reached 25.
Most human and animal rabies cases have been confirmed near popular tourist destinations on the southern tip of Bali.  However, because the situation is evolving, CDC advises travelers to take precaution on the entire island.
 http://wwwnc.cdc.gov/travel/content/outbreak-notice/rabies-bali-indonesia2008.aspx

Yellow Fever
Argentina-
Yellow fever vaccination is recommended for all travelers older than 9 months who are going to the northern and northeastern forested areas of Argentina, including Iguaçu Falls and all areas bordering Paraguay and Brazil.
See the Updated CDC Yellow Fever Risk Map for Argentina.
http://wwwn.cdc.gov/travel/contentYellowFeverArgentina.aspx

Bolivia-
According to the CDC:
Yellow fever vaccination is required for all travelers >1 year of age. Medical waivers must be translated into Spanish and accompany the International Certificate of Vaccination or Prophylaxis (ICVP). Travelers who do not have a valid ICVP will still be allowed to enter Bolivia if they agree to sign an affidavit exempting the Bolivian state from any liability in the event the traveler gets sick with yellow fever within the Bolivian territory. This last option may cause delays at the point of entry.

CDC recommendations for Bolivia:
Yellow fever vaccination is recommended for all travelers >9 months of age traveling to areas east of the Andes Mountains (see Map 4-16).  This does not include the cities of La Paz or Sucre. Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.
http://wwwn.cdc.gov/travel/destinationBolivia.aspx

Brazil-
Since December 2008, the state of Rio Grande do Sul, on the southern tip of Brazil, has reported 18 confirmed human cases of yellow fever infection. Seven of these people died. This is the first time since 1966 that human yellow fever cases have been reported in Rio Grande do Sul.

Since February 2009, the state of São Paolo in Southern Brazil has reported 25 confirmed human cases of yellow fever, including 9 deaths.  These cases represent an expansion of yellow fever transmission in São Paolo. 

The southern, coastal area of Bahia state and the northern, coastal area of Espírito Santo are no longer considered risk areas for yellow fever transmission, while the yellow fever risk areas have expanded in the states of São Paulo and Paraná.
 http://wwwn.cdc.gov/travel/contentYellowFeverBrazil.aspx

Brazil currently does not require yellow fever vaccination for entrance into the country. However, travelers are strongly urged to get the yellow fever vaccine before traveling to an area of Brazil with risk of yellow fever transmission.  Please refer to the CDC yellow fever risk map for Brazil to see the areas with risk for yellow fever transmission.
 http://wwwn.cdc.gov/travel/contentUpdatedYFMapBrazil.aspx

Ecuador-
According to Shoreland, effective March 1, 2008 the Ecuadorian Ministry of Health requires travelers to the Amazon region of Ecuador to present a yellow fever vaccination certificate.  All travelers should carry their certificate with them when entering that region.

Ivory Coast-
Since May 2008, the Côte d’Ivoire (Ivory Coast) has experienced an outbreak of yellow fever chiefly in and around the city of Abidjan. Nineteen cases have been confirmed by the Côte d’Ivoire Ministry of Health.

Paraguay-
On the basis of Paraguay case reports and the vaccination campaign taking place among the local population, travelers are strongly advised to follow the expanded CDC yellow fever vaccination recommendations for Paraguay.  Until further notice, yellow fever vaccination is now recommended for all travelers older than 9 months who are going to all areas of Paraguay.
wwwn.cdc.gov/travel/contentYellowFeverParaguay.aspx

Tanzania-
According to the embassy of Tanzania web site, travelers arriving from countries where yellow fever is present must present proof of yellow fever vaccination. Vaccination should be given 10 days before travel and at 10 year intervals if there is on-going risk.
wwwn.cdc.gov/travel/destinationTanzania.aspx

Trinidad-
On January 22, 2009, the Trinidad Ministry of Health confirmed that two monkeys have died from the yellow fever virus infection.  This indicates that yellow fever is circulating in the mosquito population.  People traveling outside Port of Spain, especially those who visit rural or forested areas of Trinidad, are at risk for infection with yellow fever virus.
wwwn.cdc.gov/travel/contentYellowFeverTrinidadTobago.aspx

Yellow Fever Vaccination Certificate Issues
This is currently the only disease for which the World Health Organization (WHO) officially establishes vaccination requirements for international travel.

Proof of vaccination may be required for the following reasons:

  1. To obtain a visa to a country with YF.

  2. When arriving in a country from one that has YF.

  3. To enter national parks or other areas in countries with YF.

  4. At the discretion of individual countries.

If proof of vaccination is required, the vaccination must be done at least 10 days before entry.  Certificates are good for 10 years.

As per the WHO, the International Certificate of Vaccination or Prophylaxis (ICVP) for yellow fever is a legal document.  It must be filled out and stamped at an official yellow fever vaccination site  and must be complete in every detail to be valid.

To prevent importation and indigenous transmission of YF, a number of countries require a certificate of vaccination from travelers arriving from endemic areas, even if only in transit.  Such requirements may be strictly enforced.  You may be denied entrance unless you submit to taking the vaccine at that time or quarantine.  This can put one at risk for HIV and hepatitis B and C from contaminated needles.  Also, in some situations, the vaccine may be ineffective due to improper handling.

According to the State of South Dakota "yellow fever vaccination center guidelines":

  • The International Certificate of Vaccination for yellow fever is an official record.

  • The vaccination center is required to assume responsibility for immunization and health education for travelers receiving yellow fever vaccination. 

 

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