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
travel vaccinations, such as typhoid and yellow fever, and prevention of
malaria and other travel
diseases. We welcome any travel and vaccination questions you
may have at 718-3300.
South
Dakota Yellow Fever Vaccination Site
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Clinic Hours: 8 AM to 5 PM Monday -
Thursday
(Friday AM by special appointment)
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Phone: 605-718-3300
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Fax
605-718-3425
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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 June 5, 2009
Airport Screening
Do you know what 3-1-1 means? See
www.tsa.gov/travelers
Aviation Notes - 1
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Always keep prescription medicines in your carry-on
in the original labeled container.
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Use the 3-1-1 rule for toiletries, cosmetics, lotions
etc.
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To allow for
parking, check-in and other unforeseen
delays, travelers should plan on arriving at the
airport:
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2 hours before domestic
flights
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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 Notes - 2
Aviation Notes - 3
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 been occurred in a number of
countries which have never previously reported chikungunya. Travelers are advised to practice daytime and
nighttime insect precautions.
http://wwwn.cdc.gov/travel/contentChikungunyaFever.aspx
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.
wwwn.cdc.gov/travel/contentDengueTropicalSubTropical.aspx
Argentina-
Approximately 25,000 people have reportedly become ill.
Bolivia-
In January 2009 health officials in Bolivia declared a health
emergency due to increasing cases of dengue fever. As of May 20, 2009, the Bolivian Ministry of Health reports 59,900
suspected cases of dengue fever. For more information on this
outbreak, listen to this
podcast from the World Health Organization (WHO).
Brazil-
Over 226,500 suspected cases of dengue and 87 deaths were
reported through April 15, 2009.
Paraguay-
As of May 20, 2009, 3,000 cases have been reported.
Malaysia-
During the first 3 weeks of January 2009, 4,200 cases and 12
deaths from dengue fever were reported. Kuala Lumpur has been
particularly hard hit, reporting over 400 cases and 2 deaths
during this time period.
Netherlands Antilles-
There was an increase in dengue cases on the islands of St.
Maarten, Saba, and Curaçao in late 2008. More than 500 cases of
dengue fever have been confirmed on St. Maarten and nine cases
of dengue fever have been recorded in Saba. Saba officials say
this is the largest number of dengue cases reported on the
island in the past 30 years.
Australia-
As of May 5, 2009, Queensland Health reported 993 confirmed
cases of dengue fever in the northern part of that state, which
is located in northeastern Australia.
French Polynesia_
As of April 12, 2009, just over 300 cases of dengue have been
confirmed on the islands of Tahiti, Tahaa, Bora-Bora, Raiatea,
Moorea, Tahaa, and Ua Pou.
Netherlands Antilles-
As of November 5, 2008, health officials in the Netherlands
Antilles reported an increase in dengue cases on the islands
of Saint Martin, Saba, and Curaçao in late 2008. More than
500 cases of dengue fever have been confirmed on Saint
Martin and nine cases of dengue fever have been recorded in
Saba. Saba officials say this is the largest number of
dengue cases reported on the island in the past 30 years.
Flooding in Fiji
Torrential rains in January caused massive flooding
throughout low-lying areas of Fiji. As of February 3,
2009, the Ministry of Health in Fiji has reported 50 cases of
dengue fever and 8 cases of leptospirosis associated with the
flooding. The Ministry of Health has also warned its citizens
about typhoid.
wwwn.cdc.gov/travel/contentFloodingFiji.aspx
Flu (Swine)
see Swine Flu
below.
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:
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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.
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Eat foods that are fully cooked and
served hot.
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Drink beverages that have been properly
bottled and sealed (water, carbonated drinks, or sports
drinks).
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Do not put ice in drinks.
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Eat only fruits and vegetables that you
can wash and peel yourself.
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Do not share eating utensils, such as
forks, spoons, and cups.
Hemorrhagic Fever
Uganda-
In January 2008, during trip to Uganda, a US
citizen contracted Marburg Hemorrhagic Fever visiting “the
python cave” in the Maramagambo Forest in western Uganda (at the
southern edge of Queen Elizabeth National Park). A popular
tourist destination, this cave contains large numbers of fruit
bats. These bats can harbor Marburg virus.
In July 2008, a Dutch tourist visited this
same cave and died from infection due to Marburg virus after she
returned home.
http://wwwn.cdc.gov/travel/contentMarburgUganda.aspx
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
Japanese Encephalitis Vaccine Shortage
As of May 2008, Sanofi Pasteur will be
limiting US travel clinic orders of JE-VAX®
to a total of 9 doses per month. This
means you should plan as far ahead as possible for your JE
vaccination. These ordering restrictions are expected to
last until 2009 when
Intercell's IC51 JE vaccine will be available in the US.
http://wwwn.cdc.gov/travel/contentJapaneseEncephVaccine.aspx
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
Since the beginning of 2009, CDC has received reports of
several outbreaks of measles worldwide, including:
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An outbreak of measles in the Swiss
cantons of Vaud and Lucerne.
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Reports of increased numbers of
measles cases in Victoria and Queensland, Australia.
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An outbreak of measles in Vietnam,
including the city of Hanoi.
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From December 1, 2008, through
January 31, 2009, CDC received reports of nine imported
cases of measles; six of these cases were imported from
the United Kingdom.
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/contentMeasles.aspx
Meningitis
Meningitis is a life threatening, bacterial infection that
occurs worldwide.
Africa-
Epidemic
meningitis activity is occurring across the meningitis belt.
While several countries in this area are currently reporting
meningitis activity, the majority of cases during this period
come from Nigeria, Niger, Chad, and Burkina Faso.
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Nigeria: As of late April 2009, the
United Nations reported 39,841 cases and 1,886 deaths.
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Niger: As of May 4, 2009, 11,609 cases
and 472 deaths have been reported. According to WHO, 2
districts have crossed the epidemic threshold while 8 others
have crossed the alert threshold.
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Chad: As of April 26, 2009, a total of 1,
165 cases and 128 deaths from meningitis have been reported.
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Burkina Faso: As of April 20, 2009, a
total of 3, 390 suspected cases and 438 deaths have been
reported.
wwwn.cdc.gov/travel/contentMeningAfrica.aspx
India-
Since January 2009, local health officials in India have
reported 230 deaths and 2,000 possible cases of meningitis in
the northeastern states of Tripura, Meghalaya, and Mizoram.
These states are in the part of India bordered by Bangladesh to
the west and Myanmar (Burma) to the east. Travelers to
this part of India or to any other area currently experiencing
meningitis epidemics should get the meningococcal vaccine.
wwwn.cdc.gov/travel/contentMeningococcalIndia.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 infectious 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.
www.cdc.gov/mmwr/PDF/rr/rr5517.pdf
Poisons & Toxins
China-
According to the CDC,
as of September 22, 2008, contaminated milk products
in China have caused nearly 40,000 infants to be brought in for
medical care, with almost 12,900 hospitalizations, and at least
three infant deaths in China. Similar health problems have been
reported in Hong Kong and Singapore but have not been confirmed.
wwwn.cdc.gov/travel/contentMelamineChina.aspx
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. Since January 2008, over 1000 human
cases have been reported. 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/contentQFeverNetherlands.aspx
Swine Flu (H1N1
Flu)
Mexico-
CDC’s Travel Health Warning recommending against non-essential
travel to Mexico, in effect since April 27, 2009, has now been
downgraded to a Travel Health Precaution for Mexico.
http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx
Official Swine Flu web site:
http://www.cdc.gov/swineflu
Rabies Outbreak Notice
Bali, Indonesia-
On December 18, 2008, the Indonesian Ministry of
Agriculture reported to the World Organization for Animal
Health an ongoing outbreak of rabies in dogs on the island
of Bali, Indonesia. Rabies has been confirmed in dogs from
at least
two villages near popular tourist destinations on the
southern tip of Bali. At this stage rabies has
been identified in animals in only one district but CDC
advises travelers to take precautions on the entire island.
http://wwwn.cdc.gov/travel/contentRabiesBaliIndonesia2008.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:
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To
obtain a visa to a country with YF.
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When arriving in a country from one that has YF.
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To enter national parks
or other areas in countries with YF.
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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":
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The
International Certificate of
Vaccination for yellow fever is an official record.
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The vaccination center is required to
assume responsibility for immunization and health education
for travelers receiving yellow fever vaccination.
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