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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 travel vaccinations, such as typhoid and yellow fever, and prevention of malaria and other travel diseases.  Look at the page Why Travel Medicine? to better understand how travel medicine can help you have a safe trip.

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

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

  • Phone:               605-718-3300

  • Fax                    605-718-3425 

     

  • 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
October 10, 2008

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

Aviation Notes - 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 Notes - 2

  • Many airlines are starting to charge for each checked bag.  Also, be prepared to pay for blankets, pillows and other amenities.  Check with your airline.

Bird Flu
According to the WHO, travelers to countries experiencing bird flu (avian influenza) are not considered to be at risk unless there is direct and unprotected contact with infected birds, including feathers, feces, under-cooked meat or egg products.  Avoid handling surfaces contaminated by above.

In infected countries, avoid direct contact with poultry, including well appearing, sick, or dead chickens or ducks.  Avoid places such as poultry farms, bird markets where live or poultry are kept or raised.  There is no risk in eating cooked chicken or duck.
wwwn.cdc.gov/travel/contentAvianFluInformation.aspx

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://www.cdc.gov/ncidod/dvbid/Chikungunya/index.htm
http://wwwn.cdc.gov/travel/contentChikungunyaFever.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.

Brazil-
As of March 28, 2008, Brazilian Health Authorities reported a national total of 120,570 cases of dengue fever, including 647 DHF cases and 48 deaths for 2008.

As of April 10, 2008, a total of 75,399 cases of dengue fever, including 80 confirmed deaths had been reported in Rio de Janeiro this year.
http://wwwn.cdc.gov/travel/contentDengueTropicalSubTropical.aspx

In the August 18, 2008, ProMED-mail report:
The coastal state of Ceara, Brazil,  is recording the 2nd largest epidemic of dengue since 1986.  The weekly bulletin of the Secretariat of Health reports 37,549 cases in 184 municipalities. Fortaleza continues to have the greatest number of recorded cases of DHF, totaling 250, with 8 confirmed deaths and 12 under
investigation. More than 98 percent of the neighborhoods have
confirmed [cases of] classical [dengue] disease.

Hand, Foot, and Mouth Disease

Asia-
Since March 2008, a growing number of cases of hand, foot, and mouth disease (HFMD) has been reported in parts of Asia, mainly affecting children. HFMD is common among infants and 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.

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.

http://wwwn.cdc.gov/travel/contentHandFootMouthAsia.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

Japan & Import of Banned Medications
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

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

Israel & Switzerland-
Currently, numerous measles outbreaks are ongoing worldwide, including outbreaks in Switzerland and Israel, which have resulted in cases imported into the U.S.
http://wwwn.cdc.gov/travel/contentMeasles.aspx
http://wwwn.cdc.gov/travel/contentIsraelPassover.aspx

Passports-Western Hemisphere
Implemented on January 23, 2007, ALL PERSONS traveling by air between the United States and Canada, Mexico, Bermuda, and the Caribbean region are required to present a passport or other valid travel document to enter or re-enter the United States.

LAND AND SEA TRAVEL
The following summarizes information available on the Department of Homeland Security’s website.

  • JANUARY 31, 2008
    U.S. and Canadian citizens will need to present either a WHTI-compliant document, or a government-issued photo ID, such as a driver’s license, plus proof of citizenship, such as a birth certificate. DHS also proposes to begin alternative procedures for U.S. and Canadian children at that time.

     
  • LATER
    At a later date, to be determined, the departments will implement the full requirements of the land and sea phase of WHTI. The proposed rules require most U.S. citizens entering the United States at sea or land ports of entry to have either a U.S. passport; a U.S. passport card; a trusted traveler card such as NEXUS, FAST, or SENTRI; a valid Merchant Mariner Document (MMD) when traveling in conjunction with official maritime business; or a valid U.S. Military identification card when traveling on official orders.
     

Note: The passport requirement does NOT apply to U.S. citizens traveling to or returning directly from a U.S. territory.

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.  Specific advice for travelers to China can be found on the following web site:  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. Between January 1 and July 24, 2008, 660 human cases have been reported in 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

Rabies-Unavailability of Rabies Pre-exposure Vaccination
As of May 20, 2008, both Sanofi Pasteur and Novartis rabies vaccine producers have been supplying rabies vaccine only for treatment of patients potentially exposed to rabies.  This is due to Sanofi Pasteur renovating it's production facilities in France.  Pre-exposure vaccination must be delayed until further notice. 

Novartis Vaccines is no longer be shipping supplies of RabAvert®. To obtain IMOVAX® rabies vaccine, clinics must first contact their Rabies State Health Official so that a risk-assessment can be conducted for the suspected exposure.  
September 4th update:
http://www.cdc.gov/RABIES/news/RabVaxupdate.html

Tetanus & Whooping Cough
Tetanus, also known as "lockjaw," and whooping cough (pertussis) are serious illnesses.   Both illnesses occur worldwide. 

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.  All unvaccinated travelers are at risk for pertussis.
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.  All unvaccinated travelers are at risk for pertussis.
www.cdc.gov/mmwr/PDF/rr/rr5517.pdf

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-
On December 1, 2007, the Bolivian Consulate General in the US, advised that all persons older than 12 months traveling to Bolivia must have a valid International Certificate of Vaccination or Prophylaxis (ICVP) to ensure protection against yellow fever.  

According to the CDC:
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.

According the CDC recommendation for Bolivia:
(Yellow fever vaccination) for all travelers >9 months of age traveling to areas east of the Andes Mountains (see Map 4-16). 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-
Travelers are strongly advised to follow the CDC yellow fever vaccination recommendations for Brazil, with the addition of the northern part of Espiritu Santo state and the western part of Santa Catarina state. The Federal District of Brasilia is also an endemic area. The Brazilian MOH has recommended vaccination of travelers >6 months of age.
wwwn.cdc.gov/travel/contentYellowFeverBrazil.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 CDC yellow fever vaccination requirements for Tanzania have changed. Vaccination is now required for travelers arriving from all countries.
wwwn.cdc.gov/travel/destinationTanzania.aspx

Yellow Fever Vaccination Certificate Issues
This is currently the only disease for which the World Health Organization (WHO) officially makes 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. 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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