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.
Dakota Yellow Fever Vaccination Site
Rabies Vaccination Site
Clinic Hours: 8 AM to 5 PM Monday -
(Friday AM by special appointment)
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 -
Notices to Travelers
updated March 11,2010
Information for Healthcare
Providers & Others Traveling to or from Haiti
Do you know what 3-1-1 means? See
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
To allow for
parking, check-in and other unforeseen
delays, travelers should plan on arriving at the
2 hours before domestic
3 hours before international
*Travelers may be denied boarding passes at
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
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
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
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
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
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
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.
Recommendations and guidance for clinicians
in prescribing antiviral medications for treatment and
prevention of influenza during the 2009-2010 season.
Banned Medications & Drugs
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
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
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
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
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 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.
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.
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.
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
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.
Dengue Fever & Dengue Hemorrhagic Fever (DF
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)
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
The country of Cape Verde reported its first outbreak of dengue
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.
Dengue is circulating widely throughout this region. Examples of
outbreaks include the following:
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.
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
As of September 5, the Western Pacific Region of the WHO has
reported more than 24,000 cases of dengue and 224 deaths for
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.
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,
Distribution of Dengue maps. For more information on
dengue and updates on worldwide activity, see CDC’s
Dengue website and WHO’s
Hand, Foot, and Mouth Disease
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.
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
Drink beverages that have been properly
bottled and sealed (water, carbonated drinks, or sports
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.
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.
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.
Japanese Encephalitis-New Vaccine IXIARO®
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.
is no longer being produced, and limited
supplies remain. Therefore, the CDC currently recommends that
only be used for children aged 1-16 years of age.
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).
The CDC recommendations for traveler antimalarial medication in Kingston, Jamaica
have been rescinded as of February 2008.
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.
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 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
Pertussis (Whooping Cough)
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
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.
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
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
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
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.
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
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:
details on pertussis infection (whooping cough) and pertussis
County specific information-
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
Update of Bali rabies fatalities
Date: Thu, 17 Dec 2009
From: ProMED-mail <email@example.com>
The Bali rabies outbreak human death count,
according to Bali [local] media, has reached 25.
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.
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.
Updated CDC Yellow Fever Risk Map for Argentina.
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
Yellow fever vaccination is recommended for all travelers >9 months of age traveling to areas east of the Andes Mountains (see
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.
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.
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.
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
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.
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.
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.
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.
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.
Yellow Fever Vaccination Certificate
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:
obtain a visa to a country with YF.
When arriving in a country from one that has YF.
To enter national parks
or other areas in countries with YF.
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.
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":
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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