Beware of fake malaria drugs in Asia

by Erik McLaughlin on

A really interesting article over at Medical News Today looks at the prevalence of fake anti-malarial medications being sold, especially in China. The article is the result of a communal project involving physicians, public health workers, and Interpol participating in “Operation Jupiter” to uncover the unfortunately common practice of fake medication being sold to travelers. The original article, published in the Public Library of Science can be read here.

The anti-malarial drugs often contained no medications of benefit to malaria prevention. Worse than that were the medications that actually contained harmful substances such as banned medicines and ingredients from the street drug Ecstasy. But wait, it gets even worse! Some of the medicines sold had trace amounts of the known anti-malarial drug called Artesunate. There was just enough to pass the drug screening test, but not enough to provide any decent protection. This means that a resistance to Artesunate can build, rendering a very potent anti-malarial drug worthless.

One suspect, from the Yunnan province, is charged with selling 240,000 packs of fake Artesunate. This is an amount large enough to give false hope of protection from malaria to almost a quarter of a million people. However, only ten percent of this was able to be seized and removed from the market.

This article underscores the importance of knowing where your medication comes from. There are many reputable pharmacies worldwide, but there are also some shadier, backdoor places that have these unlicensed and harmful products. The best advice would be to get your medications from your home country or from a known and confirmed reputable place.

Make sure you get the medications you are paying for and are actually being protected from malaria.

Prevent the dangerous “economy class syndrome”

by Erik McLaughlin on

A DVT (deep vain thrombus) is a condition that can be life threatening in travelers. You can get this from having poor blood circulation in the lower body, which leads to the blood clotting in the veins of the legs. The danger occurs if this clot finds its way to the lungs, suffocating the victim. This condition also goes by a few other names like VTE (venous thrombo-emobolism), PE (pulmonary emolism) or “economy class” syndrome” due to the cramped leg space on some airline carriers.

The veins of the legs carry blood, under low pressure, back to the heart and lungs, to be recharged with fresh oxygen. When a clot develops in these veins, it can be very large due to the increased diameter of the veins in the legs. Normal, healthy blood is made to clot and prevent somebody from bleeding to death in the event of a trauma. Blood also clots if it is not moving at its standard rate as well. A person sitting in a plane or car, for greater than 3-4 hours, is at risk for having decreased blood flow in the legs which can cause this dangerous clotting.

A sharp pain in the chest, increased heart rate and shortness of breath are all common symptoms. The DVT can occur several days after a trip and is, usually, first noticed as swelling of one leg more than another.

Travelers need to know how to maintain good blood flow in the legs, thus minimizing the risks of this deadly condition. For longer flights, trains, and drives, they key is mobility! Get up and out of your seat every hour to walk around. Visit the bathroom, walk the isle for a few paces or do some simple stretches in your chair. Some of my favorite stretches include flexing my calf muscles by raising my heels off the ground and placing my weight on the balls of my feet. Deep knee bends also work very well for stretching the muscles of the legs and increasing blood flow to the area.

Treatment for these conditions are required immediately. Medicines such as heparin or enoxaparin are commonly used. Awareness of this condition and taking steps to ensure good blood flow to the legs, during travel are the keys to prevention.

Resources: CDC Traveler’s Health Yellow Book: DVT

Painful lesson on stray pets in foreign countries

by Iva Skoch on

Have you ever been tempted to save that “poor little puppy’s” life by airlifting it from its miserable life in Egypt, Greece or Asia, and bringing it home, so you can pamper it with vitamin bones and pet spa treatments? I have friends who have rescued a puppy from one of the Greek islands (don’t ask how they got her on the plane) and after 10 years, they are still enjoying each other’s company in DC.

However, after reading this blog on latimes.com, you might want to stay away from stray pets for a while. Especially in Iraq.

Apparently, the rule for troops about wild animals in Iraq is very clear: Leave them alone, no matter how cute they are. But what’s a soldier, missing his pets from home, to do? One young Marine could not resist a stray cat in an Iraqi village. As he was holding the cat, the animal went on a biting and scratching jag, “striking the Marine in a vulnerable spot”. The Marine ended up being evacuated for medical care. He will certainly have some good stories about his war wounds.

Israeli pilots may receive Viagra to boost performance

by Aaron Hotfelder on

According to a recent study conducted by Israeli doctors, the erectile-dysfunction drug Viagra may help the performance of pilots at high altitudes. Now, doctors in the Israeli army are considering giving the drug to their combat pilots, who can fly at altitudes of up to 50,000 feet.

According to some military doctors, “The Viagra family of drugs is considered effective in these conditions because when there is a long shortage in oxygen it leads to high blood pressure in the lungs, and the drugs help fight that.”

The pilots are being asked to see their doctors if they are kept in the air for over four hours.

More here.

Yellow Fever: Vaccine Deaths and Outbreaks in South America

by Erik McLaughlin on

Most travelers to Africa and South America have heard of Yellow Fever, even if only because there are countries within that have mandatory vaccinization requirements. People that live in these “Yellow Fever Zones” (an estimated 508 million in Africa alone) know this disease as a killer. This is also what is happening in Brazil.

ProMED mail, from the International Society of Infectious Disease, recently reported a third case and second fatality from YF since the new year. The latest case involved a 24-year-old man from the region of Goianesa. In 2008, there are 26 suspected cases, three confirmed, and 17 pending results of labwork. Six of the suspected cases have been excluded. Brazil also reported to the World Health Organization (WHO) that monkeys were dying of YF, in December 2007.

The Center for Disease Control (CDC) in Atlanta has also released an outbreak notice and stresses the importance of the vaccine for travelers heading to yellow fever areas.

Immunization is the traditional preventative measure against Yellow Fever, and the in Congonhas airport in Sao Paulo — a major travel hub for the region — 1000 people a day are receiving the free vaccine. Savvy travelers may have heard news of a few vaccine associated deaths recently, in Peru. The vaccines in question were manufactured in Brazil, by Bio-Manguinos. All deaths are still under investigation and believed to be associated with the same lot numbers. The vaccines used in North America are from a seperate manufacturer, Sanofi-pasteur. All vaccines from the batch in question, and several from related lots, have been removed.

The Yellow Fever vaccine is considered relatively safe and effective by the CDC. Administered as a single dose under the skin, the vaccine is a live virus. Contraindications to the vaccine are people who are pregnant, immunocompromised or less than 9 months old. Interestingly, the vaccine is grown in chicken eggs and is also to be avoided by those with egg allergies. WHO advises the vaccine be given routinely to children in endemic areas, around the age of 9 months to one year of age. For travelers who are not candidates for the vaccine, a waiver is possible.

Why do you need the vaccine? Besides the country requirements for entry, the disease can be fatal.

Here is some basic information on the disease:

Basics: An Arbovirus spread via arthropods (mosquitos) in the genus Flavivirus. Symptoms include fever, head and backaches, fatigue and nausea. May progress to hemorrhagic complications and/or liver failure. Jaundice is also common. This is a vaccine preventable disease and proof of vaccinization is often required at customs.

Location: Only in Africa and South America. No reported cases in Asia, although the required mosquito species is present to carry the disease.

Transmission/Incubation: Bites from infected Aedes species mosquitoes in cities or Haemagogus species in jungles. The main vector is Aedes Aegypti in urban areas and an incubation of 3-6 days.

Prevention: Vaccination lasts for 10 years and is a live virus. Contraindicated with egg allergy, immunocompromised, pregnancy or less that 9 months old individuals. Mosquito awareness/ bite prevention is the other key.

Diagnosis: Antibodies to YF through a blood draw.

Treatment: This is a vaccine preventable disease, treatment once infected is supportive.

Resources:

CDC Yellow Fever Page

WHO Yellow Fever Vaccine

Interactive Health Map of South America