Preventative Care

Seasonal Flu Shots

The flu shot is an inactivated vaccine that is given with a needle, usually in the arm. The seasonal flu vaccine protects against three influenza viruses. Read more at the Centers for Disease Control & Prevention Website.

The Flu shots are available to our patients starting September – December.

Hepatitis A – Hepatitis A is caused by the Hepatitis A virus (HAV). Worldwide there are an estimated 1.4 million cases of Hepatitis A infection every year. Distribution is global but the infection is most common in areas where sanitation is poor and food and water safety is questionable. Hepatitis A is endemic throughout the underdeveloped world and it occurs in pockets in developed countries as well. This highly contagious disease is spread through contaminated food and water including ice; breakdowns in sanitation due to natural disasters and floods; infected food handlers; ingestion of raw or undercooked shellfish harvested from sewage-contaminated waters; ingestion of uncooked and unpeeled fruits and vegetables. Although rare, it can be transmitted through blood transfusions, sexual relations or needle sharing.

The risk of infection for travelers to developing countries increases with extended stays. Areas of high risk for Hepatitis A include Africa, Mexico, the Middle East, Central and South America, Asia, and the Caribbean. Hepatitis A virus is also present in the Mediterranean basin and Eastern Europe where the risk of infection is greater for those who visit rural areas, the back country, or those who eat or drink in areas of poor sanitation.

Adult travelers are urged to receive at least the first injection before departure and a follow-up booster at 6 months. Twinrix combines Hepatitis A and Hepatitis B into a 3 dose series saving several needle sticks.

Source: CDC Vaccine Information Statement (VIS): Hepatitis A – (3/21/06) 42 U.S.C. § 300aa-26

Hepatitis B – Hepatitis B is caused by the Hepatitis B virus (HBV). Hepatitis B exists everywhere in the world and cuts through all socioeconomic groups and it’s chronically present in all of Africa, China, Korea, Indonesia, the Philippines, the southern and western Pacific, the Middle East, Haiti, the Dominican Republic and the Amazon River Basin. Intermediate incidences of chronic Hepatitis B occur in South and Central America, Russia, Japan, southwest Asia, eastern and southern Europe and most areas surrounding the Amazon River Basin.

The Hepatitis B virus is transmitted primarily through contact with blood or blood-derived fluids, often by unprotected sexual activity. Open skin lesions from scabies and scratched insect bites can play a role in transmission of the Hepatitis B virus if direct exposure to wound exudates occurs. Hepatitis B can be easily transmitted through blood transfusions and through medical, dental or other exposure to contaminated needles (e.g. IV drug use, acupuncture, tattooing, etc).

Chronic Hepatitis B infection can lead to cirrhosis and liver cancer. Adult travelers are urged to receive a full course of injections (3) before departure. If this is not possible, the Hepatitis B vaccine can be administered in an accelerated schedule. Hepatitis A & Hepatitis B are available together in a 3 shot series vaccine called Twinrix, saving several needle sticks.

Source: CDC Vaccine Information Statement (VIS): Hepatitis B (7/18/07) 42 U.S.C. § 300aa-26

Pneumococcal – Pneumococcal disease (Pneumonia) is generally caused by the Bacterium Streptococcus Pneumoniae and it is the most common complication of the flu. Infection is acquired by direct person-to-person contact via respiratory droplets. Travelers at risk to contract Pneumonia include children under 5; adults older than 55; those with sickle cell disease and other blood diseases, diabetes, HIV, chronic renal (kidney) failure, cerebrospinal leaks and people with compromised immune systems. There are several drug-resistant strains of the bacterium that causes Pneumonia and that is why travelers should consider the vaccine if they are at high risk.

Source: CDC Vaccine Information Statement (VIS): Pneumococcal Polysaccharide 4/16/09 and Pneumococcal Conjugate 12/09/08

Polio – Measles is a highly contagious viral disease that causes up to 875,000 deaths annually around the world. Measles associated symptoms include fever; generalized, blotchy rash; runny nose and white spots in the mouth. Transmission occurs primarily through respiratory droplets and all non-immunized travelers are at high risk of exposure outside the United States.

Mumps is an acute viral disease characterized by fever, swelling and tenderness of at least one salivary gland. Travelers’ at risk of infection can be high since many countries do not use the Mumps vaccine routinely.

Rubella is another acute viral disease that usually affects susceptible individuals of any age. Rubella is prevalent worldwide and the risk of exposure outside the United States is high. Rubella is associated with significant morbidity in adults and high rates of miscarriage and anomalies of congenital Rubella syndrome if contracted in the first trimester of pregnancy.

Source: CDC Vaccine Information Statement (VIS): MMR Vaccine (3/13/08) 42 U.S.C. §300aa-26

Tetanus/Diphtheria and Pertussis – Tetanus can occur anywhere in the world in inadequately vaccinated persons. Diphtheria and Pertussis (Whooping Cough) are more frequent in parts of the world where vaccination levels are low.

Diphtheria is a very contagious and potentially life-threatening infection. It can attack the nerves and heart and leave you with severe, life-long complications. Diphtheria is caused by Corynebacterium diphtheriae, a bacterium. The bacterium produces a toxin (poison) that is carried in the bloodstream. Diphtheria is a serious risk for travelers, particularly in Eastern Europe where many people are not vaccinated. Diphtheria bacteria live in the mouth, nose, throat, or skin of infected persons and it spreads from person to person very easily. A traveler can get Diphtheria by breathing in Diphtheria bacteria after an infected person has coughed or sneezed. People also get Diphtheria from close contact with discharges from an infected person’s mouth, nose, throat, or skin. Symptoms include a sore throat and mild fever, difficulty swallowing, swollen lymph glands. Diphtheria is easily preventable with the Tetanus/Diptheria or Tetanus/Diphtheria/Pertussis (Whooping Cough) vaccine.

Tetanus is another vaccine preventable disease that can be fatal even with intense supportive treatment (up to 20% of all cases). Tetanus is caused by the bacterium Clostridium tetani which lives in the soil worldwide. Tetanus is a global problem occurring in unimmunized persons after an uncleaned wound or cut. Tetanus is characterized by uncontrolled muscle spasms caused by the neurotoxin that attacks the central nervous system. Seizures are not uncommon.

Pertussis or Whooping Cough is a highly contagious disease of the respiratory tract caused by Bortedella Pertussis that kills close to 300,000 humans every year. It is transmitted by direct contact with airborne discharges from infected persons. Most fatalities occur in the new born population and infants in underdeveloped countries. Patients with respiratory Pertussis require hospitalization, immediate treatment with Pertussis antitoxin, appropriate antibiotics, and supportive care. It is recommended that all travelers receive a vaccine to protect themselves against Pertussis. There are two options for vaccination against these diseases: Diphtheria and Tetanus (Td) vaccine and Diphtheria, Tetanus and Pertussis (Tdap – Adacel) vaccine.

Sources: CDC Vaccine Information Statements (VISs): Tetanus/Diphtheria Vaccine 6/10/94 and Tetanus/Diphtheria/Pertussis Vaccine 11/18/08

Varicella – Varicella (Chickenpox) is a common disease of childhood caused by a virus that is very easily passed from person to person. It usually causes 250-500 itchy blisters, fever, and fatigue and usually lasts 4-5 days. Anyone who has not had Chickenpox may be at risk. The disease is more severe in older individuals who missed getting it when they were children and adults are 5 to 10 times more likely than children to have complications. Vaccination may be appropriate for adults and children over 12 months of age who have not had Chickenpox. Chickenpox is a common childhood disease in the U. S.; however it is an adult disease in many tropical climates. Traveling adults should consider vaccination if they have not had the disease.

Source: CDC Vaccine Information Statement (VIS): Varicella Vaccine (3/13/08) 42 U.S.C. §300aa-26

What is Osteopenia? Osteopenia describes bone that is weaker than normal bone. It can lead to Osteoporosis.

Prevention Strategies

What is Osteoporosis? Osteoporosis is a condition that is characterized by bones that are less dense than, and fragile than normal bone. Osteoporosis increases the risk of bone fracture with even minor trauma, such as a fall from standing height, or even from a cough or sneeze. Unfortunately, people often do not realize they have osteoporosis until either they have a fracture or have a screening test ordered by their doctor to check for osteoporosis.

Osteoporosis and low bone mass affect an estimated 44 million Americans (National Osteoporosis Foundation 2008). Women are four times more likely to develop osteoporosis than men. Other risk factors include older age, family history of osteoporosis, small and thin stature, inactive lifestyle, smoking, alcohol, and use of certain medications including steroids.