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Travel Medicine Clinic – Vaccinations and Advice

Staff

Clinic Director: Dr. Sharon Reisfeld
Clinic Head Nurse: Aliza Vaknin
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About the clinic

The Travel Medicine clinic offers advice and explanations regarding common diseases in the region where you are planning to travel (gastrointestinal infections, malaria, altitude sickness, etc.), how to prevent sickness while travelling, and vaccinations before travel abroad. The advice is provided by doctors who specialize in infectious diseases and is individual for each traveler – taking into account current health, destination, length of stay, and nature of the trip.
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Important!

  • The risk of catching an infectious disease while traveling to an overseas destination is dependent on the area, sanitary conditions, length of stay, and conditions during the trip (a backpacking trip vs. staying at hotels, etc.) 
  • You must be vaccinated at least one month before your trip so as to ensure, should they be necessary, vaccinations that are given as a series and the prevention of the side effects of vaccinations during the trip itself. It should be noted that some vaccines require several injections a number of weeks apart. 
  • Please bring previous vaccination booklets so as to prevent unnecessary vaccinations, since there is no computerized information available regarding vaccinations administered at the health clinics or different travel medicine clinics. 
  • Those with special medical needs are asked to bring a summary of their medical information with them. 
  • It is recommended that travelers with medical problems consult with their regular doctor before travelling. Please take with you a supply of medications sufficient for the entire trip. Likewise, it is advisable to have a document in English that lists the nature of the disease(s) and the medications the traveler takes on a regular basis. 
  • Under age 18 – please come accompanied by one of your parents. 
  • We recommend eating before your visit.
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Health behavior overseas

  • Ensure personal hygiene, including washing your hands before eating and after leaving the bathroom. 
  • In third world countries, we recommend avoiding drinking tap water that has not been boiled. You can drink closed bottled water, boil the water, or use a water purifier. 
  • Make sure to avoid mosquito bites by applying mosquito repellant that contains at least 25% DEET to exposed parts of the body and using mosquito nets and preventative treatment in areas with high incidence of malaria. 
  • It is important to have awareness regarding altitude sickness and ensure that you ascend gradually to high altitudes. In specific cases, preventative treatment can be given. 
  • Avoid unprotected sexual intercourse, particularly in light of an increased risk of sexually transmitted diseases, including HIV (AIDS), and hepatitis B, and make sure to use a condom. 
  • In cases of bites or injuries and risk of rabies, wash the wound well with running water and seek out medical treatment within 24 hours. For specific areas and types of trips, we recommend having the rabies vaccine before your trip.
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Characteristic diseases

Mosquito-borne diseases

There are many diseases that can be transferred by mosquito bites, some common in specific areas of the world, some that can be prevented by vaccination or preventative treatment, and others where only the symptoms can be treated, with no possibility of prevention.

 

Therefore, it is important to protect yourselves from mosquito bites by applying mosquito repellant that contains at least 25% active ingredient (DEET), and in high risk areas, mosquito nets and preventative treatment for malaria should be used.

 

  1. Malaria – a parasite transferred by mosquito bites, particularly during the evening and at night. The disease is particularly prevalent in Africa, but there is also a risk for malaria in East Asia and Central and South America. The signs of the disease are primarily fever and trembling. Treatment is available for the disease, but there is a risk of complications and even death if there is a delay in diagnosis and treatment. There is no vaccination to prevent malaria, but there are, among other things, two effective pills for preventative treatment:
    • A. Malarone (Atovaquone/ Praguanil) – the pill must be taken once a day, beginning with the day before entering the area with malaria and continuing one day after leaving it. The medication is prohibited during pregnancy. The main side effects are nausea and stomach ache (uncommon).
    • B. Lariam (Mefloquine) – take the pill once a week. Begin two weeks before entering the area with malaria and continue for four weeks after leaving the region. Possible side effects are stomachache and nausea. There is also a small risk of confusion, hallucinations, depression, and psychiatric disorders. In cases where there is no alternative, a pregnant woman can be given the treatment during her second or third trimesters.
    • C. Self-treatment in an emergency – if no preventative treatment was given, malaria is suspected, and there is no quick access to medical treatment, four Malarone pills can be taken for three days, in one go. We recommend being seen by a doctor as fast as possible for the best possible diagnosis and treatment.
  2. Dengue – a virus transferred by mosquito bites during the daytime. The disease is characterized by fever, intense muscular and bone pain, a rash, etc. It is common in Central and South America, Africa, and East Asia. There is no vaccine or specific treatment. Avoid mosquito bites in areas where the disease is found.
  3. Japanese encephalitis – a virus transferred by mosquito bites. Prevalent in East Asia, particularly rural regions. Causes fever and non-specific symptoms, and in severe cases, brain damage. Protect yourself against mosquitos, and on certain trips (for an extended time or to areas where the disease is particularly prevalent), vaccination is recommended. An effective vaccine against the disease is available, that can be given from the age of two months.
  4. Yellow Fever – a virus transferred by mosquito bites and that can cause severe sickness and even death. The disease is prevalent in specific areas of Africa, and Central and South America. There are certain countries that demand vaccination as a condition of entry. There is a very effective vaccination, but it must not be used by people who are immunocompromised, infants under nine months of age, or adults over the age of 70. The person must be vaccinated at least one week before entering the area where the infection is found. There can be mild side effects from the vaccine, such as fever, muscular pain, or headache. In rare cases, or in people who are immunocompromised – the vaccine itself can cause a serious disease, and they are therefore prohibited from being given the vaccination.

Diseases of the digestive system

The more the trip tends to be of a backpacking character and to be in areas with poorer sanitary conditions, the more the risk of gastrointestinal disorders and diarrhea increases. Ensure you drink bottled/ boiled water or water that has been purified. Ensure you eat cooked food and avoid, as far as possible, raw meat or uncooked seafood. When eating fruit and vegetables, make sure to wash them with soap and water, and prefer peeled fruit and vegetables. A vaccine is available against the bacterial disease of typhoid fever (salmonella) and is recommended for most travelers to third world countries. Most cases of diarrhea and stomachache will pass on their own, or with the help of symptomatic treatment to stop diarrhea and reduce pain, and we therefore recommend taking such medications with you on your trip (e.g. Kalbeten or Imodium). Should the diarrhea continue for three days, or if it is accompanied by a high fever or bloody diarrhea, take antibiotics – Azenil (azithromycin) 500mg, once a day, for three days. If satisfactory improvement is not seen, seek medical treatment.

 

Altitude sickness

As altitude increases, there is a drop in the percentage of oxygen, and there is a risk of altitude sickness. The risk begins at an altitude of around 2,800 meters, and increases with altitude. It appears that certain chronic diseases are linked to a higher risk of altitude sickness, although it is difficult to predict who will suffer from the disease and who will not. The initial symptoms of the disease are a lack of concentration, sleep disorders, headaches, nausea, dizziness, and vomiting. These can be followed by breathing difficulties, convulsions, loss of consciousness, and even death.

 

As soon as the initial signs of the sickness appear, the person must descend to an altitude at which the symptoms pass, remain there for at least 24 hours until they have adapted to the altitude, and renew their ascent at a slower and more gradual manner. It is possible to avoid becoming sick by ascending gradually. Initial treatment for mild symptoms is with anti-inflammatory drugs, such as ibuprofen.

 

When reaching high altitudes by plane meaning the body does not have time for gradual adjustment, or when ascending to altitudes above 2,800 meter, preventative treatment should be considered, taking Acetazolamide (Uramox) 125 mg twice a day. Begin treatment the day before ascending to high altitudes, continue each day while ascending, and stop two days after reaching the highest altitude. There is no need for treatment when descending from high altitudes. Possible side effects are itching and numbness in the palms, soles of the feet, nose, and ears, that pass once treatment is stopped, in addition to frequent urination.

 

Tuberculosis

Those traveling for six months or more to areas with high incidence of tuberculosis should turn to their nearest center for prevention of tuberculosis for advice, and, when needed, a tuberculin test before and following the trip.

 

Pregnant women

When pregnant or when planning pregnancy, other considerations are needed when choosing a destination for a trip: 

  • Most vaccines are killed (inactivated) that are safe during pregnancy (e.g. hepatitis A, typhoid fever, tetanus) and it is preferable to have them during the second or third trimesters. 
  • Live virus vaccines (such as for yellow fever) are usually forbidden during pregnancy. 
  • There are infectious diseases that are particularly dangerous for pregnant women, and therefore the trip, and possibilities for vaccination or preventative treatment must be considered on an individual basis. 
  • There are areas where viruses, such as the Zika virus, linked to increased risk of birth defects, are prevalent and it should therefore be ensured that the destination is not an area where the virus is found, when pregnancy is planned during or soon after the trip.

High-risk populations

Seniors, infants, and people who suffer from primary or acquired immunodeficiency (those with specific illnesses and people undergoing certain treatments, including steroids, various biological and chemical treatments, radiation, etc.) are usually at high risk for infectious diseases. In addition, some of the vaccinations are specifically prohibited in this population due to a fear of significant side effects. It is therefore recommended to ask for advice before planning the trip, so as to prevent heartache, and check whether the destination is safe for travel, and if it is possible and recommended to get vaccinated or whether the travel plan should be changed. When getting advice, please bring a medical summary from the family doctor or regular doctor to enable reference to the traveler’s specific situation.

 

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Vaccinations – Additional information

Every vaccination can cause localized side effects, such as pain and sensitivity at the site of the vaccination or fever during the day after the vaccination. Painkillers can be taken. Should there be extended or more serious side effects, such as diarrhea, vomiting, stomachaches, rashes, itching, or shortness of breath, consult your regular doctor or an available medical center as soon as possible.

 

Hepatitis A – a virus transferred in contaminated water or food, extremely common in third world countries. There is a very effective and safe vaccine against the disease, and it has been routine for all children in Israel since 1999. It is recommended that whoever was not fully vaccinated in the past (two doses of vaccines at least six months apart) gets vaccinated before traveling to third world countries, for any length of stay.

 

Typhoid fever – the salmonella bacterium is transferred in contaminated water or food, and causes fever and diarrhea, and sometimes severe infection with complications. There is a safe, relatively effective (approximately 80% effectivity) vaccine that lasts for two years and recommended for travelers to countries with high incidence of this disease.

 

Infantile paralysis – polio – a virus transferred in contaminated water or food, that cause paralysis. The disease has been eradicated in many countries. When traveling to a place where there is risk of the disease, it must be certain that the person has been given the inactivated vaccine through injection in one dose, after the age of 18.

 

Hepatitis B – a virus primarily transmitted through unprotected sexual relations or by contact with infected blood. It can cause severe and long-term damage to the liver, and even death. Since 1992 the vaccination against this virus has been one of the routine vaccines given to all those born in Israel. If someone was not vaccinated with three doses of the vaccine and is traveling for an extended period – it is recommended that he should be vaccinated with at least two doses (a month apart) before traveling, and complete the third dose after 6-12 months, so as to provide lifelong protection.

 

Meningococcal meningitis – a bacterium transferred through close contact between people and that causes meningitis – a serious disease with a very high risk of death. The vaccine is recommended for those traveling to specific regions in Africa, on pilgrimages to Mecca in Saudi Arabia, or in line with reports of the disease breaking out around the world. An effective and safe vaccine against this bacterium is given in Israel to everyone who enlists in the IDF, and it lasts for five years.

 

Tetanus, diphtheria, and whooping cough – the vaccine is given routinely to children, and later when enlisting in the IDF. This is a bacterium with a toxin found in soil that can cause a fatal disease when someone unvaccinated is exposed through broken skin. Vaccination every 5-10 years is recommended, dependent on the risk of the trip. In light of the increased number of cases of whooping cough in recent years, there is a protective vaccination for the three diseases.

 

Yellow fever – a vaccination that is effective for at least 10 years against a viral disease transferred by mosquito bites in Africa and certain regions in Central and South America. The vaccination is forbidden to people who received treatment that leaves them immunocompromised, those suffering from chronic disorders of the immune system, multiple sclerosis, infants under nine months of age, or adults over the age of 70. Possible side effects during the week after vaccination – fever, muscular pain, headaches, generally feeling unwell. Should there be side effects, consult your regular doctor or a medical center immediately.

 

TBE (tick-borne encephalitis) – a virus transferred by ticks, that causes fever, headaches, muscular pain, and sometimes neurological complications, such as meningitis and encephalitis, and can be fatal. The disease is common in wooded areas and camping areas in some of the countries of the former Soviet Union, and some countries in Central Europe (Germany, Switzerland). There is an effective vaccine intended for those traveling for an extended period (several weeks) to rural areas. Aside from vaccination, the disease can be prevented by wearing long pants, and closed shoes and socks in wooded areas, and using tick repellant.

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Useful information

Which medical supplies should I take on my trip?

  • We recommend packing an “upgraded first aid kit” that contains the following items: wound disinfectant solution, bandages, scissors and tweezers, a thermometer, antifungal cream, antibiotic cream, sunscreen, mosquito repellant (with at least 25% active ingredient DEET). 
  • Don’t forget all the medications you use regularly in Israel, as needed: medicines for colds, allergies, headaches, fever, diarrhea, constipation, nausea, or contraceptive pills, and all your regular medications, if you have any. It is important to buy these medications in Israel, and not to rely on availability and quality of the medicines at your destination. 
  • Add the medications recommended by the doctors of the malaria prevention clinic, treatment for diarrhea, and water purification products. 
  • An up-to-date international vaccination booklet. 
  • Medical insurance.

Payment methods and refunds

  • Payment is by cash or credit card. Payment will be charged for consultation even if no vaccination was given. 
  • Refunds are available through your health fund or private insurance – we recommend checking in advance regarding policy for refunding fees through your health fund and/ or insurance company.

Clinic location: Hospital Building A, Outpatient Clinics, the entrance next to the shopping center corridor.

Free parking for visitors to the clinic.

 

Days and times for the clinic: Sunday, 15:30-18:00.

 

For appointments and further information, call: 04-7744252 or *6742.

Email: moked1@hymc.gov.il

 

We wish you an enjoyable and healthy trip!

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