Vaccination Information: Carribean

IMMUNIZATIONS AND PERSONAL SAFETY

Before traveling abroad on a medical mission, you need to get various vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination.

To have the most benefit, see a health-care provider at least 6 to 8 weeks before your trip to allow time for your vaccines to take effect, and to start taking medicine to prevent malaria, if you need it.

Even if you have less then 4 weeks before you leave, you should still a health-care provider for needed vaccines, and other medications and information about how to protect yourself from illness and injury while traveling.

The Centers for Disease Control and Prevention (CDC) recommends that you see a health-care provider who specializes in Travel Medicine.  An excellent Internet resource for finding a local Travel Clinic is www.travelersvaccines.com. Locally you can call the UCONN travel clinic in West Hartford, CT, or try the personnel health department of your hospital.

Routine vaccines (for influenza, chickenpox, polio, measles/mumps/rubella, and diphtheria/pertussis/tetanus) are given at all stages of life.  They are recommended for travelers because although the childhood diseases these vaccines prevent are now rare in the United States, they are still common in many undeveloped parts of the world and a traveler whose vaccines are not up to date would be at risk for infection.

VACCINE-PREVENTABLE DISEASES for The Dominican Republic and Haiti:

Vaccine or Disease:   And Recommendation or Requirements

Cholera:

Hepatitis A or immune globulin:                                                                         Recommended for all non vaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection where exposure might occur through food or water.

Hepatitis B:                                                                                                              Recommended for all non vaccinated people traveling to or working in countries with an intermediate to high levels of endemic HBV transmission, especially those who might contact blood or body fluids.

Routine:                                                                                                                    Recommended if your are not up-to-date with routine shots such as MMR vaccine, DPT vaccine, polio virus vaccine, etc.

Typhoid:                                                                                                                    If visiting smaller cities, villages, or rural areas.

Rabies:                                                                                                                        Recommended for the Veterinary Team (not necessary for others)

MALARIA PREVENTION IN THE DOMINICAN REPUBLIC

ALL AREAS OF THE DOMINICAN REPUBLIC (INCLUDING RESORT AREAS) HAVE REPORTED MALARIA CASES.

Ways to prevent malaria include the following:

-Taking prescription drugs
-Using insect repellent and wearing long pants and long sleeves to prevent insect bites
-Sleeping in air-conditioned or well-screened rooms or using bed-nets

All of the following antimalarial drugs are equal options for preventing malaria in the Dominican Republic:  Atovoquone/proguanil, chloriquine, doxycycline, or mefloquine.  For information that can help you  and your doctor decide which of these drugs would be best for you, please see Choosing a Drug to Prevent Malaria (hhtp://www.cdc.gov/malaria/travelers/drugs.html)

A SPECIAL NOTE ABOUT ANTIMALARIAL DRUGS
You should purchase your antimalarial drugs before travel.  Drugs purchased overseas may not be manufactured according to United States standards and may not be effective.  They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

Halafantrine (marketed as Halfan) is widely used overseas  to treat malaria.  The CDC recommends that you do NOT uses halafantrine because of serious heart-related side effects, including death.  You should avoid using  antimalarial drugs that not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

OTHER DISEASES FOUND IN THE CARIBBEAN

DengueFever epidemics have occurred on many of the Caribbean islands.  Protecting yourself against insect bites (see below) will help prevent this disease.

Cholera cases were confirmed in the Dominican Republic in November 2010.  Cholera is most often spread through the ingestion of contaminated food or drinking water.  Water may be infected by the feces of an infected person or by untreated sewage.  Food is often contaminated by water containing cholera bacteria or being handled by a person ill with cholera.  Dominican Republic authorities have been taking measures to prevent the spread of the disease.

The risk of cholera for travelers to the Dominican Republic is likely very low if precautions are taken:
1)     Drink and use safe water*
–Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink
and use.
–Use safe water to brush your teeth.
*Piped water sources, drinks sold in cups or bag, or ice may not be safe.  All drinking water and water used to make ice should be boiled or treated with chlorine.

2)     Wash your hands often with soap and safe water*
*If no soap is available, use and alcohol-based hand cleanser (containing at least 60% alcohol).

STAYING HEALTHY DURING YOUR TRIP

–     Prevent insect bites:

-Use insect repellent with 30%-50% DEET.  Picaridin, available in 7% and 15% concentrations
needs more frequent application and may be less effective against the types of mosquitoes that
spread malaria
-Wear long-sleeved shirts, long pants, and a hat outdoors.
-Avoid being outside during peak biting times (dawn and dusk).
-Sleep in beds covered by nets treated with permethrin, if not sleeping in a well-screened room.
Spraying rooms with products effective against flying insects, such as those containing pyrethroid.

–     Be careful about food and water:

-Wash your hands often with soap and water, especially before eating.  If soap and water are
not available, use an alcohol-based hand gel (with at least 60% alcohol).
-Drink only bottled or boiled water, or carbonated drinks in cans or bottles.  Avoid tap water,
fountain drinks, and ice cubes.
-Do not eat food purchased from street vendors.
-Make sure food is fully cooked.
-Avoid dairy products, unless you know they have been pasteurized.
–     Prevent sunburn:
-Use sunblock rated at lest SPF 15.

Other health tips:

-To avoid animal bites and serious diseases, (including rabies and plague), do not handle or
animals, especially dogs and cats.  If you are bitten or scratched, wash the wound immediately
with soap and water and seek medical attention to determine if medication or anti-rabies         vaccine is needed.
-To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot
especially on beaches where animals have defecated.

Because risks are constantly changing in the areas to which we may travel, Saint Francis Medical Missions highly recommends that each participant utilize the CDC website for the most accurate and up-to-date information before traveling:  www.cdc.gov/travel/destination.

Sources:   www.cdc.gov/travel/destination.

Written By:

Denise Bolduc
Blue Team: Chief CRNA,
Patient Safety Officer
Founding Member St. Francis IMM