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**CDC Guidelines for Medical Professionals Traveling to Area

 
Anonymous Coward
09/05/2005 06:09 PM
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**CDC Guidelines for Medical Professionals Traveling to Area
Announcement
Interim Guidance for Healthcare Professionals Advising Travelers to Hurricane Affected Areas in the United States

This information is current as of today, September 5, 2005, 06:05:36 PM

Released: September 2, 2005

This notice is intended to provide information to health-care professionals who assess travelers (e.g. relief workers) going to areas affected by the recent hurricane about current health risks in those areas and recommended vaccines and other measures to minimize infection or injury in travelers. Affected areas include coastal areas of the following states:

* Louisiana
* Mississippi
* Alabama
* Florida

For more information about Hurricane Recovery see: [link to www.bt.cdc.gov]

The response to the recent hurricane will probably be both immediate and long term. Persons traveling to affected areas should ideally be assessed by a health-care professional at least 4-6 weeks before travel so recommended vaccines can be completed and provide maximum benefit however the following recommendations apply even if travel is imminent. All travelers with a history of incomplete or lapsed routine, "childhood" immunization schedules should be brought up-to-date for these vaccines. A full medical history should be taken to determine fitness for travel. Travelers who are acutely ill, medically or psychologically unstable, or pregnant should be advised to postpone travel if at all possible. In addition, because of the loss of possibly thousands of lives and widespread damage to affected areas, travelers should be made aware they may be at risk for increased emotional stress.
Immunizations for All Travelers

* Tetanus/diphtheria (Td). Tetanus and diphtheria toxoid (receipt of primary series, and Td booster within 10 years)

Immunizations for persons with high likelihood of exposure to blood and body fluids such as healthcare workers

* Hepatitis B. Hepatitis B vaccine series for persons who will be performing direct patient care or otherwise expected to have contact with bodily fluids.

Risks from Injury

The risk for injury during and after a natural disaster is high. Persons who anticipate the need to travel in hurricane-affected areas should be advised to wear sturdy footwear to protect their feet from widespread debris present in these areas. Tetanus is a potential health threat for persons who sustain wound injuries. Any wound or rash has the potential for becoming infected and travelers should be advised to have such wounds or rashes assessed by a health-care provider as soon as possible. Travelers should also be instructed to immediately cleanse any wounds, cuts, or animal bites with soap and clean water. Familiarity with basic first aid is advised to self-treat any injury until medical attention can be obtained.
Preventing Electrocutions

Travelers should be cautioned to avoid downed power lines. During power outages, many people use portable electrical generators ( [link to www.bt.cdc.gov] If the portable generator is improperly sized, installed, or operated, it can send power back to the electrical lines. This problem is called backfeed or feedback in the electrical energy in power lines. Backfeed can seriously injure or kill repair workers or people in neighboring buildings. In addition, electrical power and natural gas or propane tanks should be shut off to avoid fire, electrocution, or explosions. Battery-powered flashlights and lanterns, rather than candles, gas lanterns, or torches, should be used.
Risks from Food and Water

Natural disasters contribute to the spread of many serious food and water-borne diseases, especially since water supplies and sewage systems have been disrupted. Diarrheal diseases, due to bacteria, parasites or hepatitis A can possibly occur. If a trusted source of bottled water is not available, water should be boiled or disinfected. For more details, see [link to www.cdc.gov]

An antibiotic for self-treatment of acute diarrhea, such as a fluoroquinolone (e.g. ciprofloxacin), can be given. Azithromycin can be used as an alternative. The traveler should be instructed to take this medication until symptoms subside (typically 3 days). Anti-motility agents such as loperamide and diphenoxylate and/or bismuth subsalicylate (Pepto-Bismol) can reduce bowel movement frequency.

Instruct travelers to seek medical attention for diarrhea accompanied by a high fever or blood. Additionally, replacement of lost fluids by drinking clean water is the most important means of maintaining wellness, although oral rehydration solutions are ideal for the treatment of severe diarrhea.

Stress the importance of handwashing in preventing disease transmission, recommend frequent handwashing with either soap and water or a waterless, alcohol-based hand wash.
Risks from Insect Bites

Because of standing water in these areas, mosquito breeding can become a problem. The first mosquitoes to appear and the majority will be a nuisance to travelers but not transmit disease. The potential exists for outbreaks of West Nile, St. Louis Encephalitis, and dengue however this has not been typical of similar events in the US. Prevention of mosquito bites is recommended through combined use of insect repellent containing DEET or picardin ( [link to www.cdc.gov] and wearing long sleeved shirts and long pants when outdoors.
Risks from Snake Bites

Displaced reptiles, such as snakes, are likely to be found following flooding and other natural disasters. Travelers should be advised about the danger of attempting to kill snakes. The venom of a small or immature snake can be even more concentrated than that of larger ones; therefore, all snakes should be left alone. Fewer than half of all snakebite wounds actually contain venom, but travelers should be advised to seek medical attention any time a bite wound breaks the skin.

If medical care is rapidly available,then initial treatment should include immobilization of the affected limb and minimizing physical activity as much as possible (ideally of the entire patient) while transport to a medical facility occurs. If care is delayed, then a loose fitting pressure bandage that does not restrict arterial and venous flow (but does limit lymphatic flow) is the recommended first-aid measure while the victim is moved as quickly as possible to a medical facility. Tourniquets that impair blood flow to the affected limb are generally contraindicated.

Specific therapy for snakebites is controversial, and should be left to the judgment of local emergency medical personnel. Snakes tend to be active at night and in warm weather. Advise the traveler that, as a precaution, boots and long pants should be worn when walking outdoors at night in areas possibly inhabited by venomous snakes. Proper protection such as the aforementioned clothing, careful attention to one´s surroundings and overall avoidance of contact are the best measures that can be taken to avoid injury.

cont. here:
[link to www.cdc.gov]
Anonymous Coward
12/08/2005 10:20 AM
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Re: **CDC Guidelines for Medical Professionals Traveling to Area
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