This month, Sydney Spiesel explains and ventures an opinion about travel vaccines, computerized medical records, hand-washing, and a study on breast-feeding and nearsightedness. (Click here for the June roundup.)
Travel tips: Which shots do you need?
It's summer—vacation time. (Well, not for me: I went to a medical meeting in Santa Fe in May and, sadly, that's the end of it.) So, which shots to get for which trips? The Centers for Disease Control travel-tips Web site is a valuable resource and recommends immunizations based on destination, but I'd like to add a few comments (and some travel tips related to recent medical news).
Cholera. This month brings reports of a not-yet-available but promising new oral vaccine against this disease, which is so terrible that it was used as a curse in the old country ("may you be taken by a cholera"). This is a major stride forward, since the old vaccine was worthless, caused unpleasant side effects, and has been off the market for some time. If the new vaccine lives up to its promise, it will have some value for travelers and a great deal for poor people who live without sanitation.
Hepatitis A. This vaccine is excellent, providing a high level of protection against a common affliction that targets travelers to tropical paradises. Sure, hepatitis A isn't likely to kill you, but it's a shame for your holiday to be needlessly trashed by an illness that causes you to feel like death and to change color.
Polio. Once almost extinguished by immunization campaigns, this disease is oozing back, especially in central Africa and northern India. If these are your destinations, a booster dose of the current (higher potency) version of polio vaccine is probably a good idea, especially for adults who might have been immunized a long time ago.
Rabies. Last week, a British traveler who was bitten by a dog while vacationing in Goa died of rabies after she returned to England. The disease is uncommon in North America and Europe (though not as much so lately). It's prevalent in places where people are too poor to vaccinate dogs. Only some spelunkers, field biologists, and veterinarians need pretravel rabies shots, but any animal bite in most of the world should be taken seriously and treated immediately with a series of the shots.
Meningitis. The new meningococcus vaccine is a very good idea for travelers to sub-Saharan Africa, where meningococcal disease is endemic.
Computerized Medical Records: The curse and the promise.
There was a time (thankfully, long past) when I was a software developer. This enabled me to implement and use a computerized system for medical records, a system I've been using for more than 25 years. (Though, frankly, I don't trust computers as far as I can spit, so I keep a complete paper record as well.) The payoff has been quite good: I've been able to keep close track of my patients and their problems and to offload time-consuming and boring work, like filling in forms and writing prescriptions. That frees up a substantial amount of time, and I am old-fashioned enough to believe that the most important thing I have to give my patients is my time.