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Summer Fun

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Saima Aslam, MD, MS
University of California San Diego
San Diego, CA, USA

As we are midway into summer and transplant patients and providers alike head off to vacation, it's a good time to remind people about the existence of travel clinics and vaccinations. There are a number of excellent resources available to the public that can help navigate a virtual minefield of infectious diseases.

Travel advice can be as mundane as washing hands and carrying alcohol hand gel at all occasions (yes, especially when camping but keep away from the log-fire), mosquito repellant (West Nile virus, anyone?), no skinning animals (wild game or otherwise) and properly cooked meats (Dutch ovens have made a comeback on the camping trail). There is always "glamping" which may mitigate infectious concerns, but beware rodent droppings in the finest of wood cabins (hantavirus), inhaling river water while gasping for air when kayaking down rapids (leptospirosis) or drinking untreated well/ spring/river water (giardiasis).

Some summer travelers may head further out of their comfort zone by taking in a foreign country. The CDC website has excellent advice according to area visited and the type of traveler https://wwwnc.cdc.gov/travel. For starters, always make sure that emergency medical insurance coverage is available. For patients, it is generally recommended that they are aware of the location of the nearest hospital and have emergency medical phone numbers on hand. It is always helpful to have a list of medications and medical problems on paper, and to take extra medications just in case. While camping abroad, additional things to keep in mind are the local epidemiology of infections.

Foreign travel generally encompasses delicious local cuisine (which may or may not be spiked with Escherichia coli, Salmonella typhi and relatives - keep antibiotics on hand and start if gastroenteritis occurs), and may encompass cruise ships (norovirus), "massage" parlors (sexually transmitted diseases), tattoo shops (hepatitis B/ C) and wide-open spaces (mosquitoes carrying malaria, dengue, chikungunya, etc. and ticks carrying rickettsia). Some fecal-orally transmitted infections may be preventable with immunization such as hepatitis A and Salmonella typhi vaccination, though advance planning is required and highly recommended; travel clinics can help best when consulted a few months before a planned trip, rather than the week before. Certain trips necessitate yellow fever vaccination or malaria prophylaxis.

While relaxing at the beach and reading "Links" on your screen, consider limiting sun exposure by using sun screen and cover-ups (increased risk of skin cancer with immunosuppression as well as photosensitivity if on various antifungals). Additionally, warm sea water on fresh abrasions may be associated with a rapidly progressive cellulitis/ fasciitis (vibrio sp.), Schistosoma larvae can "crawl" through bare feet to set up home in the GI/GU tract, and raw oysters/ sushi are a big no-no for our patients (vibro again, various parasites).

PS. Excellent NEJM article for "fever in the returning traveler" http://www.nejm.org/doi/pdf/10.1056/NEJMra1508435

Disclosure Statement: The author has no conflicts of interest to disclose.

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