Volume 30 Number 1 ISSN:1059-6518

By Frank Hubbell, DO

FACT: 1.1 billion people cross international borders every year!

How many of these international travelers know what is waiting for them at the end of the runway or on the other side of the border? At home you are most likely safe. You have potable drinking water, safe food to eat, reliable power, screens on your windows and doors to protect you from marauding insects, and have excellent, available, immediate health care when needed. To put it simply, most of us live in a bubble. The question is, are you sure that you are prepared for the times when you leave the safety of your bubble?

This is the material that we use in our Travel Clinic to help educate and prepare people for international travel. We offer it here for your review and, if necessary, take with you to a consult for travel medicine.           


Make Out a Trip Itinerary:

When are you going and for how long?



Where are you going?



What are you planning on doing while there?

Travel plans?

How are you planning on getting around?

Previous International Travel History:

When did you go?

Where did you go and for how long?

Past Medical and Surgical History:


Medications – name and dosage

Immune Status – any history of autoimmune diseases, HIV, DM

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Diphtheria – a vaccine preventable disease

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Volume 29 Number 2

ISSN 1059-6518

By Frank Hubbell, DO

The use of vaccines to prevent disease has been around for over 80 years and the number of vaccines has grown to over 25. For some individuals this is an area of confusion, debate, and disagreement. The reality is that vaccines are very well-studied and profoundly safe to use. As with any medication, there are risks, but the risks are far out-weighed by the benefits of not getting that particular disease.

I doubt there is anyone on this planet that would want to see the return of small pox or an increase in the cases of polio, or diphtheria. It is the vaccination process that builds up immunity to these diseases by stimulating the immune system to make antibodies to defeat the illness before it could cause symptoms and potentially death. However, there are those who, for whatever reason, refuse to be vaccinated, thereby putting themselves and others at risk.

To follow are a series of articles that will discuss and explain the various vaccine-preventable diseases and the consequences of acquiring that particular illness for which the vaccine was created. As stated above, currently, there are a total of 25 vaccines to prevent disease. For no particular reason, we will start with diphtheria.


A vaccine-preventable disease.

It is caused by a bacterium – Corynebacterium diphtheria.

It is an aerobic, gram-positive bacillus.

The reservoir in nature is us, human carriers.

The primary vector is droplet-spread through the air by coughing and sneezing.

There are toxigenic and non-toxigenic forms of diphtheria.

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Japanese Encephalitis

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Travel Immunizations

Japanese Encephalitis

By Frank Hubbell, DO

Japanese Encephalitis (JE) is more correctly known as Japanese B Encephalitis.

It is a virus in the family Flaviviridae.

The reservoirs in nature that harbor the JE virus are pigs and herons.

The vector for JE is the mosquito – Culex tritaeniorhynchus & C. vishnui.

JE is not contagious, in that it cannot be transferred from human-to-human. It has to be spread by the Culex mosquito vector.

The incubation period from mosquito bite to symptoms is 5  – 15 days.

The vast majority of those infected are asymptomatic.

Only 1 in 250 cases develops into encephalitis.

Still JE is the leading cause of encephalitis in Asia with 30,000 – 50,000 cases per year.

One in four patients that develop JE encephalitis will die. There is a 25% fatality rate caused by brain damage.

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Vaccines – Typhoid and Paratyphoid Fever

May/June 2012 ISSN-1059-6518 Volume 25 Number 3

By Frank Hubbell, DO


What is Typhoid and Paratyphoid?

Typhoid fever, also known as typhoid is a life-threatening illness caused by the bacterium Salmonella typhi. It is also known as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, and pythogenic fever.

Paratyphoid fever, also known as enteric fever, is a less serious illness that is also caused by Salmonella bacteria, but the symptoms are very similar to those of Typhoid Fever.


Warning: Typhoid fever is different from Typhus. Typhus is an illness caused by the bacterium Rickettsia while Typhoid is caused by Salmonella bacteria.


Pathophysiology of Typhoid:

Salmonella typhi lives only in humans – there is no other reservoir in nature besides humans.

The Salmonella typhi is spread from one person to another via the oral-fecal route where food or water has become contaminated by poor sanitation. Inadequate conditions have allowed the water source to become contaminated with human excrement – urine and feces, or by improper food handling and preparation.

Salmonella can also be spread by flying insects, such as flies, that feed on feces and then land and walk on food that you might then eat.

Flies: Their dirty little foot prints on your food is enough to spread Salmonella and other intestinal illnesses from one animal to another.

Once the Salomella bacterium has been consumed in food or water, it passes through the stomach into the intestinal tract where is multiplies and invades the mucosa wall. Within the mucosa wall the Salmonella bacteria are phagocystized (surrounded and consumed) by macrophages (white blood cells). If the bacteria manage to avoid the immune system in the gut wall, they will then invade and multiple in the blood stream.

It is the invasion and multiplication of the Salmonella in the bloodstream that causes the signs and symptoms of Typhoid.

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