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WHAT YOU NEED TO KNOW BEFORE YOUR TRIP TO INDIA

Traveling abroad doesn’t have to be confusing if you know the right things before you go.

BEFORE YOUR TRIP:

  1. Make sure you are up-to-date on routine vaccines before every trip. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot.
  2. CDC recommends Hepatitis A vaccine since it spreads through contaminated food or water in India.
  3. You may also get typhoid through contaminated food or water in India. CDC recommends this vaccine for most travelers, especially if you are staying with friends or relatives, visiting smaller cities or rural areas.
  4. Rabies can be found in dogs, bats, and other mammals in India, so CDC recommends this vaccine. Children tend to play with animals and are more likely to have animal bites on their head and neck.
  • Malaria Risk Areas: All areas throughout the country, including cities of Bombay (Mumbai) and Delhi, except none in areas >2,000 m (6,561 ft) in Himachal Pradesh, Jammu and Kashmir, and Sikkim. Malaria drugs are not 100% effective, and other diseases (such as dengue, leishmaniasis, and trypanosomiasis) also are spread by insects, so children (and their parents!) need to avoid bug bites. Children should wear bug spray and long pants and sleeves. At night, children should sleep in screened, air-conditioned rooms or under a bed net.
  • Japanese Encephalitis Risk Areas: Human cases reported from all states except Dadra, Daman, Diu, Gujarat, Himachal Pradesh, Jammu and Kashmir, Lakshadweep, Meghalaya, Nagar Haveli, Punjab, Rajasthan, and Sikkim. Highest rates of human disease reported from the states of Andhra Pradesh, Assam, Bihar, Goa, Haryana, Karnataka, Kerala, Tamil Nadu, Uttar Pradesh, and West Bengal. Most human cases reported May–October, especially in northern India; the season may be extended or year-round in some areas, especially in southern India.
  • Chikungunya and Dengue are also transmitted by mosquito bite during the day and night, both indoors and outdoors that often live around buildings.
  • Diarrhea is the most common illnesses experienced by children who are traveling. For infants, the best way to prevent diarrhea is breastfeeding. Older children should follow basic food and water precautions: eat only food that is cooked and served hot, peel fresh fruits and vegetables or wash them in clean water, and drink only beverages from sealed containers or water that has been boiled or treated. Children should wash their hands or use alcohol-based hand cleaner frequently.

Car crashes are the leading cause of death in children who travel, and drowning is the second-leading cause of death. Children should always ride in age-appropriate car seats when traveling.

PACKING FOR YOUR TRIP

MUST

  • Your prescriptions
  • Consider packing spare glasses or contact lenses
  • Diabetes testing supplies
  • Insulin
  • Inhalers
  • Epinephrine auto-injectors (EpiPens)
  • Antacid
  • Diarrhea medicine: like loperamide [Imodium] or bismuth subsalicylate [Pepto-Bismol]
  • Antihistamine
  • Medicine for pain and fever: Examples: acetaminophen, aspirin, or ibuprofen
  • Saline nose spray
  • Alcohol-based hand sanitizer containing at least 60% alcohol or antibacterial hand wipes
  • insect repellent based on CDC recommendations
  • Sunscreen
  • child safety seats, bicycle helmets
  • 1% hydrocortisone cream
  • Antifungal ointments
  • Antibacterial ointments
  • Antiseptic wound cleanser
  • Mosquito repellent
  • Health insurance card (your regular plan and/or supplemental travel health insurance plan) and copies of claim forms
  • Copies of all prescriptions including generic name
  • Carry a contact card containing the street addresses, phone numbers, and e-mail addresses of US embassy, family members, hospitals.
  • An electrical adapter to change voltage for any appliances brought from America
  • some non perishable snacks
  • Traveler’s checks and enough cash, keep them in separate places. An ATM card is also convenient.

OPTIONAL

  • Travelers’ diarrhea antibiotic
  • Medicine to prevent malaria
  • Water purification tablets
  • Bed net
  • Disposable gloves
  • Digital thermometer
  • Scissors and safety pins
  • Cotton swabs (Q-Tips)
  • Tweezers
  • Eye drops
  • Oral rehydration salts
  • A small flashlight
  • You may also want to bring a money belt, or thin wallet to keep in your front pocket.
  • Combination lock

DURING YOUR TRIP

  • Eat Food that is cooked and served hot and Pasteurized dairy products.
  • Avoid Room temperature food and Food from street vendors
  • Drink Bottled water that is sealed or Water that has been disinfected. If you buy water from a vendor in the streets, make sure the lid is still on properly.
  • Avoid Tap or well water or Ice made with tap or well water.
  • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Use an appropriate insect repellent and Use a bed net if the area where you are sleeping is exposed to the outdoors
  • Heat-related illness, such as heat stroke, can be deadly. Eat and drink regularly, wear loose and lightweight clothing, and limit physical activity during high temperatures. Use sun-screen.
  • Schistosomiasis and leptospirosis, infections that can be spread in fresh water, are found in India. Avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers.
  • Some diseases in India—such as dengue, filariasis, and leishmaniasis—are spread by bugs and cannot be prevented with a vaccine.
  • Do not touch or feed any animals you do not know.
  • Review your health insurance plan to determine what medical services it would cover during your trip. Consider purchasing travel health and medical evacuation insurance.
  • Carry a card that identifies, in the local language, your blood type, chronic conditions or serious allergies, and the generic names of any medications you take.
  • Be smart when you are traveling on foot. Pay attention to the traffic around you, especially in crowded areas.
  • Enroll in the Smart Traveler Enrollment Program (STEP)
  • Leave a copy of your itinerary, contact information, credit cards, and passport with someone at home.
  • Carry contact information for the nearest US embassy or consulate
  • Carry a photocopy of your passport and entry stamp; leave the actual passport securely in your hotel.
  • Stay at a trustworthy place.

AFTER YOUR TRIP

  • See your doctor if you or your child is feeling sick. Tell them about the potential exposures that you may have had (including TB patients, malarial location, animal contacts) etc.

Source: Multiple including CDC


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TO BUY OR NOT TO BUY GENERICS?

Generic drugs, both over-the-counter and prescription medications, are very strictly regulated by the Food and Drug Administration’s (FDA) rules for generics. Regulations include:

· A generic’s active ingredient, dosage, and strength must be the same as its brand-name equivalent.

· Generic drugs must be "bioequivalent" to brand-name drugs, meaning they have to show up as the same in the bloodstream and work in the exact same way.

· Manufacturing, testing, and packaging sites are subject to the same FDA regulations, whether the product in question is a brand name or a generic. (About half of generic drugs are actually made by the same companies making the brand-name versions.)

In the end, the variation in performance between brand names and generics is about the same as the variation between brands.

So, do Doctors buy generic?

Source: Bronnenberg et al

YES!

Now, you decide.


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DRUG AND FOOD INTERACTIONS TO AVOID

This is more for adults than for children:

· Grapefruit juice negatively interacts with more than 50 medications, including statins. Because the effects of the citrus juice last more than 24 hours, simply taking your meds at a different time won’t solve the problem.

· An enzyme found in pomegranate juice can break down several blood pressure prescriptions.

· Calcium can interfere with the effectiveness of thyroid medication. Wait at least 4 hours after dosage to drink any calcium-rich beverages.

· Caffeine can pose a serious health threat when taken with stimulants. Avoid a cup of joe when taking ephedrine (appetite suppressants), asthma prescriptions, and amphetamines (such as Adderall).

· The potassium in Sport drinks can be dangerous when coupled with some heart failure or hypertension drugs. Bananas are also very rich in potassium.

· Skip the dinnertime glass of wine when taking antidepressents; the combo can cause hypertension, headaches, fast heart rate, and stroke. The same goes for energy drinks.

· Vitamin K, also found in broccoli and kale, can decrease the effect of blood thinners such as coumarin or warfarin.


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DOES THIS SOUND RIGHT? JUST THINK FOR A MINUTE

A new government survey has found that 1 in every 13 child is taking at least one medication for emotional or behavioral problems.

Of these, 81 % of the children on medication had been diagnosed with attention-deficit/hyperactivity disorder (ADHD) at some point.

Now sit back and think for a minute…….

Aren’t children meant to be full of energy and unfocussed?

Do we want them growing up like robots that follow instructions precisely?

Isn’t the act of growing up fundamentally an act of developing patience, focus, and self-confidence?

If so, why do we rush to put them on psychotropic drugs?

Note that only 55 % of parents reported that these psychiatric medications are helping their children.

Does this sound right to dose young growing mind with drugs that impact their hormone level and brain functions?

Have we truly exhausted all non-chemical options before we medicate our kids?

Before you open the next Ritalin bottle, just think for a minute.


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PREGNANT AND SICK? – NEWS ALERT

A new study suggests a link between attention deficit hyperactivity disorder and pregnant women who take acetaminophen/Tylenol. According to the study in the Journal of American Medical Association of Pediatrics, pregnant women who took Tylenol for 20 weeks or more had a 50 percent higher risk of their child needing ADHD medication.

Talk to your OB-Gyn before you take meds during pregnancy


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NEWS FLASH: FDA warns pregnant women to not use certain migraine prevention medicines

FDA warns pregnant women to not use certain migraine prevention medicines

Valproate products can lower IQ scores in children of mothers who used them during pregnancy

The U.S. Food and Drug Administration is alerting health care providers and patients that medications including and related to valproate sodium can cause decreased IQ scores in children whose mothers took the medication during pregnancy. Therefore, these drugs are being contraindicated for (should never be used by) pregnant women for the prevention of migraine headaches. Valproate products include valproate sodium (Depacon), divalproex sodium (Depakote, Depakote CP, and Depakote ER), valproic acid (Depakene and Stavzor), and their generics.

Valproate products have several FDA-approved uses including: prevention of migraine headaches; treatment of epilepsy (seizures); and treatment of manic episodes associated with bipolar disorder (manic-depressive disorder).

Medicines that contain valproate already have a boxed warning for fetal risk, including birth defects. The recently published Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study found further evidence of the IQ risk, leading to today’s strengthened warnings.

Women who are pregnant, or who become pregnant while taking one of these medications, should talk to their health care professional immediately. Women shouldnot stop taking their medication without talking to their health care professional because stopping treatment suddenly can cause serious and life-threatening medical problems for the woman or the developing fetus. Women of childbearing age taking valproate products should use effective birth control.

It is not known if there is a certain time period during pregnancy when valproate exposure can result in decreased IQ. The women in the NEAD study were exposed to antiepileptic drugs throughout their pregnancies.

The FDA’s strengthened recommendations are based on the final results of the NEAD study, which showed that children exposed to valproate products in utero had decreased IQ at age 6 when compared to children who were exposed to other antiepileptic drugs. The difference in average IQ between the children who had been exposed to valproate and the children who had been exposed to other antiepileptic drugs varied between 8 and 11 points depending on the antiepileptic drug.

For additional information:

· FDA Valproate Information

· North American Antiepileptic Drug Pregnancy Registry

· FDA Patient Network