Skip to Content
Skip to Navigation

Travel Clinic

The following list of health topics are of particular interest for travelers.  Please check out the "health topics" tab at the top for more.

Immunizations

Immunizations
Available at Hall Health Center

UW Measles Requirement
All enrolled matriculated students, and all students living in University of Washington residence halls or single-student apartments, are required to provide proof of measles (rubeola) immunity.


Hall Health Center offers the following vaccines.

NOTE: The Centers for Disease Control and Prevention (CDC) provides thorough, up-to-date information on vaccines. The Immunization Action Coalition is also a reliable resource.


What is malaria?

Malaria is the most significant parasitic disease threat you will face in most tropical and subtropical countries. It is a microscopic blood- borne parasite transmitted to humans by the bites of infected mosquitoes.  There are 300 to 500 million cases a year of malaria worldwide —approximately 1000 a year are reported in U.S. travelers. 

Symptoms can include: fever and flu-like symptoms, chills, generalized muscle aches and pains, tiredness, headache, abdominal pain, and even diarrhea.  Symptoms usually begin 1 to 2 weeks after an infected bite, but onset can be as late as 4 or more weeks afterwards in some cases.  If left untreated, malaria can cause anemia, jaundice, kidney failure, coma, and death. 

Travelers can decrease the risk of malaria by taking certain drugs to prevent a malaria attack (malaria chemoprophylaxis) and by using measures to prevent mosquito bites.  However, in spite of all precautions, travelers occasionally might become infected with malaria.  Therefore, while traveling and up to five years after returning home, travelers should seek medical evaluation for any flu-like illness accompanied by fever.

If you have an extended period of travel or experience numerous mosquito bites in a malaria area, you may need additional anti-malarial medication after your return, to eradicate a possible asymptomatic incubating malaria infection.  If this situation applies to you, continue your prescribed malaria chemo-prophylaxis medication and seek care within two weeks after your return.

You are excluded from blood donation for 1 year after being in a malarious area.

Prevention

Travelers should limit their time outdoors in rural tropical areas between dusk and dawn, when the mosquitoes transmitting malaria are most likely to bite.  When outdoors, prevent mosquito bites by staying in screened areas as much as possible; wearing protective clothing that covers arms and legs; using an insect repellent on exposed skin areas when outdoors; and using a mosquito net where you sleep.  For more detailed information on procedures and products to prevent mosquito and other insect bites, see our health information article or brochure Avoiding Insects.

Drugs against malaria

No anti-malaria drug is 100% effective and drug resistant strains of malaria are being reported throughout the world.  Selection of the most effective regimen depends on itinerary, whether drug resistant malaria is reported at destination areas, age, health, allergies, and other factors. One of the following options may be selected.

1. Chloroquine Phosphate  (Aralen®)

Adult dosage: 500 mg orally once/week for use in areas with chloroquine-sensitive Plasmodium falciparum malaria. Take weekly dose starting 1 week before entering a malaria area, each week while there, and for 4 weeks after leaving the area.

Notes on Chloroquine:

  • Drug interactions can occur with Kaopectate®, methotrexate, metronidazole (Flagyl®), Phenergan®, and cimetidine.
  • Chloroquine can be used with caution in persons who have psoriasis, porphyria, or liver dysfunction, but not in those with retinal degeneration.
  • Chloroquine can decrease the effectiveness of the rabies vaccine given by intra-dermal administration, if taken sooner than 1 week following the last vaccine dose.
  • Chloroquine is considered safe in pregnancy.

2. Hydroxychloroquine Sulfate (Plaquenil®)

Adult dosage: 400 mg (2x 200 mg) orally once/ week—an alternative to chloroquine.

Notes on Hydroxychloroquine:

  • Drug interactions can occur with digoxin and rifampin and possibly with the drugs listed above under Chloroquine.
  • Hydroxychlorquine can be used with caution in persons who have psoriasis, porphyria, or liver dysfunction, but not in those with retinal degeneration.
  • Hydroxychloroquine can decrease the effectiveness of rabies vaccine given by intra-dermal administration, if taken sooner than 1 week following the last dose.

3. Malarone® (Atovaquone/Proguanil)

This drug is recommended for travelers going to areas of chloroquine-resistant Plasmodium falciparum malaria.

Dosing: 1 tab daily. Dose 1 day before through 7 days after leaving area of malaria risk.

Adult dosage: 250mg/100mg

Pediatric dosage: 62.5mg/25mg

Notes on Malarone:

  • Common side effects include mild stomach upset, headache, nausea and mouth ulcerations
  • Serous/rare side effects are hair loss, rash
  • Take with food or milky drink at same time each day
  • Do not take with tetracycline, rifampin, or metoclopramide

4. Doxycycline

Used for patients with intolerance to other antimalarials.

Adult dosage: Take 1 (100mg) tablet daily with evening meal starting 2 days before entering malarious area, each day while in the area and daily for an additional 4 weeks after leaving. Missing even one day's pill can result in malaria.

Notes on Doxycycline:

  • Doxycycline is not to be used by pregnant women or children under 9 years of age.
  • Due to increased sensitivity to the sun, wear a   sunscreen with a high SPF that covers both UVA and UVB.
  • Other potential side effects: vaginal yeast infections; erosion of esophagus if taken immediately before reclining without adequate liquids.
  • Pepto-Bismol® interferes with doxycycline absorption.

Treatment

If you have any of the aforementioned symptoms during or up to 3 years after leaving a malarious area, seek medical counseling. If a fever develops within 3 months after possible exposure, immediately seek medical help. Malaria can be treated if caught early enough, but delay in appropriate therapy can have serious or fatal consequences.

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


What is dengue (deng-gay) fever?

Dengue fever and dengue hemorrhagic fever are viral illnesses transmitted by the bite/sting of a mosquito. The mosquito species that carries dengue virus is active, biting during daylight hours, with a peak of activity just after daybreak, and then again for several hours before dark. These insects are often present indoors, and are common in areas of human habitation, including urban and rural areas throughout the tropical areas of the world.

Symptoms

Symptoms of dengue fever include:

  • Relatively sudden onset of high fever
  • Severe frontal headache
  • Muscle and joint pains
  • Nausea and/or vomiting
  • Rash

On the third or fourth day of the fever, many people will develop a rash on the torso, which then spreads to the arms and legs.

Usually the illness is "self-limited" in travelers and relatively mild, meaning it runs its course over a week or two, though in rare circumstances it can cause severe symptoms.

Another name for this illness is "break-bone fever" due to the extreme bone pain that can accompany this disease.

Treatment

There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. To help with recovery:

  • Get plenty of bed rest
  • Drink lots of fluids
  • Take acetaminophen to reduce fever (not aspirin nor non-steroidal anti-inflammatory products such as aspirin or ibuprofen)

Risk to travelers

International travelers to areas where Dengue Fever occurs are at risk, more so if there is current epidemic activity underway at the time of the trip. Dengue is becoming an increasing health concern worldwide due to spread of significant disease in 2005-2007 in areas of the world without previous recent Dengue Fever.

Luckily, cases of severe Dengue Hemorrhagic Fever are rare, since this typically afflicts only those persons who reside in areas where dengue exists and are subject to repeated infections. Your travel health care adviser will let you know if dengue is a risk for you on your planned travel abroad.

Prevention of dengue fever

Since there is no vaccine against dengue at this time, the best prevention is to avoid getting bitten by mosquitoes in the first place. Follow these tips to prevent being bitten by mosquitoes:

  • Stay in screened or air-conditioned environments as much as possible
  • Use DEET-containing insect repellent on your skin

Your travel health adviser will discuss use of DEET in preventing dengue and other mosquito-borne diseases including malaria during your Travel Clinic visit.

If you have dengue fever

  • Avoid mosquito bites while you have a fever. Don't let mosquitoes bite you. They can infect other members of your family with dengue after biting you.
  • Use mosquito barriers until the fever subsides, to prevent day-biting mosquitoes from biting a sick person, becoming infected, and then biting someone else.
  • Rest in a screened room or under a bed net.
  • Use insect repellents and spray insecticide indoors if there are mosquitoes.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


mosquito.jpgBy avoiding insect bites during your travels to tropical and subtropical regions, you can prevent the following diseases:

  • Malaria
  • Dengue fever
  • Yellow fever
  • Japanese encephalitis
  • Lyme disease
  • Tick typhus
  • Chagas disease

Care should be taken to protect yourself and your family from most bugs you might encounter. 

Tips to avoid bites and stings

Be aware

  • Learn about the feeding and nesting habits of insects at your destination and take extra precautions and/or minimize activities accordingly. Ask your hosts about seasonal or local pests to be on the lookout for.

Use insect repellant

  • Use an appropriate insect repellent. DEET (N,N-diethylmetatoluamide) has a long and safe track record and is very effective at sufficient concentrations. Hall Health Pharmacy sells DEET insect repellant.
    • The Centers for Disease Control and Prevention (CDC) suggest DEET strengths of up to 30-50%. Concentrations up to 30% are  considered safe in children 2 months and older.  Concentrations greater than 50% do not provide better protection, but may have longer lasting protection. We do not recommend concentrations greater than 50%.  When you purchase insect repellant, check the label for strength information.
  • Repellents containing Picaridin at 7-20% concentrations are also available, and compared to the products above, may be as effective, but need more frequent application.

  • When applying both insect repellent and sunscreen, always apply the sunscreen liberally first, wait 10 to 15 minutes if possible, then apply insect repellent.

Dress for success

  • Wear protective clothing such as long sleeves and pants whenever practical.  Shirts should be tucked in.  Foot wear that provides maximum coverage is ideal, including socks, (sandals are not recommended).  Avoid jewelry and bright or dark-colored clothes; the best colors are light green, tan and khaki.
  • Use permethrin on your clothes and gear.
  • Do not walk barefoot.

Insect proof your surroundings

  • When at the beach or pool, lie on a chair or, at the very minimum, on a blanket or long towel.  Do not lay clothes on ground since perspiration or other scents may attract insects.  Shake them vigorously before putting them back on.
  • Sleep in well-screened areas, air-conditioned rooms, or use bed (mosquito) nets.
  • Clothing and bed nets can be impregnated with permethrin insecticide.
  • Avoid using fragrance-containing products such as perfumes, colognes, after-shaves, scented soaps, shaving creams, hair sprays, etc.  Use only unscented hygiene products.

Insect behavior and habits

Mosquitoes

  • Species that carry malaria and Japanese encephalitis bite from dusk till dawn.
  • Species that carry dengue fever, chikungunya fever, and yellow fever bite during daylight hours.
  • Mosquitoes are most active right around dawn and right around dusk, so extra care at those times is necessary.

Ticks

  • Burrow into your skin.
  • Are carried on animals, but picked up by humans from brush, grass, trees.
  • Check your skin at least once daily for presence of ticks if in high risk areas. Armpits and hairline are common places for ticks.
  • Remove ticks with a slow steady tug, pulling perpendicular to the skin at the site of attachment of the tick, using tweezers or a tick remover, if available.

Fleas

  • Especially present on and around animals and in sand and soil.

Product information: What to buy

The following products are used to avoid bites and stings of insects, and thereby reduce the risk of contracting the diseases they carry.   They can be purchased in many pharmacies and outdoor supply stores (e.g., REI), including at Hall Health Pharmacy.  Some specific products are listed for your information.

Repellents for use on the skin

NOTE: Please note that these repellents are to be used only on exposed skin and not under clothing.

DEET repellent – DEET (N, N-diethyl-m-toluamide) is the most effective repellent against mosquitoes, chiggers, ticks, fleas, and biting flies.  Controlled release formulations have longer lasting effectiveness. Avoid contact with eyes, mouth, and synthetic materials. Toxic only if swallowed.

We strongly recommend DEET-containing repellents over all others, based on its proven safety, effectiveness, and ease of use. Look for a minimum concentration of 20% and a maximum concentration of 50%.

Other repellents

Picaridin – available for many years in Europe at 21% concentration. Higher concentrations provide longer duration of protection.

  • Cutter Advanced® sprays containing 7% and 15% picaridin are available.
  • Sawyer Go Ready® spray contains 20% picaridin

Higher concentrations provide longer lasting protection.

Newer repellents

  • Cutter Lemon Eucalyptus® spray contains Oil of Lemon Eucalyptus (PMD), approved by the EPA and CDC as a "biopesticide repellent"
  • Sawyer makes a DEET-free repellent containing IR-3535, another biopesticide repellent approved by the EPA and CDC.

Insecticide for use on clothing and nets

Permethrin is a synthetic chemical analogue of pyrethrum, which is the natural substance found in chrysanthemums. It effectively repels and kills insects. Permethrin is available in various formulations, as a spray for clothing, or as a liquid for “soaking” clothing or bed nets.

See manufacturer’s recommendations for application. Generally, permethrin is effective for 6 washings on clothing. If clothing is ironed after application, permethrin can last up to 12 washings. Some manufacturers offer travel clothing that is already treated with permethrin.

Mosquito nets

Locally, REI sells mosquito nets. Various companies sell mosquito nets and netting on the web. Here is a sampling, in no particular order, and without endorsement.

Military surplus stores also may stock mosquito nets.

Bee stings

Talk to your travel consultant at Hall Health or your personal health care provider if you are allergic to bee stings. The products discussed above may not be effective against bee stings and you should be appropriately prepared to manage a bee sting reaction.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff (AT), May 2014


Physician

Dr. Haulman graduated from the University of California at San Diego School of Medicine in 1980 and completed her residency in pediatrics at the Children's Hospital Medical Center in Seattle in 1983. She is board certified in both Pediatrics and Emergency Medicine. She currently holds the faculty appointment of Clinical Assistant Professor of Pediatrics in the UW School of Medicine.

In 1996 she returned to the UW.  Since that time she has been involved in travel vaccine research.  She is currently the Medical Provider for the Travel Clinic and serves as the communicable disease liaison for the UW Campus.  Her clinical practice is currently limited to counseling pre-travel patients.


1. Why is it important to maintain a medical record?

Each time you visit a Hall Health Center provider, a record of your visit is made. Typically this record contains your symptoms, examination and text results, diagnoses, treatment, and a plan for future care or treatment. This information, often called your health or medical record, serves as:


Family Nurse Practitioner

Britt Murphy is a Family Nurse Practitioner with an interest in college health and travel medicine. She has been a health care provider at the Hall Health Primary Care Center on the University of Washington campus for over 10 years.  
 
Ms. Murphy earned her BSN from the University of Vermont in 1992.  After working as an RN in oncology, she served as a Peace Corps Volunteer in Nepal from 1996 -1998.   Following her service in Nepal, Ms. Murphy pursued her MSN from the University of Washington, graduating in 2000.  She is a member of the International Society of Travel Medicine and is certified as a travel healthcare provider.


Patient Care Philosophy
I enjoy listening to my patients’ concerns and working together with them to maximize their health and wellbeing.

Personal Interests
International travel, outdoor activities and spending time with family

Clinical Interests
Primary care, travel medicine, including pre-travel concerns and infectious disease.  Has special interest in health care of the transgender community.

Languages
English

Expertise
Primary Care, Travel Medicine


Nurse Practitioner

Ms. McCadden has been an Nurse Practitioner since 2006. Prior to graduate school she worked as RN within the University of Washington system for over 20 years in such diverse specialties as ICU, ER, Research, and Occupational Health. She currently works as a Nurse Practitioner at Hall Health in Employee Health, Primary Care, Travel Medicine, and the Health Science Immunization Program.  Martae is also certified by the D.O.T. to perform commercial driver physical exams.


Family Nurse Practitioner, Manager, UW Medicine Travel Clinic at Hall Health

Anne C. Terry is a nurse practitioner who works in primary care and travel medicine at Hall Health Center at the University of Washington. Her special interests include pre- and post-travel assessments, infectious disease challenges and dermatology. Anne is currently the director of the UW Medicine Travel Clinic at Hall Health Center.

She obtained her Master of Science in nursing at the University of Tennessee, Knoxville in 1997. In addition, she has a Certificate in Infectious Disease and Infection Control from the UW School of Nursing and is certified as a travel provider by the International Society of Travel Medicine (ISTM).


Patient Care Philosophy
I strive to inspire patients to make good health decisions and to give them the tools to make things happen. Without patient input and effort, good health cannot be achieved.

Personal Interests
International travel, hiking, cycling and knitting.

Clinical Interests
Travel medicine, including pre-travel consultations and figuring out complex post-travel issues; infectious disease; and dermatology, including the management of acne with Accutane.

Teaching Interests
Mentoring nurse practitioner students and UW residents in global health.

Languages
English

Expertise
Primary Care, Travel Medicine


Syndicate content