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EXECUTIVE TRAVEL MEDICINE

Travel Vaccines

Park Avenue Concierge Medicine provides comprehensive travel medicine services. Dr. Mulvehill is a member of The International Society of Travel Medicine and The American Society of Tropical Medicine and Hygiene. He is a contributor to Forbes Traveler and MSNBC.com.

Park Avenue Concierge Medicine prepares the traveler with travel medicine services ranging from common vaccines to advice on high-altitude sickness. Dr. Mulvehill has extensive experience readying patients for complicated and exotic travel.

The following travel services are provided

  • High-Altitude Sickness
  • Common Vaccines
  • Heat-Related Illness
  • Vaccine Tips and Information
  • Malaria
  • Traveler’s Diarrhea
  • Vaccine Insurance Questions

High-Altitude Sickness

General Information

Patients planning travel to altitudes above 6,000 to 8,000 feet above sea level may be susceptible to high-altitude illness. Vulnerability to these conditions is not affected by fitness or physical training. Previous experience in high-altitude conditions seems to be the only reliable predictor of susceptibility, and even that is not completely reliable. The three most common types of high-altitude illness are Acute Mountain Sickness, High-Altitude Cerebral Edema, and High-Altitude Pulmonary Edema.

  • Acute Mountain Sickness (AMS) results from rapid ascent to high altitude in patients who are not acclimatized to conditions at that altitude. It is common in mountain climbers, but also people flying or taking other rapid transportation (e.g., trains, cars or buses) to locations at altitudes above 8,000 feet. The altitude at which the patient sleeps is a critical factor, with incidence increasing sharply above a sleeping altitude of 9,000 feet.
  • At onset, AMS feels exactly like a hangover. Symptoms include throbbing headache, nausea, vomiting, frequent awakening during sleep, dizziness or lightheadedness, and fatigue. Ascent to higher altitudes should be halted until acclimatization occurs.
  • Generally treatment involves alleviation of symptoms with oxygen during sleep, aspirin for headache, and anti-nausea medication for nausea and vomiting. Symptoms should be monitored; if they do not improve or if they worsen, the patient should descend to a lower altitude.
  • AMS may increase in severity, causing swelling in the lungs or brain. These conditions, High-Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema (HACE), require immediate descent to lower altitudes and immediate medical attention.
  • Symptoms of HAPE and HACE include difficulty breathing, increased heart rate, fatigue, weakness, low grade fever, cyanosis or pallor, confusion, drowsiness, loss of coordination, nausea and vomiting, and, rarely, hallucinations and seizures. Treatment can include supplemental oxygen, steroids, and hyperbaric treatments.
  • Other disorders are experienced at high altitudes, including sleep disturbances, swelling of the extremities, sore throat or bronchitis, retinal hemorrhages (common above 15,000 feet), migraine, stroke and ultraviolet keratitis (“snow blindness”). These can be experienced concurrently with or independently of AMS, HAPE and HACE.

Centers for Disease Control and Prevention Information on High-Altitude Sickness

Travelers Checklist

Common Vaccines for International Travelers

Click on the name of the disease to go to its CDC information page.

Vaccines
Standard Regimen
Hepatitis A
two doses, 2nd dose 6-12 months after the 1st
Hepatitis B
three doses, at 0, 1, and 6 months
Japanese Encephalitis
three doses, at 0, 7, and 30 days; booster every 2-3 years
Meningitis
one dose; booster every three to five years
Rabies
three doses, at 0, 7, and 21 days; booster and antibody check every 2-5 years
Typhoid Fever
one dose; booster every two years
Yellow Fever
one dose; booster every ten years
Vaccines
”Patient
Hepatitis A
Hepatitis B
Japanese Encephalitis
Meningitis
Rabies
Typhoid Fever
Yellow Fever
Vaccines
Side Effects
Hepatitis A
Injection site soreness, headaches
Hepatitis B
Injection site soreness, headaches
Japanese Encephalitis
Fever, headache, nausea, vomiting (hives and swelling are rare)
Meningitis
Injection site soreness
Rabies
Muscle aches, swollen lymph nodes
Typhoid Fever
Nausea, vomiting, cramping
Yellow Fever
Headaches, muscle aches, fever (encephalitis in the elderly is rare)
Vaccines
Notes
Hepatitis A
Safety in pregnancy not determined
Hepatitis B
Safety in pregnancy not determined - Contraindicated in yeast hypersensitivity
Japanese Encephalitis
Safety in pregnancy not determined
Meningitis
Administer last dose at least 10 days before trip departure
Rabies
Safe in pregnancy
Typhoid Fever
Pregnancy not contraindicated to pre exposure therapy - After animal bite, rabies vaccine on day of bite and on 3rd day post-bite required if pre exposure rabies vaccine administered (rabies immune globulin not necessary) - If administered concurrently, some anti-malarials may interfere with immune response of rabies vaccine
Yellow Fever
Safety in pregnancy not determined - Contraindicated in pregnancy, patients with egg allergy, and immunocompromised patients - - Consider carefully in elderly patients - Avoid concurrent administration with other live virus vaccines - (MMR, oral polio, varicella, oral Typhoid

Heat-Related Illness

General Information

Travel to tropical and subtropical climates exposes travelers to heat extremes not normally experienced at home. These high temperatures increase the risks of developing heat-related illnesses, including heat exhaustion and heatstroke. These conditions may be very serious and can potentially result in permanent injury or death, but they are both preventable and treatable.

  • Heat exhaustion occurs when core body temperature rises to a level between normal body temperature (98.6°F) and 104°F. It is characterized by nonspecific symptoms, such as thirst, dizziness, visual disturbances, headache, weakness, malaise, and nausea.
  • Heatstroke is a less common and more serious condition that generally progresses from untreated heat exhaustion. It results in core body temperatures in excess of 104°F and can be caused by environmental exposure or physical exertion. Associated symptoms are tied to central nervous system dysfunction and include delirium, convulsions, and coma. Because of common symptoms, heatstroke can be difficult to distinguish from septic infection.
  • People who work outdoors, athletes, children and the elderly are most susceptible to the effects of heat-related illness, with the elderly and sufferers of chronic illness being particularly vulnerable to heatstroke.
  • Certain medications and other drugs can contribute to heat-related illnesses because of their stimulant or diuretic properties. These include alcohol, amphetamines, antihistamines, benzodiazepines, beta blockers, calcium channel blockers, cocaine, laxatives, neuroleptics, phenothiazines, thyroid medications, and tricyclic antidepressants. Extra care should be taken in extreme heat when using these substances.

Heat-Related Illness Prevention and Treatment Information

Centers for Disease Control and Prevention Information on Heat-Related Illness

Vaccinations

Tips and General Information

  • Keep in mind that when researching your trip, you may be told by a travel agency or embassy that no vaccines are needed for the area you are visiting. This may indicate that no vaccines are required for entry into that country or return to the United States, but vaccination still may be prudent if there is a risk of disease in that country.
  • It is important to remember that vaccines are not always 100% effective in preventing infection. The earlier you are vaccinated prior to exposure, the more effective the vaccine will be in helping to fight off the infection. There are also infections that cannot be prevented by vaccination, such as traveler’s diarrhea, malaria and HIV. As a result, taking normal preventive measures to limit the chance of exposure (e.g. washing hands frequently, avoiding contact with animals, avoiding raw or undercooked foods, avoiding potentially contaminated water, using insect repellent, and practicing safer sex) is just as important as being vaccinated.
  • There are two main types of vaccines: live and inactivated. Generally, inactivated vaccines consist of a primary dose and one or more booster doses administered at varying intervals. Except in cases where reactions to the vaccine might be exacerbated by other vaccines, inactivated vaccines can be administered simultaneously. They may also be administered at the same time as an active vaccine (which require only one dose). If multiple active vaccines are required, they should be administered with an interval of at least three weeks.
  • Under certain circumstances, routine vaccination may not be advisable. Patients with acute illnesses like colds or flu should postpone vaccination until they are well. Additionally, pregnant women should only be vaccinated in cases where the risk of exposure to an illness outweighs the risk of possible harm to the unborn child. For many vaccines, the risk to unborn children is unclear. Women who are breast-feeding can safely receive most vaccinations, but should be aware that immunity does not pass to the child through breast milk.
  • Patients who are immunocompromised or immunosuppressed due to HIV infection, radio- or chemotherapy treatment, or other immunosuppressive treatment should not receive live vaccines. Certain inactivated vaccines may be administered to these patients, but they may be ineffective or less effective than in patients with strong immune systems. HIV patients who may be at risk for exposure to Yellow Fever should consult a specialist regarding vaccination.

Information on Common Travel Vaccines

Malaria

General Information

Malaria is a serious and potentially fatal illness caused by blood borne parasites. These parasites are spread from person to person through the bite of the anopheles mosquito. Because malaria is caused by a parasite and not a virus, there is no vaccine for the disease. There are, however, several drugs available for both treatment and prevention of malaria.

  • Malaria is a tropical and subtropical disease, occurring in over 100 countries around the world. Areas of high malaria risk include Central and South America, Africa, the Middle East, India, Southeast Asia, and Oceania.
  • Malaria symptoms are similar to the flu, including fever, chills, headache, muscle ache and fatigue. Sufferers may also experience nausea, vomiting and diarrhea, and anemia and jaundice in rare cases.
  • Most people begin to exhibit symptoms from 10 days to four weeks after infection, though symptoms can arise as early as eight days and as late as a year post-infection.
  • Malaria is a very serious illness and kills over 2 million people a year worldwide.

Malaria Prevention and Treatment Information

Centers for Disease Control and Prevention Information on Malaria

Traveler’s Diarrhea

General Information

Up to half of all travelers spending two or more weeks in developing countries will experience Travelers’ Diarrhea (TD). TD generally strikes during the first week of travel, but may occur at any time during a trip or even after returning home. Some travelers may experience TD more than one time in a single trip, but the condition is rarely life-threatening. Most cases will resolve on their own in three to four days, but if symptoms persist they may be a sign of a more serious infection.

  • TD may be a simple matter of adjusting to a change in diet, but is usually caused by ingestion of contaminated food or water. Even cooked food can cause TD if it has been handled improperly.
  • Foods that pose a high risk of contamination include raw or undercooked meat, poultry, seafood, and raw fruits and vegetables. Tap water, ice, and dairy products may also carry contaminants that can cause TD.
  • Be sure to eat only meat that has been thoroughly cooked, and eat it while it is still hot. Avoid leftovers.
  • Seafood may remain contaminated even after cooking. If you are in doubt about the safety or quality of seafood, don’t eat it.
  • Peel all fruit before eating it, and avoid raw vegetables (including salads).
  • Beverages that are safe to drink include bottled soft drinks, beer, wine, hot coffee or tea, and purified water. Keep in mind that even brushing your teeth with contaminated water can cause TD.

TD Prevention and Treatment Information

Centers for Disease Control and Prevention Information on Travelers’ Diarrhea

Insurance and Payment Information

For all travel consultations and vaccines we require payment in full on the day of the visit.

The following form is intended for use when calling your insurance company to establish if you have coverage for vaccines.

Use the member service number on the back of your card. You must be specific that the vaccines are intended for travel purposes

For each vaccine give the name and the CPT code (the number beginning with 90 directly following the name.

Park Avenue Concierge Medicine (PACM) is the private, internal medicine practice of Joseph Mulvehill, M.D.
Park Avenue Concierge Medicine (PACM) is the private, internal medicine practice of Joseph Mulvehill, M.D.
Park Avenue Concierge Medicine (PACM) is the private, internal medicine practice of Joseph Mulvehill, M.D.

Testimonials

What Our Patient’s Say

“I know we can always rely on Dr. Mulvehill’s experience, medical knowledge, and compassion to provide excellent care for our members. Dr. Mulvehill is a wonderful resource for PinnacleCare in New York.” 

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Teresa Lepore, Vice President, Director Northeast Region, PinnacleCare

“Dr. Mulvehill has provided medical care for myself and my family for over eight years, he is an outstanding physician who always goes the extra mile for his patients.”

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John Murray, Attorney at Law

“As a visiting nurse I appreciate the problems of visiting sick people in their home. I have had the opportunity to work with patients under Dr. Mulvehill’s care for the past 7 years. Dr. Mulvehill treats his patients with compassion whether in his office or in their home. His care extends to encompass both patients and their families. He is truly a DOCTOR in the classic sense that cares for his patients 24/7” 

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Hanna Jacub, RN BS