Sunday, August 10, 2008
News

Welcome to China. Don’t pet the dogs

“China is known as second in the world only to India for rabies.”— Phyllis Kozarsky, Emory University

By Mark Woolsey

Don’t drink the water. Make sure your immunizations are up to date. Get your prescriptions refilled and stick them in your travel kit. All solid advice for those traveling to foreign countries.

But visitors from Atlanta headed to the People’s Republic of China for the Olympics have heard different marching orders. How about: Don’t pet Fido, no matter how cute and cuddly he looks. And watch what time of day you’re out in the air.

Later this month, more than a few Atlantans may return from China sickened, despite taking such precautions.
 
Keeping healthy and safe in Beijing, and possibly avoiding a return trip on a gurney, is a topic looming larger with the Olympics Games underway. But it also speaks to a larger frame of reference: Atlanta’s business and travel links with China have firmed up noticeably in recent years. The Metro Atlanta Chamber says that in the past 18 months, Georgia’s Economic Development Department has announced some $75 million in Chinese investment in the area. For Atlanta businesspeople, that means more face time on Chinese soil.
 
“The natural assumption is that when you’re traveling to an exotic place, that you’re going to be exposed to exotic disease,” says Phyllis Kozarsky, who, aside from being an infectious diseases expert at Emory University School of Medicine, is also medical director of TravelWell, a pre- and post-travel clinic based at Emory Crawford Long Hospital, and a travel consultant with the Centers for Disease Control. “So we went back and pulled the records.”

The resulting China travel study, published in the July issue of the American Journal of Tropical Medicine and Hygiene, contains some surprises. It fingers respiratory illnesses as a primary concern. No shock there, considering Beijing’s notorious air pollution. The chunky air turned out to be the most common reason travelers sought medical care in China. Also not surprising: acute diarrhea (the unwanted souvenir for so many travelers everywhere), as well as cuts, sprains and strains. Eczema and insect stings factored in as well.

On the other hand, the study by Kozarsky, CDC colleagues and the GeoSentinel Surveillance Network (a global association of medical/travel clinics) showed that the incidence of tropical and parasitic disease was low. No one complained of malaria or dengue fever in the 10 years of visits the study examined--all surprising discoveries.

Even more surprising were the dog bites. Jimi Hendrix’s famous line, “move over, Rover,” makes a handy mnemonic device for dog-loving visitors.
   
“China is known as second in the world only to India for rabies,” says Kozarsky. “Here in the U.S. when we think of it, we think of rare exposure to a bat.” But China is a different story: Our high rate of animal vaccinations and compliance with leash laws isn’t the case there. “A scratch or bite might seem fairly benign, but it could be a serious problem. That’s why [there’s a] recommendation to stay away from animals.”

If bitten, travelers should seek medical treatment immediately, Kozarsky says, imparting a scary statistic: Nearly 3,300 people died from rabies in China in 2006. In the same year, 140,000 animal bites were reported in Beijing.

In recent months “a few hundred people” came thru the TravelWell clinic heading for the games, Kozarsky says. In addition to addressing the potential for critter encounters, she and her staff have stressed respiratory issues, some related to the foul air. The junk being thrown into the Chinese atmosphere can exacerbate underlying issues like asthma—something Atlantans can relate to during smog season.
   
“On top of that, there might be respiratory viruses circulating there that Americans may have not seen or built up immunity to,” she says. Visitors can also add common colds, bronchitis and pneumonia to the list of breathing bugaboos. Kozarsky advises travelers to exercise outside early in the day to avoid pollution exposure.

Other pre-travel orders at the clinic have included bringing vaccinations up to date for communicable maladies such as hepatitis and measles (more common in China), advising travelers to consume only properly prepared food and drink, stressing frequent-hand-washing, stocking a travel kit with over-the counter and chronic medication, exercising common sense in crowds and wearing sensible shoes. Despite that, clinic officials anticipate some post-travel visits from those whose Olympic experience turned medically sour.  
    
Asked how sick some of those folks might become, Kozarsky says, “People can come back from New York and require intensive care just as frequently as they might when they come back from Beijing. Sometimes people don’t manage underlying illnesses well regardless of where they travel. All the same, I don’t think people can think of [traveling to China] as going to Kansas City.”
   
TravelWell serves several thousand people a year, many traveling to remote, exotic destinations, as eco-tourism and adventure travel have staked an increasing claim on the sightseeing public’s imagination.

But travel to China isn’t all fun and games. Some of it is work-related. Citing demand, Atlanta-based Delta Air Lines began its first-ever nonstop service between Hartsfield-Jackson and Shanghai this spring. The U.S.-China business connection is accelerating: Such companies as Sany Heavy Industry Co. Ltd. are landing here, with its first North American assembly plant expected to roost in Peachtree City. Other ventures include a condiment plant in Newnan and an electric plug manufacturer in Lamar County. Atlanta Mayor Shirley Franklin and state officials made several visits to China between 2005 and 2007 to sniff out new business and build relationships.
   
All of which adds a tad more urgency to travel clinic warnings about China: Don’t expect the same standards you enjoy here. From bad air to spottier public-health practices and a booming trade in counterfeit medications, China can throw medical curveballs at the unwary visitor.
 
As Kozarsky puts it, “People make sure their passports and hotel bookings are in order, but they don’t pay attention to health issues. And then they come back and say, ‘Why didn’t you tell me? I was sick the whole time.’”

Linda Milfred, an Atlanta attorney who’s going to China in conjunction with the games, says Kozarsky’s advice doesn't make her think twice about going, but "It does make me think twice about walking up to a dog." SP