Histex PD and Japanese Encephalitis Vaccine

• Generic Name: carbinoxamine
• Dosage Forms: n.a.
• Other Brand Names: Histex PD, Pediatex, Arbinoxa, Karbinal ER, Ryvent, Histex PD, Histex CT, Carbinoxamine PD, Pediox, Histex I/E, Palgic, Histex Pd 12, Carboxine, Cordron NR, Pediatex 12, Mintex PD

Cough/cold combinations are used mainly to relieve the cough due to colds, influenza, or hay fever. They are not to be used for the chronic cough that occurs with smoking, asthma, or emphysema or when there is an unusually large amount of mucus or phlegm (pronounced flem) with the cough.

Cough/cold combination products contain more than one ingredient. For example, some products may contain an antihistamine, a decongestant, and an analgesic, in addition to a medicine for coughing. If you are treating yourself, it is important to select a product that is best for your symptoms. Also, in general, it is best to buy a product that includes only those medicines you really need. If you have questions about which product to buy, check with your pharmacist.

Since different products contain ingredients that will have different precautions and side effects, it is important that you know the ingredients of the medicine you are taking. The different kinds of ingredients that may be found in cough/cold combinations include:

Antihistamines—Antihistamines are used to relieve or prevent the symptoms of hay fever and other types of allergy. They also help relieve some symptoms of the common cold, such as sneezing and runny nose. They work by preventing the effects of a substance called histamine, which is produced by the body. Some examples of antihistamines contained in these combinations are:

• Bromodiphenhydramine
• Brompheniramine
• Carbinoxamine
• Chlorpheniramine
• Dexchlorpheniramine
• Diphenhydramine
• Doxylamine
• Phenindamine
• Pheniramine
• Phenyltoloxamine
• Pyrilamine
• Promethazine
• Triprolidine

Decongestants—Decongestants produce a narrowing of blood vessels. This leads to clearing of nasal congestion. However, this effect may also increase blood pressure in patients who have high blood pressure. These include:

• Ephedrine
• Phenylephrine
• Pseudoephedrine

Antitussives—Antitussives help relieve coughing and are some contain a narcotic. These antitussives act directly on the cough center in the brain. Narcotics may become habit-forming, causing mental or physical dependence, if used for a long time. Physical dependence may lead to withdrawal side effects when you stop taking the medicine.

Narcotic antitussives
• Codeine
• Dihydrocodeine
• Hydrocodone
• Hydromorphone

Non-narcotic antitussives
• Carbetapentane
• Caramiphen
• Dextromethorphan

Expectorants—Expectorants work by loosening the mucus or phlegm in the lungs. The main expectorant used in cough and cold medicines is guaifenesin. Other ingredients added as expectorants (for example, ammonium chloride, calcium iodide, iodinated glycerol, ipecac, potassium guaiacolsulfonate, potassium iodide, and sodium citrate) have not been proven to be effective. In general, the best thing you can do to loosen mucus or phlegm is to drink plenty of water.

Analgesics—Analgesics are used in these combination medicines to help relieve the aches and pain that may occur with the common cold. These include:

• Acetaminophen
• Aspirin
• Other salicylates such as salicylamide and sodium salicylate

The use of too much acetaminophen and salicylates at the same time may cause kidney damage or cancer of the kidney or urinary bladder. This may occur if large amounts of both medicines are taken together for a long time. However, taking the recommended amounts of combination medicines that contain both acetaminophen and a salicylate for short periods of time has not been shown to cause these unwanted effects.

Anticholinergics—Anticholinergics, such as homatropine may help produce a drying effect in the nose and chest.

These cough and cold combinations are available both over-the-counter (OTC) and with your doctor's prescription.

Do not give any over-the-counter (OTC) cough and cold medicine to a baby or child under 4 years of age. Using these medicines in very young children might cause serious or possibly life-threatening side effects .

• Generic Name: japanese enceph vacc sa14-14-2, inactivated
• Dosage Forms: n.a.
• Other Brand Names: Ixiaro

Prevention of disease caused by Japanese encephalitis virus in adults, adolescents, and children 2 months of age or older. Used to stimulate active immunity against Japanese encephalitis virus in travelers and other individuals (e.g., laboratory personnel) at risk of exposure to the virus.

Japanese encephalitis virus, a Flavivirus closely related to West Nile virus (WNV), St. Louis and Murray Valley encephalitis viruses, yellow fever virus, and dengue virus, is transmitted to humans through the bite of infected mosquitoes that acquired the virus by biting infected vertebrate hosts (usually pigs or wading birds). Humans are incidental or dead-end hosts for Japanese encephalitis virus since level or duration of viremia usually insufficient to infect mosquitoes. Direct person-to-person transmission of the virus does not occur; however, intrauterine transmission from mother to child during pregnancy can occur and transmission through blood products or transplanted organs theoretically could occur.

Endemic transmission of Japanese encephalitis virus reported in ≥24 countries in Southeast Asia and Western Pacific. Although infection with the virus usually results in asymptomatic or mild disease (fever, headache, aseptic meningitis), 1 out of every 200–250 infections results in severe disease (rapid onset of high fever, headache, vomiting, generalized weakness, neck stiffness, disorientation, seizures, spastic paralysis, coma, death). In areas where the virus is endemic, approximately 30,000–68,000 cases of Japanese encephalitis reported annually; case fatality rate is approximately 20–30% and 30–50% of survivors have permanent neurologic or psychiatric sequelae.

For most travelers to Asia, risk of acquiring Japanese encephalitis virus is very low, but varies depending on location and duration of travel, season, and traveler's expected activities. Overall incidence of Japanese encephalitis among individuals from nonendemic countries traveling in Asia is estimated to be <1 case per 1 million travelers. Although risk considered minimal for most short-term travelers (traveling for <1 month) who only visit urban areas in Asia, risk for travelers who stay for prolonged periods in rural areas where active transmission of Japanese encephalitis virus is occurring and short-term or recurrent travelers who have extensive outdoor or nighttime exposure in rural areas during periods of active transmission of the virus is probably similar to risk in susceptible resident populations.

Risk of transmission of Japanese encephalitis virus is greatest in rural agricultural areas where the virus is endemic and often is related to rice production and flooding irrigation, which results in large numbers of vector mosquitoes breeding in close proximity to amplifying vertebrate hosts. In temperate areas of Asia, Japanese encephalitis virus is transmitted seasonally (usually peaking in the summer and fall) and large seasonal epidemics can occur. In tropical and subtropical areas, transmission of the virus can be sporadic or occur all year, but often peaks during the rainy season.

When making recommendations regarding vaccination against Japanese encephalitis virus for travelers, consider overall low risk for travel-associated Japanese encephalitis virus disease, high morbidity and mortality associated with Japanese encephalitis, low probability of serious adverse effects following vaccination, and vaccine cost. Also consider planned itinerary, including destinations, duration of travel, season, accommodations, and activities as well as possibility of unexpected travel to high-risk areas.

Travelers planning to spend ≥1 month in endemic areas during Japanese encephalitis virus transmission season: USPHS Advisory Committee on Immunization Practices (ACIP) and CDC recommend vaccination with JE-VC for all such travelers. This includes long-term travelers, recurrent travelers, or expatriates who will be based in urban areas but are likely to visit endemic rural or agricultural areas during a high-risk period of Japanese encephalitis virus transmission.

Short-term travelers (traveling for <1 month) to endemic areas during Japanese encephalitis virus transmission season if they are planning to travel outside of urban areas or do activities associated with increased exposure: ACIP and CDC state that vaccination with JE-VC should be considered for such travelers. This includes those who will spend substantial time outdoors in rural or agricultural areas (especially during the evening or nighttime), those who will participate in extensive outdoor activities (e.g., camping, hiking, trekking, biking, fishing, hunting, farming), and those staying in accommodations without air conditioning, screens, or bed nets.

Travelers to areas with an ongoing Japanese encephalitis outbreak and travelers to endemic areas who are uncertain of specific destinations, activities, or duration of travel: ACIP and CDC state that vaccination with JE-VC should be considered for such travelers.

Short-term travelers (traveling for <1 month) to Asia when visit restricted to urban areas or times outside a well-defined Japanese encephalitis virus transmission season: Vaccination with JE-VC not recommended.

All individuals considering travel to areas where Japanese encephalitis has been reported: Because risk of infection with Japanese encephalitis virus is highly variable within endemic regions and varies from year to year within a given region, consult current CDC recommendations for international travel for information concerning geographic areas where transmission of the virus is being reported. Information on risk of Japanese encephalitis in specific countries, information on mosquito avoidance and protective measures against mosquito bites, and additional information regarding benefits and risks of JE-VC vaccination in travelers is available from CDC.

Laboratory personnel at risk of exposure to infectious Japanese encephalitis virus: ACIP recommends vaccination with JE-VC for all such workers. Laboratory-acquired cases of Japanese encephalitis reported; the virus may be transmitted in laboratory settings through needlestick injuries or, theoretically, through mucosal or inhalational exposures.