Ch 25: Travelers

Question 1

travelers diarrhea (TD), highest risk

Answer 1

asia, middle east, africa, mexico, central and south america. usually bacterial (e. coli), lasts 3-7 d, but if persistent is >14 d.

Question 2

dysentery

Answer 2

blood mixed in with stool. sometimes has fever. considered severe travelers diarrhea

Question 3

TD ppx non drug

Answer 3

“cook it, peel it, or forget it”. +avoid food sitting on buffet. + avoid ice (cannot boil). eat at well-known restaurants. keep hands clean

Question 4

TD ppx drug

Answer 4

bismuth subsalicylate (BSS or peptobismol) dec incidence by 50%. abx ppx not rec - only if high risk for complications of TD (rifampin preferred)

Question 5

TD tx

Answer 5

hydration (inc fluid and Na intake). OTC antidiarrheals - primarily loperimide (imodium A-D) to dec freq and urgency. 4 mg after 1st loose stool and 2 mg after each subseequent loose stool. max of 16 mg/d for up to 2 days. BSS is alt, less effective.

Question 6

abx for TD

Answer 6

shortens duration of mod-to-severe TD. macolides, quinolones, or rifaximin preferred. azithromycin preferred for severe TD and dysentary

Question 7

typhoid fever bug + location

Answer 7

salmonella typhi transmitted by contaminated feces of person with acute infection or from chronic asymptomatic carrier. E and SE asia, africa, caribbean, central and south america

Question 8

typhoid fever vax

Answer 8

Vivotif - PO live 1 wk prior to travel for 6+ YO. Typhim Vi - IM inactivated 2+ wks before travel for 2+ YO. no vax for paratyphoid fever. vax only 50-80% effective so wash hands and use food/water precautions.

Question 9

cholera

Answer 9

vibrio cholerae. africa, SE asia, haiti “rice water stools”. food and water precautions. Vaxchora - PO live vax 10 days before travel for adults 18-64 YO.

Question 10

polio

Answer 10

poliovirus. single lifetime booster dose of inactivated IPOL >4 wks prior to travel for adults with previously completed poliovirus vaccine series traveling to regions where polio is circulating. may require certificate of vax or ppx (ICVP) to travel back to polio vax country from polio infected country

Question 11

hepatitis A

Answer 11

highest risk for patients traveling form developed countries to developing countrys. consider vax for most parts of world with Havrix or VAQTA (hep A inactivated only).

Question 12

hepatitis B

Answer 12

6 month vax series (engerix-B or recombivax B - both inactivated), admin as many as possible before travel and complete upon return. low risk unless providing medical work, have sex with new partners, or receive med care.

Question 13

meningococcal meningitis

Answer 13

sx of fever, severe or unrelenting HA, nausea, stiff neck, AMS require urgent tx. spread by resp secretions. Vax with Menveo or Menactra (inactivated) before travel to regions of pandemic or hyperendemic. no rec for serogroup b meningococcal for travelers.

Question 14

meningococcal meningitis locations

Answer 14

meningitis belt of africa, vax required in saudi arabia for travel during haff and umrah pilgramages.

Question 15

vector

Answer 15

insect that carries organism (disease) to individual

Question 16

reservoir

Answer 16

where disease lives and can multiple, host or soil/etc

Question 17

strategies to avoid insect bites

Answer 17

stay/sleep in AC room with bed net (pretreated with mosquito repellant), cover exposed skin, properly apply mosquito repellents with 20-50% DEET on exposed skin, which also helps with ticks. picaridin, oil of lemon, eucalyptus, IR3535 repel mosquitos but not ticks. permethrin treats clothing, gear and bed nets but do not apply directly to skin

Question 18

dengue

Answer 18

transmitted between people by aedes aegypti and aedes albopictus mosquitoes. no vax avail, treat with supportive care. protect from mosquito bites to ppx.

Question 19

malaria

Answer 19

transmitted by anopheles mosquito. P. vivax is most common of human malaria species. can be fatal even with tx. ppx med recommended, which are region specific per CDC and may change annually.

Question 20

quick start malaria ppx

Answer 20

1-2 days prior to travel. atovaquone/proguanil (malarone). doxycycline (dorynx, vibramycin). or primaquine. all cause nausea and GI distress so take with water, food or milk. avoid in preg.

Question 21

malarone

Answer 21

atovaquone/proguanil. take 1-2 days before travel, QD, until 1 wk after travel. do not use in preg, breastfeeding, renal impairment. good coverage for all areas.

Question 22

doryx

Answer 22

vibramycin other brand. doxycycline. take 1-2 d before travel, QD, until 4 wks after travel. avoid in preg, children <8 YO, sun exposure. also prevents rickettsial infections and leptospirosis.

Question 23

primaquine

Answer 23

take 1-2 d before travel, QD, until 1 wk after travel. avoid in g6pd deficiency d/t risk of hemolytic anemia, preg, breastfeeding. most effective against p. vivax.

Question 24

advance starts

Answer 24

start 1-2 wks before travel. chloroquine and mefloquine (Lariam) available. all cause nausea and GI distress so take with water, food or milk. weekly regimens. safe in children and preg. choice depends on resistance in region

Question 25

chloroquine

Answer 25

start 1-2 wks before travel, q1wk, stop 4 wks after travel. if taking chronic hydroxychloroquine –> covered. resistance issues with P. falciparum and P. vivax

Question 26

Lariam

Answer 26

mefloquine. start 1-2 wks before travel, q1wk, stop 4 wks after travel. do not use in underlying psych condition, seizures, or arrhythmias

Question 27

japanese encephalitis

Answer 27

trasmitted by mosquitoes. ppx is reduce exposure to mosquitoes. highest risk in rural agricultural areas. vax is rec to asia and parts of western pacific with ixiaro in pts 2+ mo old, esp if spending at least 1 mo outdoors (camping) in endemic areas during transmission season.

Question 28

yellow fever

Answer 28

virus found in (sub)tropical areas in africa and central and S. america. reduce mosquito exposure. no tx except sx relife with fluids, analgesics, and antipyretics - not ASA or NSAIDs d/t inc risk of bleeding

Question 29

zika virus

Answer 29

transmitted by aedes mosquito. sexual and possible blood transfusion assoc transmission. no vax avail. avoid mosquito bites and use condoms as ppx. preg pts infected had babies with microencephaly and other birth defects

Question 30

acute mountain sickness (AMS) aka altitude sickness

Answer 30

sx: HA, dizziness, tachycardia, SOB. ppx with acetazolamide (diamox) 125 mg BID started on day before (preferred) or day of ascent. higher doses for tx. ADRs of polyuria, taste altered, risk of dehydration, photosens, urticaria, possible severe skin rash. contraindicated in sulfa allergy. hydrate and protect from sun.

Question 31

yellow fever vax

Answer 31

YF-VAX - live. after vax, pts receive international certificate of vax and ppx (ICVP) aka yellow card, required in some coutnries. only valid if vax completed <10 days before travel. CDC 2015 says 1 dose is lifelong protection but some countries still require q10yrs booster dose. contraindicated in pts with hypersens to eggs d/t ADRs - still need ICVP if country requires it