Chapter 21: Travelers

Question 1

CDC’s Health Information for International Travel

Answer 1

Yellow Book

Question 2

Dysentery

Answer 2

Blood mixed in with the stool, often accompanied by more severe systemic symptoms such as fever

Question 3

Traveler’s Diarrhea pathogen

Answer 3

E.coli

Question 4

TD prevention non-pharm

Answer 4

Avoid food that has been sitting on a buffet.
Use bottled water or boil for approximately 1 minute before drinking or using to brush teeth.
Avoid ice

Question 5

TD prevention pharm

Answer 5

Prophylaxis with bismuth subsalicylate (BSS) reduces the incidence of TD by ~50%
Abx prophylaxis should not be used by most travelers

Question 6

TD Treatment

Answer 6

• Hydration (increased fluid and salt) intake is essential
• Loperamide
• BSS
• If abx are needed azithromycin or a quinolone is low resistance, or rifaximin

Question 7

Typhoid Fever pathogen

Answer 7

Salmonella typhi

Question 8

Cholera Pathogen and vaccine

Answer 8

Vibrio cholerae

Vaxchora is the vaccine

Question 9

Polio booster

Answer 9

A single lifetime booster for people traveling to polio infected areas, 4 weeks prior to travel

Question 10

Hep A

Answer 10

people from developed countries who travel to developing countries are at the highest risk

Question 11

Hep B transmission

Answer 11

Transmitted through contaminated blood or other body fluids. But the risk for travelers who do not participate in high-risk behaviors is low

Question 12

Hep B vaccination

Answer 12

The series takes 6 months to complete, if they cannot be completed before travel administer as many doses as possible before departure and complete series upon return.

Question 13

Meningococcal Meningitis symptoms

Answer 13

Fever, severe and unrelenting headache, nausea, stiff neck, and mental status change requires urgent tx to avoid risk of permanent neurological damage and death
Spread by respiratory secretions

Question 14

High Risk Regions for M. Menigitis

Answer 14

• Meningitis belt of africa during the dry season

- Saudi Arabia requires the vaccine for travel during the annual Hajj and Umrah pilgrimages

Question 15

Recommended Meningitiss vaccines

Answer 15

Menactra and Menveo contain the 4 bacterial types ACWY

Question 16

Mosquitos transmit which viruses

Answer 16

Japanese encephalitis
Yellow fever
Dengue
Malaria
Zika

Question 17

Ways to avoid insect bites

Answer 17

Mosquito repellants containing 20-50% DEET as active ingredient on exposed skin.
Permethrin to treat clothing, gear, and bed nets. Do not apply directly to skin.

Question 18

Japanese Encephalitis Vaccine

Answer 18

Ixiaro

Question 19

Malaria transmission

Answer 19

It is transmitted by the anopheles mosquito

Question 20

Malaria Pathogen

Answer 20

-P. vivax causes 50% of malaria cases in India
-P. falciparum is the most deadly species
Even with tx malaria can be fatal so prophylaxis is recommended

Question 21

Malaria Quick Start Prophylaxis Options

Answer 21

Doxycycline
Atovaquone/proguanil (Malaron)
Primaquine (do not use in G6PD deficiency)

All are daily regimens, avoid in pregnancy, and cause nausea

Question 22

Malaria Advanced Start Options

Answer 22

Chloroquine (taken weekly, stop 4 weeks after travel)
Mefloquine (start >=2 weeks before, stop 4 weeks after, taken weekly)(do not use with underlying psychiatric conditions, seizures, arrhythmias)
Above safe in pregnancy and children

Tafenoquine (taken weekly)(avoid in G6PD deficiency)

Question 23

Altitude Sickness preventions

Answer 23

Acetazolamide 125mg started the day before travel
SE: polyuria, photosensitivity
CI: patients with sulfa allergy