Chapter 21: Travelers Flashcards
Travel vaccinations should be listed on what for travelers?
International Certificate of Vaccination or Prophylaxis (ICVP) OR yellow card
Travel health information, including travel health insurance recommendations, is available on the CDCs travel website where the ____ is located
Yellow Book
Which drugs can be used for traveler’s diarrhea prevention
Bismuth subsalicylate
Antibiotics if indicated
If there is bloody stool with traveler’s diarrhea it’s called
dysentery (SEVERE)
usualyl accompanied by systemic symptoms
primary causative pathogen in traveler’s diarrhea
bacterial
E. coli
prophylaxis for traveler’s diarrhea
Bismuth subsalicylate (BSS) in Pepto-Bismol
Bismuth subsalicylate should be avoided in which patients
Aspirin allergy Pregnancy renal insufficiency gout anyone taking anticoagulants
If antibiotic ppx is indicated for TD, which antibiotic is preferred
Rifaximin
should not be used by most traveler’s though
Traveler’s diarrhea treatment
oral rehydration
antimotility (loperamide)
Pepto-Bismol
antibiotics (azith, quinolones, rifaximin)
Which drugs can be used for mild traveler’s diarrhea treatment
loperamide or BSS
How does loperamide work for traveler’s diarrhea?
Decreases the frequency and urgency of bowel movements
Loperamide dose for Rx and OTC
Rx: 4 mg after the first loose stool, then 2 mg after, up to a max dose of 16 mg/day
OTC: 8 mg/day
Loperamide can be used as self-treatment for up to how many days
2 days
Which drugs can be used for moderate Traveler’s Diarrhea treatment
Loperamide ± antibiotics (quinolones if low resistance, azithromycin or rifaximin)
Which drugs can be used for severe Traveler’s Diarrhea treatment (including dysentery)
antibiotics (azithromycin preferred, quinolones or rifaximin as alternatives) ± loperamide
azithromycin is preferred for TD and dysentery
What is the BSS dose for TD ppx
524-1050 mg PO QID (with meals and HS)
Which bacterium causes Typhoid Fever
Salmonella typhi
How is typhoid fever spread
food or water contaminated by the feces of someone with either an acute infection or from a chronic, asymptomatic carrier
What are the names of the Typhoid vaccines and their route of administration
Vivotif (oral, live attenuated) - remember this by the word “vivo” which means to live
Typhim Vi (inactivated IM) - remember typhIM
When should the oral typhoid vaccine be completed
≥ 1 week prior to travel
When should the IM typhoid vaccine be completed
≥ 2 weeks before the expected exposure
Which bacterium causes Cholera
Vibrio cholerae
What is the most common symptom of cholera
watery diarrhea, which is referred to as “rice-water stools”
What is the name for the cholera vaccine & route of administration
Vaxchora; oral solution
Live attenuated vaccine
vaxchORA(L)
The CDC recommends ____ booster doses for poliovirus vaccine at least ____ prior to travel for adults who have previously completed a poliovirus vaccine series & who are traveling to regions where poliovirus is circulating
1 booster dose
4 weeks
HepA high risk individuals
people from developed countries traveling to developing countries
how is HepB transmitted?
through blood or bodily fluids
HepB vaccination is most important for those doing high risk activites like ____
planning to receive medical care, provide medical work, unprotected sex, piercings and tattoos
How long does the Hep B vaccine series take to complete
3-dose series takes 6 months to complete
What should be done if a traveler is unable to complete the Hep B series before departure
Administer as many doses as possible before departure and complete the series upon return
What are the symptoms of meningococcal meningitis
Fever, severe and unrelenting HA, nausea, stiff neck (nuchal rigidity), and mental status change - all require urgent treatment
how is meningitis spread?
respiratory secretions
Which meningococcal vaccines are quadrivalent
Menactra and Menveo
no recommendations for sero B vaccines for travelers
Which diseases can mosquitos transmit to travelers
Japanese encephalitis, yellow fever, dengue, malaria and zika virus
Those dengue Japanese mosquitos causing yellow male zebras
To avoid mosquito bites, proper repellent should contain which active ingredient on exposed skin
DEET
What should be used to treat clothing, gear and bed nets, but should NOT be applied directly to the skin
Permethrin
Severe dengue can include
severe bleeding
no treatment, only supportive care
What is the Japanese encephalitis vaccine called
Ixiaro
malaria is transmitted via
the Anopheles mosquito
Which malaria species is the most common
P. vivax
Which malaria species is the most deadly
P. falciparum
which mosquito-borne illnesses require prophylaxis?
Malaria, yellow fever
What is a common side effect of malaria drugs
Nausea - taking with sufficient water, food or milk decreases nausea
What are the quick start medications for malaria ppx & how long in advance should they be started before travel
How many times a day are they taken
Atovaquone/Proguanil
Doxycycline ** (know this one)
Primaquine (avoid in G6PD Deficiency)
1-2 days
Once daily
daily regimens, avoid in pregnancy, all cause nausea
Quick start drugs for malaria ppx must be avoided in which population(s)
pregnancy
What are the advance start medications for malaria ppx & how long in advance do they need to be started?
How often are they taken
Chloroquine
Mefloquine
Tafenoquine (avoid in G6PD deficiency)
1-2 weeks prior to travel
once weekly
T/F: Advance start medications for malaria ppx are safe in children & pregnancy
True
Mefloquine should not be used in
Underlying psych conditions
Seizures
Arrhythmias
When should chloroquine therapy be stopped for malaria ppx
4 weeks after travel
Side effects of chloroquine
Retinal toxicity, visual changes
What symptomatic treatments cannot be used for Yellow Fever
ASA and other NSAIDs d/t increased risk of bleeding
no specific treatment for acute infectoins except symptomatic relief
What is the vaccine for Yellow Fever called
YF-VAX
When is the Yellow Card valid
10 days after vaccination
Yellow Fever vaccine is contraindicated with
hypersensitivity to eggs
(eggs are yellow)**
transmission of Zika
mosquitos mostly
some sexual or blood transfusion transmission risk
What is the biggest concern with Zika virus
infants born with microcephaly
What is the primary ppx medication for Acute Mountain Sickness (AMS) & what is the brand name
When should it be used?
acetazolamide (Diamox)
Start the day before the day of descent
What is the most common SE of acetazolamide
polyuri, also photosensitivty risk
Acetazolamide is CI with
sulfa allergy
