Global Health Flashcards
Name 4 potentially life threatening acute tropical infections
P. Falciparum malaria
Typhoid fever
Paratyphoid fever
Leptospirosis
Where is travellers diarrhoea most common? %?
India (1 week risk 54%)
What is the ABCD of malaria advice?
Aware of risk (fever up to 6 months after return) Bite avoidance (DEET insect repellant, nets, long sleeves dawn till dusk) Chemoprophylaxis compliance (duration, SE, cost) Diagnose early
Name the 3 most commonly used malaria prophylaxis treatments
Malarone (proguanil +atovaquone)
Doxycycline
Mefloquine
How many vaccinations are covered by the green book?
27
What vaccinations are often legally required?
Yellow fever, meningococcus ACWY, Polio
List 5 common travel vaccines
Hep A Typhoid Yellow fever Rabies Meningococcal ACWY
What vaccines are legally required for the Hajj pilgrimage?
Meningococcal ACWY
Polio & yellow fever if from a country at risk
What is Ebola?
A viral haemorrhagic fever
Name the 6 most affected countries by Ebola
Guinea, Sierra Leone, Liberia, Senegal, Nigeria, Mali
Signs and symptoms of Ebola
Fever Headache Weakness (more fatal) Dizziness (more fatal) Diarrhoea (more fatal) Abdo pain Sore throat Vomiting Conjunctivitis
Treatment of Ebola
No cure Supportive care IV fluids Antimalarials Antibiotics
What was the likely viral reservoir for Ebola?
Fruit bats
Peak incidence of infection (age) for Ebola?
15-18yrs, 26-40yrs
Incubation period? Death? (Ebola, %)
6-12 days
8-9 days
Fatality? (%, Ebola)
74%
How was it transmitted? (Ebola)
Through contact with bodily fluids
What made the outbreak worse? (Ebola)
Delayed recognition and response
Fear & distrust of authorities
Limited sanitation and overcrowding
Long incubation, no vaccine and no treatment
Fluid borders
Poor infrastructure and healthcare resources
What are emerging infections driven by?
Increased global travel
Environmental and climate change (deforestation, flooding, drought, urbanisation)
Political instability and breakdown of public health measures
Widespread antibiotic use
Decline in immunisation
Better diagnostics
What is MERS?
Middle eastern respiratory sydrome Coronavirus Camels likely host Mainly in Saudi Arabia 36% mortality
Name the last 3 influenza pandemics
2006 novel H1N1 swine flu
H5N1 avian flu, Hong Kong
H7N9 avian flu, Far East
What species of mosquito spreads malaria?
Anopheles mosquito
How many types of malaria are there?
5
What type of malaria is the most deadly? Deaths a year?
P. Falciparum, 0.5mill deaths a year
Where are most deaths from P. Falciparum located?
Sub Saharan Africa:
Kenya, Angola, Zambia, Tanzania, Sierra Leone
What stage of plasmodium parasite is inoculated into the blood stream by the mosquito?
Sporozoite
What stage of the plasmodium is found in liver cells?
Hypnozoites
How long is the liver multiplication stage?
5-12 days
What stage of the plasmodium enters the bloodstream from the liver?
Merozoites
What stage of the plasmodium is found when it invades RBCs?
Trophozoite
What stage of the plasmodium is sucked up into the mosquito?
Gametocyte
Signs and symptoms of P. Falciparum malaria
Fever (continuous/tertian) Rigors Vomiting Headache Arthrlagia Malaise
When does P. Falciparum commonly present?
4 weeks after returning from an endemic area
When is malaria classed as sever?
Parasitaemia>2% or complications: Cerebral malaria AKI Pulmonary oedema (ARDS) Metabolic acidosis Hypoglycaemia
How do you diagnose malaria?
Blood film
Antigen testing
PCR (used as research tool)
Low platelets, raised bilirubin is suggestive
Non severe treatment of P/ Falciparum malaria?
Oral quinine + second agent
Malarone (atovaquone + proguanil)
Co-artem (artesunate +halofantine)
Treatment of severe P/ falciparum malaria?
IV Quinine or IV Artesunate
Where is P. Vivax endemic?
Pakistan, India, SE Asia, Oceania, S America, Mediterranean
Treatment of P. Vivax
Multiple relapses if untreated
oral chloroquine or oral primaquine
What needs to be checked before giving primaquine?
G6PD deficiency
How many cases of malaria are imported to the UK each year?
1500 cases a year
What type of malaria is imported to the UK?
P. Faliparum (74%) (Africa, Nigeria)
P. Vivax (14%) (India)
What is the efficacy of chemprophylaxis in sub saharan Africa?
95%
What reason for travel is the most likely to get malaria infection and import to UK? Why?
Visiting friends and family
Stay longer in rural/semi urban areas that tourists
Do not take prophylaxis
DO not perceive themselves to be at risk
What continents are you most likely to acquire an illness?
Asia (32.6%) Subsaharan Africa (26.7 %)
Where are you most likely to acquire GI disease? What % of total illness?
34% of all illnesses
SC Asia, C America
Where are you most likely to acquire a febrile illness?What % of total?
Africa, SE Asia
23.3%
Where are you most likely to acquire a dermatologic illness? What % of total?
Caribbean, S America
19.5%
What is the most common cause of GI illness?
Parasitic (Giardia) except in SE Asia where Campylobacter is most common
Most common causes of febrile illness and area
Malaria (Subsaharan Africa)
Dengue fever (SE Asia and Caribbean)
Mononucleosis (EBV, CMV, acute HIV) (Caribbean, C America)
Enteric fever/typhi (SC Asia)
Most common causes of dermatological disease and area
Insect bites (C America)
Cutaneous larava migrans (Caribbean)
Allergy (everywhere esp Caribbean)
Skin abscess (SC Asia & Sub Saharan Africa)
What reason for travel are least likely to become ill? Most common disease type in that group?
Business
Respiratory
What % of travel related legionella, measles and HIV is acquired in Europe?
1/3 legionella
20% measles
15% acute HIV
Causes of death abroad
Trauma
Chronic disease
Suicide/homicide
Infectious cause (malaria)
