Immunizations & Travelers: Travelers Flashcards
What is the “Yellow card”?
International Certificate of Vaccination or Prophylaxis
Travelers Diarrhea info
30-70% of travelers
If blood in stool, then dysentery….= severe
80% of cases are bacterial, primary pathogen is usually E.coli
Travelers Diarrhea prophylaxis?
Can use bismuth subsalicylate (BSS), reduces by ~50%
Who shouldn’t take BSS?
aspirin allergy
pregnant
renal insufficiency
gout
anyone taking anticoagulant
Taking BSS with aspirin or other salicylates can cause….
Salicylate toxicity
Who should use abx prophylaxis for TD?
no one really
rifaximin is preferred if used.
Travelers Diarrhea treatment
Hydration = essential
loperamide often used for antidiarrheal
Can use BSS but black tongue/stools & Reyes syndrome in kids
Loperamide dose?
4mg after first loose stool, 2mg every loose stool after for max of 16mg/day if RX, 8mg if OTC
can be used for up to 2 days, see provider if symptoms > 48hrs
Abx for severe & dysentery Travelers Diarrhea?
Azithromycin
Abx for severe & non dysentery Travelers Diarrhea
quinolones, rifaximin or rifamycin
Typhoid Vaccine info?
Vivotif = oral, live attenuated, finish > 1 week prior and good Q5 yrs
Typhim Vi = inactivated, IM, finish > 2 weeks prior and good Q2 yrs, not rec < 2yrs old
Most common Cholera symptoms
rice-water stools
Cholera vaccine?
Vaxchora = live, attenuated, 10 days prior to travel, ages 2-64yrs old
CDC polio recommendations?
1 time booster dose to those traveling to areas where it is circulating
Bacterial Meningitis symptoms
fever, severe and unrelenting headache, nausea, stiff neck and mental changes requiring urgent treatment.
spread by respiratory secretions
diagnosed via lumbar puncture
Quick start Malaria prevention meds
Doxy = QD, stop 4 weeks after travel (dont use preg/children < 8yo)
Atovaquone/Proguanil = QD, stop 1 week after travel (dont use preg, breastfeeding, renal impairment)
Primaquine = QD, stop 1 week after travel (dont use preg, G6PD deficiency, breastfeeding)
Advance start Malaria prevention meds
Chloroquine = QW, start 1-2wk before trip, take until 4 week after. Watch out for retinal tox/visual changes
Mefloquine = QW, start 2 wk before, take until 4 wks after. Dont use in Arrhytmias, seizures, psych conditions
Arakoda (Tafenoquine) = can be used for 6 months continuously, dont use in preg/psych conditions, breastfeeding and G6PD deficiency
Which meds shouldn’t be used in yellow fever?
aspirin and NSAIDs cannot be used due to inc risk of bleeding
Who is yellow fever vaccine contraindicated in?
hypersensitivity to eggs
severely immunocompromised
AMS prophylactic med
Diamox (Acetazolamide) 125mg BID started day before ascent
CI in sulfa allergy
