Infections in travellers

Question 1

Describe the trend in short term visitor arrivals to Australia?

Answer 1

Increasing number of arrivals

Question 2

Describe the trend in the number of international travellers?

Answer 2

Increasing number of international travellers

Large volumes of movement around the world

Question 3

Which infectious diseases have been eradicated?

Answer 3

Only smallpox

Question 4

Are travel related illnesses always infectious?

Answer 4

No

Question 5

Describe the incubation period for a travel-related illness?

Answer 5

Vary widely

Question 6

How far must a person travel for their illness to be described as travel-related?

Answer 6

Can be within own country, but to different conditions (eg. tropics)

Question 7

What is the commonest cause of fatal community-acquired pneumonia in the NT?

Answer 7

Melioidosis

Question 8

Which of the following additional immunisations should a medical student going on an elective to a remote indigenous community in Northern/Central Australia receive?

a) Hep A
b) Japanese encephalitis
c) Hep B
d) MMR

Answer 8

Hep A

Question 9

Approximately what proportion of travellers to developing countries develop a health problem abroad?

Answer 9

50%

Question 10

Approximately how many cases of travel-associated malaria occur each year?

Answer 10

30,000

Question 11

What is the estimated incidence of traveller’s diarrhoea during travel in a developing country?

Answer 11

20-60%

Question 12

Which bacteria associated with travel-related illness have the potential for lifetime persistence?

Answer 12

Mycobacterium leprae

Mycobacterium tuberculosis

Treponema pallidum

Rickettsia prowazeki

Salmonella typhi

Question 13

Which helmiths associated with travel-related illness have the potential for lifetime persistence?

Answer 13

Enchinococcus granulosus

Strongyloides stercoralis

Taenia solium

Schistosoma species

Question 14

Which protozoa associated with travel-related illness have the potenital for lifetime persistence?

Answer 14

Plasmodium malariae

Toxoplasma gondii

Trypanosoma cruzi

Question 15

Which viruses associated with travel-related illness have the potential for lifetime persistence?

Answer 15

Hep B, C, D

Herpes

HIV-1 and HIV-2

HTLV-1

Question 16

Which fungi associated with travel-related illness have the potential for lifetime persistence?

Answer 16

Coccidioides immitis

Histoplasma capsulatum

Question 17

What are the most common diagnoses in returned travellers with fever?

Answer 17

Malaria

Gastroenteritis/diarrhoea/parasites

Respiratory tract infections

Question 18

Describe the relationship between diseases in a febrile returned traveller and their travel destination?

Answer 18

Pneumonia: Asia

Dengue fever: Asia

Malaria: Asia, Pacific, Africa

Hep A: Asia, Pacific

Typhoid fever: Asia

Question 19

Describe the modes of disease transmission and their relative proportions for travel-related illnesses?

What are the consequences of this for travellers?

Answer 19

Most are vector, respiratory and food and water borne

So, much of the advice for travellers relates to safe behaviour (eg. bed netting, safe eating, etc.)

Question 20

Describe the rate of respiratory infections in travellers?

Answer 20

7-29%

Second most frequent cause of illness in travellers

Second most frequent cause of fever in returned travellers

Question 21

What is the commonest vaccine-preventable disease of travel?

Answer 21

Influenza

Question 22

In which regions of the world are GIT infections most common?

Answer 22

South East Asia

Africa and South America

Question 23

Describe the distribution across sexes for malaria and Dengue fever?

Answer 23

Males get more malaria than females

Not the same sex difference for Dengue fever

Question 24

In which group of travellers is malaria most common?

Why?

Answer 24

Those travelling to visit friends and relatives (35%)

Closer contact with locals for longer periods of time
Low standard accommodation

Very disproportionate, as this only represents 5% of travellers

Question 25

Describe the relationship between the mortality for malaria and the number of cases seen in that region?

Answer 25

Inverse correlation

Relates to familiarity in treating malaria

Question 26

Describe the time intervals in fatal cases of imported malaria?

Answer 26

Arrival - symptom onset: 5 days

Symptom onset - diagnosis/treatment: 5 days

Diangosis/treatment - death: 2 days

(mean time to death after symptom onset is 5 days)

Question 27

In which region are travellers most at risk of contracting P.vivax?

Answer 27

PNG and Oceania

Question 28

Describe the most common causes of mortality in travellers?

Answer 28

CVD

Injury

Medical

Cancer

Infectious disease only 1%

Question 29

How early should pre-travel healthcare begin?

Answer 29

Preferably >6 weeks

Question 30

Which travellers should be identified as high risk travellers?

Answer 30

Those with chronic illness (esp. immunocompromised)

Pregnant

Long term, remote, high risk location

Extremes of age

Visiting friends and relatives

Question 31

Describe the key issues for traveller education?

Answer 31

Injury (esp road and water)

Diarrhoea prevention and management

Insect bites

Blood-borne, sexually-transmitted infections

Drugs (unsafe/counterfeit)

Rabies - mammal bites

Schistosomiasis (fresh water contact)