Lecture 18 - Travel Medicine

Question 1

What is travel medicine?

Answer 1

devoted to the health of travelers who visit foreign countries

interdisciplinary specialty concerned not only with prevention of infectious diseases during travel but also with personal safety and prevention of environmental risk

Question 2

Difference of tropical medicine vs. travel medicine

Answer 2

focuses primarily on pretravel preventive care of persons and less on the diagnosis and treatment of illness

Question 3

3 main areas in travel medicine

Answer 3

1. vaccine use in travel
2. the management of traveler’s diarrhea
3. the prevention of malaria

Question 4

Who practices travel medicine

Answer 4

-Physicians
Infectious disease, family practice, internal medicine
-Pharmacists
-Nurses

Question 5

What is ISTM Vision Statement?

Answer 5

International Society of Travel Medicine

committed to ongoing contributions to the advancement of travel medicine globally

developed a continuing professional development program

Question 6

What is travel medicine competency?

Answer 6

Appropriate knowledge and aptitude for practicing travel medicine thru a certificate

ongoing education and performing pretravel consultations on a regular basis

Question 7

What are the main things covered during a travel clinic visit?

Answer 7

An individualized risk assessment that takes into consideration the exact place-by-place itinerary

Immunizations, malaria considerations, and travelers’ diarrhea should be covered next

Education of prevention behaviors by the traveler

Question 8

Vaccines for travelers can be divided into which 3 categories?

Answer 8

1. those used for routine preventive health
   - –influenza, Tdap [tetanus, diphtheria, and pertussis], MMR [measles, mumps, and rubella], poliovirus, and varicella vaccinations
2. those that may be required for travel (usually according to IHRs)
   ===Yellow fever is often required as an entry requirement when travelling from endemic countries to those without
3. those that are recommended according to risk for disease acquisition
   - -Japanese encephalitis

Question 9

What is the most common ailment for travelers?

Answer 9

traveler’s diarrhea

three or more unformed stools plus at least one accompanying symptom (fever, nausea, vomiting, and abdominal cramping) in a 24-hour period during travel and for up to 7 days after travel

Question 10

Most common cause of travelers diarrhea?

Answer 10

Ingesting contaminated food

Most commonly bacterial
-enterotoxigenic Escherichia coli (ETEC),

Question 11

Other causes of travelers diarrhea?

Answer 11

Viruses

• Norovirus
• Arbovirus

Parasites

• Giardia lamblia
• etamoeba histolytica

Bacterial:
- Enteroaggregative E. coli 
Salmonella 
Campylobacter species
Shigella

Question 12

main tx for travelers diarrhea?

Answer 12

Fluoroquinolones (Cipro, Levaquin) are the mainstay of treatment
Typically 1 dose is sufficient but travelers should be given a 3 day supply

Question 13

What type of organism is malaria caused by?

Answer 13

protozoan parasite?

P. oval, P. vivax, P. falciparum, P. malariae

Question 14

T/F Malaria is transmitted through male anopheles mosquito

Answer 14

FALSE only thru Female anopheles mosquito

Question 15

Which type of malaria causes the most severe disease?

Answer 15

P. falciuparum causes the most clinically significant disease

Question 16

best way to prevent malaria?

Answer 16

Mosquito-bite prevention is a primary approach to protection from malaria

-long clothing
-DEET ((25-35%)
Treat clothing with permethrin
Sleep under net

Question 17

main symptoms of altitude sickness?

Answer 17

headache plus another nonspecific symptom

Question 18

2 best type of prevention for altitude sickness

Answer 18

• acetazolamide is effective at a dose of 125 mg twice daily beginning 24 hours before an ascent to an altitude of 2800 m or higher and continuing through the day after the highest altitude is reached
• Gradual ascent and acclimation is the best prophylaxis