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cdc yellowbook > Preparing International Travelers > Flashcards

Preparing International Travelers Flashcards

1
Q

what are 2 existing networks provide epidemiologic data on international travelers from the US and acquisition of the travel-related illness?

A
  1. GeoSentinel Global Surveillance Network
  2. Global TravEpiNet (GTEN)
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2
Q

for patients who had uncomplicated MI, how soon they can travel by air?

A

3 weeks after

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3
Q

for patients who had thoracic or abdominal surgery, how soon can they travel by air?

A

after 10 days

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4
Q

if river rafting, which diseases are likely?

A

schistosomiasis or leptospirosis

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5
Q

for spelunking in Central America could put the traveler at risk for …?

A

histoplasmosis

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6
Q

for travelers with a history of cardiac disease, what should they carry with them while traveling?

A

medical reports, including a recent ECG

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7
Q

what are the classification system for destination-specific risk for YF virus transmission?

which areas should people get vaccinate?

A

endemic
transitional
low potential
no risk

  • endemic & transitional
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8
Q

for genearlly not recommended YF area, still, vaccination of YF might be considered for a small subset of travelers at increase risk for exposure to YF virus due to …?

A

prologned travel;
heavy mosquito exposure;
inability to avoid mosquito bites

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9
Q

what is the attack rate range for traveler’s diarrhea during 2 week period?

A

30-70%

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10
Q

bacteria are the predominant enteropathogens and are thought to account for …% of cases; then viruses …%; then protozoal pathogens …%

A

80-90%
5-15%
10% in longer-term travelers

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11
Q

what are the 4 most common pathogen bacteria that cause TD?

A

enterotoxigenic E. coli;
Campylobacter jejuni;
Shigella spp;
Salmonella spp;

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12
Q

what are other pathogen that cause bacterial TD?

A

Enteroaggregative and other E. coli;
Aeromonas spp;
Plesiomonas spp;
new recognized pathogens - Acrobacter, enterotoxigenic Bacteroides fragilis, Larobacter

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13
Q

what are the viruses that cause TD?

A

astrovirus, norovirus, rotavirus

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14
Q

what are the protozoal parasites that cause TD?

A

Giardia - main one causing TD;
Entamoeba histolytica & Cryptosporidium - uncommon;
Cyclospora - highly geographic and seasonal (Guatemala, Haiti, Nepal, Peru);
Dientamoeba fragilis

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15
Q

untreated, bacterial diarrhea usually lasts… days; viral diarrhea .. days

A

3-7 days;
2-3 days

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16
Q

what is the effectiveness of bismuth subsalicylate in preventing TD?

A

50%

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17
Q

what is the contraindication of bismuth subsalicylate?

A

aspirin allergy, gout, renal insufficiency
pt taking anticoagulants, methotrexate, probenecid
<12 years
not recommended for children <3 years or pregnant people

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18
Q

is probiotic good to preveent TD?

A

inconclusive - data are insufficient

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19
Q

fluoroquinolone resistance among which species globally now limits their use in TD?

A

Campylobacter and Shigella and Salmonella species

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20
Q

what other adverse reactions occur due to fluoroquinolones?

A

tendinitis
QT interval prolongation
C. diff infection
aortic tears
hypoglycemia
mental health side effects
tendon rupture

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21
Q

how did the prophylactic AB for TD has changed?

A

fluoroquinolones –> rifaximin and rifamycin SV

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22
Q

travelers can become colonized with ……, when use prophylactic AB for TD.

A

extended-spectrum B-lactamase-producing Enterobacteriaceae (ESBL-PE)

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23
Q

what is the simpliest azithromycin treatment for TD?

A

1000mg single dose;
500mg bid for 1 day

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24
Q

which area there is more resistance of fluoroquinolones for TD?

A

South and SE Asia, where both Campylobacter infection and fluoroquinolone resistance are prevalent

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25
Q

what are other tx option of TD caused by noninvasive strains of E.coli in adults

A

Rifamycin SV & Rafaximin:
but need to carry azithromycin in case of infection due to an invasive pathogen

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26
Q

what is the cipro dose for TD?

A

750mg stat, single dose;
500mg bid for 3 days;

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27
Q

what is the rifamycin SV dose for TD?

A

388mg BID for 3 days

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27
Q

what is the levofloxacin dose for Td?

A

500mg QD for 1-3 days
(if symptoms are not resolved after 24 hours, continue daily dosing for up to 3 days)

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27
Q

what is the recommendation of mild diarrhea?

A

bismuth subsalicylate or loperamide

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27
Q

what is the rifaximin dose for TD?

A

200mg tid for 3 days

27
Q

what is ofloxacin dose for TD?

A

40mg bid for 1-3 days

27
Q

what are the treatment for Giardia duodenalis?

A

metronidazole
nitazoxanide
tinidazole

28
Q

what is the treatment for Amebiasis?

A

metronidazole or tinidazole; then treated with a luminal agent (iodoquinol or paromomycin)

29
Q

treatment for cryptosporidiosis?

A

self-limited; but can consider nitazoxanide

30
Q

treatment for cyclosporiasis?

A

trimethoprim-sulfamethoxazole

31
Q

what are the treatment of TD for children?

A

azithromycin first line;
Rifaximin children 12 and up;
(rifamycin SV is only for adults)

32
Q

which populations are at an increased risk for health consequences from ESBL-PE colonization?

A

elderly & hx of recurrent UTI

33
Q

hand sanitizer is not as effective as handwashing for removing some germs like….

A

cryptosporidium or norovirus

34
Q

prepared formula should be used within.. hr, or refrigerated for max of .. hr.

A

2 hr
24 hr

35
Q

how to prevent transmission of most infectious pathogens in water in pools?

A

maintain proper pH - 7.2-7.8;

maintain free chlorine (or bromine) concentration - 3-10 ppm in hot tubs and spas; 1-10 ppm in pools and water playground

36
Q

which can cause ‘hot tub rash’ or ‘swimmer’s ear’?

A

Pseudomonas

37
Q

which can multiply in hot tubs and spas in which chlorine or bromide concentrations are not adequately maintained?

A

Legionella

38
Q

which parasite is found around the world in warm freshwater, including lakes, rivers, ponds, hot springs, and locations with water warmed by discharge from power plants and industrial complexes, and which can cause rare but fatal infection?

A

Naegleria fowleri

39
Q

what are water disinfection methods that can be applied in the field?

A

heat, clarification, filtration, chemical disinfection, UV radiation

40
Q

what are the water disinfection method that kills all enteric pathogens?

A

heat

41
Q

what are the advantages of using chemical disinfection - halogens and electrolytic solutions?

A

inexpensive & widely available;
bad taste can be removed by simple techniques;
flexible dosing;
equally easy to treat large and small volumes;
residual protection

42
Q

what are the disadvantages of using chemical disinfection - halogens and electrolytic solutions?

A

impart taste and odor to water;
flexible dosing requires understanding of principles of chemical disinfection;
iodine is physiologically active and has potential adverse health effects;
not readily effective against Cryptosporidium oocysts;
efficacy decreases with cloudy water;
liquid disinfectants are corrosive and can stain clothing

43
Q

what are the advantage of using chlorine dioxide chemical disinfection?

A

low doses impart no taste or color to water;
simple to use and availbe in liquid or tablet form;
more potent than equivalent doses of chlorine;
effective against ALL waterborne pathogens, including Cryptosporidium

44
Q

what is the disadvantages of chorine dioxide?

A

volatile and sensitive to sunlight; do not expose tablets to air; rapidly use chlorine dioxide solutions;
no residual protection; does not prevent stored water from contamination;
requires several hours contact time for disinfection

45
Q

what is the advantages of UV radiation for disinfecting water?

A

imparts no taste, odor, color to water;
portable battery-operated devices are available;
ALL waterborne pathogens;
extra doses of UVR can be used for added assurance and with no side effects

46
Q

what are disadv. of UV radiation for disinfecting water?

A

requires CLEAR water;
no improve taste, appearance;
expensive
batteries/power source
cannot know if devices are delivering required UVR doses;
no residual protection

47
Q

what does ‘clarification’ refer to in water treatment?

A

technique that reduce the cloudiness (turbidity) of water caused by the presence of natural organic and inorganic material

48
Q

what is the difference - sedimentation vs. coagulation/flocculation?

A

sedimentation - settle by gravity
coag/floc - clumping of suspended particles in water

49
Q

which is widely used coagulation/flocculation agent?

A

ALUM - aluminum salt

50
Q

how effective is portable filters?

A

remove bacteria and protozoan parasites, but not enteric viruses with an average size of 0.03 micro meter

51
Q

which filtration can remove viruses?

A

ultrafilter (0.01 um),
nanofilter (0.001 um),
reverse osmosis (<0.0001 um)

52
Q

what vaccines are still recommended for last minute travelers?

A

cholera, hep A, meningococcal (ACWY), polio, typhoid

53
Q

which vaccines have rapid schedule for last minute travelers?

A

hep B - Heplisav-B: 0, 28 days (18 years and over);
Twinrix: 0, 7, 21-30 days, 12 month;
Japanese Encephalitis: IXIARO 0, 7 days (or single dose (Imojev) or live attenuated SA 14-14-2 JE vaccine (Chengdu)

54
Q

what is the risk of patients taking lithium for travel?

A

med evels might fluctuate, particulary if high ambient temperatures (increased perspiration can lead to lithium toxicity, even on a consistent dose)

55
Q

what do you need to screen when do travel counsel for LGBTQ?

A

hep B, hep C, HIV infection;

56
Q

what infections should you counsel for LGBTQ patients?

A

Enteric infections
- bacterial (Salmonella, Shigella) and parasitic (Blastocystis spp., Dientamoeba fragilis, Giardia);
- typhoid vaccine

Hep A - vaccination

Hep B - vaccination

Hep C - generally transmitted via parenteral routes but cacn be transmitted sexually

HIV

Human Papillomavirus

Invasive Meningococcal disease - higher carriage rates for Neisseria meningitidis; recommend vaccination

MPox - if at risk - 2 series of vaccine, complete 2 weeks before travel

57
Q

what are some of natural products that claims to have effect on altitude illness?

A

Coca leaf, garlic, ginkgo biloba, vitamin E

58
Q

what are some of natural products that claims to have effect on cold and flu?

A

echinacea (weak effect);
garlic, chinese herbs, oil of oregano, eucalyptus essential oil Oscillococcinum - no strong evidence;
probiotics (maybe - quality of evidence is low);
vitamin C (if take regular basis may lead to shorter-duration colds);
zinc (within 24 hours of symptoms onset might reduce the duration)

59
Q

what are the side effect of zinc?

A

nausea, diarrhea, copper deficiency, decreased absorption of some medications;
intranasal use - can cause anosmia (loss of sense of smell)

60
Q

Two major safety concerns about dietary supplements are ?

A

potential drug interactions and product contamination

61
Q

which natural products have been promoted for preventing or treating altitude illness?

has any shown evidence?

A

coca leaf, garlic, Ginkgo biloba, and vitamin E

NO

62
Q

Complementary health approaches that have been advocated for preventing or treating colds or influenza include … ?

A

echinacea, garlic and other herbs, nasal saline irrigation, probiotics, vitamin C, zinc products

63
Q

A variety of dietary supplements that have each been suggested to prevent or treat coronavirus disease 2019 (COVID-19)?

A

A variety of dietary supplements, including elderberry, melatonin, colloidal silver, vitamin C, vitamin D, and zinc have each been suggested to prevent or treat coronavirus disease 2019 (COVID-19).

64
Q

which complementary approaches are suggested for jet lag or other sleep problems?

A

aroma therapy and herbs (e.g., chamomile, kava, valerian), melatonin

64
Q

Products promoted as natural mosquito repellents ?

A

citronella products;
neem oil (a component of agricultural insecticide products promoted on some websites for home use);
oil of lemon eucalyptus (OLE)

65
Q

what is caution of melatonin ?

A

Caution people with epilepsy or who take an oral anticoagulant against using melatonin without medical supervision.

66
Q

what natural products have been used for TD?

A

activated charcoal;
goldenseal;
grapefruit seed extract;
probiotics;

67
Q

for resource-limited travelers, what is the recommendation of typhoid vaccine?

A

Typhoid vaccine is ≈50%–80% effective in preventing disease, and protection is not long-lasting. Thus, typhoid vaccine is more critical for travelers to higher-risk destinations where acquiring typhoid is more likely, and to areas where typhoid is harder to treat because of multidrug resistance (e.g., Southeast Asia and the Indian subcontinent).

68
Q
A

cdc yellowbook (26 decks)

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