Pretravel - Special Populations Flashcards
What is the estimated proportion of travellers for business/occupational reasons?
15-35%
What are 3 additional considerations related to immunizations for business travellers?
- Consider cumulative risks
- Consider financial consequences of lost productivity
- Offer maximum protection.
How do health risks in business travelers compare to other international travelers
Historically considered low but recent studies demonstrate similar risk
What are 6 common health risks identified in frequent business travellers?
- Higher BMI
- Increased cholesterol
- High BP
- Higher levels of stress
- Sleep disorders
- Disrupted circadian rhythm
Approximately what proportion of international business trips of 2 weeks duration will develop infectious illness?
Approximately 1/3
What are important considerations of international travel timing and influenza vaccine?
Hemisphere-specific influenza vaccine may need to be obtained on arrival
What’s the approximate incidence of travelers diarrhea among travelers?
10-40%
Approximately what proportion of business travelers are vaccinated for hepatitis B?
~60%
When is exercise advised when travelling to areas with high levels of outdoor air pollution?
In the morning
What should be done with jewelry during travel?
Left in a safe due to risk of theft
In what country is kidnapping of business travelers most common?
Mexico
What proportion of Zika virus cases are symptomatic?
20%
Which direction of flights are easier for jet lag adjustment?
Eastbound
How many days per time zone are required for adjustment?
One day per time zone
When is JE vaccine recommended or considered?
Recommended
* When spending 1 month or longer in endemic areas during the JE transmission season
Considered:
* For certain activities (camping, hiking, trekking, biking, fishing, hunting, or farming)
List 4 reasons when an obstetrician should be consulted about travel for a pregnant woman
- Any history of pregnancy issues
- Bleeding
- Preterm labour
- Chronic illness
Which trimester is the safest for pregnant women to travel
2nd trimester
What should be done prior to all travel for a pregnant woman in her first trimester?
Confirm intrauterine pregnancy
List 4 physiological changes of pregnancy may affect travel?
- Reduced exercise tolerance
- Reduced heat tolerance
- Elevated heart rate
- Physiological anemia
What is the most common cause of fetal death during travel?
Maternal trauma due to motor vehicle accidents
Can Yellow Fever Vaccine be given to pregnant women?
Recommended to be avoided, but may be given if travel to a high-risk area is unavoidable
List 7 absolute contraindications to travel for pregnant women
- Placental abruption
- Active labour
- Incompetent cervix
- Premature rupture of membranes
- Suspected ectopic pregnancy
- Threatened abortion in pregnancy
- Toxemia
When in pregnancy is a physician letter required for air travel (domestic and international)? For multiple pregnancy
- Domestic travel - beyond the 36th week
- International travel - beyond the 35th week
Up to what week should a woman with a multiple pregnancy fly?
Should only fly up to 32 weeks
Does the reduced oxygen pressure in aircrafts affect maternal or fetal oxygenation more?
Maternal
Fetal hemoglobin binds oxygen more strongly
When would supplemental oxygen during flying be recommended for a pregnant woman?
If hemoglobin is <8.5 g/dL
What is the total recommended radiation exposure recommended during pregnancy? Monthly limit? Which weeks of pregnancy are most radiation sensitive?
1 milliSievert total pregnancy
0.5 milliSievert monthly limit
Weeks 8-14 are most radiation sensitive
Do magnetometers at airports pose a risk to pregnancy? Full body scanners?
No
What 2 medications should be first line for pregnant women for motion sickness?
- Dimenhydrinate
- Diphenhydramine
What common antibiotics given for travel-related infections/prophylaxis should be avoided in pregnancy?
- Ciprofloxacin
- Doxycycline
- Sulfisoxazole (in 3rd trimester due to kernicterus)
What antimalarials should be avoided in pregnancy?
- Malarone (Atovaquone/proguanil) - avoid in 1st trimester
- Doxycycline
- Primaquine
- Quinine
At what stage of pregnancy is scuba diving considered safe?
Not considered safe at any stage
Can Yellow Fever Vaccine be given to breastfeeding women?
Should be avoided
Transmission of vaccine strain YF has been documented in breastfeeding infants of mothers who received YFV
How long should couples wait to conceive after traveling to an area with known ZIKV?
6 months
The virus can persist for up to 6 months in semen
What are recommended malaria chemoprophylaxis for pregnant women?
- Chloroquine in chloroquine-sensitive areas
- Mefloquine
Both safe in all stages of pregnancy
What stage of pregnancy has highest risk of toxoplasmosis infection transmission to the fetus? Stage with greatest severity of infection?
Most likely in third trimester
Most severe in first
What’s the recommended iodine intake per day for pregnant women?
200 ug/day
Can use for water purification for short-term but there is risk of fetal goiter and hypothyroidism
What is the maternal mortality rate due to hepatitis E?
2% in first trimester
20-30% in third trimester
What is the treatment of choice for travelers diarrhea in pregnancy?
Azithromycin
How long after receiving MMR or Varicella vaccines should couples wait to try to conceive?
1 month
When should metronidazole be avoided in pregnancy?
Avoid in 1st trimester
Are those aged >50 years more or less susceptible to motion sickness?
Less susceptible
Is Zolpidem or Melatonin more effective for jet lag?
Zolpidem
How does age affect susceptibility to acute mountain sickness?
Unclear and likely no effect
How does malaria mortality change with age?
Malaria mortality increases with age
What is the effect of age on toxicity from DEET?
No effect
