Travel Flashcards
What is another name for travel health?
Emporiatrics
List some health-related risks for travellers
Medical related:
• malaria
• influenza
• traveler’s diarrhoea
• hep A
• drowning
• driving on opposite side
• taking risks
• alcohol/drugs use
• STIs
• heart disease
What are the 3 main trends - in international travel
• change is the amount of people travelling - more people are travelling
• change in destination of travel
• change in the type of travellers
Change in the amount of people travelling?
More people are travelling to developing countries
Change in destination of travel
• More people are travelling to hight risk places
• travelling on shorter notices
• little to no planning
• require greater healthcare needs during and after the trip
Change in the type of travellers
Reasons for travels (order of most to least)
1. Leisure
2. Religious (VFR)
3. Business
*all there purposes are increasing to developing countries)
Types of traveler’s -
• older people
• those with pre existing, co-morbidities
• those using chronic medications
More people are travelling who aren’t always young and healthy
Religious travellers - VRF
• there people are in close proximity with local people
• don’t really comply with professional advise
• believe to have immunity again country specific diseases
Travel health - what do they want to cover?
• pre-assessment risks
• medication/prescriptions for managing/prophylaxis treatment of disease
• vaccinations.
• managing health issues over retiring travellers
A pre-travel assessment consists of?
• assessment of general heath
• discussion of the possible risks in that destination
• vaccinations
• education and disease prevention
Educational interventions?
Inset precautions
Malaria prophylaxis
Food and water precautions
Diarrhea and self-management
Current disease breakouts at destination
Vector-bone disease
Climate and jetlag
Routine meds
Sextual activity
First aid kits
Local medical care destinations
Crime and safety at destination
Define travellers diarrhoea
3+ loose stools within 24 hours
Sign and symptoms of TD
• n+v
• abdominal pain
• blood or mucus in stool
• fever
Pathogens which can cause TD?
Bacteria - E.coli
Virus - norovirus
Parasite
Risk factoids of TD
• consuming unclean water and food
• season
• length of stay
• medication: PPIs & H2 antagonist
Prevention of TD
Food hygiene
Water hygiene
• boil water (2-3mins) boil for longer at higher altitudes
• use chlorine or iodine (iodine-not in women)
• vaccination
• chemoporphylaxis - pepto-bismol
Treatment of TD
•hydration & diet
• Oral rehydration
• loperamide - not in young people, fever or blood/mucus in stool
• antibiotic - 3days
+ fluroquinolones
+ azithromycin or nor
Reasons for Malaria worldwide spread?
• global warming
• resistance to plasmodium
• insecticide resistance to vector
Types of malaria? 4 (5)
• p. Falciparum
• p. Ovale
• p. Vivax
• p. Malaria
• p. Knowlessi
Which agents is P.falciparum resistant to?
Chloroquine
Do people who live in endemic areas have semi-immunity to p.falciparum?
Yes
- life-threatening cases of malaria to these healthy people is rare
Risk of malaria is lower in which areas?
• Urban
• coastal
• above 2000m
Malaria - life cycle
- Bite of mosquito injects sporozoite into blood stream, enters liver an multiplies
- Merozoites enter blood steam and invade red blood cells (erythrocytes)
Early signs of p.falciparum
Fever:
• cold
• hot and flushed
• intense sweating
What can happen if p.falciparum is left untreated
Coma and death within 24 hours
P.falciparum symptoms
• fever
• n+v
• headache
• diarrhoea
High risk issue with p.falciparum in non-immune traveler’s
• carebral malaria - due to change in RBC
• renal issues
• thrombopenia
First line for plasmodium falciparum
Artemeter & Lumefantrine
3 chemoprophylaxis/treatment antimalarial agents
• chloroquine
• doxycycline
• mefloquine
MOA: suppressors blood parasite
Chloroquine?
• safe in pregnancy + breastfeeding
Doxycycline
Not safe in:
• pregnancy
• oral contraceptives
• <8
• virginal thrush
• oesophagitis
Start: 2 days before trip
Mefloquine
Not safe in those with neurological issues
Avoid in pregnancy
Start: 2-3 weeks before trip
Best agent for stand by treatment?
Artemether & Lumefeantrine
Non-pharmacological management of malaria- Bite avoidance
• cover arms and sleeves.
• wear light colour clothes and thicker material
• apply inset repelant
• apply insecticide to clothing
• avoid perfume
• avoid daytime exposure to Anopheles mosquitoes
• avoid nighttime exposure to Aedes mosquitoes
• cautious in wet weather
What causes Rabies?
rhabdovirus of the genus Lyssavirus
How is Rabia transmitted?
Virus is in the saliva of the infected animal and is transmitted to humans through bites and scratches
If rabies is untreated is it fatal?
Yes
Which countries is their a higher risk of Rabies
In the Rural areas of:
• Asia
• Africa
• south and North Africa
Which types of travellers are at a risk risk of developing rabies?
• small children
• travelling on bicycles
• adventures behaviour
• working with animals
Clincal features of rabies?
• fever
• hallucinations
• sensory changes around animals
• aerophobia
• hydrophobia
Whats is Economy Class syndrome - DVT/VTE caused by
Lack of mobility and cramp conditions
DVT = blood clots in the deep veins
What beverages contribute to dehydration and sluggish circulation?
Caffeine & Alcohol
What is jet lag?
A psychological + physiological desynchronising of sever different time zones
Which factories can aggregate jet lag?
• age
• dehydration
• poor diet
• snaps
• lack of sleep
• coffee + alcohol
• direction of travel
Melatonin can be used to reduce effects of get lag, but who should not take it?
Epileptics and those taking warfarin
Measures to take BEFORE flight
• adequate sleep
• don’t book tasks which need to be done immediately after landing
Measures to take During flight
• drink plenty of fluids
• avoid alcohol + caffeine
• avoids sleep deprivation
*hypnotics - temazepam (but can increase DVT)
Measures to take AFTER flight
• adapt to the counties sleeping and eating times
• But avoid sleep deprivation
Which health risks are associated with cruise ships?
• being in close proximity with diverse people
• risk of foodbourn + waterbourn diseases
Illnesses on board include:
• GI - norovirus
• respiratory - influenza
• slips and falls
• death - CV disease
