Travel for Work & Other reasons

Question 1

GeoSentinel analysis of 12,203 business travelers seen during 1997–2014 found that frequent diagnoses included which?

Answer 1

malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), and acute bacterial diarrhea (5%).

Question 2

Fitness for travel, particularly the risk for adverse health events overseas, depends on several factors, including …

Answer 2

how well underlying medical conditions are controlled; how easily preexisting medical conditions can be managed during travel; duration of time spent away from home; destination-specific health risks; access to health care while away; and job tasks and activities.

Question 3

Although international business travelers are aware of the need for prophylaxis, they demonstrate poor adherence that only worsens with the length of the trip. Reported reasons for nonadherence include …

Answer 3

the challenges posed by daily dosing, presumed immunity, busy schedules or forgetfulness, conflicting advice, and fear of side effects.

Question 4

what is the Smart Traveler Enrollment Program (STEP)?

Answer 4

a free program offered through the US Department of State, in which international travelers and expatriates enroll their trip with the US embassy in the country of travel or residence.

STEP benefits include receiving information alerts from the local embassy about health and safety issues, facilitating contact with the embassy if a problem arises, and helping family and friends reach international travelers through the embassy, in case of an emergency.

Question 5

what routine vaccines should aircrew be updated or checked most importantly?

Answer 5

measles, chickenpox

Question 6

what travel vaccines should you consider for aircrews?

Answer 6

japanese encephalitis, meningococcal, typhoid;
yellow fever;
hepatitis A & B

Question 7

Pilots are prohibited from flying or serving as a required crewmember within – hours after immunization because of possible transient adverse effects

Answer 7

48

Question 8

which malaria med is contraindicated for pilots due to its effects on the central nervous system?

Answer 8

mefloquine

Question 9

which antidiarrheal med is not permitted to pilots?

Answer 9

Loperamide is not permitted because it can cause drowsiness and dizziness.

Question 10

which organization examines pilots regularly and are responsible for certifying that they are fit to fly.

Answer 10

Federal Aviation Administration (FAA)–certified aeromedical examiners (AMEs)

Question 11

what is the rule for antihistamine to pilots?

Answer 11

Pilots who take sedating antihistamines, including chlorpheniramine and diphenhydramine, are not permitted to fly until >5 half-lives have elapsed after the last dose; this equates to a 9-day no-fly rule for chlorpheniramine and a 60-hour no-fly rule for diphenhydramine.

Question 12

which sleeping pill is allowed to pilots?

Answer 12

The FAA prohibits the use of all prescription sleep medication other than zolpidem, which is permitted for use on an infrequent basis (only once or twice per month), and only to reset circadian rhythm.

Taking zolpidem results in a 24 hour no-fly period and thus is more appropriate for use at the end of a trip than during a multiday international flight assignment.

Question 13

Do aircrew have higher rates of cancer than the general population?

Answer 13

not really; but as compared to people who do not fly for a living, pilots and flight attendants might be more likely to develop skin and female breast cancers, but reasons for this are unclear.

Question 14

Are aircrew more likely to develop heart disease than the general population?

Answer 14

Aircrew might be at greater risk for developing some forms of heart disease compared with the general population.

Among pilots, heart disease and related conditions are the leading cause of grounding due to medical disqualification.

The prevalence of peripheral artery disease also has been shown to increase with the number of years flight attendants have worked.

Question 15

Are commercial aircrew at increased risk for contracting infectious diseases?

Answer 15

Aircrew, especially flight attendants, interact with many people daily and can be exposed to infectious diseases

Question 16

Are workplace exposures linked to reproductive health effects in aircrew?

Answer 16

Some evidence suggests that cosmic radiation exposure, high physical job demands, and working during typical sleep hours might be associated with an increased risk for miscarriage among pregnant flight attendants.

Flight attendants do not, however, appear to be at elevated risk for preterm birth, low infant birthweight, or female reproductive (e.g., ovarian, uterine) cancers.

Question 17

what are some vaccines and screening considered for health care workers abroad beside the routine vaccinations?

Answer 17

Ebola virus
Hep B
Hep C & HIV - perform baseline testing
TB - baselien screening for latent TB infection

Question 18

Other pathogens (other than HBV, HCV, HIV) transmitted to health care workers via blood or bodily fluids include several not endemic to the United States?

Answer 18

Brucella species, the bacteria that cause brucellosis; viruses like dengue and Ebola; and parasitic infections, such as malaria

Question 19

Hepatitis B virus (HBV): If the health care worker is not a documented serologic responder to hepatitis B vaccination or is incompletely vaccinated, conduct baseline and follow-up testing for HBV infection for those with known or potential HBV exposure.

Answer 19

Perform a baseline test for total antibodies to HBV core antigen (HBcAg) as soon as possible after exposure.

Perform follow-up testing for HBV surface antigen (HBsAg) and HBcAg at 6 months after exposure.

Question 20

Hepatitis C virus (HCV): Conduct baseline and follow-up testing for HCV infection for those with known or potential exposure to HCV.

Answer 20

Perform a baseline test for HCV antibody; if the baseline test is positive, perform an HCV RNA test.

Perform follow-up testing for HCV RNA at 3–6 weeks after exposure.

Test for HCV antibody at 4–6 months after exposure; if positive, perform a confirmatory RNA test.

Question 21

HIV: Conduct baseline and follow-up testing for HIV infection for those with known or potential HIV exposure.

Answer 21

Follow-up testing at 6 weeks, 3 months, and 6 months.

Follow-up testing at 6 weeks and 4 months is acceptable if a 4th-generation, combination HIV p24 antigen-HIV antibody test is used.

Extended HIV follow-up testing for ≤12 months, for people infected with HCV (after exposure to a co-infected source).

Question 22

Ongoing surveillance of violence directed against humanitarian aid and disaster relief workers continues to demonstrate that most of these events occur in a few insecure locations, including which countries?

Answer 22

Afghanistan, Cameroon, Central African Republic, Democratic Republic of the Congo, Ethiopia, Mali, Nigeria, Somalia, South Sudan, and Syria.

Question 23

what is Force health protection (FHP)?

Answer 23

all measures taken by commanders, supervisors, individual service members, and the Military Health System to conserve, improve, promote, protect, and restore the mental and physical well-being of service members across the range of military activities and operations.

Delivery of vaccines, use of malaria chemoprophylaxis agents, and mental health screening are examples of the many measures employed under the umbrella of FHP and are likely the most common scenarios that civilian providers will encounter. Medical and mental health screenings, both pre- and postdeployment, also support FHP to identify, track, and treat concerns.

Question 24

what are the 2 types of exemptions from immunization for military person?

Answer 24

administrative and medical.

Granting administrative exemptions is a nonmedical function, usually controlled by the unit commander with input from other sources (e.g., religious counsel).

Granting medical exemptions is a medical function that can be validated only by a health care professional.

Question 25

which is the recommended malaria prophylaxis option for all personnel for both short- and long-term deployments (military) in high-transmission areas of Africa?

Answer 25

Atovaquone-proguanil;
doxycycline (2nd line);
mefloquine (3rd line)

Question 26

what is typhoid vaccine repeating protocol if continued risk?

Answer 26

a repeat dose of ViCPS is recommended every 2 years for travelers at continued risk of infection. For Ty21a recipients, a booster is recommended every 5 years.

Question 27

which is used for terminal prophylaxis (or presumptive antirelapse therpay) in returning military populations?

Answer 27

primaquine - 15mg qd for 14 days (CDC recommended dose is 30mg qd) - which is FDA aproved regimen - but now higher dose regimen is recommended for military personnel

2nd line - tafenoquine

Question 28

If extended (>5 years) use of chloroquine is planned, what baseline exam is recommeneded?

Answer 28

ophthalmic examination with biannual follow-up is recommended to screen for potential retinal toxicity.

Question 29

If a person traveling long-term is taking atovaquone-proguanil, doxycycline, or primaquine, what do they need to do before planning to get pregnancy?

Answer 29

they should discontinue their medication and begin weekly mefloquine (or chloroquine in those areas where it remains efficacious) for at least 3–4 weeks to build up a therapeutic blood level of mefloquine before attempting to conceive.

Question 30

When conducting pretravel consultations with student travelers, cover the core topics of ….

Answer 30

risk assessment, risk mitigation, and preparation to respond effectively to health and safety problems while abroad

Question 31

Conduct a physical examination focused on specific signs and symptoms, and a selected array of tests for long-term travelers & expatriates after return. which tests should you do?

Answer 31

a complete blood count with differential, hepatic transaminases, stool ova and parasite examination, and serologic markers depending on types of exposure, but most importantly for schistosomiasis and strongyloidiasis.

Question 32

what are specific issues that need to be counseled to studying abroad?

Answer 32

alcohol & illicit drugs;
bloodborne pathogens;
emergency contact information card;
gender-related issues;
mental health;
safer sex

Question 33

what are Reported reasons travelers visiting friends and relatives (VFR) are at increased risk for travel-associated infections & diseases?

Answer 33

cultural & societal barriers;
HEALTH CARE PROVIDER–DEPENDENT BARRIERS;
LOGISTICAL BARRIERS;
UNIQUE ELEMENTS OF VFR TRAVEL

Question 34

VFR travelers at aged <15 years are at greatest risk for which infectious disease?

Answer 34

hep A

Question 35

what are the 2 variables that function as Risk for travel-associated illness and injury?

Answer 35

probability and consequence

Question 36

Risk for travel-associated illness and injury is a function of 2 variables: probability and consequence. Probability is based on ..

Answer 36

frequency (how often); duration (how long), and severity (how bad)

Question 37

Risk for travel-associated illness and injury is a function of 2 variables: probability and consequence. consequence is..

Answer 37

a measure of the outcome or result of an illness or injury

Question 38

what are some extra health insurnace that adventurous travelers should consider getting?

Answer 38

wilderness rescue insurance;
short-term rescue insurance;
comprehensive expedition policies (include medical, travel, rescue, repatriation, and security services)