Travel health

Question 1

what is the advice for a person with chronic illness?

Answer 1

Carry medication in hand luggage
Take copy of prescription or note from GP
Care with analgesics
Use “home time” during journey
Adjust to “local time” gradually on arrival
Consider schedule before departure

Question 2

what is the advice for travelling with diabetes?

Answer 2

Insulin should not be frozen - crystals
Exemptions to hand luggage rules but
contact airline
GP letter is essential
Insulin can be stored
Cooling Wallets
Destination guides from Diabetes UK
Foot care

Question 3

what should be done to prevent DVT?

Answer 3

• Risk on long haul flights
• “Economy Class Syndrome” - myth
• Exercise during flight
• Avoid dehydration
• Consider Class 1 Support Hosiery only for
  those at risk of DVT

Question 4

what are the symptoms of travel sickness?

Answer 4

• Dizziness
• Increased awareness of stomach
• Nausea and often vomiting
• Pallor
• Cold sweat
• Headaches
• Drowsiness

Question 5

what should be given as prophylaxis for travel sickness?

Answer 5

Antimuscarinics
Hyoscine Hydrobromide
* Most effective – shorter journeys
* Different dose ranges
* 20 mins before journey
* Side effects: drowsiness, blurred vision, dry
mouth
or * Antihistamines
* Equally effective
* Differ in duration of action and incidence of
antimuscarinic side effects
* Cinnarizine – 6 to 8 hrs
* Adults, elderly and >12 years: 2 tablets 2 hours
before travel and 1 tablet every 8 hours during
journey
* Children 5 to 12 years: half the adult dose

Question 6

what is a non-pharmacological option for travel sickness?

Answer 6

• Acupressure bands
• Put pressure on the P6 acupressure point in the wrist
• Mechanism of action unclear
• Effectiveness varies

Question 7

what counselling should you give about travel sickness?

Answer 7

• Drowsiness with drug treatment
• Enhanced sedation with alcohol
• Advise to have plenty of drinks available in
  case of increased thirst with drug
  treatment
• Drive if possible
• Concentrate on path ahead/horizon
• Avoid activities such as reading
• Plenty of fresh air

Question 8

when should you refer someone for travel sickness?

Answer 8

• Children under 2 years
• Pregnant & breast feeding
• Concurrent disease states
  o glaucoma
  o epilepsy
  o urinary retention
  o hepatic/renal disease

Question 9

what are the symptoms and treatment for bites and stings?

Answer 9

Symptoms
* Itchy red swollen weal
* Usually harmless
* Anaphylaxis
Treatments
* Topical Corticosteroids
* Topical Anaesthetics
* Topical Antihistamines
* Oral Antihistamines

Question 10

what should you avoid with bites and stings?

Answer 10

• Biting times
• Repellents (DEET)
• Insecticides (Permethrin)
• Nets
• Long sleeves/long trousers
• Plug-in dispensers

Question 11

what is the role of the pharamcist in prevention of malaria?

Answer 11

• Advice and Information
• OTC prophylactic medication
• Symptoms recognition and referral
• Who is travelling?
• Where to?
• When?
• How long for?
• Purpose of travel?
• Underlying conditions?
• Allergies?
• Medication?
  nvestigate if / what chemoprophylaxis needed
• NPA leaflet www.npa.co.uk

Question 12

what is chemoprophylaxis for malaria?

Answer 12

OTC:
* Chloroquine (Avloclor)
* Proguanil (Paludrine)
* Maloff Protect (Atovaquone/Proguanil) –
rarely sold due to side effects
POM:
* Doxycycline
* Mefloquine (Lariam)
* Malarone (Atovaquone/Proguanil)

Question 13

what advice should you give about malaria?

Answer 13

Awareness of risk
Bite avoidance
Chemoprophylaxis
Diagnosis and treatment

Question 14

what is encephalitis?

Answer 14

Tick-borne encephalitis
* Viral disease – flavivirus

Question 15

how should you deal with encephalitis?

Answer 15

• Grasp tick with tweezers
  close to skin
• Avoid squeezing
• Pull tick straight out
• Ensure mouth removed
• Do not coat tick with
  petroleum jelly
• Vaccine available
• Ticovac

Question 16

what are some other insect borne diseases?

Answer 16

Japanese encephalitis
* Flavivirus transmitted by mosquitoes
* Vaccination recommended for specific travellers
Yellow Fever
* Virus transmitted by mosquitoes
* Regulated Internationally
* Certificate of vaccination needed for travel to risk areas
Dengue
* RNA virus transmitted by mosquitoes
* Not notifiable and self-limiting

Question 17

what is the cause/ symptoms of travellers diarrhoea?

Answer 17

Cause: contaminated food and water
* Vaccination recommended for specific travellers
* Symptoms: sudden watery diarrhoea, loss of
* appetite, nausea, vomiting, abdominal cramps,
* flatulence, bloating

Question 18

who is at risk of travellers diarrhoea?

Answer 18

Risk: determined geographically
* Particularly at risk: Children, elderly, immunosuppressed

Question 19

how should you prevent travellers diarrhoea? what should you avoid?

Answer 19

PREVENTION
* Bottled water
* Freshly cooked hot food
* Peel raw fruit
* Hand washing – hand gels/wipes
Avoid:
* Ice-cream
* Ice in drinks
* Salads
* Shellfish
* Unpasteurized dairy
* Uncovered food

Question 20

what is the treatment for travellers diarrhoea?

Answer 20

• Maintain adequate fluid intake
• Avoid carbonated drinks
• Oral Rehydration Sachets
• Loperamide
• Most cases are short-lived and self-limiting

Question 21

when should you refer someone for travellers diarrhoea?

Answer 21

• Stools are blood-stained
• There is high or persistent fever
• Severe abdominal pain.
• Severe diarrhoea occurs in infants, children or elderly
• The person becomes dehydrated - (restlessness or irritable, very
  thirsty, sunken eyes, and dry skin with reduced elasticity)
• If > 6 diarrhoea stools are passed in 24 hours and cause
  incapacitation, or there is marked vomiting, medical attention
  must be sought
• There is a medical comorbidity (for example immunosuppression
  or gastrointestinal disorder)

Question 22

how is HEP A transmitted? what are the symptoms? how can it be prevented?

Answer 22

Transmission-Viral disease causing inflammation of liver
Contaminated water, poor sanitation & hygiene
Symptoms
* Fever, loss of appetite, nausea, abdominal discomfort,
jaundice, joint and muscle pain
Prevention
* Vaccination – booster at 6 and 12 months will give 20yrs
protection

Question 23

what are food and water borne diseases?

Answer 23

Typhoid salmonella enterica
* Vaccine 55-75% efficient
* Avoid high risk foods/drinks
* Fatal if untreated
* Highly contagious
Cholera vibrio cholerae
* ‘Rice water stools’
* Vaccination considered for most at risk e.g. aid
workers

Question 24

what is zoonotic disease?

Answer 24

Rabies virus
* Transmitted to humans from animals
* Via infected saliva through bites or scratches
* Dogs are the source of 99% of human rabies deaths
If bitten or scratched
* Wash wound with soap and running water
* Apply antiseptic/alcohol
* Seek medical assistance for vaccination
* Avoid having wound stitched

Question 25

what are some other diseases to consider?

Answer 25

Tetanus
* Toxin of common bacterium Clostridium tetani
* Affects nerves resulting in spasms of jaw and neck muscles
Diphtheria
* Travel clinics will notify which countries require vaccine
Tuberculosis (TB) Mycobacterium tuberculosis
* Airborne
* Latent and active forms
Hepatitis B
* Vaccination for travel to high risk countries

Question 26

how do you prevent sunburn?

Answer 26

• Sun screen
• Skin type
• SPF (min 15)
• Star rating (min 5*)
• Application
• Exposure

Question 27

how do you treat sunburn?

Answer 27

Analgesics /Calamine/Crotamiton/Cold compress /
* Antihistamines