Travel Health Flashcards
personal travel risk factors include
medical conditions, medications, allergies, vax hx, travel experience, risk perception and tolerance, financial
destination travel risk factors include
Where: not just the country but the specific location within the country- urban or rural?
When: date of departure and duration (must plan around timeline)
Why: business, holiday, visiting family, volunteer, medical tourism
How: transportation, accommodation
What: types of activities
T or F: pharmacists can carry out a care plan for travel without need for MD intervention
T
traveler’s diarrhea is primarily caused by
bacteria, less often virus or protozoa
TD is often ________ to _______ days
self limiting
3-4 days
which of the following is considered a “riskier choice” for traveler’s diarrhea
1. boiling water involved in cooking cabbage
2. apples
3. hibachi grills
4. bananas
2- not peelable or cooked
Dukoral vaccine is originally a _______ vaccine
cholera
dukoral offers some protection against ________ which protects against TD
ETEC, enterotoxigenic E coli
which of the following is the best description of the dukoral vaccine
1. benefits are limited, risks are significant
2. benefits are limited, risks are limited
3. benefits are significant, risks are significant
4. benefits are significant, risks are limited
2
the use of a dukoral vaccine is primarily based on
1. location of travel
2. hx of GI issues
3. patient’s willingness to get it (ex- $$, other med issues, risk tolerance)
4. none of the above
3
what 2 OTCs can be used for TD
bismuth subsalicylate
loperamide
what is the first choice abx for TD tx
azithromycin
what is the main AE of azithromycin
QT interval prolongation
what are options for TD for pts who can not take azithromycin
ciprofloxacin and rifaximin
ciprofloxacin is
1. limited in effectiveness in asia due to resistance
2. not used in children
3. only used in adults who can’t tolerate azithro
4. has risk of tendon injury
5. all of the above
5
hepatitis A is transmitted through
fecal oral, contaminated food and water
T or F: hep A vaccines are not part of routine childhood immunizations in Canada
T
what is the Hep A schedule? how many doses are needed for trip protection?
2 doses: 0 and min 180 days apart
1 dose needed for trip protection, get FU dose in 180+ days
what is the twinrix schedule and accelerated schedule? how many doses are needed for protection?
Schedule: 0, 30d, 180d
2 doses needed to provide sufficient immunity
Accel sch: 0, 7, 21, 365d
3 doses needed to provide sufficient immunity
Difference of 7 days
what is the Twinrix Jr schedule
0, 30, 180 days
what is the alternative peds twinrix schedule
use adult twinrix at 0 and 180 days
how many doses of hep A offers trip protection?
1
hep B is transmitted by
contaminated blood or body fluids
those born before ____ are not hep B vaxxed as part of childhood vaccines
1982
typhoid fever is a ______ infection spread by ____________
bacterial
contaminated food and water
sx of typhoid fever
fever, rash, stomach pain
how to tx typhoid fever
antibiotics
highest risk of typhoid fever is in
south asia
the oral typhoid vaccine
_________vaccine
PO schedule: day ___________
Protected ~_____days after last dose + lasts _____ yrs
For ________yrs old
Live vaccine
PO schedule: day 1, 3, 5, 7
Protected ~7 days after last dose + lasts 5-7yrs
For =>5yrs old
Injectable typhoid vaccine
________ vaccine
________ dose
_____ days for protection which lasts ___ yrs
For ____ yrs old
Inactivated vaccine
IM single dose
~14 days for protection which lasts 2-3yrs
For =>2yrs old
yellow fever is _________ infection spread by ______
viral
mosquitos
highest risk of yellow fever is in _______ and ________
sub Saharan Africa and South America
the yellow fever vaccine is a ____ given ________ as a ____ dose
live
SC
single dose
the yellow fever vaccine takes ____ to take effect
10 days
what is the age limit for yellow fever vaccine
=>9mths
japanese encephalitis is a _____ infection spread by ____
viral
mosquitos
japanese encephalitis is a risk throughout
Asia- primarily rural/ agricultural areas
the japanese encephalitis vaccine is an __________ vaccine, administered IM on days __________. it provides protection for _______ or ______ if a booster is given at 1-2rys
inactivated
0, 7-28
protection for 1-2yrs
10yrs
the pt must be > _____ to receive the japanese encephalitis vaccine
2 months
rabies is a _____ infection spread through __________
viral
saliva of ifnected animal
If infected with rabies + no post exposure prophylaxis =
99.99% fatal and horrible way to die
what is the #1 animal for rabies transmission
dogs (others include monkeys, bats, other mammals)
the rabies vaccine is an _________ vaccine given IM on adys _____________
inactivated
IM on days 0, 7, 21-28
duration of rabies protection is determined by
titres
factors to consider when offering rabies vaccine
Activities on trip- related to animals?
Spending a lot of time in caves?
Remote travel- access to medical care and post exposure prophylaxis
Future travel
Risk tolerance
Price (~$700 if no coverage)
meningococcal vaccine
________ vaccine
Protects against _______
______ dose
Protection for _________yrs
____________ vaccine given as part of G9 vax in AB
Inactive vaccine
Protects against 4 serotypes
IM single dose
Protection for 3-5yrs
Quadrivalent ACWY vaccine given as part of G9 vax in AB
what is the meningitis bell in africa
high risk travel area esp in dry season (Nov-May) when outbreaks can occur
meningitis is a __________ infection spread by __________
viral
coughing, sneezing
polio is a ______ infection spread by ________
viral
fecal oral route
polio is endemic in
afghanistan and pakistan
adults can get a booster dose of polio as a single ______ dose
SQ
polio is a(n) ___________ vaccine
inactivated
4 antimalarial options
chloroquine
mefloquine
doxyxycline
atovaquone/ proguanil
pros for chloroquine
weekly dosing
cheap
cons for chloroquine
Resistance in most of the world except Central America and Caribbean
Have to take at least 2 wks before + 4 wks after leaving risk area
Tablets not commercially available in Canada rn
pros of mefloquine
Weekly dosing
Inexpensive
cons of mefloquine
AEs include psych SEs (avoid in those w/ FHx mental illnesses even if it is mild or well controlled)
Have to take at least 2 wks prior + 4 wks after leaving risk area
doxycycline pros
Inexpensive
Typically 1st or 2nd choice
cons of doxycycline
Daily dosing
SEs: GI irritation, ↑ sun sensitivity, vaginal yeast infxns
Have to take 28 days after leaving area
pros of atovaquone/ proguanil
Mostly well tolerated- possible GI upset
Need to take only 7 days after leaving risk area
cons of atovaquone/ proguanil
Daily dosing
Expensive
May be 1st choice if cost not a concern
dangue fever is a virus transmitted by the
aedes mosquito
dengue fever has
1. a risk anywhere tropical
2. severe sx can result in hemorrhagic fever
3. tx only with supportive and sx tx
4. 4 serotypes
5. all of the above
5
preventative measures for dengue fever include
bite protection, clothing, bug sprays
T or F: there are currently no vaccines available in Canada for Dengue fever
T- dengvaxia and qdenga in progress
which country requires yellow fever vaccine
kenya
south africa and mozambique require proof of vax if traveling through coutnry with risk of yellow fever transmission
If pt has been to malaria country + develop a fever =
treat like pt has malaria until proven otherwise
