Travel health

Question 1

How is malaria transmitted?

Answer 1

Mosquito bites
Parasite injected into humans
Sporozoites travel to the liver and develop into schizonts with many offspring
These can all infect RBC
Parasite can grow and divide inside RBC
RBC burst and parasites are released

Question 2

What are some symptoms you might expect someone to present with?

Answer 2

Fever or chills
Cough
Diarrhoea 
Headache
Myalgia

*MEDICAL EMERGENCY
always important to ask if they’ve been abroad recently with diarrhoea, cough and headache cases

Question 3

What symptoms might you expect in the later stages?

Answer 3

Impaired consciousness
Renal impairment
Acidosis 
Shock
Bleeding

*MEDICAL EMERGENCY

Question 4

I am travelling to … what advice can you offer me?

Answer 4

First of all I can check on a map we have here to see if you would need prophylaxis to travel to that area.
If not needed, here is the advise you should follow:
- use repellents (DEET), advise on suncream
- mosquito nets with no tears and tucked into mattress, insecticide impregnated nets are best
- Clothing
- Check accommodation has air conditioning, screens, spray room with insecticide at dusk to kill any

Question 5

What chemoprophylaxis would be best for me?

Answer 5

I have got the different options here I can read them out to you and we can go through them:
Do you take any other medication?
Are you pregnant or breastfeeding?
Do you suffer from any other conditions? Any mental health conditions?

Question 6

I was born and raised in this region, do I still need treatment?

Answer 6

Any immunity from being in that region is rapidly lost after leaving so you will need chemoprophylaxis to prevent you becoming ill

Question 7

Do I need tablets if I am going on a cruise?

Answer 7

Depends entirely on your itinerary for the trip. Find out where you will be stopping, for how long and if it will be overnight. Most stops are during the day so will not need it because mosquitos not feeding in daylight hours. However if you are stopping overnight, depending on the region you may need it. Use prevention methods.

Question 8

I have psoriasis. Does this change which tablet I should take?

Answer 8

NOT chloroquine and chloroquine related drugs

Proguanil might be appropriate

Question 9

What if the traveller is moving across several regions?

Answer 9

Advised to take only ONE treatment for the entire visit instead of different ones

Question 10

Chemoprophylaxis - questions to ask patient to check medication is suitable

Answer 10

Ask what other medication they are on
*amiodarone and chloroquine contraindicated
*anticoagulants need to make sure INR stable
Ask if they have any other health conditions, including mental health
*mefloquine contraindicated in mental health disorders
*for epilepsy doxycycline or atovaquone/proguanil good
Ask if they are pregnant or breastfeeding OR trying to get pregnant
*only chloroquine and proguanil good for all trimesters
*if trying to get pregnant may need expert advise or use time intervals
Is the patient a child
Are you taking anything on Rx for smoking cessation

Question 11

Last minute travellers

Answer 11

Maloff Protect can be purchased if you feel you will not have time to get anti malarials for over 18s only
Commercial travel clinics offer walk ins