Travel health

Question 1

Possible interventions for the risks associated with travel

Answer 1

1. Vaccination
2. Counselling re: sex
3. Health insurance
4. Malaria prevention

Question 2

Malaria chemoprophylaxis - drugs available

Answer 2

Malarone (Atovaquone/proguanil)
Doxycycline
Mefloquine
Chloroquine
Primaquine

Question 3

Doxycycline as malaria chemoprophylaxis - pros and cons

Answer 3

Pros:
- Already using it for acne or other infection prophylaxis
- In severe renal failure
- Cheap

Cons:
- Adjust dose if on carbamazepine/phenytoin
- Cannot use in porphyria, children, pregnancy or breastfeeding
- Oesophagitis, photosensitivity, bone or teeth health

Question 4

Mefloquine as malaria chemoprophylaxis - pros and cons

Answer 4

Pros
- Weekly dosing for longterm use
- Chloroquine resistant malaria
- Safe in pregnancy/babies/breastfeeding and renal failure

Cons
- Neuropsych effects
- CI epilepsy

Question 5

Malarone (atovaquone/proguanil) as malaria chemoprophylaxis - pros and cons

Answer 5

Pros
- Great for everyone including pregnancy

Cons
- Avoid if eGFR <30
- Expensive

Question 6

Chloroquine as malaria chemoprophylaxis - pros and cons

Answer 6

Pros
- Well tolerated and suitable in pregnant women

Cons
- Chloroquine resistances e.g. Africa/Asia
- GI side effects
- Interacts with QT prolonging drugs

Question 7

Primaquine as malaria chemoprophylaxis - pros and cons

Answer 7

Pros:
- Effective against dormant liver stages of P vivaz and P ovale

Cons
- Requires G6PD deficiency screening
- GI upset
- Not safe in pregnancy

Question 8

Pregnancy and malaria effects

Answer 8

1. Increased risk of severe malaria and placental sequestration
2. Chloroquine, malarone as chemoprophylaxis

Question 9

Anticoagulation and malaria chemoprophylaxis

Answer 9

Mefloquine fine with warfarin but not DOAC

Question 10

Epilepsy and malaria chemoprophylaxis

Answer 10

Doxycycline and malarone good, chloroquine and mefloquine avoid

Question 11

Children and malaria chemoprophylaxis

Answer 11

Mefloquine easiest and malarone
Avoid doxycycline in young children

Question 12

Renal impairment and malaria chemoprophylaxis

Answer 12

Avoid malarone

Question 13

Liver disease and malaria chemoprophylaxis

Answer 13

Doxycycline best option

Question 14

Principles of travel clinic

Answer 14

Update routine vaccinations: MMR
Check certification requirements: YF, Polio, Men ACWY, COVID
Check additional person specific risks: ICT (immunocompromised), pregnant
Consider levels of sanitation: Hep A, typhoid, Cholera
Estimate additional risks: animal bites, HepB, JE, TBE, Flu etc

Question 15

Differentials for spastic paraparesis

Answer 15

Syphilis
HIV
TB
Neurobrucellosis
HTLV1

MS
Familial spastic paraplegia
Primary lateral sclerosis
Trauma
B12 deficiency
Anterior spinal thrombosis

Question 16

What are some impacts of climate change on food production and nutrition? (5) Direct vs indirect effects

Answer 16

Direct impacts:
1. Heat stress, water scarcity and CO2 impacts crop production

Indirect impacts:
2. Increased pests
3. Reduced soil fertility
4. Socio-economic effects.

5. Stunting in Children:
   Vulnerable food systems lead to malnutrition and developmental issues.

Question 17

Tic bite prevention advice

Answer 17

1. Insect repellent
2. Long sleeve clothing
3. Check for tics and arrange early removal post exposure

Question 18

Barriers to policy change in climate change

Answer 18

Vested interests
Organised denialism
Political short-termism
Divided public opinion
Perception that change is expensive and difficult