Travel Health + Infection Prevention

Question 1

List some recommended resources that provide advice on infection prevention in travelers

Answer 1

1. CDC Yellow book
2. WHO travel advice
3. (Local) MFA travel restrictions and requirements

Question 2

When should pre-travel consultations take place?

Answer 2

4-6 weeks before departure
- ensure sufficient time for vaccine to elicit protective response ~ 2 weeks
- assess risk, suitability of vaccines

Question 3

What are the 3 main steps in the structured and sequences approach to address necessary preventive and education interventions for medical advice before international travel?

Answer 3

1. Risk assessment
2. Standard in-office interventions
3. Focused education before the trip

Question 4

What does risk assessment (in the structured approach to medical consultation before international travel) entail?

Answer 4

• Medical history + special conditions (e.g., pregnancy)
• Immunization history
• Prior travel experience (e.g., experience with malaria chemoprophylaxis)
• Specific itinerary (exposure to VPD, severity of disease if acquired)
• Activities
• Accommodation
• Risk tolerance
• Financial challenges

Question 5

What do the interventions (in the structured approach to medical consultation before international travel) include?

Answer 5

1. Immunizations
   - update routine vaccines, routine travel vaccines (e.g., HepA, typhoid), special travel vaccines (e.g., yellow fever, rabies)
2. Malaria chemoprophylaxis (if risk)
3. Travelers’ diarrhea
   - food and water precautions
   - oral rehydration, loperamide, bismuth
   - antibiotics for prophylaxis and/or treatment

Question 6

What does education (in the structured approach to medical consultation before international travel) entail?

Answer 6

Educate on:
- personal protection against vectorborne diseases (e.g., malaria, yellow fever)
- travel-related illness (altitude, thrombosis, water exposure, rabies)
- medical kit and medical care abroad (personal health kit, available medical facilities, insurance)

Question 7

What are the major routes of infection?

Answer 7

1. Food or water-borne pathogens (fecal-oral transmission)
2. Insect vector-borne infections
3. Transcutaneous
4. Respiratory - air-borne or droplets
5. Blood and body fluids (e.g., sexual contact, contaminated needles)

Question 8

Which 3 vaccines are mandatory and require proof of vaccination to the relevant country?

Answer 8

1. Meningococcus (respiratory)
2. Poliomyelitis (food and water)
3. Yellow fever (vector-borne)

Question 9

List the vaccines that prevent respiratory transmissions

(which are travel vaccines)

Answer 9

Travel vaccines:
- Influenza (inactivated)
- Meningococcus* (quadrivalent bacterial polysaccharide, conjugated)
- Diphtheria (toxoid)
- Pertussis (protein antigen)
- MMR (live-attenuated)

Non-travel vaccines:
- Pneumococcus
- Hemophilis influenzae
- BCG (TB)

Question 10

List the vaccines that prevent food and water-borne transmissions

(which are travel vaccines)

Answer 10

Travel vaccines:
- Hep A (inactivated)
- Typhoid (bacterial cell wall polysaccharide)
- Cholera (live-attenuated)
- Poliomyelitis* (inactivated)

Question 11

List the vaccines that prevent vector-borne transmissions

(which are travel vaccines)

Answer 11

Travel vaccines:
- Yellow fever* (live attenuated)
- Japanese encephalitis (inactivated)

Question 12

List the vaccines that prevent blood and bodily fluids transmissions

(which are travel vaccines)

Answer 12

Travel vaccine:
- Hep B (recombinant hep B surface antigen)

Non-travel vaccine:
- HPV

Question 13

List the vaccines that prevent transcutaneous transmissions

(which are travel vaccines)

Answer 13

Travel vaccines:
- Tetanus (toxoid)
- Rabies (inactivated)

Question 14

Which vaccines are recommended for destination with poor hygiene and sanitation?

Answer 14

Typically recommend the food and water-borne vaccines
- Hep A (inactivated)
- Typhoid (bacterial cell wall polysaccharide)
- Cholera (live attenuated)
- Poliovirus (inactivated)

Question 15

Which vaccines are recommended for destinations with mass gatherings?

Answer 15

Typically respiratory transmissions:
- Influenza (inactivated or recombinant)
- MMR (live-attenuated)
- Meningococcal (quadrivalent, bacterial polysaccharide conjugated)

Question 16

What specific group of travelers must undertake Meningococcal vaccine with proof of vaccination before entry?

Answer 16

Muslims undertaking Hajj and Umrah pilgrimages in Saudi Arabia
=> They must be vaccinated with proof of vaccination before entry into Saudi Arabia (both quadrivalent conjugated or quadrivalent polysaccharide are acceptable)

Question 17

Which vaccine should be recommended if travel destination involves agricultural areas, open-air accommodations, rural

Answer 17

Japanese encephalitis (inactivated virus)
- vector-borne

Question 18

Which vaccine should be recommended if traveler is participating in injury-prone activities?

Answer 18

Tetanus (toxoid, protein antigen) - transcutaneous

Question 19

What should be done for last minute urgent travels in which there is inadequate time for vaccines to elicit protective response?

Answer 19

1. Accelerated immunization schedules (shorter interval between doses or single dose vaccines)
2. Counsel on risk avoidance
3. Drug prophylaxis
4. Referral to health services at the destination

Question 20

Co-administration of which two live-attenuated vaccines is recommended?

Answer 20

Yellow fever and measles-containing vaccines