Travel health part 3 - insect bites and malaria Flashcards
Insect Bite Prevention - what advice would you give to someone
Covering up at dusk and dawn when malaria carrying mosquitos are active
Insecticide impregnated clothing is also available
Apply repellents containing 50% DEET to exposed skin:
Work for up to 12 hours
Should be worn during the day as well as other times, as daytime biting mosquitos carry other disease
Recommended in pregnant and breastfeeding mothers, and children over 2 months old
Should be applied after sunscreen
Can damage plastics such as glasses and watches
Insecticide impregnated mosquito net
For beds, cots and pushchairs
Take extra hooks for hanging, check for tears regularly and tuck under mattress
Plug-ins and coils:
Need socket for plug-ins and may only last 6 hours so would need changing in the night ready for dawn
Burning insecticide coils good outdoors but harmful if used indoors
Air conditioning/physical barriers:
Leave AC and ceiling fans on to deter insects
Windows and doors should be fitted with mesh, take strong tape to cover holes
Avoid using strong perfumes, soaps, shampoos, deodorants – these attract insects
Be careful around flowering plants, rubbish, compost, stagnant water & outdoor areas where food is served
Never disturb insect nests
Avoid camping near water
Keep food & drink covered
Treating bites - initial advice and when to seek medical attention
Initial Advice:
Remove sting or tick if still in skin
Wash affected area with soap & water
Apply a cold compress or an ice pack for at least 10 mins
Raising/elevating the area can help reduce swelling
Avoid scratching or bursting blisters
Analgesia – paracetamol/ibuprofen
Itching – crotamiton cream, hydrocortisone cream, antihistamines topical/oral
When to seek medical attention:
A lot of swelling or blistering
Presence of pus
Stung or bitten in mouth or throat, or near eyes
Area around the bite swells to around 10cm or more
Immediate Emergency Action - insect bite
Wheezing or difficulty breathing
A swollen face, mouth or throat
Feeling sick or being sick
A fast heart rate
Dizziness or feeling faint
Difficulty swallowing
Loss of consciousness
What is Malaria
Parasitic infection of red blood cells
In over 100 tropical/subtropical countries
Caused 665000 deaths in 2010
1500-2200 cases of malaria imported to the UK each year
5 strains of malaria parasite affect humans
Plasmodium falciparum is the most common and severe strain
Chemoprophylaxis - draw the table of OTC and POM products
ON WHITEBOARD! - MEDS CAN BE LOOKED AT ON BNF!!
So how would you know if you may have malaria?
Medical attention should be sought if anyone develops a fever a week or more after entering a malarial risk area
Malaria should be considered for up to 1 year after return
Other symptoms vary but may include headache, muscle pain and GI disturbances
Plasmodium falciparum can cause coma, shock, organ failure and death within 24 hours of onset of symptoms
Self diagnosis kits are unreliable and not recommended
Treatment kits should be carried by any traveller in a malarial risk area where they may not be able to get medical attention within 24 hours
Other insect-borne diseases
Dengue
Chikungunya
Yellow fever (can be vaccinated against; vaccinations carried out only in certified Yellow Fever Centres)
Japanese encephalitis
Tick-borne encephalitis
Dengue
Also known as Dengue fever
Transmission
Mosquito-borne
Mosquitos carrying the dengue virus during the day
Symptoms
Usually start 4-10 days after being bitten
Similar to flu – high temperature, severe headache, pain behind the eyes, muscle and joint pain, feeling or being sick, swollen glands, blotchy rash
Severe symptoms – severe stomach pain, repeatedly being sick, fast breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or faeces
No treatment available
Symptom relief – resting, fluids, paracetamol (must not take NSAIDS/aspirin as increases risk of bleeding)
Prevention
No vaccine available
Bite avoidance
Chikungunya
Transmission
Mosquito-borne
Symptoms
Onset usually 4-8 days (range 1-12 days) after being bitten by infected mosquito
Abrupt onset of fever, often with severe joint pain
Joint pain is often debilitating and usually lasts days, but can lasts weeks, months or years
Other symptoms – joint swelling, muscle pain, headache, nausea, fatigue and rash
Evidence suggests future immunity
Treatment
Paracetamol, NSAIDs if dengue fever is ruled out, fluids and rest
Prevention
Bite avoidance
No vaccine currently available
Yellow Fever
Transmission
Mosquito-borne
Symptoms
Onset usually 3-6 days after being bitten by infected mosquito
High fever, headache, feeling or being sick, aches & pains, loss of appetite, generally feeling unwell
Symptoms last 3-4 days
More severe symptoms requiring immediate medical attention – jaundice, dark urine, stomach pain, bleeding from eyes, nose, mouth or stomach, blood in vomit or faeces
Treatment
Paracetamol, NSAIDs if dengue fever is ruled out, fluids and rest
Prevention
Bite avoidance
Vaccine
some destinations require travellers to carry yellow fever certificate as proof of vaccination before entry is allowed
Vaccine provides life-long immunity
Japanese Encephalitis
Transmission
Mosquito-borne
Symptoms
Most people have no symptoms
Some get flu-like symptoms - fever, headache, feeling or being sick, stomach pains
More severe symptoms requiring immediate medical attention – a severe headache, feeling confused, paralysis, seizures
Long-term complications – paralysis, seizures, loss of speech
Treatment
At a hospital as disease can be life threatening
Analgesia & steroids
Prevention
Bite avoidance
Vaccine
Tick-borne encephalitis (TBE)
Transmission
Tick-borne
Low risk
Symptoms
Most people have no symptoms
Some get flu-like symptoms - fever, headache, feeling sick, aches & pains, tiredness
More severe symptoms requiring immediate medical attention – a stiff neck and a severe headache; pain when looking at bright lights; seizures; a change in behaviour, confusion or slurred speech; weak or loss of movement in part of the body
Treatment
Remove tick as soon as possible using tweezers or a tick removal tool, pulling upwards slowly and firmly
Clean bite with antiseptic or soap & water
Prevention
Bite avoidance
Vaccine
What are other diseases (End of lecture)
rabies and hepatitis B
Rabies
Transmitted
Infected mammals
Any mammal has potential to carry but dogs, cats and bats most commonly transmit to humans
Symptoms
Onset usually 3 – 12 weeks
Numbness or tingling where bitten or scratched; hallucinations; feeling of anxiety or hyperactivity; difficulty swallowing or breathing; paralysis
Almost always fatal once symptoms appear
Treatment
2 or more doses of the vaccine
Cannot be treated once symptoms appear
Prevention
Vaccine
Hepatitis B
Transmitted
Blood-borne infection of the liver
Sexually transmitted
Symptoms
Fever, tiredness, pain in the upper stomach, feeling or being sick, hives, jaundice
Infection usually lasts 1 to 3 months
Most people have no or mild symptoms
Infection lasting longer than 6-months referred to as chronic hepatitis B
Treatment
Antivirals
Symptom relief – analgesia, anti-emetics, anti-pruritics, hydration & rest
If untreated – cirrhosis and increased risk of liver cancer
Prevention
Vaccine
Barrier methods of contraception
Avoid sharing personal hygiene items
What travellers need, but may not have considered
Sleep and travel
Allergies i.e. hay fever
Sexual health i.e. condoms/advanced supply of EHC
First aid kit
