travel vaccines

Question 1

measles highest risk counties:

Answer 1

Nigeria, Somalia, India
also outbreaks in Europe

Question 2

measles

Answer 2

about 1/4 will require hospitalization

Question 3

varicella

Answer 3

in tropical climates - seroconversion later in adulthood and there is seasonal variation

Question 4

YF vaccine reactions

Answer 4

SE: HA, fever, myalgias
major: severe allergic - eggs, gelatin
YEL-AND - risk ~ 0.8 / 100,000 doses or
2.2/100,000 doses >60yo
onset ~ 2-56 days following vaccine
- meningoencephalitis, Guillain Barre, demyelination, CN palsies. Rarely fatal. Almost all YEL-AND in 1st dose

Question 5

YEL-AVD

Answer 5

severe illness, similar to wild-type YF dz
median onset 4D (range 1-18)
case fatality ~ 48%
0.4 cases / 1000,000 doses, 1.2 / 100,000 >60yo
^risk - thymus dz / thymectomy, immunosuppressed, immunomodulatory meds, older age

Question 6

live vaccine and receiving live virus vaccine

Answer 6

radiation/chemo/immunosuppressive drugs - 3 months at least.
lymphocyte depleting - rituximab/alemtuzumab, thymoglobulin - >/= 6 mos, some say >1 yr

Question 7

Hepatitis E

Answer 7

fecal, oral / waterborne / foodborne - meat and offal (boars, deer, pigs) can be particularly severe in pregnancy. no vaccine

Question 8

Typhoid Fever

Answer 8

Salmonella enterica serotype Typhi

Enteric Fever
includes also Paratyphoid Fever, Salmonella paratyphi A, B or C serotype

Question 9

typhoid

Answer 9

26 million infections / year
highest risk South Asia (India), then SE Asia and W Africa
incubation 6-30 days
fever, headache malaise
Rose spots, abd pain (not a diarrhea illness)
late complications - intestinal hemorrhage or perf.

Question 10

typhoid treatment

Answer 10

azithro or inj 3rd gen cephalosporin
FQ resistance now the norm in Indian subcontinent and MDR typhoid on the rise

Question 11

typhoid vaccines

Answer 11

oral and inj both protect 50-80% of recipients but little or no protection against Salmonella paratyphi infection

Question 13

oral typhoid

Answer 13

> 6yo, swallow whole
SE ?

Question 14

meningitis

Answer 14

6 major serotypes, A, B, C, W, X and Y
trans: close contact, resp secretions or saliva
Sub-Saharan Africa, mostly dry season
Saudi Arabia - required for Hajj and Umrah
crowded situations - dorm, military, etc

Question 15

rabies

Answer 15

Rhabdoviridae, genus Lyssavirus
neurotropic
acute fatal encephalomyelities
bites, licks scratches - esp dogs, also bats, skunks, raccoons

Question 16

rabies vaccine in travel

Answer 16

rabies-risk countries, especially kids and those with occupational risk. resource limited country with difficult or no access to RIG

Question 17

rabies post exposure prophy

Answer 17

previously vaccinated:
- 2 doses vaccine days 0 and 3
not previously vaccinated:
- full PEP RIG plus vaccine days 0, 3, 7 and 14 (28)
there are many different scheduled RIG for category 3

Question 18

rabies and monkeys

Answer 18

monkeys are not a primary resevoir but 130 cases confirmed over 50 yrs (Brazil and S America

Question 19

JE

Answer 19

culex
season/geography
- May -Oct China, Japan, India, Nepal
- year round - Malaysia, Indonesia, Papua New Guinea, Philippines, SE Asia

Question 20

tick borne encephalitis

Answer 20

Risk: Europe and a line across Asia
not available in US