Traveler's Medicine Flashcards
Meningococcal disease prevention
Required by Saudi Arabia during the time of the Hajj
Recommended for hyperendemic regions including the meningitis belt of Africa during the dry season December through June
Symptoms of meningitis are fever, severe, unrelenting headache, nausea, stiff neck and mental status changes which require urgent treatment to avoid the risk of permanent brain damage and death
Three vaccines are available Menactra (2 doses for age 9-23 months or 1 dose for age 2-55), Menveo (2-55), Menomune (>56 yo)
Vaccine should be given 7 to 10 days prior to exposure
Resource
CDC’s website or the yellow book
Prevention of diseases transmitted by insect bites
Primarily mosquitoes which can transmit Japanese encephalitis, yellow fever, dengue and malaria
Tsetse fly spread African sleeping sickness
There is no vaccine or prophylactic drugs for African sleeping sickness, malaria, dengue
Prevention of mosquito borne illness
- Stay and sleep in screened or air-conditioned rooms
- Cover exposed skin with long sleeve shirts, long pants and hats
- Use a bed net, which can be pretreated with mosquito repellent
- Use mosquito repellent containing 20 to 30% DEET; permethrin can be used to treat closing gear and bed nets but should not be applied to the skin
Prevention of African sleeping sickness
As the fly can bite through thin fabric closing should be medium weight and neutral in color as the flies attracted to bright or dark colors
No evidence if insect repellent works
Prevention of Japanese encephalitis
These prevention against mosquito bites and consider vaccine (Ixiaro)
Prevention of yellow fever
Caused by a virus transmitted by mosquitoes
Common in the tropical and subtropical areas of south America and Africa
Often asymptomatic but can present like influenza. Most patients improve but can progress to jaundice, hemorrhagic symptoms and risk of shock organ failure
Treatment is usually with fluids, analgesics and antipyretics remember to never use aspirin or inside as you will increase the risk for bleeding
Vaccine is highly recommended inpatient received a yellow card signifying their vaccination
This is a live vaccine
Should not be used in: immunosuppressed, pregnant or anyone with a hypersensitivity to eggs, egg products, chicken proteins or gelatin, myasthenia gravis
Malaria
transmitted by mosquito in tropical and subtropical areas of Asia, N. & S.America, Middle East, N. Africa and S. Pacific (high risk sub-Saharan Africa).
Most common strain: P. Vivax (building resistance)
Antimalarial: Mefloquine (Larium)
Dose: once weekly 1–2 weeks prior to travel
Side effects: psychiatric (anxiety, paranoia, depression, hallucinations and psychosis) and neurologic (seizures, dizziness or vertigo, tinnitus, and loss of balance)
Antimalarial: Atovaquone/Proguanil (Maleron)
once daily 1–2 days before travel and is taken for seven days post travel
Well-tolerated but cannot be used during pregnancy
Antimalarial: chloroquine
Dosed once weekly and the started 1-2 weeks before travel and is taken four weeks post travel
Side effects: visual problems such as retinopathy, can exacerbate psoriasis, G.I. upset
should not be used in pregnancy or severe renal impairment
Antimalarial: primaquine
Effective for P. vivax
Dosed once daily and is started 1–2 days before travel and taken for 7 days post travel
Cannot be taken in pregnancy or G6PD deficiency
The CDC requires G6PD screening prior to initiation
Typhoid fever
Highest risk in southern Asia
Spread through contaminated (feces) food or water
Can also be spread through sexual contact among men who have sex with men
Symptoms: fatigue, fever, malaise, rose-colored spots on trunk. Will progress to intestinal hemorrhage or perforation which is fatal
Vaccine (Vivotif Berna capsules or Typhim Vi IM injection) is recommended but only 50 to 80% effective ; should use precautions with food and water and wash hands frequently
Vivotif Berna capsules or Typhim Vi IM injection
Capsules: four capsules every other day, refrigerated, with cool liquid one hour before a meal, this is completed one week far to travel
Injection: IM greater than or equal to two weeks before exposure
Travelers diarrhea prevention
Often caused by unclean food or water (E. coli)
Precautions: eat food that is cooked and served hot, avoid food on a buffet, eat raw fruits and vegetables only if washed with clean water or peeled, drink only beverages from factory sealed containers and avoid ice, wash hands frequently
Treatment: hydration and loperamide or Imodium can be used, bismuth subsalicylate it can also be used that should never be used in children due to the rest of Greysens room
