Travelers

Question 1

International Certificate of Vaccination Prophylaxis

Answer 1

“yellow card”
document travel vaccinations

Question 2

where should meds/supplies be packed

Answer 2

carry-on

Question 3

how diseases spread when traveling

Answer 3

1) food/water
2) blood/bodily fluids
3) insects

Question 4

information for international travel

Answer 4

“yellow book”
through CDC

Question 5

diseases through contaminated water/food

Answer 5

TD
typhoid fever
cholera
polio
hepatitis A

Question 6

dysentery

Answer 6

stool with blood
often with systemic symptoms
severe diarrhea

Question 7

travelers’ diarrhea prophylaxis non-antibiotic drug

Answer 7

bismuth subsalicylate 524-1050 mg PO 4 times daily (meals + bedtime)

Question 8

travelers’ diarrhea prophylaxis antibiotic

Answer 8

rifaximin preferred
use only if high risk of complications from TD (immunosuppressed, significant comorbidities) or performance reason (pro athlete)

Question 9

mild travelers’ diarrhea treatment

Answer 9

loperamide or bismuth subsalicylate

Question 10

moderate travelers’ diarrhea treatment

Answer 10

loperamide +/- antibiotics

Question 11

moderate travelers’ diarrhea treatment antibiotic

Answer 11

azithromycin or quinolone (if low resistance)

Question 12

moderate travelers’ diarrhea treatment antibiotic alternative

Answer 12

rifaximin

Question 13

severe TD treatment (dysentery) treatment

Answer 13

antibiotics +/- loperamide

Question 14

severe TD treatment antibiotic preferred

Answer 14

azithromycin

Question 15

severe TD treatment antibiotic alternative

Answer 15

rifaximin or quinolones

Question 16

common causes of TD

Answer 16

bacteria
primarily E. coli

Question 17

TD prevention tips

Answer 17

“boil it, cook it, peel it or forget it”
avoid food sitting on buffet
drink bottled water or boil for approx 1 min
avoid ice

Question 18

CI to taking Pepto-Bismol for TD treatment/prevention

Answer 18

ASA allergy
pregnancy
renal insufficiency
gout
using anticoagulants

Question 19

TD treatment

Answer 19

hydration (inc fluid + salt) is essential for all (oral rehydration solution is preferred)
loperamide: antimotility for acute diarrhea; dec frequency/urgency; 4 mg after 1st loose stool + 2 mg after each subsequent loose stool up to 16 mg/day by Rx or 8 mg/day OTC; self-treat for up to 2 days
BSS: another option; counsel on black tongue/stools
antibiotic: azithromycin preferred for severe/dysentery; quinolones or rifaximin also available

Question 20

thyroid fever cayses

Answer 20

Salmonella typhi

Question 21

how typhoid fever is spread

Answer 21

food/water contaiminated by feces of human with acute infection or chronic, asymptomatic carrier

Question 22

typhoid vaccines

Answer 22

recommended
still need food/water precautions + was hands bc not fully effective

Question 23

Vivotif

Answer 23

oral
live-attenuated typhoid vaccine
complete 1 wk or more before travel

Question 24

Typhim Vi

Answer 24

IM injection
typhoid vaccine
complete 2 wks or more before travel

Question 25

cholera cause

Answer 25

Vibrio cholerae

Question 26

most common cholera symptom

Answer 26

water diarrhea - "rice-water stools"

Question 27

Vaxchora

Answer 27

live-attenuated cholera vaccine

Question 28

polio vaccine recommendations

Answer 28

childhood in US CDC - single lifetime booster dose for adults before travel to regions where poliovirus is circulating

Question 29

hepatitis A

Answer 29

take when going from developed countries to developing countries

Question 30

diseases spread through blood/bodily fluids

Answer 30

hepatitis B meningococcal meningitis

Question 31

hepatitis B

Answer 31

risk is low for those who do not participate in high-risk behaviors

Question 32

high risk for hepatitis B

Answer 32

receiving medical care provide medical care unprotected sexual encounters piercings/tattoos

Question 33

how long does it take to give hepatitis series

Answer 33

3 shots over 6 months give as many as possible before trip and complete upon return if needed

Question 34

meningococcal meningitis symptoms

Answer 34

symptoms: fevere, severe unrelenting headache, nausea, stiff neck/nuchal rigidity

Question 35

meningococcal meningitis diagnosis

Answer 35

lumbar puncture

Question 36

how meningococcal meningitis is spread

Answer 36

respiratory secretions

Question 37

meningitis high risk regions

Answer 37

meningitis Belt of Africa Hajj and Umrah pilgrimages in Saudi Arabia require vaccine for travel

Question 38

meningitis vaccines

Answer 38

quadrivalt Menactra and Menveo

Question 39

diseases spread by insects

Answer 39

dengue Japanese encephalitis malaria yellow fever zika

Question 40

insect bites

Answer 40

mainly from mosquitos avoid insect bites: mosquito repellents with 20-50% DEET exposed skin; use permethrin on clothing but not on skin

Question 41

dengue

Answer 41

from mosquitos severe - can have severe bleeding protect from mosquito bites

Question 42

Japanese encephalitis

Answer 42

from mosquitos reduce exposure to mosquitoes Ixiaro for travelers <2 mo old going to extended outdoors exposures or at least 1 mo in endemic area during JE season

Question 43

Malaria source

Answer 43

Anopheles mosquito to human host

Question 44

most common malaria species

Answer 44

P. vivax

Question 45

most deadly malaria species

Answer 45

P. falciparum

Question 46

malaria prophylaxis

Answer 46

recommended bc can be fatal look at region-specific recommendations can cause nausea; take with water, food, or milk

Question 47

malaria quick starts

Answer 47

initiate 1-2 days before travel daily meds avoid in pregnancy cause nausea doxycycline (Doryx/Vibramycin) Atovaquone/Proguanil Primaquine

Question 48

primaquine notes

Answer 48

stop 1 week after travel; don't use in G6PD deficiency

Question 49

malaria advanced starts

Answer 49

weekly regiment safe in kids and pregnancy (except Tafenoquine start 1-2 weeks before travel chloroquine Mefloquine Tafenoquine

Question 50

chloroquine notes

Answer 50

stop 4 weeks after travel renal toxicity/visual changes

Question 51

Mefloquine notes

Answer 51

start >=2 weeks before travel stop 4 weeks after travel don't use in underling psych conditions, seizures, arrhythmias

Question 52

Tafenoquine notes

Answer 52

not used in G6PD deficiency

Question 53

how yellow fever is spread

Answer 53

mosquitos - reduce exposure

Question 54

what meds are CI in yellow fever

Answer 54

ASA/NsAIDs - inc bleeding risk

Question 55

what is available to prevent yellow fever

Answer 55

live-attenuate YF-VAX documented on ICVP "yellow card" - valid after 10 days

Question 56

what makes YF-VAX CI

Answer 56

allergy to eggs severely immunocompromised

Question 57

who is recommended to get YF-VAX

Answer 57

only if traveling to high risk area/required to travel serious ADRs

Question 58

how is Zika spread

Answer 58

primarily mosquito sexual and blood transfusion transmission reported

Question 59

what can happen to babies with Zika mom

Answer 59

infants born with microcephaly

Question 60

how to prevent Zika

Answer 60

no vaccine avoid mosquito use condoms with those who possibly have Zika

Question 61

how to prevent DVT in travel

Answer 61

compression stocking in long trips perform lower leg exercises when sitting

Question 62

primary prophylaxis for acute mountain sickness

Answer 62

acetazolamide - start day before

Question 63

acetazolamide side effects

Answer 63

polyuria photosensitivity

Question 64

who is CI for acetazolamide

Answer 64

sulfa allergy