Travelers Flashcards
International Certificate of Vaccination Prophylaxis
“yellow card”
document travel vaccinations
where should meds/supplies be packed
carry-on
how diseases spread when traveling
1) food/water
2) blood/bodily fluids
3) insects
information for international travel
“yellow book”
through CDC
diseases through contaminated water/food
TD
typhoid fever
cholera
polio
hepatitis A
dysentery
stool with blood
often with systemic symptoms
severe diarrhea
travelers’ diarrhea prophylaxis non-antibiotic drug
bismuth subsalicylate 524-1050 mg PO 4 times daily (meals + bedtime)
travelers’ diarrhea prophylaxis antibiotic
rifaximin preferred
use only if high risk of complications from TD (immunosuppressed, significant comorbidities) or performance reason (pro athlete)
mild travelers’ diarrhea treatment
loperamide or bismuth subsalicylate
moderate travelers’ diarrhea treatment
loperamide +/- antibiotics
moderate travelers’ diarrhea treatment antibiotic
azithromycin or quinolone (if low resistance)
moderate travelers’ diarrhea treatment antibiotic alternative
rifaximin
severe TD treatment (dysentery) treatment
antibiotics +/- loperamide
severe TD treatment antibiotic preferred
azithromycin
severe TD treatment antibiotic alternative
rifaximin or quinolones
common causes of TD
bacteria
primarily E. coli
TD prevention tips
“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
CI to taking Pepto-Bismol for TD treatment/prevention
ASA allergy
pregnancy
renal insufficiency
gout
using anticoagulants
TD treatment
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
thyroid fever cayses
Salmonella typhi
how typhoid fever is spread
food/water contaiminated by feces of human with acute infection or chronic, asymptomatic carrier
typhoid vaccines
recommended
still need food/water precautions + was hands bc not fully effective
Vivotif
oral
live-attenuated typhoid vaccine
complete 1 wk or more before travel
Typhim Vi
IM injection
typhoid vaccine
complete 2 wks or more before travel
cholera cause
Vibrio cholerae
most common cholera symptom
water diarrhea - “rice-water stools”
Vaxchora
live-attenuated cholera vaccine
polio vaccine recommendations
childhood in US
CDC - single lifetime booster dose for adults before travel to regions where poliovirus is circulating
hepatitis A
take when going from developed countries to developing countries
diseases spread through blood/bodily fluids
hepatitis B
meningococcal meningitis
hepatitis B
risk is low for those who do not participate in high-risk behaviors
high risk for hepatitis B
receiving medical care
provide medical care
unprotected sexual encounters
piercings/tattoos
how long does it take to give hepatitis series
3 shots over 6 months
give as many as possible before trip and complete upon return if needed
meningococcal meningitis symptoms
symptoms: fevere, severe unrelenting headache, nausea, stiff neck/nuchal rigidity
meningococcal meningitis diagnosis
lumbar puncture
how meningococcal meningitis is spread
respiratory secretions
meningitis high risk regions
meningitis Belt of Africa
Hajj and Umrah pilgrimages in Saudi Arabia require vaccine for travel
meningitis vaccines
quadrivalt Menactra and Menveo
diseases spread by insects
dengue
Japanese encephalitis
malaria
yellow fever
zika
insect bites
mainly from mosquitos
avoid insect bites: mosquito repellents with 20-50% DEET exposed skin; use permethrin on clothing but not on skin
dengue
from mosquitos
severe - can have severe bleeding
protect from mosquito bites
Japanese encephalitis
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
Malaria source
Anopheles mosquito to human host
most common malaria species
P. vivax
most deadly malaria species
P. falciparum
malaria prophylaxis
recommended bc can be fatal
look at region-specific recommendations
can cause nausea; take with water, food, or milk
malaria quick starts
initiate 1-2 days before travel
daily meds
avoid in pregnancy
cause nausea
doxycycline (Doryx/Vibramycin)
Atovaquone/Proguanil
Primaquine
primaquine notes
stop 1 week after travel; don’t use in G6PD deficiency
malaria advanced starts
weekly regiment
safe in kids and pregnancy (except Tafenoquine
start 1-2 weeks before travel
chloroquine
Mefloquine
Tafenoquine
chloroquine notes
stop 4 weeks after travel
renal toxicity/visual changes
Mefloquine notes
start >=2 weeks before travel
stop 4 weeks after travel
don’t use in underling psych conditions, seizures, arrhythmias
Tafenoquine notes
not used in G6PD deficiency
how yellow fever is spread
mosquitos - reduce exposure
what meds are CI in yellow fever
ASA/NsAIDs - inc bleeding risk
what is available to prevent yellow fever
live-attenuate YF-VAX
documented on ICVP “yellow card” - valid after 10 days
what makes YF-VAX CI
allergy to eggs
severely immunocompromised
who is recommended to get YF-VAX
only if traveling to high risk area/required to travel
serious ADRs
how is Zika spread
primarily mosquito
sexual and blood transfusion transmission reported
what can happen to babies with Zika mom
infants born with microcephaly
how to prevent Zika
no vaccine
avoid mosquito
use condoms with those who possibly have Zika
how to prevent DVT in travel
compression stocking in long trips
perform lower leg exercises when sitting
primary prophylaxis for acute mountain sickness
acetazolamide - start day before
acetazolamide side effects
polyuria
photosensitivity
who is CI for acetazolamide
sulfa allergy
