Travelers Flashcards by Emily Byford

Where should your Vaccines be documented in

International Certificate of Vaccination or Prophylaxis [ICVP]
“Yellow Card”

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What is the most common travel-related illness?

Travelers Diarrhea [30 - 70%]

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What are some of the symptoms of traveler diarrhea and is the most common bacteria?

Cramping, Loose Stools, Fever, Vomiting
Dysentery if blood in stools
Caused by E. Coli

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What is the way that we prevent travelers diarrhea?

Eat only COOKED foods [Avoid buffets]
Bottle Water or Boil for 1 min [Avoid Ice]
Prophylaxis: Bismuth Subsalicylate

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Who should not take Bismuth Subsalicylate for Prophylaxis of Travelers Diarrhea?

Apsirin Allergy, Pregnancy, Renal Insufficiency, Gout, Taking Anticoagulants

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What are some of the Treatment options for Travelers Diarrhea?

Hydration [essential - oral is the best]
Antimotility [Loperamide - decreases the frequeny and urgency]
Antibiotics [mod to severe TD - Azithormycin, Quinolones or Rifaximin]

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What is the recommended dosing for Loperamide for Traveler Diarrhea?

4 mg at the first loose stool;
2 mg after each loose stool
MAX: 16 mg/day [Rx] & 8 mg/day [OTC]

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What is the baceria that can cause typhoid fever?

Salmonella typhi

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What is teh only way that Typhoid Fever can spread?

ONLY by humans through; food/water contaminated withe feces

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What is recommended for someone trying to prevent typhoid fever?

Vaccines [only 50 - 80% effective though]
Vivotif: Oral, Live-attenuated [complete > 1 week before trip]
Typhim Vi: IM [Get > 2 weeks before trip]

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What is the bacteria that causes Cholera?

Vibrio Cholerae

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What is the most common symptom for Cholera?

Watery Diarrhea [Rice-Water Stools]

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What is recommended for those going to a place with cholera risks?

Vaxchora: Live-attenuated vaccine [single oral dose 10 days before trip]

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What is recommended to get if you are going to a place with an increased polio risk?

Single lifetime booster dose at least 4 weeks before trip

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How are at the highest risk of getting hepatitis A?

Those going from a delevop country to a developing country

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What are the Inactivated Vaccines for Travelers?

Hep A [Havrix]
Hep B [Engerrix-B, Heplisav-B, Recombivax HB]
Hep A/B [Twinrix]
Japan Encephalitis [Ixiaro]
Meningococcus [Menveo, MenQuadfi]
Polio [IPOL]
Typhoid-IM [Typhim VI]

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What are the Live Vaccines for travelers?

Cholera-PO [Vaxchora]
Typhoid-IM [Vivotif]
Yellow Fever [YF-VAX]

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What is the way that Hepatitis B is transmitted?

Through contaminated blood or body fluids [low risk if your not doing any high-risk activities]

For those that are traveling to place where Hepatitis B is high risk, who are recommended to get the vaccines?

Planning to get medical care
Providing medical care
Unprotected sex
Piercing or Tattoos

What is the recommended prevention for Hepatitis B for those traveling to high risk places?

3 Dose series over 6 months OR
as many dose as possble before the trip

What is the bacteria that can cause Meningitis?

N. Mengitidis

What are some of the Symptoms of Menigitis?

Severe Headache, Fever, Nausea, Sniff Neck

What is the way that Meningitis is spread?

Respiratory Secretion

What is important to know how insects spreads diseases?

Insects are vectors [carries illness to other things

What **insect** is the most common transmitter and what are some things it can transmit?

- **Mosquitoes** - Carries **Japan Encephalitis, Yellow Fever, Dengue, Malaria, Zika**

What are some of the ways to avoid **mosquito bites?**

- Sleep or stay in a screened area - Mosquito repellents with 20-50% **DEET** onto skin - **Permethrin** treated ON Clothes

What is the way that **Dengue** is transmitted?

- By **Mosquitoes**

What are some of the **symptoms** of **Dengue**?

- Shock, **Severe bleeding**, organ failure

What is the treatment/prevention for **Dengue?**

- Dengvaxia [only for those with past Dengue] - **Protection** from mosquito

What is the way that **Japanese Encephalitis** is transmitted?

- By mosquitos

What is the way that **Japanese Enchephalitis** is treated/prevented?

- Best preventions is **reduce exposure to mosquito** - Ixario is a vaccine

What is the way that **Malaria** is transmitted and what happens once it is transmitted?

- By **anopheles mosquitoes** - Once in human, it multiles in liver and then goes to RBC to destory them

What is the common **Bacteria** that causes **Malaria**?

- **P. Vavix** is most common; **P. Falciparum** is most deadly

What is the treatment/prevention for **Malaria**?

- **Prophylaxis** is key as even with treatment is can be fatal

What is the **Quick Start Phrophylaxis Agents** for **Malaria**?

- **Doxycycline** [Stop 4w after travel] - Atovaquone/Proguanil [Stop 1w after travel] - Primaquine [**Stop 1w after travel**] | **Starts 1-2 days before traveling** ## Footnote **Daily Regimens; AVOID in pregnancy; causes Nausea**

What are some of the **Advance Start Prophylaxis Agents** for **Malaria**?

- Cholorquine [**Stop 4w after travel**] (Renal Toxcity/Visual Changes) - Mefloquine [**Start >2w before & Stop 4w after travel**] (Underlying Psychiatric, Seizures, Arrhythmias) | **Start 1-2 weeks before traveling** ## Footnote **Weekly, Safe in kids and children**

What is the way that **Yellow Fever** is transmitted?

- By Mosquitoes [reducing exposure is key]

What are some things to **avoid** in **Yellow Fever**?

- Aspirin and Other NSAIDS [increased bleeding]

What is the way to treat/prevent **Yellow Fever**

- YF-VAX that goes on your **Yellow Card** [becomes vaild after 10 days] ## Footnote **CONTRAINDICATED**: in those with hypersensitivity to Egg or severly immunocomprosed

What is the way that **Zika Virus** is transmitted?

- By Mosquitoes - Can be sexually by mainly blood-transfusions

What is the treatment/prevention of **Zika Virus**?

- NO VACCINES - Avoiding bites and using condoms

What is important to know about **VTE and Traveling**?

- Wearing compression stocking during long trips - Lower Leg Exercises [walking, curling toes]

What is important to know about **Altitude Sickness/Motion Sickness and Traveling**?

- Primary Prophy: **Acetazolamide** 125mg BID starting the day before trip ## Footnote CONTRAINDICATED with sulfa