Travelers

Question 1

Where should travel vaccinations be documented?

Answer 1

International Certificate of Vaccination or Prophylaxis (ICVP)

YELLOW CARD

Question 2

When preparing a patient for travel, HCP should consider ___

Answer 2

1. Disease spread through food and water
2. Diseases spread through blood and bodily fluids
3. Diseases are transmitted by insects

Question 3

What is dysentery?

Answer 3

Blood mixed in with the stool

Question 4

Primary pathogen for TD

Answer 4

E. coli, Campylobacter jejuni, Shingella, Salmonella

Question 5

What is the rule of TD

Answer 5

Boil it, cook it, peel it, or forget it

Question 6

Food and water precautions

Answer 6

1. Avoid food sitting on a buffet
2. use bottled water or boil for approximately one minute. avoid ice

Question 7

TD prophylaxis

Answer 7

Bismuth subsalicylate (Pepto-Bismol) 524-1050 mg PO QID

Question 8

When is ABX recommended for TD prophylaxis? What ABX?

Answer 8

High risk developing complications of TD (immunocompromised or significant cormorbidities)

ABX: rifaximin, azithromycin, and rifamycin

Question 9

What is the preferred tx for TD

Answer 9

ORS

Question 10

Tx or mild TD

Answer 10

Loperamide
BSS

Question 11

How should Loperamide be given

Answer 11

Used to ↓ the frequency and urgency of bowel movements:

4 mg after 1st loose stool and 2 mg after each subsequent loose stool up to 16 mg/day by rx or 8mg/d OTC

Can be used up to 2 days

Avoid in <2YO RX (<6YO OTC) or dysentery

Question 12

CI of BSS? ADR

Answer 12

Reye’s syndrome

ADR: black tongue/stools

Question 13

ABX for severe TD and dysentery

Answer 13

Azithromycin

Question 14

ABX for mod-severe TD with no dysentery

Answer 14

Azithromycin, FQ, or rifaximin, rifamycin

Question 15

What pathogens are not covered by rifaximin or rifamycin?

Answer 15

Campylobacter, Salmonella

Question 16

What causes typhoid

Answer 16

Salmonella typhi

Question 17

Transmission of typhoid?

Answer 17

Food or water contaminated by feces or someone with acute infection or chronic asymptomatic carrier

Question 18

Typhoid vaccine

Answer 18

Vivotif: PO live completed ≥1 wk prior to travel not recommended <6YO, pts taking ABX, or sensitive stomachs
Typhim Vi: IM ≥2 wks before exposure not recommended for <2YO

Question 19

When to revaccinate for typhoid

Answer 19

Vivotif x 5 yrs
Typhim Vi x 2 yrs

Question 20

Pathogen for cholera

Answer 20

Vibrio cholerae

Question 21

Sx of cholera

Answer 21

Rice-water stools

Question 22

Vaccine for cholera

Answer 22

Vaxchora: PO live at least 10 days before travel and approved for 2-64 yrs

Question 23

How do you dose polio vaccine

Answer 23

Single lifetime booster dose 4 weeks prior to travel for adults who have completed series

Question 24

Inactive travel vaccines

Answer 24

Hepatitis A and B
Japanese’s encephalitis
Menungococcus
Polio
Typhoid IM

Question 25

Live travel vaccines

Answer 25

Cholera PO Typhoid PO Yellow fever-sc

Question 26

Who should receive the HBV vaccine

Answer 26

1. Receives med care 3. Provide med work 3. Unprotected sex 4. Piercing/tattoos

Question 27

How long does it take to finish HBV vaccine series

Answer 27

3 doses within 6 months

Question 28

Regions that may require meningococcal vaccine

Answer 28

1. Meningitis belt in Africa (Dec-June) 2. Saudi Arabi during Hajj and Umrah pilgrimages

Question 29

Quadvalent menigococal vaccines

Answer 29

Menveo, MenQuadfi

Question 30

Diseases that can be transmitted by mosquitos?

Answer 30

Japanese encephalitis Yellow fever Dengue Malaria Zika virus

Question 31

How to avoid insect bites?

Answer 31

1. Screened or air conditioned rooms nd use of bed net 2. Cover exposed skin 3. DEET 20-50% on exposed skin 4. Permethrin on clothing, gear, and bed nets not exposed skin

Question 32

Bactierial that causes meningococcal>

Answer 32

N. menintitidis

Question 33

What transmits dengue

Answer 33

Aedes aegypto and Aedes albopictus

Question 34

Dengue vaccine

Answer 34

Dengvaxia

Question 35

Japanese encephalitis vaccine

Answer 35

Ixiaro

Question 36

Malaria is transmitted by what mosquito

Answer 36

Anopheles P. vivax and P. falciparum (most deadly)

Question 37

What are the quick start malaria regimens

Answer 37

started 1-2 days prior to travel 1. Doxycycline stop 4 wks after travel 2. Atovaquone/Proguanil (Malarone) stop 1 week after travel 3. Primaquine stop 1 week after travel

Question 38

Who should not take quick start

Answer 38

1. Pregnant 2. Doxy: <8YO 3. Malarone: breastfeeding and severe renal impairment 4. Primaquine: G6PD, breastfeeding

Question 39

Drug most effective against P vivax

Answer 39

Primaquine

Question 40

ADR of quick start

Answer 40

Nausea to ↓ take with food and water

Question 41

Advance start drugs

Answer 41

1. Chloroquine 2. Mefloquine 3. Tafenoquine

Question 42

When is chloroquine used? Duration?

Answer 42

Resistance issues with P falciparum and vivax Start 1-2 wks prior Stop 4 weeks after QW Patient on Plaquinel are covered

Question 43

ADR of chloroquine

Answer 43

Retinal tox, visual changes

Question 44

Mefloquine duratin

Answer 44

Start: ≥2 wks before Stop: 4 wks after QW

Question 45

When to avoid Mefloquine

Answer 45

1. Underlying psych issues 2. Seizures 3. Arrhythmias

Question 46

When is tafenoquine initiated

Answer 46

3 days before travel

Question 47

Malaria prophylaxis for pregnancy

Answer 47

1. Chloroquine 2. Mefloquine

Question 48

How long is yellow card valid for after the yellow fever vaccine?

Answer 48

10 days

Question 49

CI of yellow fever vaccine

Answer 49

Eggs

Question 50

How is zika transmitted

Answer 50

Blood transfusion and sexual transmission

Question 51

How to avoid VTE

Answer 51

Compression stockings Perform lower leg exercises when sitting

Question 52

Primary prophylaxis for altitude sickness

Answer 52

Acetazolamie (Diamond) started the day before travel

Question 53

ADR and CI of acetazolamide

Answer 53

ADR: polyuria, photosensitivity, taste alteration, dehydration, skin rash CI: sulfa allergy