Travelers Health Flashcards

1
Q

When should a pre travel evaluation be obtained?

A

At least one month before travel
-Medical history
-Vaccines
-Allergies
-Pregnant

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2
Q

What are the three categories for immunizations when traveling

A
  1. Routine prevention
  2. Required for travel
  3. Recommended based on the risk of exposure to disease
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3
Q

What are infections that are transmissible by contaminated food and water?

A

Travelers diarrhea
Hepatitis A and E
Transmission of parasitic infections

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4
Q

What are vector born disease/

A

Malaria
Dengue
Chikungunya
Zika

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5
Q

What is malaria/

A

Plasmodium parasite in mosquito transmission through bite, fever, sweats, myalagias, confusion

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6
Q

What is Dengue?

A

mosquito born fever, rash, bleeding manifestations (vaccine)

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7
Q

What is chikungunya?

A

Mosquito born fever, myalgias, arthritis, rash (no vaccine)

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8
Q

What is Zika virus?

A

mosquito born pregnancy transmit to fetus
-congenital defects, microcephaly
-no vaccine

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9
Q

What can rafting and exposure to floodwaters result in?

A

Exposure to leptospirosis

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10
Q

What is leptospirosis?

A

Bacterial illness infecting humans from direct contact with animal urine
-through cuts, mucous membranes, or conjunctiva

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11
Q

What is schistosomiasis?

A

Infection with parasitic blood flukes
-from bathing in fresh water contaminated by cercariae carried by snails
-“snail fever”

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12
Q

What is stronglyoidiasis?

A

Infection with the helminth
-Filariform larvae penetrate the skin and migrate via the blood stream and lymphatics to the lungs
-Strongyloides stercoralis
-S. Stercoralis

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13
Q

What is the most common cause of death among travelers?

A

Traffic accidents

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14
Q

If someone has a unstable medical condition should they fly?

A

No

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15
Q

If someone has a medical condition that could lead to inflight illness what might they need to have?

A

A medical certificate

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16
Q

Can someone with TB or epilepsy fly/

A

TB: NO
Epilepsy: yes
>1 seizure in the prior month should not fly

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17
Q

What can the lower partial pressure of oxygen in a flight cause to individuals with pulmonary issues/

A

Hypoxia

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18
Q

What should asthmatics carry on the flight with them?

A

A rescue inhaler
-SABA (short-acting beta agonist)

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19
Q

What is a CI to air travel (pulmonary)

A

Pneumothorax

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20
Q

If someone has OSA what must the get approved before coming onto the flight?

A

Portable oxygen concentrator

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21
Q

How to determine if a patient needs supplemental oxygen?

A

Use 6 minute walk test
-Resting pulse ox is not fully predictive of in-flight hypoxia

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22
Q

Does DVT get worse with air travel?

A

Yes
-long distance travel, either air or land (2-3 fold increase)

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23
Q

What is a life threat to a mother and fetus?

A

Malaria prophylaxis key

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24
Q

What are risk factors for venous thromboembolism/

A

Recent major surgery
Prior VTE
Active malignancy
Pregnancy

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25
What are some contributing factors to VTE?
Venous stasis secondary to immobility Elevate levels of activation of coagulation factors
26
Does dehydration or alcohol consumption contribute to increased risk of VTE?
No
27
What are the prevention guidelines for VTE?
WITHOUT risk factors: ambulate every 1-2 hours With: -ambulate every 1-2 hours and graduated compression Stockings
28
What is a medication option for people at high risk of VTE?
Thromboprophylaxis
29
What are pregnant women more susceptible to when traveling?
VTE Malaria SARS Zika -should consider postponing travel to areas with mosquito borne Zika virus transmission due to the chances of congenital microcephaly
30
Should someone with diabetes have their insulin in the checked in bag?
No it will denature -carry insulin in the carry-on bag
31
What are the pre-travel immunizations?
Yellow fever Meningococcal Typhoid Hep A/B Rabies Cholera Japanese encephalitis Covid
32
What are the pre-travel prophylaxis?
Malaria Travelers diarrhea
33
What is the yellow fever infection/
Mosquito borne -transmitted by Aedes aegypti
34
When should the yellow fever vaccine when administered to travelers?
>9 months yoa traveling to an area of high transmission -live vaccine -only given at designated vaccination centers
35
What are the precaution of the yellow fever vaccine?
>60 yoa 6-8months old Pregnant
36
What serogroup is the most common cause of epidemic meningococcal disease?
Serogroup A -spreads via respiratory secretions “Meningitis belt” of Africa
37
Is type B meningococcal infection a specific travel related infection?
No - usual recommended for 10 and older high risk patients
38
What causes typhoid fever?
Salmonella enterica typhi -fecal-oral
39
What type of travelers are at high risk of infection of typhoid fever?
Visiting family and friends
40
What are the two types of typhoid vaccines?
1. Oral, live -four dose (Days 1,3,5,7) -ages >6yoa 2. Inactivated vaccine -Preferred 2 weeks prior to travel >2yoa
41
Hep A vaccine recommendation
Unvaccinated adults -single dose any time prior to travel -second dose 6-12 months after Unvaccinated children -Havrix: 0 and 6-12 months -Vaqta: 0 and 6-18 months
42
Is a booster necessary for Hep A vaccine?
no
43
How is Hep a/ b transmitted?
Hep A: fecal oral Hep B: blood
44
How many doses of Hep B are there?
3 dose if not previously vaccinated
45
How is rabies transmitted?
viral illness (MC worldwide=dogs) (MC USA=bats) -leads to encephalopathy and death -children at higher risk
46
When is pre-exposure rabies prophylaxis taken?
Three dose -0,7,21 and or 28
47
When is post-exposure rabies prophylaxis taken?
4 doses (unvaccinated) 0 IG, 3, 7, 14 (day) 2 dose (vaccinated) 0, 3 no IG
48
What causes cholera?
Diarrheal illness caused by gram negative bacterium vibrio cholera -live attenuated oral vaccine -single dose 10 days before travel
49
Can someone younger than 18 yoa take the cholera vaccine?
No
50
What causes the Japanese encephalitis?
Arborviral encephalitis -inflammation of the brain caused by infection with an arbovirus MC mosquito
51
Where are the highest rates of Japanese encephalitis at?
Asia and parts of western pacific -Rural agricultural areas
52
What is the Japanese encephalitis vaccine?
IXIARO -2 months to 2yoa: two half strength doses (0,28 days) -3yoa to 18yoa: two dose (0-28 days) -18-65: two dose (0, 7-28 days) - single booster if ongoing risk
53
What causes malaria?
Protozoan plasmodium -P.falciparum causes the most severe disease and life-threatening within hours
54
What is the first line protection of malaria in sensitive areas?
Chloroquine
55
What are the four types of malaria chemoprophylaxis approach?
Mefloquine (lariam): 250mg tablet once weekly Atovaquone-proguanil (malarone): 250mg/100mg once daily -safe in pregnancy Doxycycline: 100mg daily Tafenoquine: 100mg 2 tablets daily
56
What is the most common illness in travelers/
Travelers diarrhea MC E.coli Prevention: boil it, peel it, forget it
57
Are prophylactic ATB recommended for travelers diarrhea/
NO
58
What medication is preferred for travelers diarrhea/
Rifampin 200mg TID Pregnancy: -3rd gen cephalosporin (keflex) or -Azithromycin (z-pack) use for children
59
What are the non antibiotic agents for prevention of travelers diarrhea/
Bismuth subsalicylate or BSS Pepto-Bismol Side effects: black tarry stools, black tongue
60
What is recommended for mild travels diarrhea?
NO antibiotics Pepto-Bismol Loperamide
61
What is recommended treatment of moderate travers diarrhea/
Antibiotics may be used (rifampin) Azithromycin: young, pregnant, renal insufficiency
62
What is recommended for severe travels diarrhea?
Antibiotics should be used -Rifampin -Azithromycin -fluroquincolones
63
What is barotrauma?
Tissue injury caused by a change in pressure -Pulmonary barotrauma: most serious -Ear barotrauma: pain and vertigo MC
64
What is a pneumothorax? (pulmonary barotrauma)
Air that leaks out of the lungs can be trapped in the space between the lungs and the chest wall
65
What is a pneumomediastinum? (pulmonary barotrauma)
Air may be forced out of the lungs into the tissues surrounding the heart
66
What is subcutaneous emphysema (pulmonary barotrauma)
Under the skin of the neck and upper chest
67
What is an air embolism? (pulmonary barotrauma)
Air in the blood vessels -most serious pulmonary barotramua
68
What is decompression sickness?
The bends or generalized barotrauma -affects the whole body
69
What is nitrogen narcosis?
Caused by the raised partial pressure of nitrogen in nervous system tissue from breathing in excess gasses -occurs at depths greater than 100 feet
70
What is high altitude illness?
Pathological syndromes that can develop following an initial ascent to high altitude
71
What is acute mountain sickness (AMS)
Headache, Anorexia, dizziness, fatigue -caused by rapid exposure to low amounts of o2 at high elevation
72
What is high altitude cerebral edema? (HACE)
Poor concentration, lethargy, ataxia, altered consciousness, coma -severe progression of AMS
73
What is high altitude pulmonary edema (HAPE)
Dry cough, SOB at rest, production of frothy pink sputum, decreased exercise tolerance