Traveller Health Flashcards
What is the most common cause of fatal community acquired pneumonia in the Northern Territory?
**Melioidosis **
Melioidosis is an infectious disease caused by the Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water.
Burkholderia pseudonmallei infections are endemic in the Northern Territory
What additional immunisations are required for people undertaking travel amongst indigenous communities in the NT/Central Australia?
Hepatitis A
The NT and Central Australia regions have developing nation-like patterns on Hepatitis A - in some areas is endemic
What are the estimated incidences of contracting illness during travel to developing countries?
Travellers Diarrhea = 20-60%
Acute Respiratory Infection = 5-20%
Malaria (no chemoprophylaxis in West Africa) = 2%
Dengue Fever = 0.1%
Hepatitis A = 0.03-0.3%
Rabies = 0.3%
**Note: **incidence of illness maredly varries depending upon the destination, duration of travel and activities undertaken while travelling
For every 100,000 travellers to developing nations, breakdown the incidence of medically related events
For every 100,000 travellers:
- 50,000 will develop some sort of health problem during the course of their trip
- 8,000 will see a physician
- 5,000 will be confined to bed
- 1,100 be incapacited in their work abroad or upon returning home
- 300 will be hospitalised during travels or upon return
- 50 will be air evacuated out of the trip they are visiting
- 1 will die
Discuss the incidence of respiratory tract infections amongst travellers to developing nations
**Respiratory tract infections are the second most frequent cause of illness in travellers **
Infections occur at a rate of 5-20% in all travellers
Upper respiratory tract infections are more common in younger travellers; while lower respiratory tract infections were more common in older travellers
Influenza is the most commonest vaccine-preventable disease of travel
Discuss the relative risks of contracting GIT infections while travelling to regions around the world
Compared to GIT infection risks in a developed nation like Australia; a traveller has an elevated risk:
- >200x risk in the subcontinent (India and surrounds)
- 150-200x risk in Africa (except Northern Africa)
- 100-150x risk in South America
- 50-100x risk in South East Asia
Discuss Malaria as a travellers disease
Malaria is responsible for 2% of health burden in travellers to developing nations
Travellers have the greatest risk of acquiring P. falciparum from Africa; whereas greater risk of P. vivax from Oceania/Sth East Asia
Mortality from malaria is highest in elderly patients >65 y.o
What is the most common reason for travel amongst returning malaria patients?
Visiting friends / relatives (35%)
It is thought that these people are significantly more relaxed about taking health precautions due to the percieved “familiarity” of travelling to regions known to them due to their connections to these places and it’s people -> correlation to greater rate of malaria
Describe the relationship between the number of malaria cases a Western Hospital/Health Service observes and their rate of malaria mortality?
The greater number of malaria cases observed in a health institution, the lower the rate of malaria mortality in that institution.
With malaria being a relatively unspecific symptomatically, there is a low index of suspicion of malaria when people present with illness. This often means that the disease is not recognised nor diagnosed until later -> quickly leading to more severe illness and death from the malaria
Institution familiar with the disease do better at identifying it early.
Important to obtain relative travel history
Discuss the relevance of Dengue Fever as a traveller illness
10 million cases of Dengue and 250,000 cases of Dengue Haemorrhagic Fever are reported annually in endemic countries
Dengue infection account for 0.1% of all travelling illnesses but 8% of all febrile illnesses in returning travellers
Can also aquire Dengue Fever from areas of endemic in the Northern Territory and Central Australia
How common is it that people fail to immunise before travelling and subsequently develop preventable illnesses?
Approximately 6% of returning travellers develop vaccine preventable illnesses; including:
- Influenza
- Typhoid
- Hepatitis A
- Measles
Interestingly, 31% of people who obtain pre-travel health advice don’t take the recommended vaccines
- 7% of all people seek health advice before travelling (any source)
* Only 35% in 18-39 y.o demographic
Who would be considered high risk travellers?
Patients with:
- Chronic illness
- particularly those with immunocompromised conditions
- Pregnant
- Travelling to remote and high risk locations for extended periods of time
- Very young or very old people
- Visiting friends or family
Explain the principles of pre-travel health care that should be addresses during a patient consult
- Understand the epidemiology of travel and travel related conditions
- Provide up-to-date and authoratative information on current health risks of travel regions
- Individualise advice to particular patients
- Start vaccination / prophylaxis early ( >6 weeks prior to travel) allowing sufficient time
- Identify high risk travellers
- Encourage personal responsibility for safe behaviour
- Recommend a medical kit
- Oportunistic interventions - provide broader non-travel related immunisations concurrently as well as screenings
What key issues should a doctor discuss with a pre-travel patient in regard to travel education?
- Injury - particularly road trauma and water safety
- Diarrhea prevention and management
- Insect bites
- Blood-borne, sexually-transmitted infections
- Drugs
- Rabies - mammal bites
- Schistosomiasis
- Stress and security for expats esp humanitarian workers
- Specific to patient or region or activities
- Pacific - ciguatera fish poisoning
- Altitude
Discuss the epidemiological basis of blood-borne viruses
The majority of blood borne viruses aquired during travel occur as a result of sexual contact
Rates of sex while travelling: all travellers (5%) and men travelling alone (20%).
<50% of sexual contacts during travels are protected
Substance abuse, unusual situation, removal of home restraints and close contact increased the rate of unprotected sex in travellers
USE CONDOMS - STRESS IMPORTANCE OF SAFE SEX
The only vaccine preventable STI’s are Hepatitis B + A and HPV
Illustrate the regions of travel requiring immunisation for Rabies
Illustrate the regions of travel that have high risk for schistosomaisis
