Traveller Medicine Flashcards
Pre traveling evaluation
Health status
Medical needs
Travel itineratiy
Traveling food advice
Advise patients that fruits are safe only when
peeled and that vegetables need to be fully cooked to
prevent contamination from fecally passed organisms in
the soil. Unpasteurized dairy products and inadequately
cooked fish or meat should be avoided
Chlorination kills most organisms excepst
Giardia lamblia
Water advice for travellers
Avoid ice cubes
Water safe only when boiled
Iscet reppelent advice for exposed skin
20% DEET on clothing and exposed skin to
prevent mosquito-borne infections such as
malaria, yellow fever, and dengue fever.
Protection with DEET lasts for several hours but
is mitigated by swimming, washing, sweating,
wiping, and rain.
Treating clothes with inscet reppeling
permethrin, which can
effectively repel mosquitoes for more than a
week, even with washing
Avoiding outdoor exposure during mosquito
feeding time
Day time
Yellow
Zika
Chick
Dengue
Avoiding outdoor exposure during mosquito
feeding time between dask and dawn
Japanese encphalitis
West nile
Malaria
Travelers also should be cautioned about the
risks of walking barefoot or in loose-fitting
footwear on beaches, on soil, or in water that
may be contaminated with human or canine
feces. Such exposure may lead to contact with
hookworm or Strongyloides larvae.
Air travel — Prolonged immobilization during
flight may cause
venous thrombosis in individuals
with preexisting thrombotic or venous disease
Travelers with upper respiratory tract
infections, differential air pressures between
blocked eustachian tubes or sinuses and the cabin
may develop on ascent or descent and impair
hearing or cause pain in the ears or sinuses.
Symptoms can be relieved by
decongestants
Jet lag
as impaired
alertness during the desired wake
time and/or difficulty sleeping during the
allotted time for sleep at the destination.
Women with complicated pregnancies that
may be exacerbated by flight conditions or
require emergency care should ——- air travel.
Avoid
Most airlines allow women to fly up to ——
weeks of gestation, although individual
policies may vary. Commercial airline travel is
generally safe for women with uncomplicated
37
Supplemental oxygen should be administered to pregnant women whooooom>
eg, women with sickle cell disease, severe anemia [hemoglobin
<8 g/dL], or cyanotic heart disease
Incidence lf traveller diarrhea
40%–60% of travelers to
developing countries develop diarrhea.
• Of these cases, 85% are caused by bacterial
pathogens, the most common of which is
enterotoxigenic E coli (ETEC). Parasites
account for 10% and viruses for 5% of cases.
Counsel patients traveling to developing
countries on the following preventive
Describe prophylaxis for traveller diahreea
Side effects
Complication
Anti biotic
bismuth subsalicylate, the active
ingredient in Pepto-Bismol, which has been shown to ↓
the incidence of traveler’s diarrhea from 40% to
14%. Discuss side effects, which include blackening of
the tongue and stool, nausea, constipation, and, rarely,
tinnitus.
• Avoid use in children with viral infections because of
the risk of Reye syndrome.
• Do not routinely offer prophylactic antibiotics to
Advise patients to seek medical care in the
presence of
high fever, severe abdominal pain,
bloody diarrhea, or vomiting, and when
antibiotics have not been helpful.
bismuth subsalicylate,
Properties in treating diarrhea not prevention
antisecretory and antimicrobial properties,
to ↓ stool frequency and shorten the duration
of illness (15 mL or 2 tablets every 30 minutes
for up to 8 doses).
The 1° and most important treatment! In diarrhea
Replace fluids
Volume
Electrolytes
Describe anti otility use in diarrhea
Do not use antimotility agents for mild to moderate
cases; use only in severe cases in conjunction with
antibiotics. Discontinue if abdominal pain worsens or if
diarrhea persists after 2 days.
Describe antibiotics use in traveller diarhhea
Don’t use in prevention
Give antibiotics for those presenting with moderate to
severe diarrhea characterized by more than 4 unformed
stools daily; fever; or blood, pus, or mucus in the stool.
Use a fluoroquinolone such as ciprofloxacin or
azithromycin in areas of increasing resistance to
fluoroquinolones
Mention usual and unusual symptoms of diarrhea
Fahma abdominal cramps with sudden onset of watery diarrhea
Less colitis blood or pus in stool
Routine or standard immunization
childhood
immunization programs and age-appropriate updates,
regardless of travel
Required immunizations
Offer yellow fever vaccine for
travel to certain parts of sub-Saharan Africa and tropical
South America. Offer the meningococcal vaccine for travel
to Saudi Arabia during the Hajj (required by the Saudi
Arabian government)
Recommended immunizations:
HAV, HBV, typhoid
fever, meningococcal meningitis, Japanese encephalitis,
rabies, and tick-borne encephalitis
Yellow Fever Vaccine Side
Effects
Adverse Reactions (10-30%)
–Local soreness
–Mild fever
–Headache
–Myalgias
Yellow Fever Vaccine
Contraindications
•Age <9 months old*
Can consider at 6-9 months old during
outbreaks
•Pregnant women
*Yellow fever can cross placenta
•Severe egg allergies
•Severe immunocompromise
Yellow Fever Vaccine
Decription
Type
Dose
•Live-attenuated vaccine
•Single 0.5ml subcutaneously
•Revaccination at 10-year intervals required by
World Health Organization
–Protection from one vaccine, however, may last
30 or more years
Mention yellow fever stages
•Mosquito-borne hemorrhagic fever
3 stages
- Infection (3-4 days)
leukopenia
- Remission (48 hours)
• Abatement of symptoms
• 15% progress
- Intoxication
• Return of symptoms,
• Organ dysfunction, hemorrhage
Yellow fever prevention
DEET
Clothing
Mosquito nets
• Eliminate standing water
- Vaccination
Meningococcal Disease
Cause
•Neisseria Meningitidis –
Gram negative diplococci
Meningococcal Diseas
Site
Greatest risk
Meningitis Belt” –
Sub-Saharan Africa
•Greatest risk: dry season (Dec. -June)
annual
pilgrimage to Mecca
Vaccines required
If under age 15, polio vaccination
Menenigococcal
Available vaccines of meningococcal
MenACWY-CRM (Menveo®)
•11-55 years old
–MCV4 (Menactra™)
•2-55 years old
•Preferred in <11 year olds
–MPVS4 (Menomune®)
•2 years and older
•Use for >55 years old
Only meneingiococcal vaccine more than 55 y
Mpvs4
Preferd vaccine less than 11 years of meneingiocccoal
Mcv4
Sites for malria
Subsahars africa
Malaria vaccine
No vaccine
How to prevent malaria
•Prevention –
Clothing –Insect
repellant
–Mosquito netting
•Chemoprophylaxis –
Atovaquone/proguanil (Malarone®)
–Primaquine
–Chloroquine
–Mefloquine
–Doxycycline
Family Med
Who should get COVID vaccine?
The COVID-19 vaccines are safe for most people
18 years and older, including those with pre-existing
conditions of any kind, including auto-immune
disorders. These conditions include: hypertension,
diabetes, asthma, pulmonary, liver and kidney
disease, as well as chronic infections that are
stable and controlled.
Is it safe to take antibiotics before or after the
vaccine
There is no known influence or interaction
between antibiotics and COVID-19
vaccines. If you are prescribed antibiotics
by a health professional before or after
your vaccination, you should go ahead
and take the full course.
However, if you have a temperature over
38.5 ºC at the time of your vaccination
appointment, you should reschedule for
when you feel better.
People are considered fully vaccinated* covid
2 weeks after their second dose in a 2-dose
series, such as the Pfizer or Moderna
vaccines, or
• 2 weeks after a single-dose vaccine, such as
Johnson & Johnson’s Janssen vaccine
Recommendations for Fully Vaccinated People
Covid
During Travel: Wearing a mask over your
nose and mouth is required and social
distancing.
• After Travel: Self-monitor for COVID-19
symptoms; isolate and get tested if you
develop symptoms
Recommendations for People Who Are Not Fully
Vaccinated
Covid 19
Before you travel:
• Get tested with a viral test 1-3 days before your trip.
• While you are traveling:
• Wearing a mask over your nose and mouth is
required
• Avoid crowds and stay at least 6 feet/2 meters
• Wash your hands often or use hand sanitizer (with
at least 60% alcohol).
If you don’t get tested, stay home and self-
quarantine for 10 days after travel.
• Avoid being around people who are
at increased risk for severe illness for 14
days, whether you get tested or not.
After you travel:Get tested with a viral
test 3-5 days after travel AND stay home
and self-quarantine for a full 7 days after
travel.
• Even if you test negative, stay home and self-
quarantine for the full 7 days.
• If your test is positive, isolate yourself to
protect others from getting infected
Malraia symp
Intail flu like
Classical paroxysm
Sudden coldness shivering fever sweating
Malaria chemoprohylaxis for preg women
Chloroquine
Mefloquine
Describe chemoprophylaxis of malrai
Long trips
Last minute travellers
