Traveller, Surgical prophylaxis (ic12) (no surgical yet) Flashcards
Factors affecting effectiveness of vaccines
Vaccine itself
Site vaccine is given
Patient age and immune status
Cold chain problems
Special populations that cannot use live attenuated vaccines
Immunocompromised
Hematologic or Solid organ cancers
Immunosuppressive meds, chemo
HIV patients with CD4 < 200
Transplant receivers
Avoid in pregnancy women
Avoid in infants less than 1yo
Mother’s antibodies still circulating in infant, may neutralise vaccine
how to administer 2 live vaccines?
Give both on same day or space both at least 28 days apart
What kind of procedures also require spacing out from live attenuated vaccine
take MABs or Antibody containing products eg. Blood transfusion
What vaccines cannot be administered simultaneously (3 points)
PCV (Pneumococcal conjugate vaccine)
Pneumococcal polysacc vaccine
Meningococcal conjugate vaccine
Which 2 vaccinations are recommended to be taken together?
yellow fever vaccine and measles containing vaccine
5 species of plasmodium
falciparum, malariae, ovale, vivax, knowlesi
Which species of plasmodium most prevalent
falciparum and vivax
symptoms of malaria
Fever, chills, sweats, headache, body ache and weakness, nausea, vomiting, cough, diarrhea, abdominal pain
how is malaria spread
Bites of infected female Anopheles mosquito
Contaminated blood products, organ transplantation, vertical transmission (mother to fetus)
transmission of malaria increases when
Between dusk to dawn (whole night)
At the end or after rainy season
transmission of malaria decreases when
During colder seasons
In deserts (except oasis)
Higher altitudes
3 cycles of Plasmodium cycle
Exo-erythrocytic cycle
Erythrocytic cycle (in RBC)
Sporogonic cycle (in mosquito)
Atovaquone + Proguanil (Malarone) dose, regimen, contraindications, pregnancy/children
Dose
1 tab daily with food or milky drinks
Regimen
Start 1-2 days prior to trip, during trip and continue for 7 days after return
Good for last min travellers
Contraindications
Hypersensitivity
Renal impairment (CrCl < 30ml/min)
Pediatric strength tablet and dose for children >5kg
Avoid in pregnancy, children <5kg
advantage of Malarone (3 points)
Good for last min travellers, start 1-2 days before
Some prefer daily medicine
Take medication 7 days after returning
Well tolerated, SE uncommon
Pediatric tablets available
Disadvantages of Malarone (3 points)
Not suitable for pregnancy, lactation <5kg
Severe renal impairment
Expensive
Chloroquine dose, regimen, precautions, pregnancy/children
Dose
300mg (2 tabs) weekly
Regimen
Start 1-2 weeks before departure, during trip, continue 4 weeks after return
Special population
Can be used by children, pregnant and breastfeeding
Advantages of Chloroquine (3 points)
Weekly medication, good for long trips
People taking hydroxychloroquine for rheumatologic conditions
Do not need to take additional medications
Can be used for pregnancy
Disadvantages of Chloroquine (3 points)
Resistance
Not suitable for short trips
Not suitable for last min travellers, need to start 1-2 weeks before
Doxycycline dose, regimen, contraindications, ADR
Dose
100mg daily
Swallow with full glass of water and maintain upright for 30 mins
Regimen
Start 1-2 days before trip, during trip, continue for 4 weeks after return
Contraindications
Pregnancy, breastfeeding
Children below 8yo
ADR
GI discomfort (oesophagitis, gastritis)
Photosensitivity
Nausea, vomiting
Vaginal candidiasis
Advantages of Doxycycline (3 points)
Good for last min travellers (1-2 days before travelling)
Least expensive antimalarial
Can prevent additional infections eg. Rickettsiae, Leptospirosis
Disadvantages of Doxycycline (5 points)
Contraindicated in pregnancy, children below 8
Daily medication
Take 4 weeks after returning
Women prone to vaginal yeast infection
Prone to phototoxicity
Mefloquine dose, regimen, contraindications, ADR, pregnancy/children
Dose
250mg (1 tab) weekly
Regimen
Start 2-3 weeks before departure, during trip and 4 weeks after return
Contraindications
Mefloquine resistance
History of psychiatric conditions (eg. depression, generalised anxiety disorders, psychosis, schizophrenia)
Convulsive disorders
Cardiac conduction abnormalities
ADR
GI discomfort
Insomnia
Vivid dreams
Neuropsychiatric disorder
Can be used by children >5kg, pregnant and breastfeeding
Advantages of Mefloquine (2 points)
Weekly drug
Can be used in pregnancy
