Unit 3 - Travel Health

Question 1

What are the symptoms of malaria ?

Answer 1

Incubation period varies form 7-18 days to months or years dependant on the parasite, presence of partial immunity or suppression by antimalarials.
Malaria begins with non-specific symptoms;
Fever/sweats/chills/malaise
Myalgia
Headache
Diarrhoea
Cough
Major features of severe or complicated falciparum malaria;
Impaired consciousness
Renal impairment
Acidosis (pH <7.3)
Spontaneous bleeding
Shock
Haemaglobinuria

Question 2

where would you look to identify areas of malaria risk and the prophylactic therapeutic agent options available for those areas.

Answer 2

Travel Health Pro

Question 3

What are some factors that affect the risk of infectious bites?

Answer 3

Factors affecting risk of infectious bites;
Temperature
Altitude
Season
Type of accommodation
Length of stay

Question 4

Which repellents should be recommended to prevent bites?

Answer 4

DEET (diethyltoluamide)
ACMP advises use
Available from 20% concn.
The higher the concentration the longer the duration of protection. Up to 12hrs with 50% DEET.
Reduces protection form factor 15 sunscreen, therefore factor 30-50 used to compensate.
ACMP advises application of DEET after sunscreen.
Other options – lemon eucalyptus, Icaridin, 3-ethylaminopropionate. DEET most effective.
Use of oil of citronella NOT ADVISED.

Question 5

how should nets be used to prevent bites ?

Answer 5

If sleeping outside or in unscreened rooms insecticide treated nets advised.
Mosquito bed nets should be free of tears and tucked under mattress.
Most pyrethroid-impregnated nets now available are long lasting – 3 years.
Impregnated bed nets help improve protection because they help to prevent:
Biting through the net on parts of the body touching the net.
Mosquitos surviving long enough close enough to the net to find any tears.
Diversion of mosquitoes from someone under a net to someone without a net in the same room.

Question 6

How can clothing be used to prevent bites ?

Answer 6

Within limits of practicality, cover up with loose-fitting clothing with long sleeves, long trousers and socks if out of doors after sunset.
Clothing may be sprayed or impregnated with an insecticide e.g permethrin.
Cotton clothing can be sprayed with DEET. (DEET will damage any plastic based garments).

Question 7

Mr Mal Aria comes in to the pharmacy. He is travelling to India for a family wedding. He is asking about the need for Malaria prophylaxis. What information would you require to provide the necessary advice?

Answer 7

Throughout the majority of India, there is a low risk of malaria however in some parts it is high risk so it will depend which area he goes to.
To prevent being bitten in the first place he should take a DEET spray to reduce the likelihood of being bitten during the day. The higher the % the longer lasting the spray
He should also consider getting nets or seeing whether the place he is staying provides nets for at night time as these prevent the mosquitos from being able to bite the person whilst they are sleeping.
The antimalarials recommended for if he is visiting a high risk area are atovaquone proganuil, doxycycline or Mefloquine.