WK 12- Travel Medicine Flashcards
What is involved in a risk assessment during a travel consult
- Ask; who, where, why, how and what
- ask about previous medical history/ medical conditions
- current medications
- vaccine history
Why is it important to know who is travelling
Need to identify high risk individuals:
- pregnancy, children (more likely to undertake risks), elderly (related to frailty, immune compromised)
- those with chronic medical conditions→ diabetes, asthma, heart disease, serious allergies, psychiatric conditions
- those with immune compromise→ HIV/AIDS, cancer, transplant patient
Why is it important to know where they are travelling
Need to know:
- exact destinations→ base, day trips, terrain- ie think of altitude sickness, think of what risks they will be exposed to (like food and mozzies)
- style of travel e.g. package tour or backpacking- more risks in budget travelling
- duration of stay→ how much prophylaxis medication are you able to give them
- season→ monsoon, snow (some illnesses are seasonal)
- modes of transport→ ie driving is dangerous
- accommodation → backpackers, luxury hotel, home stay→ important to know if in mosquito epidemic area
- individual risk tolerance
- country- different regions have different health warnings (ie. malaria endemic area, poor water sanitation in LIC)
Why is it important to know what a person is doing overseas
- Why is the patient travelling?–> leisure, business, volunteer work, study, medical tourism (ie. Will they get the correct post-op care)
- What activities will they be doing? →ie risk of rabies in caves in America, altitude sickness, contraindications of diving (like asthma)
- Taking risks we wouldn’t normally chance at home especially on the roads
- Drugs are cheap and everywhere
- Psychoactive substance possession or use is considered a serious crime in quite a few countries
- Adventure sports → high risk e.g. parasailing
- increased exposure→ aid or volunteer work, pilgrimage, veterinary/zoology
- VFR’s→ visiting friends and relatives→ pt become complacent = higher risk
How can risks be managed for overseas travel
-Ensure medical conditions are controlled
-Adequate supply of medications→ are certain ingredients restricted, does a travel letter need to be issued
-Mitigate medical risks with prevention or prophylaxis
→travel sickness (metoclopramide), thrombosis (stockings, aspirin), altitude sickness (acetazolamide→ ), travellers diarrhoea (ORS, antidiarrhoeals, antibiotics), vaccine preventable diseases, mosquito borne illness (chemoprophylaxis)
-Travel insurance→ Need appropriate travel insurance
-Discuss; document/money safety, STI’s, Transport safety(→ ie cars, scooters, jet skis), Theft, Crime, Accessibility to medical attention
-Discuss drinking clean water→ Water-borne infections (bottled water is best)
-Food safety-> only eat things that can be peeled, boiled or washed
-Handwashing→Reduce risk of transmission of any diseases
What advice can be given to avoid travellers diarrhoea
-encourage safe drinking water and handwashing
food handling a significant contributor–> only eat things that are boiled, bottled or in a peel, avoid cooked food that has been allowed to cool. beware of seafood and dairy products, avoid ice cubes and icecreams
-just because locals are eating it doesn’t mean you can→ they have an innate immune system
What are the general vaccinations that all travellers must have
- Childhood vaccines→ MMR, Polio, Varicella, Hep B, HiB
- Tetanus, whooping cough, diphtheria→
- Influenza
- Pneumonia
- Pneumoccocal
What are the other vaccinations available for travellers (mainly specific immunisations for certain at risk countries)
- Cholera
- Hep A
- Japanese encephalitis
- Meningococcal
- Rabies
- Typhoid fever
- Yellow fever
What is Hep A and what immunisations are available
Hep A:
- viral infection causing inflammation and dysfunction of liver
- faecal-oral transmission→ contaminated undercooked shellfish, or inadequately cooked of frozen fruits/veggies
- those most at risk= budget travellers, backpackers, treckers
- Single vax gives 3 years coverage→ booster for 6-12 months for life long immunity
- very high efficacy
- comes in combination with either Hep B or typhoid
What is Typhoid and what immunisations are available
- caused by salmonella typhi
- bacteria penetrates the M cells of the epithelium in the small intestine→ cause chemotaxis→ bacteria will enter the MO and travel around the body as a systemic disease
- food and drinks contaminated by faeces”
- 10% fatality in untreated countries
- 90%+ protection from vaccination
- Injectable, 1 dose
- Or oral 3-4 doses→ coverage up to 5 years→ oral not commonly given
- Booster every 3 years
- Moderate efficacy 60-80%
What is Meningococcus
- What serotypes are most common in certain areas
- What immunisations are available
- Potentially fatal bacterial infection due to Neisseria meningitis
- Occurs world wide→ highest incidence with
- C and W→ Sub-Saharan Africa (meningitis belt) and pilgrims to mecca
- B and C→ industrialised countries, schools, close quarters
- Serotype A commonest in Asia/Middle East vaccination for areas with current outbreaks/frequent epidemics
- Boost after 5 years
- Mening C= on immunisation schedule→ give above 6 weeks
- Mening B= give above 2 months
- Recommendation for travel→ quadirvalent vaccine (ACWY)→ now on immunisation schedule to get it up until 19
What is cholera
-how can it be prevented
Acute watery bacteria diarrhoea from V.cholerae
- Causes severe dehydration
- generlaised contaminated faecal-oral or poorly cooked shellfish/seafood
- ONLY give cholera vaccine if someone is going during monsoonal season (don’t routinely given it-only for people at increased risk)
- Oral, inactivated → 2 doses at least 1 week apart and gives around 2 years coverage
- Covers ETEC→ only lasts around 3-6 months
- If not going in monsoonal season, can still prevent cholera through encouraging hand washing and food and water safety
What is JEV
-what vaccinations are available
-flavivirus spread throughout asia via culex mosquito
-year round in SE asia and seasonal in china and japan
-can cause lifelong neurological sequale if pt survives
-2 types→
JEspect: inactivated one that requires 2 doses (0 and 28 days) and booster needed at 6 years
-Imojev: live attenuated, single injection, no booster→ cannot give to immunocompromised/ preg
-Depends on risk
->1/12 in high risk rural areas of Asia during wet season
What is rabies
- can it be vaccinated against
- what happens if someone is bitten by a rabid animal
- progressive CNS infection from lyssavirus
- 8x more likely to get it from lick than a bite
- no cure, only prevention
- pre-exposure for high risk
- highest risk in asia, south America, America, Africa
- IP 20-90 days
- post-exposure after potential exposure (usually dogs and monkeys)
- 3 doses→ days 0, 7, 28 → given IM or intradermal
- Booster at 3 years
What happens if someone is bitten by a rabid animal
- If you are bitten and have:
- Pre-prophylaxis= 2 post exposure vaccines at day 0 and 3
- No pre-exposure prophylaxis= +/- rabies immunoglobulin and vaccine on day 0, 3, 7, 14
