PREPARING A PT FOR TRAVEL
1. Diseases spread through food and water |
2. Diseases spread through blood and bodily fluids |
3. Diseases transmitted by insects |
DISEASE TRANSMITTED THROUGH FOOD AND WATER
DISEASE |
NOTES |
PX/TX |
TRAVELER'S DIARRHEA
E. coli (80-90%)
Campylobacter jujuni
Shigella
Salmonella |
- Dysentry - if blood is in the stool (classified as severe).
- Mild: tolerable, doesn't interfere with activities
- Mod: distressing, interferes with planned activities
- Severe: incapacitating, completely prevents activities
- Onset of sx: 6-72 hrs
- Untreated TD:3-7 days
- Persistent TD = >14 days
- TD can result in IBS |
RULE:" cook it, peel it, or forget it"
PX:
- Bismuth subsalicylate (BBS), Pepto-Bismol
- Abx is not usually rec., give to high risk pts
- Recommended Abx: Rifaximin
TX: Hydration (↑ fluid and salt)
Mild: Loperamide
Mod: *Loperamide +/- antibiotics
Severe: Azithromycin 1g x 1 +/- Loperamide
Note: Loperamide = 'IMODIUM A-D' |
TYPHOID FEVER
Salmonella typhi |
- Can be severe and life-threatening
- Vaccines are 50-80% effective
- Wash hands and take food/water precautions even if vaccinated |
Vaccines:
Vivotif
- Oral, live, attenuated
- Dont use if on Abx or stomach's sensitive
- Q5yrs
- 1 week before traveling
- Don't use <6yo
Typhim Vi (inactivated, IM)
- Q2yrs
- ≥ 2 weeks before
- Don't use <2yo |
CHOLERA
Vibrio cholerae |
- "Rice water stools" |
Vaccines:
Vaxchora
- Live-attenuated
- Single, oral
- Min: 10 days before
- Age: 18-64 |
POLIO |
- Vaccine given in childhood
- Single lifetime booster dose min 4 wks prior to travel is recommended for adults who are traveling to regions with it
- May have to show proof of vaccination
- Documented on Certificate of Vaccination or Prophylaxis (ICVP) |
HEPATITIS A |
- At highest risk: person traveling from developed country to developing countries
- Can be asymptomatic
- Symptoms: fever, malaise, jaundice, nausea, abdominal discomfort |
DISEASES TRANSMITTED THROUGH BLOOD & BODILY FLUIDS
HEPATITIS B |
- Cause: blood and bodily fluids
- Incubation of 90 days
- Sx: malaise, jaundice, nausea, GI discomfort
- Chronic infection can result in chronic liver disease or liver cancer
- Vaccine is really important if travelers plan on:
- Receive medical care
- Provide medical work
- Have sex w/ new partners
- Avoid piercings/tattoos |
- 3-dose vaccine series
- 6 mo to complete
- Receive as many doses as possible before traveling
- Can complete upon return
- High risk: May admin accelerated series
- Requires booster dose at 1 yr for long-term immunity |
MENINGOCOCCAL MENINGITIS
N. menigitidis
- Belt of Africa
(Dec-Jun) |
- Cause: respiratory secretions
- High mortality rate
- Medical emergency
- Sx: fever, HA, nausea, stiff neck, mental changes
- Requires urgent tx |
- Quadrivalent vacine containing 4 bacterial types: ACWY
- Required by Saudia Arabia govt. during annual Hajj and Umrah pilgrimages |
DISEASES TRANSMITTED BY INSECT BITES
THESE ARE ALL TRANSMITTED BY MOSQUITOES |
DENGUE
Aedes aegypti
Aedes albopictus |
- Asymptomatic
- Can develop life-threatening disease
- Sx: shock, severe bleeding, organ failure |
- No vaccine
-Tx: Supportive care |
MALARIA
Anopheles mosquito |
- Multiplies in the liver and then moves into RBCs - Sx: shaking chills, high fever, flu-like illness Types: - Plasmodium vivax (most common)
- P. falciparum (most deadly)
- P. malariae - P. ovale |
Quick start PX: - Atovaquone/Proguanil (Malarone)
- Doxycycline (Doryx, Vibramycin)
- Primaquine (most effective against P. vivax) Advance start PX: - Chloroquine - Mefloquine (Lariam)
|
JAPANESES ENCEPHALITIS |
- Sx: asymptomatic or
Sx: encephalitis w/ rigors & seizure risks, coma, and death
- Mostlikley infected in rural agricultural areas |
PX: reduce exposure to mosquitoes
Vaccine: IIxiaro
- Age > 2 mo
- who's spending time outdoors or
- who's staying min 1 mo in endemic areas |
YELLOW FEVER |
- Sx: most are asymptomatic, influenza-like sx, risk of shock and organic failure |
Vaccine:
YF-VAX
- Live-attenuated
- Contra: hypersensitivity to eggs
- ICVP ("yellow card") provided after
- Card is only valid if completed 10 days before
TX: symptomatic relief with fluids, analgesics, and antipyretics
- Aspirin and other NSAIDs cannot be used (↑ risk of bleeding)
|
ZIKA VIRUS
Aedes |
- Sex or blood transfusion-associated transmission
- Sx: fever, maculopapular rash, arthralgia, conjunctivitis
- Caused babies to be born with microcephaly |
- No vaccine
- Use condom
- Avoid mosquitoes
- Do not travel to areas if pregnant |
- Insects that transmit disease are vectors
- Stay and sleep in screened or rooms w/ AC
- Use bed net (can be pre-treated w/ repellant)
- Cover exposed skin
- DEET: mosquito repellant
- Picaridin, oil of lemon, eucalyptus, or IR3535: mosquito repellant (not ticks)
- Permethrin to treat clothing, gear, bed nets
- Do not apply directly to skin
ADDITIONAL CONCERNS FOR TRAVELING INDIVIDUALS
VENOUS THRMBOEMBOLISM PX |
PX:
- Compression stockings
- Walk
- Lower leg exercises |
ALTITUDE SICKNESS AND MOTION SICKNESS |
- Acute mountain sickness (AMS) - Occurs when you climb rapidly to a high altitude PX:- Acetazolamide (Diamox)
125 mg BID day before (preferred) or day of - Contra: sulfa allergy - AE: rash, taste alteration, dehydration, photosensitivity, urticaria |
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