Travelers

Travel vaccinations should be documented on the ____ Sometimes called the "___"

ICVP: International Certificate of Vaccination Prophylaxis

"Yellow Card"

Medications should be packed in:

carry-on luggage

(in original containers)

Consider diseases that can be spready through

-food and water

-blood/bodily fluids

-insects

The CDC's health information for interanational travel is also called that

yellow book

Traveler's diarrhea is common, but if blood is mixed in, it is called:

dysentery

Dysentery is often accompanied by

more severe systemic symptoms

T/F: Dysentery is classified as severe

true

T/F: Most cases of traveler's diarrhea are bacterial

true

Primary pathogen of Traveler's diarrhea (TD)

E. Coli

Advice to avoid food-water pathogens

boil/cook it, use bottled water, avoid ice, boil water for one minute before using it

Prophylaxis with____ reduces incidence of TD by half

bismuth subsalicylate (BSS)

(active ingredient in pepto-bismol)

Do not use bismuth subsalicylate in those with

aspirin allergy, renal insufficiency, gout, those on anticoagulants

Bismuth subsalicylate can be taken ages:

12+ FDA approved

off-label 3+ - as long as no recent viral or current viral infections (risk of reye's)

T/F: Antibiotic prophylaxis should be recommended to all travelers

FALSE: It should not be used by most travelers

-only people at high risk of developing complications of TD (immunosupp, significant comorb.)

antibiotic prophylaxis preferred to use:

rifaximin

if not using rifaximin, alternatives for antibiotic prophylaxis include

azithromycin, rifamycin

TD treatment includes

hydration, fluid and salt

-oral rehydration preferred

-loperamide (Imodium A-D)

-Bismuth subsalicylate

-antibiotics (azithro, quinolones, rifaximin single dose)

Loperamide owrks by

decreasing frequency and urgency of bowel movements (antimotility drug)

Dose of loperamide

4mg after first loose stoole

2mg after each subsequent loose stool,

up to max dose of 16 mg/day by Rx

or 8mg/day OTC

Max doses of loperamide:

16mg/day Rx

8mg/day OTC

Bismuth subsalicylate side effect

black tongue/stools, risk of reye's syndrome in children, salicylate toxicity

T/F: loperamide shows greater reduction in diarrheal stools than BSS

true

Drugs used for prophylaxis of TD:

Bismuth subsalicylate, antibiotics (Rifaximin preferred only if high risk of complication)

Drugs used for treatment of TD:

mild TD: loperamide or bismuth subsalicylate

mod TD: loperamide +/- Abx

-azithro or quinolone (if low R)

-Rifaximin is alt.

Severe TD (including dysentery): Abx +/- loperamide

-Azithro preferred

-quinolones or rifaximin as alt

T/F: Antibiotics shorten the duration of mod-severe TD

true

Antibiotics used in moderate-severe TD

azithrom quinolones, rifaximin

Preferred antibiotc in severe TD and dysentery

azithromycin

Antibioti that can be used if no dysentery is present in sever TD

quinolones, rifaximin, rifamycin

T/F: Rifaximin and rifamycin cannot be used to treat infections in which invasive pathogens are suspencted

true

Typhoid fever is caused by bacterium

salmonella typhi

Highest risk areas of contracting typhoic include

east and southeast asia, africa carribean, central and south america

______ are the only source for salmonella typhi

humans

Typhoid is spread through

food or water contaminated by the feces of someone with an acute infection or from a chronic asymptomatic carrier

T/F: While typhoid vaccines are recommended ,they are not 100% effective and even vaccinated travelers must follow food and water precautions and wash their hands frequently

true

Vivotif is a thyphoid vaccine taken _____, that is _____

taken orally

is a live-attenuated vaccine

Thyphim Vi is taken ______, it is a _____ typhoid vaccine

Typhim Vi is taken via intramuscular injection

it is an inactivated typhoid vaccine

Vivotif is a _____ vaccine and therefore must be completed ______ prior to travel

oral vaccine

complete 1 week+ prior to travel

Typhim VI is a ______ vaccine, and must be completed ____ prior to travel/expected exposure

intramuscular injection

2 weeks+ prior to exposure

Cholera is a bacterial infection caused by

vibrio cholerae

Cholera still occurs in

africa, southeast asia, haiti

Hallmark symptom of cholera:

"rice water stools"

-watery diarrhea, dehydration

Vaxchora is recommended to those traveling to a region where cholera is a risk, and is a _____

live-attentuated vaccine

Vaxchora is a live-attenuated _____ vaccine adminstered _____ prior to travel

oral liquid, administered 10 days+ prior to travel

For polio, the CDC recommends:______________ for adults who have previously completed the serious if traveling to a region where the virus is circulating

administered at least 4 weeks prior to exposure

a single lifetime booster of inactivated poliovirus vaccine

administered at least 4 weeks prior to exposure

Those most at risk for hepatitis A are those who

developed countries to developing countries

T/F: A traveler who does not participate in high-risk behaviors has a low chance of contracting Hep B

true

-it is transmitted by body fluid/blood

Activities/ways someone can contract Hep B

volunteering/receiving medical help, unprotected sexual encounters, piercings/tattoos

How long does the 3-dose Hep B series take to complete

6 months

Diagnosis of bacterial meningitis is diagnosed via

lumbar puncture

menigitis is spread via

respiratory secretions

symptoms of meningococcal meningitis

fever, severe headache, nausea, stiff neck (nuchal rigidity)

High risk regions of meningococcal meningitis

meningitis belf of africa (during dry season)

T/F: The Saudi arabia govenment requires the meningococcal vaccine for travel during the annual Hajj and Umrah pilgrimages

True

Current recommendations for meningococcal meningitis include only:

quadivalent:

menactra, menvel

(menquadfi) - all contain ACWY, no recommendations to use the serogroup B vaccines for travelers

T/F: There are currently no recommendations to use the serogroup B vaccines for travelers

true

Inactivated travel vaccines include

Hep A (havrix, VAQTA)

Hep B (engerix-B, Heplisav-B, REcombivax HB)

Hepatitis A/B (TwinRix)

Japanese encephalitis (ixiaro)

meningococcus (menveo, menactra)

Polio (IPOL)

Typhoid- IM (Typhim VI)

Live- Vaccines for travelers include

Cholera-PO (Vaxchora)

Typhoid-PO (Vivotif)

Yellow fever-SC (YF-VAX)

T/F: Live vaccines must be avoided in immunocompromised

true

vector definition

insects that transmit disease

reservoir definition

any place (animal, insect, soil, plant) in which diseases, live and can multiply

primary insects that transmit infections to travelers

mosquitoes

mosquitoes transmit which diseases

Japanese enchephalitis, yellow fever, dengue, malaria, Zika virus

Recommendations to avoid mosquito bites and their disease

Repellants containing DEET on exposed skin

use permethrin to treat clothing/nets, DO NOT apply directly to skin, sleep in screened rooms and nets w/ mosquito repellent, cover up

T/F: Permethrin can be applied to the ankles and wrists to keep mosquitos away

false, do NOT apply permethrin directly to skin, use only on clothing/gear. use repellant containing DEET

Dengue is transmitted by

mosquitoes

Dengue severe symptoms include

shock and severe bleeding, organ failure

Dengvaxia is a live-attenuated vaccine recommended only to those who:

have had a past dengue infection

Prevention of dengue involves

protection from mosquito bites

Japanese encephalitis is transmitted by

mosquitoes

Best way to avoid japanese encephalitis

reduce exposure to mosquitoes

Japanese enceph. vaccine ____ is sometimes recommended to those traveling to asia

Ixiaro

Malaria is transmitted via

mosquitoes (anopheles)

human host

Malaria destroys _____ in the human host

red blood cells

Most deadly species of malaria

P. Falciparum

Malaria species responsible for 50% of cases in India and becoming resistant to drug treatment

P. vivax

For malaria, ____ is recommended

prophylaxis

Side effects of malaria drugs

nausea, can take with water, food and milk to decrease nausea

Daily regimen malaria Phx.

doxycycline (doryx, vibramycin)

atovaquone/proguanil

primaquine

AVOID IN PREGNANCY

malaria prophylaxis in pregnancy

chloroquine

mefloquine

tafenoquine

Malaria medication not used in G6PD deficiency

Primaquine

Doryx generic

Doxycycline

Chloroquine side effects

retinal toxicity/visual changes

Mefloquine should be started

2 weeks prior to travel

Mefloquine should be avoided in underlying psych conditions, seizures, arrx

mefloquine is taken weekly

T/F: Mefloquine is safe in children and pregnancy

true

Mefloquine is started 2 weeks before travel and stopped _____

4 weeks after travel

Chloroquine is taken ____ and stopped _____

taken weekly

stopped 4 weeks after travel

Chloroquine and mefloquin are stopped _____ weeks after travel

4 weeks

Tafenoquine, mefloquine, and chloroquine are all meds that are taken _____ and safe in ____________

taken weekly

safe in pregnancy and children

Tafenoquine should not be used in _____

G6PD deficiency

Malaria drugs to avoid in G6PD deficiency

Tafenoquine and primaquine

Avoid vibramycin in:

pregnancy and children <8 (tooth development/discoloration

Doxycycline, atovaquone/proguanil, and primaquine must all be initiated _____ prior to travel

1-2 days prior to travel (makes them ideal for little notice

Stop primaquine ______

1 week after travel

A patient has a G6PD deficiency but must travel to an area at risk for malaria in the next 2 days. What medication can they start?

Doxycycline, atovaquone/proguanil

Malaria drug that causes photosensitivity

doxycycline

Yellow fever is transmitted by

mosquitoes

_____ should NOT be used in yellow fever due to increased risk of bleeding

NSAIDS and aspirin

T/F: Aspirin can be used to reduce fever in yellow fever

FALSE: this only increases bleeding risk, same with NSAIDS

Yellow fever treatment for acute infection:

no specific treatment: only symptomatic relief: fluids, analgesics, antipyretics