Travel Vaccines

🧠 BIG PICTURE (HOW TO APPROACH EVERY CASE)

From the slides + answer key, your brain should ALWAYS go:

🔑 7-step framework (THIS IS YOUR GOLD SCRIPT)

  1. Where are they going? 🌍

  2. Check guidelines (CDC/BCCDC)

  3. Mode of travel (plane, hiking, cruise)

  4. Patient risk factors (pregnancy, DM, psych, etc.)

  5. Environmental risks (malaria, altitude, bugs)

  6. Are meds appropriate? (safety + adherence)

  7. Non-pharm advice

👉 If you say this out loud = PROF HAPPY

🏔 ALTITUDE SICKNESS (SUPER HIGH YIELD)

Types:

  • AMS (mild)

  • HAPE (lungs, can be fatal)

  • HACE (brain, LIFE THREATENING)

💊 Prevention:

  • Acetazolamide 125 mg BID

    • Start day before ascent

    • Continue during climb

👉 MOA: causes metabolic acidosis → ↑ breathing → ↑ oxygenation

🚨 MOST IMPORTANT:

👉 DESCENT = BEST TREATMENT

🤢 MOTION SICKNESS

  • Dimenhydrinate 50–100 mg q4–6h PRN

  • Ginger option 🌿

💩 TRAVELER’S DIARRHEA

Prevention:

  • Food/water hygiene

  • NOT always vaccines

Treatment:

  • Loperamide

  • Oral rehydration

  • Antibiotics (azithromycin preferred in Asia)

❗ DUKORAL:

  • Cholera vaccine

  • RARELY needed

  • Mostly overused

🦟 MALARIA PROPHYLAXIS (HIGH YIELD TABLE IN YOUR HEAD)

💊 First-line options:

Drug

Start

Stop

Avoid

Atovaquone/proguanil

1–2 days before

7 days after

renal, pregnancy

Doxycycline

1–2 days before

4 weeks after

pregnancy, kids

Mefloquine

1–2 weeks before

4 weeks after

psych hx ❗

Chloroquine

1–2 weeks before

4 weeks after

resistance, psoriasis ❗

🔥 KEY EXAM PEARLS:

  • Tanzania → chloroquine resistance ❌

  • Mefloquine → BAD for anxiety/depression ❌

  • Doxy → yeast infections, GERD ❌

💉 VACCINES (THE USUAL SUSPECTS)

Always think:

  • Hep A

  • Hep B

  • Typhoid

  • Rabies (rural)

  • Japanese encephalitis (rural/long stay)

🫀 VTE (FLIGHTS >4 HOURS)

Risk factors:

  • Previous DVT ❗

  • Cancer

  • Surgery

  • Pregnancy

  • Obesity

Prevention:

  • Walk q1–2h

  • Hydrate

  • Compression stockings

  • ± LMWH if HIGH RISK

🧠 CASE PATTERNS (THIS IS THE REAL TEST)

🧗 Case 1 (Kilimanjaro)

👉 Problems:

  • Chloroquine = WRONG (resistance + psoriasis) ❌

  • Mrs dose = TOO LOW ❌

👉 Fix:

  • Both → Atovaquone/proguanil

🔥 EXTRA POINTS:

  • DVT prophylaxis (history of DVT!!)

  • Typhoid + rabies vaccine

  • Acetazolamide for altitude

Dukoral?

👉 Not needed but optional

🎒 Case 2 (SE Asia backpacking)

👉 Key ideas:

  • Cities (Bangkok/Chiang Mai) = LOW malaria risk

  • BUT rural = risk changes

💉 Vaccines:

  • Hep A/B

  • Typhoid

  • Rabies

  • Japanese encephalitis (if rural)

💊 Meds:

  • Azithromycin for diarrhea

  • Loperamide

  • ORS

❗ Dukoral:

👉 NOT recommended

👨‍👩‍👦 Case 3 (Japan + cruise)

👉 LOW risk trip → minimal interventions

💉 Vaccines:

  • Routine + Hep A/B

👉 Japanese encephalitis?

  • ❌ NOT needed (short urban trip)

💊 Meds:

  • Motion sickness (pregnant → dimenhydrinate OK)

❗ Dukoral:

👉 NOT needed

🧠 ULTRA FINAL TLDR (READ BEFORE EXAM)

  • Always start with destination + risks

  • Malaria → check resistance + patient factors

  • Dukoral = usually unnecessary

  • Altitude → acetazolamide + DESCENT

  • VTE → flights + history = important

  • Vaccines = Hep A/B + travel-specific

  • Think:

    • pregnancy

    • psych hx

    • GI issues

    • rural vs urban