Travel Medicine

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Travel Medicine
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The Pre-Travel Visit Questions to ask your
Patient

• What countries and areas are you visiting?
• How long will you stay?
• What types of activities do you plan?
• What vaccinations have you already had?
• What medical conditions do you have?
• Do you have any allergies?
• Could you be pregnant?

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Pre-Travel Visit

• Advice Food Water, Insects, other
• Medications Rx for diarrhea, malaria
• Vaccines Health Dept. or CDC have list of where
  to get uncommon vaccines.

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Vaccines

• Often recommended
• Sometimes required
• Proof of vaccination needed to enter destination
  country
• Yellow fever
• Travel to Saudi Arabia during pilgrimage seasons

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International Certificate of Vaccination

• If a vaccine is required, this is the best way to
  document it was given
• Purchase via U.S. Government Printing Office (GPO)

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wwwn.cdc.gov/travel/
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wwwn.cdc.gov/travel/
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The Basics Pearls

• CDC website is a great source of info.
• The Yellow Book is a good office reference
• Travelers often need advice, medications and
  vaccinations
• Some vaccines may be required.

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• Food Water Precautions
• Travelers Diarrhea
• Hepatitis A
• Typhoid
• Polio

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Food Water Precautions

• High risk foods are raw or undercooked
• Unsafe drinks include tap water ice
• Safer foods are those you can peel, thoroughly
  cook
• Safer drinks are boiled water, alcohol, reputably
  bottled water

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Travelers Diarrhea

• What is it?
• Loose stools lasting 1 to 4 days
• Usually caused by bacteria such as E.coli
• 40 must curtail scheduled activities
• Is my traveler at risk?
• Occurs in 40 to 60 of travelers to developing
  countries

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Travelers DiarrheaPrevention/Protection

• Avoid unsafe food and water
• Carry an antimotility agent such as loperamide
• Carry an antibiotic such as a quinolone to take
  IF diarrhea occurs. See CDC website for
  recommended antibiotics and doses
  (wwwn.cdc.gov/travel)

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Hepatitis A

• Food and water precautions
• Inactivated vaccine is highly effective and
  provides long-term immunity
• Vaccination recommended for developing areas
• Gamma globulin is used for temporary protection
  in special circumstances

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Hepatitis A risk is as high as 1 per month of
travel
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Typhoid

• Risk is about 3 per million
• Food and water precautions
• 2 choices for vaccination
• Live attenuated vaccine given orally
• Injectable polysaccharide vaccine
• Both provide 50-80 protection

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Polio

• CDC recommends a single booster shot (inactivated
  polio vaccine, IPV) in adulthood for travelers to
  developing areas
• Travelers to Saudi Arabia during the Hajj may be
  required to show proof of vaccination !

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Pearls

• Travelers Diarrhea
• Very common
• Carry imodium and antibiotic
• Hepatitis A
• Fairly common
• Vaccine highly effective
• Typhoid Fever
• Less common
• Vaccine oral or injectable
• Polio
• Single booster dose in adulthood

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Insect-Borne Diseases

• Insect Precautions
• Malaria
• Yellow Fever

Meningococcus
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Insect Precautions

• Insect repellants containing DEET
• Protective clothing
• Mosquito netting if available
• Clothing or bed nets treated with insecticides

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Malaria

• Febrile illness caused by Plasmodium, a protozoa
  which infects human red cells and liver
• Mosquito vector mostly bites from dusk to dawn
• Potentially fatal

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Malaria Prevention/Protection

• Insect precautions
• Prescribe the appropriate antimalarial drug along
  with instructions on how to take and side effects
• Travelers should start taking the medications
  before traveling to the area and continue after
  leaving the area. The exact schedule and dosage
  varies according to the medicine used.

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Medications to Prevent Malaria

• Chloroquine
• Atovaqone/proguanil (Malarone)
• Mefloquine

• Check the CDC web page or Yellow Book for up to
  date, country-specific info
• Even in countries with malaria, major cities and
  tourist areas may be spared, so check your
  patients itinerary carefully

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Malaria risk area in India Risk in all areas
throughout country except no risk in areas
above 2,000 m (gt6,561 ft) in Himachal Pradesh,
Jammu, Kashmir, and Sikkim. Risk also exists in
urban areas below 2000 m, including Delhi and
Mumbai (Bombay).
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Malarone

• Take one tablet daily starting 1-2 days before
  travel, while there, and for 7 days after
  returning
• Take with food
• Not for pregnant women, breast-feeding, small
  children, or CCllt30
• Side effects nausea

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Malaria Areas at Risk

• Check the CDC web page or Yellow Book for up to
  date, country-specific information
• Even in countries with malaria, major cities and
  tourist areas may be spared, so check your
  patients itinerary carefully

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Yellow Fever

• Virus spread by a mosquito, causes hepatitis
• Live, attenuated virus vaccine is highly
  effective and recommended.
• Vaccine only available in licensed centers (check
  CDC website for location near you)
• Vaccine is required for entry into some
  countries. Check the CDC website

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Meningococcal Meningitis

• Vaccine recommended for endemic areas
• Vaccine required for travel to Saudi Arabia
  during the Hajj

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Pearls

• Malaria
• Take medications before, during and after travel
• Yellow Fever
• Only in parts of Africa and South/Central America
• Very effective live virus vaccine
• May be required
• Meningococcal Meningitis
• Vaccinate if going to endemic area or if required

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Travel Medicine more information
atwwwn.cdc.gov/travel/