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PHARM 213 Infectious Diseases > 11. Travel Medicine > Flashcards

11. Travel Medicine Flashcards

1
Q

Travel assessment

A
  • 6-8 weeks prior to departure
  • Purpose of travel
  • Underlying health & vaccination status

Itinerary:

  • Destinations
  • Accommodation
  • Planned activities
  • Duration of travel
  • Prior travel experience

Medical recommendations:

  • Vaccines
  • Prophylaxis
  • Self-treatment
  • Follow up (if required)
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2
Q

Risk factors

A
  • Young
  • Elderly
  • Disabilities
  • Pregnancy
  • Immunocompromised
  • Long term medical conditions
  • High risk destinations
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3
Q

Managing medications

A
  • Medical certificate
  • Insurance
  • Storage
  • Managing time zones

High risk medications:

  • Insulin
  • Warfarin
  • Contraception
  • Controlled drugs
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4
Q

3 R’s

A
  • Routine
  • Required
  • Recommended
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5
Q

Vector borne diseases: Insect avoidance

A

Personal protection:

  • Wear light coloured clothing
  • Use clothing that covers most of the body – long sleeves & pants
  • Use insect repellent
  • Use insecticide vaporisers
  • Minimise use of perfumes, aftershave, soaps & body lotions
  • Avoid outdoor activity during peak biting times
  • Use bed net & clothing impregnated with insecticide
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6
Q

Vector borne diseases: Insect repellent

A 
- DEET:
\+ Most studied & long term use
\+ Minimal ADRs
\+ Concentration 20 – 50%
\+ Effective for 4 – 8 hours
- Picaridin
- Oil of lemon eucalyptus
Application:
- As per manufacturer instructions
- Reapplication may be required more when often
\+ Swimming
\+ Concurrent use of sunscreen
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7
Q

Malaria

A
  • Infection due to parasites
  • Incubation 7 – 30 days

Risk factors:

  • Children < 5 years old
  • Pregnant women
  • HIV/AIDS
  • Non-immune migrants
  • Travellers
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8
Q

Malaria transmission

A

Plasmodium parasite:

  • P. falciparum – common & can cause severe disease
  • P. vivax – common
  • P. ovale
  • P. malariae
  • P. knowlesi
  • Parasite lives in anopheles’ mosquito
  • Spread to humans by bite of infected mosquito
  • Bites at night from dusk to dawn
  • No human-to-human transmission UNLESS
    + Through mother to foetus during pregnancy
    + Transfusion of infected blood
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9
Q

Malaria clinical presentation

A

Early symptoms:

  • Head & body aches
  • Fatigue & malaise

Later symptoms:

  • Fever
  • Sweating
  • Rigors
  • Chills
  • Nausea
  • Vomiting
  • Diarrhoea
  • Jaundice

Severe symptoms:

  • Caused by P. falciparum
  • Anaemia
  • Seizures
  • Mental confusion
  • Renal failure
  • Coma & death
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10
Q

Malaria prevention

A
  • No vaccine available
  • Insect avoidance
Chemoprophylaxis:
- Not 100% effective
- Takes into account patient factors:
\+ Area being visited & duration of stay
\+ Risk of exposure to malaria
\+ Extent of drug resistance
\+ Efficacy of the recommended drugs
\+ Adverse effects
\+ Patient-specific considerations
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11
Q

Malaria chemoprophylaxis

A

Medications:

  • Malarone (atovaquone & proguanil) – 1 tab once daily & initiate 1-2 days prior to departure
  • Doxycycline – 100 mg once daily & initiate 1-2 days prior to departure
  • Mefloquine – 250 mg once weekly & initiate 2-3 weeks prior to departure

Duration:

  • Continue prophylaxis up to 4 weeks after leaving endemic area
  • EXCEPT Malarone – can be stopped 1 week after leaving
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12
Q

Malaria treatment

A
  • Assess severity
  • Identify source
  • Identify drug resistance
  • Allow for any patient related considerations

Treatment options:
+ Riamet (artemether & lumefantrine)
+ Malarone (atovaquone & proguanil)

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13
Q

Vector borne diseases: Dengue fever

A

Flavivirus:
- 4 serological types - DENV 1, 2, 3 & 4

Transmission - Aedes mosquito

  • 2 species - A aegypti & A albopictus
  • Bite during the day
  • Prefer human dwellings
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14
Q

Dengue presentation

A

Symptoms:

  • ~75% asymptomatic
  • Sudden onset
  • High fever
  • Severe headaches
  • Joint & muscle pain
  • Eye pain
  • Rash
  • Minor haemorrhagic manifestations
  • Serious complications uncommon

Duration:

  • Incubation 4 – 10 days
  • Illness typically occurs for 2 – 7 days
  • Complete recovery can take 2 – 4 weeks
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15
Q

Dengue hemorrhagic fever

A
  • Serious manifestation of dengue virus
  • Can be associated with circulatory failure & shock

Characterised by 4 cardinal features

  • Increased vascular permeability (plasma leakage syndrome)
  • Marked thrombocytopenia
  • Fever lasting 2 – 7 days
  • Haemorrhagic symptoms
  • Dengue shock syndrome (DSS) is cases where shock is also present
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16
Q

Dengue fever prevention

A
  • Insect avoidance
  • Vaccine not available to travellers at present

Dengvaxia:

  • Live attenuated viral vaccine
  • Schedule of 3 injections at 6 month intervals
  • Available to individuals 9-45 years old living in endemic areas
17
Q

Dengue fever management - treatment

A

Symptomatic:

  • Best rest
  • Fluids
  • Paracetamol

Bleeding complications:

  • Avoid aspirin & NSAIDs
  • Blood transfusions
18
Q

Vector borne diseases: Zika virus - flavivirus

A

Transmission:

  • Bite of an infected Andes mosquito (A. aegypti & A. albopictus)
  • Sexual contact – semen & vaginal fluids
  • Transplacental, perinatal, breastfeeding
  • Saliva
  • Blood transfusion
  • Haemodialysis
  • Organ transplantation
19
Q

Zika clinical presentation

A

Symptoms:

  • ~80% asymptomatic
  • Mild fever
  • Headache
  • Rash
  • Joint & muscle pain
  • Conjunctivitis
  • Severe cases are rare

Duration:

  • Incubation 2 – 14 days
  • Symptoms resolve within 2 – 7 days
  • Immunity develops after primary infection
20
Q

Zika virus management

A 
Prevention:
- Insect bite avoidance
- No vaccine or chemoprophylaxis currently available
- Avoid zika in Pregnancy
\+ Congenital Zika Syndrome
\+ Precautions for both women & men

Treatment:

  • Bed rest
  • Paracetamol
  • Fluids
21
Q

Vector borne diseases: Yellow fever

A
  • Viral haemorrhagic disease

Transmission:
- Bite of an infected mosquito – Aedes or Haemagogus spp.

3 transmission cycles:
- Jungle/Sylvatic – monkey-mosquito-monkey/human in the forest canopy
- Savannah/intermediate – monkey-mosquito-human or human-mosquito-human in jungle border areas
+ Most common type of outbreak in Africa

  • Urban – human-mosquito-human with A. aegypti mosquitoes
22
Q

Yellow fever presentation

A

Symptoms:
- Asymptomatic in many cases

Classical illness is classified by 3 stages:

  • Period of infection (1st phase)
  • Period of remission (2nd phase)
  • Period of intoxication (3rd phase)

Duration:

  • Incubation 3 – 6 days
  • Acute phase illness 3 – 4 days
  • Fatality rate of 50% within 7 – 10 days of toxic phase
23
Q

Yellow fever management

A 
Prevention:
- Insect bite avoidance 
- Immunoprophylaxis Vaccination:
\+ Live attenuated viral vaccine
\+ Stamaril IM/SC
\+ Single dose

Treatment:

  • Supportive
  • Bed rest
  • Analgesia & antipyretic
  • Fluids
  • Prevent further transmission – mosquito avoidance
24
Q

Food & water borne illnesses - Travellers diarrhoea

A
  • 80 -90% of cases caused by bacteria
  • Faecal – oral transmission

Prevention:

  • Food precautions
  • Water precautions
  • Hygiene

Treatment:

  • Oral rehydration
  • Loperamide
  • +/-Antibiotic
25
Q

Food & water borne illnesses: Hepatitis A

A

Viral liver disease:

  • Self limiting
  • Range from mild to severe illness

Transmission:

  • Contaminated food or water
  • Human to human
  • Faecal-oral route

Occurrence is in LIC (mostly)

26
Q

Hepatitis A presentation

A

Symptoms:

  • Fever
  • Malaise
  • Loss of appetite
  • Diarrhoea
  • Nausea
  • Abdominal pain
  • Dark coloured urine
  • Jaundice

Duration:

  • Incubation period 14 to 28 days
  • Infection confers lifelong immunity
  • Symptoms can last weeks to months
27
Q

Hepatits A management

A 
Prevention:
- Food and water precautions
- Hygiene
- Immunoprophylaxis: Vaccination
\+ Havrix
\+ Inactivated vaccine
\+ 2 doses, 6 – 12 months apart, IM

No treatment available

28
Q

Food & water borne illnesses: Typhoid fever

A
  • Notifiable disease NZ
  • cute life-threatening illness

Bacterial

  • Salmonella Typhi
  • Salmonella paratyphi A, B or C

Transmission:

  • Contaminated food or water
  • Human to human
  • Faecal-oral route
  • Rarely through sexual contact
29
Q

Typhoid presentation

A

Symptoms:

  • Persistent high fevers
  • Diarrhoea or constipation
  • Malaise
  • Abdominal pain
  • Headache
  • Loss of appetite
  • Transient rash

Severe complications:

  • Occur after 2 to 3 weeks
  • Life threatening
  • Intestinal haemorrhage
  • Intestinal perforation

Duration:

  • Incubation period 6 to 30 days
  • Symptoms can last for 1 month if left untreated
30
Q

Typhoid management

A 
Prevention
- Food & water precautions
- Hygiene
- Immunoprophylaxis: Vaccination
\+ Efficacy 50-80%
- Oral -> Vivotif 3 doses on alternate days
\+ Injection -> Typherix IM single dose
\+ Booster after 3 years if ongoing exposure
Treatment:
- Fluids
- Antibiotics
\+ Drug resistance
\+ Fluoroquinolones, azithromycin
31
Q

Activity & injury: Hepatitis B

A

Acute viral infection of the liver

Transmission:
- Blood 
- Bodily fluids
\+ Saliva, menstrual, vagina & semen
- Horizontal transmission
- Mother to child during birth

Duration:

  • Incubation period 30 – 180 days
  • Acute phase -> several weeks
  • Chronic infection -> complications
32
Q

Hepatitis B presentation

A

Symptoms - Acute phase:

  • Minimal symptoms
  • Jaundice
  • Dark urine
  • Fatigue
  • Abdominal pain
  • Nausea & vomiting
Prevention:
- Immunoprophylaxis: Vaccination
\+ Energix – B IM
\+ Usual schedule 0, 1, 6 months
\+ Rapid schedule 0, 7, 21 days & booster at 12 months
33
Q

Activity & injury: Rabies

A

Fatal viral disease

Transmission:

  • Saliva from the bite of a rabid animal
  • Aerosolised virus
  • Organ transplantation

Symptoms:

  • Fever
  • Tingling, prickling or burning sensation at wound site
  • Hydrophobia (fear of water)
  • Paralysis
  • Delirium
  • Convulsions
34
Q

Rabies management

A 
Prevention:
- Travellers should be aware of risks
- Avoid handling wild animals
- Immunoprophylaxis: Vaccination
\+ Merieux IM on day 0, 7, 28
Post exposure:
- Immediate wound cleansing
- No pre exposure vaccination
\+ Rabies immunoglobin (RIG)
\+ Merieux IM 4-5 doses on day 0, 3, 7, 14 +/- 28
- Had pre exposure vaccination
\+ Merieux IM 2 doses on day 0, 3
\+ Rabies immunoglobin not required
35
Q

COVID-19

A

Caused by SARS-CoV-2 virus – 1st identified in Wuhan, China 2019

Transmission:
- Human – human direct/indirect contact
+ Direct: Saliva/secretion through mouth/nose/eyes
+ Indirect: Contaminated objects or surfaces (fomites)
- Other potential routes: fomite, faecal-oral, bloodborne, mother-to-child, & animal-to-human transmission

Incubation period:

  • 5-6 days but can be up to 14 days
  • Asymptomatic transmission

Symptoms:

  • Fever, cough, fatigue, loss of smell, SOB
  • Complication: Pneumonia, acute respiratory distress syndrome, cytokine storm

Prevention:

  • Identify, test, isolate
  • Face covering – fabric mask/surgical mask
  • Contact/droplet precaution – PPE
  • Hand hygiene / social distancing
36
Q

COVID-19 impact

A

Global pandemic:

  • Spanish flu
  • Global recession
  • Travel restrictions

Where can a pharmacist?

  • Essential worker
  • Bridge the gaps where GPs cannot
  • Ensure continuity of care to patients

PHARM 213 Infectious Diseases (13 decks)

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