Travel Health 1 Flashcards
RISK ASSESSMENT IN TRAVEL
HEALTH
TRAVEL RISK FACTORS
- Assessing risk to patient
- Communicating risk to patient
- Managing risk with a mutually agreed
plan
Who, What, When, Where, Why, How
Personal Factors
Destination Factors
PERSONAL FACTORS
Medical Conditions, Medications, Allergies
Vaccination History
Travel Experience
Risk perception and tolerance
Financial
DESTINATION FACTORS
Where - not just the countries
but locations within the
country - urban or rural
When - date of departure
and duration
Why - business, holiday,
visiting family, volunteer,
medical tourism
How - transportation,
accommodation
What - types of activities
Pharmacists - the ideal travel health
professional?
Assessing patient health history and details of travel
Developing and carrying out a care plan - without
need for a diagnosis from a MD
Communicating and collaborating with patients to
carry out plan and follow up
Scope of practice includes prescribing medications
and vaccines and injection of those vaccines
Convenient/accessible health professional
PRE-TRAVEL CONSULTATION
Dedicated appointment to review factors
mentioned
Important to get a feel for traveller’s
experience, risk perceptions, and patient
goals
“Why did you book appointment?”
Health care provider needs to explain risks in
a manner where patient’s risk perceptions
may need to be adjusted
Mutual agreement on a plan - higher need
for patient “buy-in” than other therapeutic
areas
Travellers’ Diarrhea (TD)
Common health problem for
travellers
Primarily caused by bacteria, less
often virus or protozoa
TD is usually self limiting -
median duration 3-4 days but
can persist - 10% of cases last
longer than a week
Prevention - education/vaccines/meds
Self Diagnosis
Treatment - Rx/non-Rx
Travellers’ Diarrhea: Prevention
Education
Food and water precautions
“Cook it, boil it, peel it or forget it”
Relatively safe choices
fully cooked and steaming
boiling water involved in cooking
(noodles, rice)
peelable fruits and vegetables
(bananas)
bottled or canned drinks
coffee or tea
pasteurized products
Riskier choices
the opposite of previous slide
undercooked or raw foods
cooked foods that are no longer hot
unpeelable fruits or veggies - not the lettuce in the salad but the
water it has been washed in
drinking from the tap
ice
Market food vendors/street food
always taking a chance but informed risk
is it being prepared on site?
Travellers’ Diarrhea: Prevention
Vaccine: Dukoral™
originally a cholera vaccine
some data vs ETEC
Approach to Dukoral™
o Benefits of vaccine are limited
o Risks associated with vaccine are minimal
Factors to consider:
o Details of trip: location, duration, activities
o History of gastrointestinal problems
o Risk perception and tolerance of patient
o Willingness to pay
Primarily a patient driven product
Travellers’ Diarrhea: Prevention
Medications
Bismuth subsalicylate (BSS)
liquid form (60 mL qid) or as tablets (2 tablets qid)
use of BSS decreased the incidence of TD by about 50% to 60% in
several studies
some travellers may be alarmed by temporary black stools or a
black tongue
Should not use
children - risk of Reye Syndrome
pregnancy
aspirin allergy
anticoagulant usage
taking salicylates for other reasons
Probiotics - inconsistent data but low risk
Antibiotics - only for those at particularly
high risk of serious consequences or if
incredibly important to mitigate risk
(athletes, CEO’s, politicians, performers)
How to define or self-diagnose
travellers’ diarrhea
a sudden onset of diarrhea - but not thatsimple
practice guidelines have changed regarding the definition of TD
historically - counting number of episodes per day
now - is it tolerable and/or affecting planned activities?
Travellers’ Diarrhea Treatment - non-RX
rehydration
particularly important in children
loperamide tablets
bismuth subsalicylate
Travellers’ Diarrhea Treatment - Rx
\Antibiotics for self treatment
Azithromycin
First choice for adults and children
Adults - 500mg daily x 3 days
Children – 10mg/kg/day (max 500mg/day) x
3 days
Drug interaction risk - QT interval
prolongation
Ciprofloxacin
Option for adults when issues with
azithromycin
Dose - 500mg twice daily x 3 days
Usually not given to children
Resistance in SE Asia limits effectiveness
Risk of tendon injury
Antibiotics for self treatment
Rifaxamin
Third choice option for adults when issues
with azithromycin or ciprofloxacin
Dose - 200mg three times daily x 3 days
Not easily available in Canada as 200mg
tablet not produced
CASE #2
Our Mexico wedding group has questions about
taking antibiotics for travellers’ diarrhea. They are:
22 year old female: healthy, no medical
conditions
4 year old male: healthy, cannot swallow tablets
46 year old male, has allergy to erythromycin
How strongly would you recommend antibiotics to
each patient? What would you recommend?
22 year old female: healthy, no medical
conditions
Azithromycin 500mg daily for 3 days
4 year old male: healthy, cannot swallow tablets
Weigh patient —- 16 kg
Azithromycin 10mg/kg/day = 160mg
Provide parent with azithromycin as unreconstituted powder
because of stability/expiry date issues
Very specific counselling about how to reconstitute and
storage requirements
46 year old male, erythromycin allergy
Ciprofloxacin 500mg bid x 3 days
Hepatitis A
Viral infection
Fecal-oral transmission
Contaminated food and water
Endemic in many developing
countries
Vaccine available but not part of
routine immunization schedule in
Canada
Hepatitis B
Viral infection
Contaminated blood or body fluids
Can cause chronic infection
Vaccine available as part of routine
immunization schedule in Canada
Grade 5/6 in Alberta but as of 2019
part of the infant vaccine schedule
