Infection in travellers

Question 1

What is considered as travelling?

Answer 1

International flights, domestic flights, camping trips, trips within Australia to the tropics. Anything that involves people moving from one area to another

Question 2

What are some common infections in specific countries?

Answer 2

Ebola - PNG
Polio - Somalia, Kenya and Ethopia
Rubella - Poland and Japan
Cholera - Haiti, cuba 
MERS-CoV - Arabia
Malaria - Egypt

Question 3

What else do we need to be aware of in terms of travelling and infection?

Answer 3

Not only what infections are prevalent in countries but also that humans can become vehicles of travel (e.g. SARS)

Question 4

What are some barriers to delivering vaccines?

Answer 4

Politics. E.g. Nigeria Kano state governor objected to polio vaccines because of a belief that that it was an attempt to exploit developing countries

Question 5

what is the problem with live polio vaccine?

Answer 5

IT can revert back to virulent type and cause disease

Question 6

What is the commonest cause of fatal community acquired pneumonia in NT?

Answer 6

Meliooidosis

Note; Pneumococcus is commonest in victoria

Question 7

What additional immunisations for medical student elective in remote indigenous communities in north/central Australia?

Answer 7

Hep A and Hep B (should already have)

Question 8

What is the most common infection in travellers?

Answer 8

Travellers’ diarrhoea

Question 9

Of the 25-30 million travellers from non-tropics to developing countries, how many develop health problems overseas?

Answer 9

50%

Question 10

How many cases of travel-associated malaria per year are there?

Answer 10

30,000

Question 11

List the common illnesses when travelling to a developing country

Answer 11

Travellers' diarrhoea: 20-60%
Acute respiratory infection: 5-20%
Malaria: 2%
Dengue fever: 0.1%
Hep A: 0.03-0.3%
Animal bites with rabies: 0.3%

Question 12

What sort of health advice will you give travellers?

Answer 12

Adopt safe behaviours. Safe sex, avoid tick bites, make sure eating and drinking from safe sources

Question 13

Of the respiratory infections in travellers, what is most common for young, adults and elderly?

Answer 13

Young (20-25): Acute OM, Streptococcus
Adult (25-40): Sinusitis, tonsilitis, URTI, influenza
Elderly (>60): Legionnaires disease

in general, younger people have more URTI and older people have more LRTI

Question 14

What is the most common vaccine-preventable disease of travel?

Answer 14

Influenza

Question 15

What countries have a lot of GIT infections (diarrhoea etc)?

Answer 15

India, SE Asia, Africa, S. America

Most are bacterial origin

Question 16

What sex does Malaria infect more?

Answer 16

Young boys

Question 17

Are there any sex difference in overseas acquired Dengue?

Answer 17

NO

Question 18

What treavellers are more likely to get Malaria if travel to malaria endemic area

Answer 18

VFR: Visiting friends and relatives because they are likely to have closer contact with locals and eat/drink their food.

Question 19

Which age group is most at risk of death due to Malaria infection?

Answer 19

> 65 years

Note; the familiarity of rare diseases - the less practitioners see Malaria the more chance of death. Low index of suspescion and lack of prompt diagnosis

Question 20

What is the mean time to death following Malaria infection?

Answer 20

3-7 days

Question 21

What is the current best drug for Malaria?

Answer 21

Artemisin. Now some strains are resistant

Question 22

Where is there a high incidence of P.vivax?

Answer 22

PNG and oceana

Question 23

What is the most common cause of mortality in travellers?

Answer 23

CVD: 49%
Inintentional injury: 22%
Medical: 13.7%
Cancer: 5.9%

Question 24

What percentage of travellers seek medical advice before they leave?

Answer 24

55% and most of these are females

35% ask GP
9.5% go to a travel clinic
6% pharmacist

Question 25

What are some principles of pre-travel health care?

Answer 25

Provide up-to-date info
Individualise advise (different travel plans and different risks/chronic diseases)
Start early: >6 weeks because for some injection may need boosters before leave
Identify high risk travellers: VFR, very young, elderly, pregnant women
Encourage safe behaviour
Recommend a medical kit
Give immunisations if needed

Question 26

What is involved in a pre-travel consultation?

Answer 26

Risk assessment: duration, place, MHx, allergy
Advice: avoid driving with caution, drugs, rabies, schistosomasis, security for aid workers, safe sex
Immunisation: STIs for HepA/B HPV
Chemoprophylaxis
Advice for self treatment: hydrolite, bandages, anti-diarrhoeals, paracetamol, sunscreen, alcohol wipes