Chapter 21: Travelers

Question 1

Travel vaccinations should be listed on what for travelers?

Answer 1

International Certificate of Vaccination or Prophylaxis (ICVP) OR yellow card

Question 2

Travel health information, including travel health insurance recommendations, is available on the CDCs travel website where the ____ is located

Answer 2

Yellow Book

Question 3

Which drugs can be used for traveler’s diarrhea prevention

Answer 3

Bismuth subsalicylate

Antibiotics if indicated

Question 4

If there is bloody stool with traveler’s diarrhea it’s called

Answer 4

dysentery (SEVERE)

usualyl accompanied by systemic symptoms

Question 5

primary causative pathogen in traveler’s diarrhea

Answer 5

bacterial
E. coli

Question 6

prophylaxis for traveler’s diarrhea

Answer 6

Bismuth subsalicylate (BSS) in Pepto-Bismol

Question 7

Bismuth subsalicylate should be avoided in which patients

Answer 7

Aspirin allergy
Pregnancy
renal insufficiency 
gout
anyone taking anticoagulants

Question 8

If antibiotic ppx is indicated for TD, which antibiotic is preferred

Answer 8

Rifaximin

should not be used by most traveler’s though

Question 9

Traveler’s diarrhea treatment

Answer 9

oral rehydration
antimotility (loperamide)
Pepto-Bismol
antibiotics (azith, quinolones, rifaximin)

Question 10

Which drugs can be used for mild traveler’s diarrhea treatment

Answer 10

loperamide or BSS

Question 11

How does loperamide work for traveler’s diarrhea?

Answer 11

Decreases the frequency and urgency of bowel movements

Question 12

Loperamide dose for Rx and OTC

Answer 12

Rx: 4 mg after the first loose stool, then 2 mg after, up to a max dose of 16 mg/day
OTC: 8 mg/day

Question 13

Loperamide can be used as self-treatment for up to how many days

Answer 13

2 days

Question 14

Which drugs can be used for moderate Traveler’s Diarrhea treatment

Answer 14

Loperamide ± antibiotics (quinolones if low resistance, azithromycin or rifaximin)

Question 15

Which drugs can be used for severe Traveler’s Diarrhea treatment (including dysentery)

Answer 15

antibiotics (azithromycin preferred, quinolones or rifaximin as alternatives) ± loperamide

azithromycin is preferred for TD and dysentery

Question 16

What is the BSS dose for TD ppx

Answer 16

524-1050 mg PO QID (with meals and HS)

Question 17

Which bacterium causes Typhoid Fever

Answer 17

Salmonella typhi

Question 18

How is typhoid fever spread

Answer 18

food or water contaminated by the feces of someone with either an acute infection or from a chronic, asymptomatic carrier

Question 19

What are the names of the Typhoid vaccines and their route of administration

Answer 19

Vivotif (oral, live attenuated) - remember this by the word “vivo” which means to live
Typhim Vi (inactivated IM) - remember typhIM

Question 20

When should the oral typhoid vaccine be completed

Answer 20

≥ 1 week prior to travel

Question 21

When should the IM typhoid vaccine be completed

Answer 21

≥ 2 weeks before the expected exposure

Question 22

Which bacterium causes Cholera

Answer 22

Vibrio cholerae

Question 23

What is the most common symptom of cholera

Answer 23

watery diarrhea, which is referred to as “rice-water stools”

Question 24

What is the name for the cholera vaccine & route of administration

Answer 24

Vaxchora; oral solution

Live attenuated vaccine
vaxchORA(L)

Question 25

The CDC recommends ____ booster doses for poliovirus vaccine at least ____ prior to travel for adults who have previously completed a poliovirus vaccine series & who are traveling to regions where poliovirus is circulating

Answer 25

1 booster dose 4 weeks

Question 26

HepA high risk individuals

Answer 26

people from developed countries traveling to developing countries

Question 27

how is HepB transmitted?

Answer 27

through blood or bodily fluids

Question 28

HepB vaccination is most important for those doing high risk activites like ____

Answer 28

planning to receive medical care, provide medical work, unprotected sex, piercings and tattoos

Question 29

How long does the Hep B vaccine series take to complete

Answer 29

3-dose series takes 6 months to complete

Question 30

What should be done if a traveler is unable to complete the Hep B series before departure

Answer 30

Administer as many doses as possible before departure and complete the series upon return

Question 31

What are the symptoms of meningococcal meningitis

Answer 31

Fever, severe and unrelenting HA, nausea, stiff neck (nuchal rigidity), and mental status change - all require urgent treatment

Question 32

how is meningitis spread?

Answer 32

respiratory secretions

Question 33

Which meningococcal vaccines are quadrivalent

Answer 33

Menactra and Menveo | no recommendations for sero B vaccines for travelers

Question 34

Which diseases can mosquitos transmit to travelers

Answer 34

Japanese encephalitis, yellow fever, dengue, malaria and zika virus Those dengue Japanese mosquitos causing yellow male zebras

Question 35

To avoid mosquito bites, proper repellent should contain which active ingredient on exposed skin

Answer 35

DEET

Question 36

What should be used to treat clothing, gear and bed nets, but should NOT be applied directly to the skin

Answer 36

Permethrin

Question 37

Severe dengue can include

Answer 37

severe bleeding | no treatment, only supportive care

Question 38

What is the Japanese encephalitis vaccine called

Answer 38

Ixiaro

Question 39

malaria is transmitted via

Answer 39

the Anopheles mosquito

Question 40

Which malaria species is the most common

Answer 40

P. vivax

Question 41

Which malaria species is the most deadly

Answer 41

P. falciparum

Question 42

which mosquito-borne illnesses require prophylaxis?

Answer 42

Malaria, yellow fever

Question 43

What is a common side effect of malaria drugs

Answer 43

Nausea - taking with sufficient water, food or milk decreases nausea

Question 44

What are the quick start medications for malaria ppx & how long in advance should they be started before travel How many times a day are they taken

Answer 44

Atovaquone/Proguanil Doxycycline ** (know this one) Primaquine (avoid in G6PD Deficiency) 1-2 days Once daily | daily regimens, avoid in pregnancy, all cause nausea

Question 45

Quick start drugs for malaria ppx must be avoided in which population(s)

Answer 45

pregnancy

Question 46

What are the advance start medications for malaria ppx & how long in advance do they need to be started? How often are they taken

Answer 46

Chloroquine Mefloquine Tafenoquine (avoid in G6PD deficiency) 1-2 weeks prior to travel once weekly

Question 47

T/F: Advance start medications for malaria ppx are safe in children & pregnancy

Answer 47

True

Question 48

Mefloquine should not be used in

Answer 48

Underlying psych conditions Seizures Arrhythmias

Question 49

When should chloroquine therapy be stopped for malaria ppx

Answer 49

4 weeks after travel

Question 50

Side effects of chloroquine

Answer 50

Retinal toxicity, visual changes

Question 51

What symptomatic treatments cannot be used for Yellow Fever

Answer 51

ASA and other NSAIDs d/t increased risk of bleeding | no specific treatment for acute infectoins except symptomatic relief

Question 52

What is the vaccine for Yellow Fever called

Answer 52

YF-VAX

Question 53

When is the Yellow Card valid

Answer 53

10 days after vaccination

Question 54

Yellow Fever vaccine is contraindicated with

Answer 54

hypersensitivity to eggs (eggs are yellow)**

Question 55

transmission of Zika

Answer 55

mosquitos mostly some sexual or blood transfusion transmission risk

Question 56

What is the biggest concern with Zika virus

Answer 56

infants born with microcephaly

Question 57

What is the primary ppx medication for Acute Mountain Sickness (AMS) & what is the brand name When should it be used?

Answer 57

acetazolamide (Diamox) Start the day before the day of descent

Question 58

What is the most common SE of acetazolamide

Answer 58

polyuri, also photosensitivty risk

Question 59

Acetazolamide is CI with

Answer 59

sulfa allergy