Travelers With Special Needs

Question 1

How many doses of meningitis C vaccine for HIV and asplenia?

Answer 1

2 doses more than 2 mos apart

Question 2

What should be done after HB vaccination for a immunocompromised?

Answer 2

Titres

Question 3

Name the conditions without immunologic compromise?

Answer 3

Corticosteroids Less than 20 mg of prednisone;
Long-term, alt day tx short-acting;
Maintenance physiologic doses;
Steroid inhalers;
Topical steroids;
Intraarticular injection;
More than 1 month since last high-dose steroids;
HIV >500/mm CD4;
Cancer patient, last chemo >3 mos & malignancy in remission
BMT: >2 yrs & not immunosupressive & without graft-versus-host;
Autoimmune disease- lupus, RA, inflammatory disease not tx immunosuppressive;
MS not on immunosuppressive or immunomodulatory agent & not experiencing exacerbation

Question 4

Which vaccines are safe for preople with MS? Live , inactivated

Answer 4

Inactivated safe. Don’t give during relapse

Safe for people tx interferon, glatiramer acetate, mitoxantrone, fingolimod, natalizumab

Live: mmr , v , zoster- maybe safe if MS stable and administered 1 mos before starting or after discontinuing immunosuppressive therapy

Don’ t give live vaccine during immunosuppressants

Question 5

When should live virus vaccine not be given to MS patient?

Answer 5

Receiving immunosuppressant: mitoxantrone, azathioprine, methotrexate, cyclophosphamide. Or
During chronic corticosteroid

Question 6

Which disease is the terminal complement deficient more susceptible?

Answer 6

Meningococcal disease

This group is susceptible to meningitis

Question 7

When should childhood vaccines be administered after BMT?

Answer 7

12 months

Question 8

When should MMR vaccine be administered after a transplant?

Answer 8

24 mos

Same rule for varicella need to make sure immunocompetent

Question 9

When should INF vaccine be administered in a transplant?

Answer 9

6 mos

Question 10

When should a solid-organ transplant travel to high risk distination?

Answer 10

1 year

Question 11

Which live virus vaccine can the household contact of severely immunocompromise receive?

Answer 11

MMR, YF, Var,

Not live influenza

Question 12

Which vaccine still used should immunicompromise still be aware of risk?

Answer 12

Risk of transmission Oral polio &

Small pox

Question 13

Can immnocompromise receive the varicella vaccine?

Answer 13

Yes. Should receive 2 doses spaced by 3 months

Question 14

Should Previously unimmunized asplenic, hiv, immunocompromised adult receive the PCV13 followed by PPSV23?

Answer 14

Should receive 1 dose of PCV13 and> 8 wks later PPSV23

Question 15

When can you give mmr vaccine to symptomatic HIV patient?

Answer 15

CD4 count greater than 200/mm without measles immunity

IG for short term protection for those facing high risk of measles and MMR vaccine is contraindicated

Question 16

Name chronic conditions associated with varying degree of immune deficit?

Answer 16

Asplenia, chronic renal disease, chronic liver disease, diabetes, complement deficiencies

Question 17

Which vaccines are recommended for asplenic patients regardless if they travel?

Answer 17

Men -c-quadrivalent
Hib conjugate vaccine
Pneumococcal

They are susceptible to overwhelming sepsis with encapsulated bacteria

Question 18

Name some special consideration for immunocompromised traveler?

Answer 18

• Discourage travel to dedtination that present true risk for YF
• if unavoidable and at risk. Teach ins. Prec. Provide medical waiver
• pt with precaution to administer YF may be offered vaccine but to monitor closely and offer serology 1 month after vaccination
• give waiver if not a true exposure and YF is a travel requirement ( waiver may be rejected)

Question 19

What are the antimalarial that would be considered reasonable for those on highly active antiretroviral therapy(HAaRT)?

Answer 19

1. Doxycycline: no effects on proteaseinhibitors & NNRTIs
2. Malarone: atovaqupne has no significant interaction with NRTIs no dta for proguanil

Question 20

What is the recommended tx for uncomplicated P. Falciparum for the immunocompromise?

Answer 20

Artemether-lumefantrine: 6 doses taken over 3 days

Question 21

Which medication is recommended to tx of sever malaria in immunocompromise?

Answer 21

IV artesunate

• quinidine should not be used if taking nelfinavir or ritonavir due to cardiotoxicity if no choice need close monitoring

Question 22

Asplenic people at high risk of complicated malaria should teach?

Answer 22

Adhere to malaria chemoprophylaxis

Question 23

What are the antimicrobial to be used for someone taking HAART?

Answer 23

Fluoroquinolones and rifaximin

Macrolide ( zithromax)may have significant interaction

• emerging therapy: probiotics

Question 24

How can you avoid cryptosporidiosis and giardiasis?

Answer 24

Avoid swallowing water during swimming & should not swim in water cantaminated with sewage animal waste)

Question 25

Best way to prevent gastoenteritis?

Answer 25

Handwashing