Traveller, Surgical prophylaxis (ic12) (no surgical yet)

Question 1

Factors affecting effectiveness of vaccines

Answer 1

Vaccine itself
Site vaccine is given
Patient age and immune status
Cold chain problems

Question 2

Special populations that cannot use live attenuated vaccines

Answer 2

Immunocompromised
Hematologic or Solid organ cancers
Immunosuppressive meds, chemo
HIV patients with CD4 < 200

Transplant receivers

Avoid in pregnancy women

Avoid in infants less than 1yo
Mother’s antibodies still circulating in infant, may neutralise vaccine

Question 3

how to administer 2 live vaccines?

Answer 3

Give both on same day or space both at least 28 days apart

Question 4

What kind of procedures also require spacing out from live attenuated vaccine

Answer 4

take MABs or Antibody containing products eg. Blood transfusion

Question 5

What vaccines cannot be administered simultaneously (3 points)

Answer 5

PCV (Pneumococcal conjugate vaccine)
Pneumococcal polysacc vaccine
Meningococcal conjugate vaccine

Question 6

Which 2 vaccinations are recommended to be taken together?

Answer 6

yellow fever vaccine and measles containing vaccine

Question 7

5 species of plasmodium

Answer 7

falciparum, malariae, ovale, vivax, knowlesi

Question 8

Which species of plasmodium most prevalent

Answer 8

falciparum and vivax

Question 9

symptoms of malaria

Answer 9

Fever, chills, sweats, headache, body ache and weakness, nausea, vomiting, cough, diarrhea, abdominal pain

Question 10

how is malaria spread

Answer 10

Bites of infected female Anopheles mosquito
Contaminated blood products, organ transplantation, vertical transmission (mother to fetus)

Question 11

transmission of malaria increases when

Answer 11

Between dusk to dawn (whole night)
At the end or after rainy season

Question 12

transmission of malaria decreases when

Answer 12

During colder seasons
In deserts (except oasis)
Higher altitudes

Question 13

3 cycles of Plasmodium cycle

Answer 13

Exo-erythrocytic cycle
Erythrocytic cycle (in RBC)
Sporogonic cycle (in mosquito)

Question 14

Atovaquone + Proguanil (Malarone) dose, regimen, contraindications, pregnancy/children

Answer 14

Dose
1 tab daily with food or milky drinks

Regimen
Start 1-2 days prior to trip, during trip and continue for 7 days after return
Good for last min travellers

Contraindications
Hypersensitivity
Renal impairment (CrCl < 30ml/min)

Pediatric strength tablet and dose for children >5kg
Avoid in pregnancy, children <5kg

Question 15

advantage of Malarone (3 points)

Answer 15

Good for last min travellers, start 1-2 days before

Some prefer daily medicine

Take medication 7 days after returning

Well tolerated, SE uncommon

Pediatric tablets available

Question 16

Disadvantages of Malarone (3 points)

Answer 16

Not suitable for pregnancy, lactation <5kg

Severe renal impairment

Expensive

Question 17

Chloroquine dose, regimen, precautions, pregnancy/children

Answer 17

Dose
300mg (2 tabs) weekly

Regimen
Start 1-2 weeks before departure, during trip, continue 4 weeks after return

Special population
Can be used by children, pregnant and breastfeeding

Question 18

Advantages of Chloroquine (3 points)

Answer 18

Weekly medication, good for long trips

People taking hydroxychloroquine for rheumatologic conditions
Do not need to take additional medications

Can be used for pregnancy

Question 19

Disadvantages of Chloroquine (3 points)

Answer 19

Resistance

Not suitable for short trips

Not suitable for last min travellers, need to start 1-2 weeks before

Question 20

Doxycycline dose, regimen, contraindications, ADR

Answer 20

Dose
100mg daily
Swallow with full glass of water and maintain upright for 30 mins

Regimen
Start 1-2 days before trip, during trip, continue for 4 weeks after return

Contraindications
Pregnancy, breastfeeding
Children below 8yo

ADR
GI discomfort (oesophagitis, gastritis)
Photosensitivity
Nausea, vomiting
Vaginal candidiasis

Question 21

Advantages of Doxycycline (3 points)

Answer 21

Good for last min travellers (1-2 days before travelling)

Least expensive antimalarial

Can prevent additional infections eg. Rickettsiae, Leptospirosis

Question 22

Disadvantages of Doxycycline (5 points)

Answer 22

Contraindicated in pregnancy, children below 8

Daily medication

Take 4 weeks after returning

Women prone to vaginal yeast infection

Prone to phototoxicity

Question 23

Mefloquine dose, regimen, contraindications, ADR, pregnancy/children

Answer 23

Dose
250mg (1 tab) weekly

Regimen
Start 2-3 weeks before departure, during trip and 4 weeks after return

Contraindications
Mefloquine resistance
History of psychiatric conditions (eg. depression, generalised anxiety disorders, psychosis, schizophrenia)
Convulsive disorders
Cardiac conduction abnormalities

ADR
GI discomfort
Insomnia
Vivid dreams
Neuropsychiatric disorder

Can be used by children >5kg, pregnant and breastfeeding

Question 24

Advantages of Mefloquine (2 points)

Answer 24

Weekly drug
Can be used in pregnancy

Question 25

Disadvantages of Mefloquine (5 points)

Answer 25

Regions with mefloquine resistance

Certain psychiatric disorders, seizures

Cardiac abnormalities

Need to start 2 weeks before

Need to take 4 weeks after returning

Question 26

Which drugs can take for last min travellers

Answer 26

Malarone
Doxycycline

Question 27

Which drugs suitable for pregnancy

Answer 27

Chloroquine
Mefloquine

Question 28

Drug taken daily

Answer 28

Malarone
Doxycycline

Question 29

Drugs taken weekly

Answer 29

Chloroquine
Mefloquine

Question 30

Drugs taken 4 weeks after returning

Answer 30

Chloroquine
Mefloquine
Doxycycline

Question 31

How long to monitor symptoms after returning

Answer 31

up to 1 year, fever or flu-like

Question 32

What can you not do after returning

Answer 32

Donate blood for 4 months