Travel Medicine Precautions
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Questions and Answers

Who are considered high-risk travelers for travel-associated illness?

Persons traveling to lower-income regions of the world, foreign-born persons, and family members returning home to visit friends and relatives

What specific measures should be taken by persons traveling by air?

Persons whose resting PaO2 is 60 –70 mm Hg may require supplemental oxygen in flight, which needs to be arranged with the airline in advance.

What general measures are appropriate to recommend for all travelers?

Travelers should receive education on strategies for risk reduction specific to accidents, water-borne illnesses, insect exposure, and food-borne illnesses. They should also maintain in-flight mobility, hydration, and use compression stockings to decrease the risk of venous thromboembolism.

What precautions should be taken regarding insect avoidance?

<p>Precautions such as using insect repellent, wearing long sleeves and pants, staying in accommodations with air conditioning, and using bed nets can help prevent insect bites.</p> Signup and view all the answers

What precautions should travelers take regarding sexually transmitted diseases?

<p>Practice safe sex with each encounter and get screened for sexually transmitted diseases after encounters.</p> Signup and view all the answers

What should travelers do to prevent environmental illness such as altitude sickness or diving-related barotrauma?

<p>Travel gradually to higher altitudes, try to sleep at lower altitudes, minimize alcohol consumption, consider prophylactic pharmacologic therapy, and practice safe diving practices.</p> Signup and view all the answers

What actions, if any, need to be taken for travel within the United States?

<p>Travelers should be cautious of certain risk areas within the United States and should consider their underlying medical conditions and planned activities for adequate precautions.</p> Signup and view all the answers

What specific measures should be taken by persons planning travel to areas endemic for malaria or arthropod-borne viruses?

<p>Use insect repellents, wear long sleeves and pants, sleep in rooms with screens or bed netting</p> Signup and view all the answers

What type of water should travelers to resource-limited areas drink?

<p>All of the above</p> Signup and view all the answers

To limit tick-borne illnesses, travelers should be instructed to avoid walking in _____ or tall grass.

<p>scrub</p> Signup and view all the answers

Travelers should avoid contact with stray dogs, feral animals, monkeys, and bats to limit the risk for rabies.

<p>True</p> Signup and view all the answers

What precautions should be taken to prevent road accidents and assault?

<p>Be aware of surroundings, follow traffic rules, avoid distracted driving, be cautious of surroundings</p> Signup and view all the answers

What is the purpose of Acetazolamide for prevention of acute mountain sickness?

<p>Prevention of acute mountain sickness</p> Signup and view all the answers

What are the 3 main categories into which vaccines for travelers can be divided?

<p>Routine</p> Signup and view all the answers

Yellow fever is endemic in Asia.

<p>False</p> Signup and view all the answers

Hepatitis A virus (HAV) infection is common throughout the developing world and is one of the most frequently acquired ______-preventable diseases.

<p>vaccine</p> Signup and view all the answers

Match the following countries with their identified risk factor for HAV infection:

<p>Mexico and Central America = Increased risk for ESBL-producing bacteria South America = Commonly identified risk factor for HAV infection in the United States</p> Signup and view all the answers

What medication is recommended by the CDC as an option for pregnant women traveling to areas endemic for chloroquine-resistant malaria?

<p>Mefloquine</p> Signup and view all the answers

What should travelers to areas endemic for malaria be instructed to do if fever develops after travel?

<p>Seek medical care urgently</p> Signup and view all the answers

What is the recommended chemoprophylactic option for most patients to prevent common travel-related disorder?

<p>Bismuth subsalicylate</p> Signup and view all the answers

Prophylactic use of antibiotics is effective in preventing travelers' diarrhea.

<p>False</p> Signup and view all the answers

What should international travelers be advised to carry for complications during travel?

<p>A simple medical kit</p> Signup and view all the answers

Which vaccine is usually administered as a 3-dose series over 6 months?

<p>Yellow fever vaccine</p> Signup and view all the answers

Typhoid fever is a water- and food-borne infection caused by Salmonella enterica serotype Typhi.

<p>True</p> Signup and view all the answers

Which vaccine is administered as 2 doses on days 0 and 28 for protection against Japanese encephalitis?

<p>Japanese encephalitis vaccine</p> Signup and view all the answers

How many hepatitis A vaccines are available in the United States?

<p>Two monovalent hepatitis A vaccines and 1 bivalent hepatitis A and B vaccine</p> Signup and view all the answers

How is cholera transmitted?

<p>Cholera is transmitted through fecal contamination of water or food.</p> Signup and view all the answers

Which vaccine is recommended for adults traveling to an area with active transmission of cholera?

<p>Cholera vaccine</p> Signup and view all the answers

True or False: The CDC recommends a 2-time booster vaccination for travelers at risk for poliomyelitis.

<p>True</p> Signup and view all the answers

Which vaccine is available in the United States to provide protection against tetanus, diphtheria, and pertussis? Only __________ vaccine is available.

<p>inactivated</p> Signup and view all the answers

Match the following prophylactic medications with their purposes:

<p>Atovaquone/proguanil or Doxycycline = Chemoprophylaxis for malaria Chloroquine = Preventive medication for malaria in chloroquine-sensitive areas Acetazolamide = Medication to prevent AMS (Acute Mountain Sickness)</p> Signup and view all the answers

What medical problem is most frequent among travelers?

<p>travelers' diarrhea</p> Signup and view all the answers

What is the recommended treatment for travelers with mild symptoms of travelers' diarrhea?

<p>Ingesting fluids ad libitum</p> Signup and view all the answers

Altitude illness should always be treated with medication.

<p>False</p> Signup and view all the answers

Travelers who have obtained travel health insurance often have access to a ______-hour hotline to help identify sources of health care while traveling.

<p>24</p> Signup and view all the answers

Study Notes

Travel Medicine

  • Primary care physicians are sources of health advice for international travelers.
  • Destination-specific disease risks, travel and routine vaccines, chemoprophylaxis regimens, and self-treatment regimens for infectious and noninfectious illnesses need to be familiar to physicians.

Pre-Travel Health Advice

  • Travelers need comprehensive medical advice and care before traveling, especially those traveling to lower-income regions.
  • Instructions on obtaining medical care should be provided, and all travelers should carry a list of medications with dosages.
  • Travelers with complex medical conditions or high-risk itineraries should consider supplemental medical insurance policies and medical evacuation insurance.

Air Travel Precautions

  • The cabin pressure during long flights approximates 1800-2400 meters of altitude, which may exacerbate certain medical conditions.
  • Prolonged immobility on long flights increases the risk of venous thromboembolism, especially in persons with predisposing conditions.
  • Maintaining in-flight mobility, hydration, and using compression stockings may decrease this risk.

Insect-Borne Illnesses

  • Prophylaxis against insect-borne diseases includes limiting unprotected exposure, habitat avoidance, and using physical barriers and insect repellents.
  • A range of arthropod vectors can transmit diseases, including mosquitoes, ticks, mites, flies, lice, and fleas.
  • Travelers to areas endemic for malaria or arthropod-borne viruses should be carefully instructed on ways to minimize mosquito bites.

Cruise Ship Travel

  • Influenza, Legionella, and norovirus infections are particularly associated with cruise ship travel.
  • All cruise ship travelers should receive influenza vaccine and be educated about respiratory hygiene and diarrhea management.

Motion Sickness

  • Requesting interior cabins and considering medications for prophylaxis and treatment, such as anticholinergics and antihistamines, may help alleviate motion sickness.

Food and Water Safety

  • Travelers to resource-limited areas should drink bottled water, carbonated soft drinks, and carbonated water to minimize the risk of water-borne illnesses.### Travel Health Risks
  • Travelers should take precautions to avoid animal-borne diseases, such as rabies, by avoiding contact with stray dogs, feral animals, monkeys, and bats.
  • Children are particularly at risk, and travelers should wash wounds with soap and water and seek medical care immediately if bitten.

Food and Water Safety

  • When safe drinking water is not available, water can be disinfected by boiling, filtering, halogenation, or exposure to ultraviolet light.
  • Ice cubes should not be used unless they are made from safe water.
  • Food should be piping hot, thoroughly cooked, processed, packaged, and peeled, and street vendors should be avoided.

Vaccination

  • Vaccines for travelers can be divided into three categories: required on the basis of international health regulations, recommended on the basis of risk at the destination, and routine as a preventive measure.
  • The risk of vaccine-preventable illness in travelers depends on several factors, including medical conditions, destination, season, duration, and purpose of travel, and planned activities.
  • Travelers with underlying medical conditions or those who plan to travel to a resource-limited country should ideally be evaluated by a clinician in advance.

Other Health Risks

  • Travelers should take precautions to prevent road accidents, such as avoiding excessive use of alcohol, using seat belts and child safety seats, and avoiding travel by motorcycle or motor scooter.

  • Altitude sickness can occur at lower altitudes, and travelers should ascend gradually, try to sleep at lower altitudes, and minimize alcohol consumption.

  • Safe sex should be practiced to prevent sexually transmitted diseases, and travelers should be screened for such diseases on their return.

  • Travelers should take precautions to prevent environmental illness, such as altitude sickness, and diving-related barotrauma.### Vaccination Recommendations for Travelers

  • Vaccination recommendations for destination-specific immunization can be found at www.cdc.gov/travel.

  • Live virus vaccines (e.g., yellow fever, varicella, zoster, measles-mumps-rubella) should be administered on the same day or 4 weeks apart.

  • Avoid live vaccines in immunocompromised persons and pregnant women, although individual risk and benefit need to be assessed.

Yellow Fever Vaccination

  • Yellow fever is a mosquito-borne disease endemic in parts of Africa and South America.
  • The vaccine is a live attenuated virus, available only through registered clinics and sites (www.cdc.gov/travel/yellow-fever-vaccination-clinics/search.htm).
  • Periodic shortages have occurred, and the only available vaccine in the United States is administered under an investigational new drug program.

Hepatitis A Vaccination

  • Hepatitis A virus infection is common in developing countries and one of the most frequently acquired vaccine-preventable diseases.
  • Vaccination is recommended for all nonimmune travelers, especially to Mexico and Central and South America.
  • Two monovalent vaccines are available in the United States, and one bivalent vaccine is also available.

Traveler's Diarrhea and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae (ESBL-PE)

  • Traveler's diarrhea is a significant risk for acquiring ESBL-PE.
  • Vaccination against Hepatitis A and Typhoid fever can reduce the risk of traveler's diarrhea.

Meningococcal Infection

  • A quadrivalent meningococcal conjugate vaccine is available in the United States.
  • Vaccination is recommended for travelers to countries that are hyperendemic or epidemic for Neisseria meningitidis, especially during the dry season (December-June).

Rabies Prevention

  • Rabies is enzootic in many countries, and preexposure vaccination should be considered for travelers at risk, such as those working with animals or traveling to rural areas for an extended period.
  • Postexposure prophylaxis involves a series of injections and may not be available or reliable in resource-limited settings.

Japanese Encephalitis

  • Japanese encephalitis is a mosquito-borne viral infection in Asia.
  • Vaccination should be considered for individuals traveling in endemic countries during the regional transmission season, especially if rural travel is planned.

Typhoid Fever

  • Typhoid fever is a water- and food-borne infection caused by Salmonella enterica serotype Typhi.
  • Two typhoid vaccines are available: an injectable capsular polysaccharide Vi vaccine and an oral live attenuated vaccine.
  • Vaccination is recommended for travelers to resource-limited areas, long-term travelers, and those traveling to southern Asia.

Cholera

  • Cholera is a severe watery diarrhea that can be fatal.
  • An oral cholera vaccine is available for travelers to areas where cholera is common.

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Learn about the essential precautions and considerations for primary care physicians when advising patients on travel medicine. This quiz covers the important aspects of travel medicine.

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