Travel Medicine

Travel Medicine

·        Travel History:

o   Where are you going

o   How are you getting there

o   How long there

o   What will you be doing

o   Where are you staying

o   Have you been there before

·        Examples: 

o   3 week package to Hong Kong, Singapore, Bangkok: Hep A and Tetanus up to date. Typhoid is overkill

o   4 month Overland through from Thailand to Turkey (Vivax Malaria): Malaria, Hep A, Tetanus

o   3 month TI in Tanzania: Hep A, Typhoid, Yellow fever (not Asia)

o   3 year diplomatic posting in PNG: Malaria prophylaxis if going rural but not continuously

Vaccination

·        Malaria chemoprophylaxis: unnecessary if in a malarious country for < 7 days. Risk in main resort areas of Asia is low

·        Typhoid:

o   Injectable: salmonella typhi antigen, 70% protection for 3 years 

o   Oral vaccine: attenuated live strain, doses at 0, 3 and 5 days gives protection for one year. Useful at short notice 

·        Yellow Fever: 

o   Attenuated live strain (Þ not if immunocompromised)

o  For travel to equatorial Africa and South America

o  Protection for 10 years 

o  Requires special certificate, stamp, etc Þ only done in designated centres

·        Polio: 

o  OPV: Oral: 2 drops po (tiny risk of giving it to adults if no previous vaccine Þ use IPV)

o  IPV: Inactivated polio vaccine: 0.5 mls sc

o  Booster every 10 years

·        Tetanus/Diphtheria Toxoid: booster every 10 years.  0.5 mls im into deltoid muscle 

·        Meningococcal Vaccine: For types A, C, W, Y – not B. sc injection gives 3 years protection. Indicated for travel to countries where epidemics occur – Nepal, West Africa, Brazil 

·        Hepatitis A: Formalin inactivated HAV. IM injection gives protection for one year. Booster dose 6 – 12 months later gives long-term protection. If over 50, check immune status – may be immune and therefore won‟t need it (its expensive) 

·        Japanese Encephalitis Vaccine: Widespread through SE Asia. Rare for travellers to get it – but high mortality. Side effects from vaccine

·        Rabies: Only for people intending to work longer term in rural/agricultural areas of Asia

Pyrexia of unknown origin if returning from 3^rd world

·        Diagnose on blood film/culture:

o  Malaria

o  Dengue 

o  Typhoid: usually constipated, used to die of peritonitis, bradycardia, high spiking fever, takes days for temperature to go down

·        Ross River

·        Syphilis

·        Filariasis (eg Samoa)

·        Other imported infections from Pacific:

o  Leprosy (mycobacterium leprae)

o  Yaws (Treponema pertenue)

o  Eosinophilic Meningitis