Transcript TRAVEL MEDICINE

TRAVEL MEDICINE
Medical insurance

Don’t travel without adequate insurance
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Make sure it covers repatriation
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In Europe have E 111 as well
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In 2nd/3rd world countries have IV kit
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Take your own medicines
Death’s abroad

69%
CVS
MI etc

21%
Accidents
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4%
Infectious diseases
Behaviour
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Drink more
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Take more risks
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Unfamiliar surroundings
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Less supervision of children
Immunisation
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Risks balanced against incidence of
disease
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Risk of japanese encephalitis 1 in 1x10 6th
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Risk of anaphylaxis due to vaccine 1 in
40,000
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Risk of vaccine greater than risk of
disease
Immunisation
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Arrange immunisation 8 weeks before
travel
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Up to date advice available from special
web site
Advice
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Drink bottled water
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Avoid ice in drinks
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Peel or wash fruit and veg
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Clean teeth with bottled water
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Be careful where you eat
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Avoid ice cream
Sun
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Cover up with tightly woven cotton clothes
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Wear hat with large brim
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Sit in shade
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Stay out of sun either side of noon
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Use high spf and uva protection creams
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Apply thickly before going out
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Reapply after swimming
Dehydration
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Drink fluids ++++
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Carry water round
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Add salt to food
Malaria
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3,500 new cases per year
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10 deaths
Malaria
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50% cases in visiting friends and relatives
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19% visitors to UK
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16% tourists
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11% immigrants
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5% expats
Diagnosis
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Must think of it
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Has the pt malaria
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Falciparum or one of the others
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From a chloroquine resistant area
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Mild Moderate or severe
History
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Travel upto a year
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Fever with rigors
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Flu like illness
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Jaundice
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Diarrhoea
Malaria
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Signs
Fever
 Splenomegally
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Investigations
Blood films
 95% thrombocytopaenia
 +_ anaemia
 Wbc normal
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Prevention
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B
prevent Bites
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C
Compliance with medication
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A
Awareness of risk
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D
Diagnose early
Risk
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Place
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Activity
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Travel
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Length of stay
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Effectiveness of prophylaxis
Countries
Africa
=
Falciparum
West Africa v high risk of catching low drug
resistance = few deaths
East Africa lower risk of catching high drug
resistance = large no of deaths
India Pakistan Thailand = Vivax
Prevention
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Mosquito nets
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repair holes
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Tuck into mattress
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Impregnated with pyrethroid
Prevention
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Clothing after dark
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Long trousers
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Long sleeved shirts/blouses
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Tuck trousers into socks
Prevention
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Use appropriate insect repellent
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Close windows if lights on after dusk
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Use knock down spray or coils
Prevention
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Chemoprophylaxsis
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Use most effective for country
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Start 1 week before travelling
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Continue for 4 weeks after return
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Away from medical help carry quinine
Resistance
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East Africa
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Mefloquine 90% protection
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Proguanil/chloroquine
70% protective
ME vs PC
Similar nos serious advers effects
 Similar nos discontinue
 ME better compliance
 ME 3x no of neuropsychiatric effects
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Doxycycline main adverse effect
photosensitisation
 Malarone licensed for 28 days only
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Remember
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Risk proportional to length of stay
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The longer the stay the greater the need to
take prophlaxsis
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Adverse effects occur early on
Travellers diarrhoea
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Tunisia
70%
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Kenya
50%
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Egypt
50%
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Spain
7%
Infectious agents
Rota virus
 E coli
 Campylobacter
 Salmonella shigella chloera
 Giardia lamblia
 Cryptosporidium
 50% no cause found
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Avoidance
Wash fruit and veg
 Drink bottled water
 No ice cubes in drinks
 Clean teeth with bottled water
 No ice cream
 Be wary of where you eat
 Hand washing
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Treatment
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Fluids only
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Rehydration salts
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Antibiotics rarely needed
ciprofloxacin
Persisting diarrhoea
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Stool culture
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Giardia
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Metronidazole
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tinidazole
Imported infectious diseases
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Malaria
2000
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Hep A
1000
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Typhoid
200
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Chloera
a few
Imported fever - causes
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Malaria
42%
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Non- specific viral
25%
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Viral dengue
6%
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Viral Hep A
3%
Investigation of fever
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Thick and thin blood films
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FBC
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Dipstick urine
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Blood cultures – typhoid
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CXR
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Serology – toxoplasma hep A
low platelets – malaria dengue