By Kathlene S. Waller, MD, MPH Lisa A.

Duggan RN, BSN

The Travel Appointment

A. Risk Assessment
1. Destination
-Location (remote?), accommodation (VFR?), length of travel, activities, purpose of travel -Climate/environment -Availability of potable water -Availability of quality health care a. Resources b. Insurance

A. Risk Assessment 2. Past Medical History

-Medical and Psychiatric conditions stable? prescriptions -Allergies/Asthma as needed medications 3. Previous vaccinations and diseases 3. -Childhood 4. -Previous Travel

A. Risk Assessment
4. Travel Notices in Effect
-Current issues in a region such as: Highly Pathogenic Avian Influenza Dengue Fever Measles/Mumps Outbreaks Chikungunya fever

A. Risk Assessment

5. Safety and Security U.S. Department of State Travel Warnings Public Announcements Worldwide Caution Crime

B. Risk Management

1. Immunizations a. Routine/Childhood-Hepatitis B, Influenza, MMR, Td (Tdap), Varicella, Polio b. Travel-Hepatitis A, Typhoid, Polio

1. Immunizations

c. Special Circumstances-Cholera, Japanese Encephalitis, Meningococcal, Yellow Fever, Tickborne Encephalitis, Rabies

Japanese Encephalitis

Meningococcal Disease

Yellow Fever

Tickborne Encephalitis

Rabies

B. Risk Management 2. Travelers Diarrhea

a. Identifying high risk factors-H2 blocker use b. Handouts on avoiding contaminated food c. Use of OTC medications such as bismuth subsalicylate and loperamide d. Probiotics e. Rehydration solutions f. Bloody stools and/or high fever

B. Risk Management B. 2. Travelers Diarrhea

Antibiotics: Ciprofloxacin 500mg. -Take one pill twice daily for 3-5 days. -Ages 18 and older -Can also be used for respiratory symptoms, urinary tract infections or skin/wound infections

B. Risk Management 2. Travelers Diarrhea Antibiotics Azithromycin -Take one gram daily until symptoms resolved (1-3 days) -Available for children >6 months (dose by weight) -Can also be used for respiratory symptoms or skin/wound infections -Effective against Quinolone resistant pathogens

B. Risk Management 2. Travelers Diarrhea

Antibiotics Rifaximin 200mg. -Take one pill three times daily for three days. -Non-invasive -Effective against E. coli only -Use for prevention?

B. Risk Management 3. Malaria

a. Risk level of destination b. Handouts/discussion on insect avoidance c. Medications Chloroquine Mefloquine Atovaquine/Proquanil Doxycycline Primaquine

Malaria

Arthropod Borne Infectious Diseases

B. Risk Management
4. Other Arthropod Borne Infectious Diseases
a. b. c. d. e. f. Dengue Japanese Encephalitis Leishmaniasis Chikungunya Fever Trypanosomiasis Myiasis

Dengue Fever

B. Risk Management 5. Other Issues

a. Water borne diseases -Schistosomiasis -Leptospirosis b. Tuberculosis c. Sexual Health Issues d. Altitude Sickness e. Motion Sickness/Flight Issues

A. Fever

Always ask about travel. Think Malaria!! B. Travelers diarrhea

Questions or Comments?