TRAVELERS MEDICINE

1 RESOURCES:

1.1 CDC:YELLOW BOOK AND ONLINE WEBSITE

1.2 INTERNATIONAL SOCIETY OF TRAVEL MEDICINE (ISTM)

GUIDELINES
2 STD RECOMMENDATIONS FOR SAFE TRAVEL

2.1 TRAVEL PREPARED

2.2 CARRY LIST OF ALL MEDS AND MEDICAL CONDITIONS

2.3 PACK MEDICATION ( AND SUPPLIES) IN ORIGINAL CONTAINERS IN

CARRY ON LUGGAGE
3 CONSIDER RISK OF EXPOSURE TO CONTAMINATED FOOD AND
WATER, BLOOD AND BODILY FLUIDS, INSECTS: CHECK FOR TRAVEL
ADVISORIES AND VACCINE REQUIREMENTS AT YOUR DESTINATION

4 STUDY TIP: TRAVEL VACCINE

4.1 INACTIVATED VACCINE

4.1.1 HEPATITIS A(HAVRIX, VAQTA), HEPATITIS B(
ENGERIXB,RECOMBIVAX HB), HEPATITIS A/B(TWINRIX), JAPANESE
ENCEPHALITIS(IXIARO), MENINGOCOCCUS(MENVEO,MENACTRA)

4.2 LIVE VACCINE

4.2.1 CHOLERA-PO(VAXCHORA),TYPHOIDPO(VIVOTIF),YELLOW
FEVER-SC(YF-VAX)

5 DISEASES FROM FOOD AND WATER

5.1 TRAVELERS DIARRHEA

5.1.1 SUDDEN ONSET OF ABNORMALLY LOOSE OR LIQUID,
FREQUENT STOOLS
80-90% OF CASES CAUSED BY BACTERIA, ONSET: 6-72 HRS AFTER EXPOSURE,
DURATION: 3-7 DAYS(WITHOUT TT)

5.1.2 PREVETION
BOIL IT, COOK IT, PEEL IT, OR FORGET IT, HAND HYGIENE, MEDICATIONS
5.1.3 STUDY TIP: DRUG PROPHYLAXIS OF TD
BISMUTH SUBSALICYLATE (PEPTO BISMOL) 525-1050 MG PO 4 TIMES DAILY: FOR ANY
PATIENT WITHOUT CONTRAINDICATIONS
ANTIBIOTICS: PATIENTS AT HIGH RISK OF COMPLICATIONS

5.1.4 TREATMENT
HYDRATION, LOPERAMIDE(IMODIUM A-D0 OR BISMUTH SUBSALICYLATE,
ANIBIOTICS
STUDY TIP: D TT OF TD BY SEVERITY:
MILD: LOPERAMIDE PRN
MODERATE: LOPERMIDE PRN+/-ANTIBIOTICS
SEVERE: ANTIBIOICS+/-LOPERAMIDE, AZITHROMYCIN 1000 MG X 1 DOSE
PREFERRED

5.2 TYPHOID FEVER

5.2.1 CAUSED BY BACTERIUM SALMONELLA TYPHI

5.2.2 PRESENTING SYMPTOMS: HEADACHE, MALAISE, ANOREXIA,

SPLEEN AND LIVER ENLARGEMENT, RASH
SEVERE: INTESTINAL HEMORRHAGE OR PERFORATION

5.2.3 PREVENTION:
SAFE FOOD AND WATER PRACTICES
HAND HYGIENE
VACCINES( IM OR ORAL)
TYPHIM VI( IM INJECTION, INACTIVATED)>OR EQUAL 2 WEEKS BEFORE TRAVEL,
PATIENTS >OR EQUAL 2 YEARS OF AGE, REVACCINATE EVERY 2 YEARS
VIVOTIF: ORAL CAPSULES , LIVE: >OR EQUAL 1 WEEK BEFORE TRAVEL,
PATIENTS>OR EUAL 6 YRS OF AGE, REVACCINATE EVERY 5 YRS, STORE IN
REFRIGERATOR
5.3 CHOLERA

5.3.1 CAUSED BY BACTERIUM VIBRIO CHOLERAE

5.3.2 PRESENTING SYMPTOMS : PROFUSE, WATERY DIARRHEA ( RICE

WATER STOOLS)
5.3.3 VACCINE ( ORAL) FOR ANYONE TRAVELING TO A REGION WITH
ACTIVE CHOLERA
5.3.4 VAXCHORA:ORAL LIQUID, LIVE:>OR EQUAL 10 DAYS BEFORE
TRAVEL, PATIENTS GAED 18-64 YRS

5.4 POLIO
5.4.1 USUALLY VACCINATED IN CHILDHOOD

5.4.2 SINGLE, LIFETIME BOOSTER DOSE

5.4.3 PROOF IF VACCINATION MAY BE REQUIRED

5.4.4 IPOL , IM INJECTION, INACTIVATED: >OR EQUAL 4 WEEKS
BEFORE TRAVEL, SINGLE BOOSTER DOSE FOR PREVIOUSLY
VACCINATED ADULTS

5.5 HEPATITIS A
5.5.1 CAUSED BY HEPATITIS A VIRUS, SPREAD BY FECAL ORAL
ROUTE
5.5.2 PRESENTING SYMPTOMS: CAN BE ASYMPTOMATIC, (FEVER,
MALAISE, JAUNDICE,NAUSEA)

5.5.3 ACUTE, SELF LIMITING ILLNESS

5.5.4 CONSIDER VACCINE FOR TRAVEL TO AREAS AT RISK

5.5.5 EX
HAVRIX: IM, INACTIVATED
VAQTA: IM, INACTIVATED
TWINRIX(HEPATITIS A,B): IM, INACTIVATED
6 diseases FROM BLOOD AND BODILY FLUIDS

6.1 HEPATITIS B
6.1.1 CAUSED BY HEPATITIS B VIRUS

6.1.2 PRESENTATION:
ACUTE:FEVER, MALAISE, HA, MYLAGIA
CHRONIC: CIRRHOSIS, LIVER FAILURE, LIVER CANCER

6.1.3 VACCINE RECOMMENDED FOR

EXPOSURE TO BLOOD OR OTHER BODY FLUIDS
SEXUAL CONTACT WITH LOCAL POPULATION
EXPOSURE THROUGH MEDICAL TREATMENT

6.1.4 EX
ENGERIX-B: IM, INACTIVATED
RECOMBIVAX HB, IM,INACTIVATED
TWINRIX ( HEPATITIS A &B):IM,INACTIVATED

6.2 MENINGOCOCCAL MENINGITIS

6.2.1 CAUSED BY BACTERIUM NEISSERIA MENINGITIDIS

6.2.2 TRANSMISSION
ORAL/NASAL SECRETIONS(COUGH, KISSING)
SEASONAL IN AFRICAN ENDEMIC ZONE(DEC-JUNE)
EPIDEMIC POSSIBLE, DORMS AND HOSTELS
LARGE NUMBER OF PEOPLE IN CLOSE PROXIMIITY

6.2.3 VACCINES
RECOMMENDED FOR TRAVEL TO HIGH RISK AREAS : AFRICAN MENINGITIS BELT
REQUIRED FOR SAUDI ARABIAN HAJJ AND UMRAH PILGRIMAGES
6.2.4 MENACTRA:IM INACTIVATED

6.2.5 MENVEO: IM INACTIVATED

7 DISEASES FROM INSECT BITES:VECTORS

7.1 DENGUE
7.1.1 TRANSMITTED BY MOSQUITOES

7.1.2 COMMON IN TROPICS AND SUBTROPICS IN TIMES OF HIGH

RAINFALL

7.1.3 75% OF INFECTIONS ARE ASYMPTOMATIC

7.1.4 5% OF PATIENTS DEVELOP SEVERE DISEASE:SHOCK, SEVERE
BLEEDING/ORGAN FAILURE

7.1.5 NO VACCINE AVAILABLE, SUPPORTIVE TT

7.1.6 PREVENT BUG BITES

7.2 MALARIA

7.2.1
PARRASITE TRANSMITTED BY ANOPHELES MOSQUITO: FOUR MALARIA SPECIES:
PLAMODIUM FALCIPARUM, P MALARIAE, P.OVALE, P VIVAX
PRESENATION: HIGH FEVER, SHAKING, CHILLS, FLU LIKE SYMPTOMS, CAN BE
FATAL
PROPHYLAXIS RECOMMENDED FOR HIGH RISK AREAS, REGIMEN BASED ON TIM TO
TRAVEL
QUICK SATRTS:1-2 DAYS BEFORE TRAVEL
DS: ATOVAQUONE/PROGUANIL(MALARONE)
DOXYCYCLINE(DORYX,VIBRAMYCINS)
PRIMAQUINE
TAKEN DAILY, AVOID IN OREGNANCY, CAUSE NAUSEA
ADVANCED STARTS:1-2 WEEKS BEFORE TRAVEL: 1-2 WEEKS BEFORE TRAVEL
DS: CHLOROQUINE, MEFLOQUINE(LARIAM)
TAKEN WEEKLY, SAFE IN PREGNANCY, CHILDREN

7.3 JAPANESE ENCEPHALITIS

7.3.1 USUALLY ASYMPTOMATIC, CAN LEAD TO ENCEPHALITIS

7.3.2 HIGHEST RISK IN RURAL AREAS OF AGRICULTURE

7.3.3 VACCINE FOR HIGH RISK

7.3.4 IXIARO, IM, INACTIVATED, PATIENTS AGED>2 MONTHS,
EXTENDED EXPOSURRE TO OUTDOORS OR >OR EQUAL 1 MONTH IN
AREA

7.4 YELLOW FEVER

7.4.1 CAUSED BY VIRUS, INFLUENZA LIKE SYMPTOMS

7.4.2 TRAVELERS AT HIGH RISK OR REQUIRED BY CONUTRY

DOCUMENT VACCINATION(YELLOW CARD)

7.4.3 CONTRAINDICTAED WITH EGG ALLERGY

7.4.4 YF-VAX, SC INJECTION, LIVE:>OR EQUAL 10 DAYS BEFORE
TRAVEL, HIGH RISK OR REQUIRED BY COUNTRY

7.5 ZIKA VIRUS

7.5.1 USUALLY ASYMPTOMATIC, NO VACCINE

7.5.2 BIRTH DEFECTS( MICROCEPHALY)

7.6 PROPHYLACYTIC MEASURES:PREVENT BUG BITES

7.6.1 COVER EXPOSED SKIN

7.6.2 USE AN APROPRIATE INSECT REPELLANT OF 20% OR MORE

DEET

7.6.3 IF APPLYING SUNSCREEN, APPLY SUNSCREEN FIRST, AND THEN

INSECT REPELLANT
7.6.4 USE PERMETHRIN TREATED CLOTHING AND GEAR

7.6.5 WEAR LONG SLEEVED SHIRTS, LONG PANTS AND HATS, TUCK
IN SHIRTS, TUCK PANTS INTO SOCKS, AND WEAR CLOSED SHOES
INSTEAD OF SANDALS
8 ADDITIONAL CONCERNS FOR TRAVELERS

8.1 VENOUS THROMBOEMBOLISM PROPHYLAXIS

8.1.1 INCREASED RISK OF DVT OR PE DUE TO LIMITED MOBILITY
8.1.2 PREVENTION: COMPRESSION STOCKINGS, LEG EXERCISES,
ANTICOAGULATION( HIGH RISK PATIENTS)

8.2 ALTITUDE SICKNESS

8.2.1 FROM RAPID CHANGE IN ALTITUDE
8.2.2 PRESENTATION: DIZZINESS, HEADACHE, TACHYCARDIA,
DYSPNEA

8.2.3 PREVENTION: ACETAZOLAMIDE( DIAMOX)

8.3 MOTION SICKNESS

9 THE REURNED TRAVELER

9.1 ANY PERSON WHO IS ILL RETURNING FROM TRAVEL SHOULD BE

EVALUATED
9.1.1 THOROUGH HISTORY OF EXPOSURE DURING TRAVEL

9.1.2 THOROUGH HISTORY OF SYMPTOMS/ONSET

9.2 TAKE CAUTION TO PREVENT SPREADING THE DISEASE