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TRAVEL MEDICINETRAVEL MEDICINE
Medical insuranceMedical insurance
Don’t travel without adequate insuranceDon’t travel without adequate insurance
Make sure it covers repatriationMake sure it covers repatriation
In Europe have E 111 as wellIn Europe have E 111 as well
In 2In 2ndnd/3/3rdrd world countries have IV kit world countries have IV kit
Take your own medicines Take your own medicines
Death’s abroadDeath’s abroad
69%69% CVS CVS MI etcMI etc
21%21% AccidentsAccidents
4%4% Infectious diseasesInfectious diseases
BehaviourBehaviour
Drink moreDrink more
Take more risksTake more risks
Unfamiliar surroundingsUnfamiliar surroundings
Less supervision of childrenLess supervision of children
ImmunisationImmunisation
Risks balanced against incidence of Risks balanced against incidence of
diseasedisease
Risk of japanese encephalitis 1 in 1x10 6Risk of japanese encephalitis 1 in 1x10 6thth
Risk of anaphylaxis due to vaccine 1 in Risk of anaphylaxis due to vaccine 1 in
40,00040,000
Risk of vaccine greater than risk of Risk of vaccine greater than risk of
diseasedisease
ImmunisationImmunisation
Arrange immunisation 8 weeks before Arrange immunisation 8 weeks before
traveltravel
Up to date advice available from special Up to date advice available from special
web siteweb site
AdviceAdvice
Drink bottled waterDrink bottled water
Avoid ice in drinksAvoid ice in drinks
Peel or wash fruit and vegPeel or wash fruit and veg
Clean teeth with bottled waterClean teeth with bottled water
Be careful where you eatBe careful where you eat
Avoid ice creamAvoid ice cream
SunSun
Cover up with tightly woven cotton clothesCover up with tightly woven cotton clothesWear hat with large brimWear hat with large brimSit in shadeSit in shadeStay out of sun either side of noonStay out of sun either side of noonUse high spf and uva protection creamsUse high spf and uva protection creamsApply thickly before going outApply thickly before going outReapply after swimming Reapply after swimming
DehydrationDehydration
Drink fluids ++++Drink fluids ++++
Carry water roundCarry water round
Add salt to foodAdd salt to food
MalariaMalaria
3,500 new cases per year3,500 new cases per year
10 deaths10 deaths
MalariaMalaria
50% cases in visiting friends and relatives50% cases in visiting friends and relatives
19% visitors to UK19% visitors to UK
16% tourists16% tourists
11% immigrants11% immigrants
5% expats5% expats
DiagnosisDiagnosis
Must think of itMust think of it
Has the pt malariaHas the pt malaria
Falciparum or one of the othersFalciparum or one of the others
From a chloroquine resistant areaFrom a chloroquine resistant area
Mild Moderate or severeMild Moderate or severe
HistoryHistory
Travel upto a yearTravel upto a year
Fever with rigorsFever with rigors
Flu like illnessFlu like illness
JaundiceJaundice
DiarrhoeaDiarrhoea
MalariaMalaria
SignsSignsFeverFeverSplenomegallySplenomegally
InvestigationsInvestigationsBlood filmsBlood films95% thrombocytopaenia95% thrombocytopaenia+_ anaemia+_ anaemiaWbc normalWbc normal
PreventionPrevention
BB prevent prevent BBitesites
CC CCompliance with medicationompliance with medication
AA AAwareness of riskwareness of risk
DD DDiagnose earlyiagnose early
RiskRisk
PlacePlace
ActivityActivity
TravelTravel
Length of stayLength of stay
Effectiveness of prophylaxisEffectiveness of prophylaxis
CountriesCountries
AfricaAfrica == FalciparumFalciparumWest Africa v high risk of catching low drug West Africa v high risk of catching low drug
resistance = few deathsresistance = few deaths
East Africa lower risk of catching high drug East Africa lower risk of catching high drug resistance = large no of deathsresistance = large no of deaths
India Pakistan Thailand = VivaxIndia Pakistan Thailand = Vivax
PreventionPrevention
Mosquito netsMosquito nets
repair holesrepair holes
Tuck into mattressTuck into mattress
Impregnated with pyrethroidImpregnated with pyrethroid
PreventionPrevention
Clothing after darkClothing after dark
Long trousersLong trousers
Long sleeved shirts/blousesLong sleeved shirts/blouses
Tuck trousers into socksTuck trousers into socks
PreventionPrevention
Use appropriate insect repellentUse appropriate insect repellent
Close windows if lights on after duskClose windows if lights on after dusk
Use knock down spray or coilsUse knock down spray or coils
PreventionPrevention
ChemoprophylaxsisChemoprophylaxsis
Use most effective for countryUse most effective for country
Start 1 week before travellingStart 1 week before travelling
Continue for 4 weeks after returnContinue for 4 weeks after return
Away from medical help carry quinineAway from medical help carry quinine
ResistanceResistance
East AfricaEast Africa
MefloquineMefloquine 90% protection90% protection
Proguanil/chloroquineProguanil/chloroquine 70% protective70% protective
ME vs PCME vs PC
Similar nos serious advers effectsSimilar nos serious advers effectsSimilar nos discontinueSimilar nos discontinueME better complianceME better complianceME 3x no of neuropsychiatric effectsME 3x no of neuropsychiatric effects
Doxycycline main adverse effect Doxycycline main adverse effect photosensitisationphotosensitisation
Malarone licensed for 28 days onlyMalarone licensed for 28 days only
RememberRemember
Risk proportional to length of stayRisk proportional to length of stay
The longer the stay the greater the need to The longer the stay the greater the need to
take prophlaxsistake prophlaxsis
Adverse effects occur early onAdverse effects occur early on
Travellers diarrhoeaTravellers diarrhoea
TunisiaTunisia 70%70%
KenyaKenya 50%50%
EgyptEgypt 50%50%
Spain Spain 7%7%
Infectious agentsInfectious agents
Rota virusRota virusE coliE coliCampylobacterCampylobacterSalmonella shigella chloeraSalmonella shigella chloeraGiardia lambliaGiardia lambliaCryptosporidiumCryptosporidium50% no cause found50% no cause found
AvoidanceAvoidance
Wash fruit and vegWash fruit and vegDrink bottled waterDrink bottled waterNo ice cubes in drinksNo ice cubes in drinksClean teeth with bottled waterClean teeth with bottled waterNo ice creamNo ice creamBe wary of where you eatBe wary of where you eatHand washingHand washing
TreatmentTreatment
Fluids onlyFluids only
Rehydration saltsRehydration salts
Antibiotics rarely neededAntibiotics rarely needed ciprofloxacinciprofloxacin
Persisting diarrhoeaPersisting diarrhoea
Stool cultureStool culture
GiardiaGiardia
MetronidazoleMetronidazole
tinidazoletinidazole
Imported infectious diseasesImported infectious diseases
MalariaMalaria 20002000
Hep AHep A 10001000
TyphoidTyphoid 200200
ChloeraChloera a fewa few
Imported fever - causesImported fever - causes
MalariaMalaria 42%42%
Non- specific viralNon- specific viral 25%25%
Viral dengueViral dengue 6%6%
Viral Hep AViral Hep A 3%3%
Investigation of feverInvestigation of fever
Thick and thin blood filmsThick and thin blood films
FBCFBC low platelets – malaria denguelow platelets – malaria dengue
Dipstick urineDipstick urine
Blood cultures – typhoidBlood cultures – typhoid
CXRCXR
Serology – toxoplasma hep ASerology – toxoplasma hep A