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TRAVEL MEDICINE TRAVEL MEDICINE

TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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Page 1: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

TRAVEL MEDICINETRAVEL MEDICINE

Page 2: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 3: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

Death’s abroadDeath’s abroad

69%69% CVS CVS MI etcMI etc

21%21% AccidentsAccidents

4%4% Infectious diseasesInfectious diseases

Page 4: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

BehaviourBehaviour

Drink moreDrink more

Take more risksTake more risks

Unfamiliar surroundingsUnfamiliar surroundings

Less supervision of childrenLess supervision of children

Page 5: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 6: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 7: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 8: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 9: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

DehydrationDehydration

Drink fluids ++++Drink fluids ++++

Carry water roundCarry water round

Add salt to foodAdd salt to food

Page 10: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

MalariaMalaria

3,500 new cases per year3,500 new cases per year

10 deaths10 deaths

Page 11: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 12: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 13: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

HistoryHistory

Travel upto a yearTravel upto a year

Fever with rigorsFever with rigors

Flu like illnessFlu like illness

JaundiceJaundice

DiarrhoeaDiarrhoea

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MalariaMalaria

SignsSignsFeverFeverSplenomegallySplenomegally

InvestigationsInvestigationsBlood filmsBlood films95% thrombocytopaenia95% thrombocytopaenia+_ anaemia+_ anaemiaWbc normalWbc normal

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PreventionPrevention

BB prevent prevent BBitesites

CC CCompliance with medicationompliance with medication

AA AAwareness of riskwareness of risk

DD DDiagnose earlyiagnose early

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RiskRisk

PlacePlace

ActivityActivity

TravelTravel

Length of stayLength of stay

Effectiveness of prophylaxisEffectiveness of prophylaxis

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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

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PreventionPrevention

Mosquito netsMosquito nets

repair holesrepair holes

Tuck into mattressTuck into mattress

Impregnated with pyrethroidImpregnated with pyrethroid

Page 19: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

PreventionPrevention

Clothing after darkClothing after dark

Long trousersLong trousers

Long sleeved shirts/blousesLong sleeved shirts/blouses

Tuck trousers into socksTuck trousers into socks

Page 20: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

Page 21: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

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ResistanceResistance

East AfricaEast Africa

MefloquineMefloquine 90% protection90% protection

Proguanil/chloroquineProguanil/chloroquine 70% protective70% protective

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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

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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

Page 25: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

Travellers diarrhoeaTravellers diarrhoea

TunisiaTunisia 70%70%

KenyaKenya 50%50%

EgyptEgypt 50%50%

Spain Spain 7%7%

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Infectious agentsInfectious agents

Rota virusRota virusE coliE coliCampylobacterCampylobacterSalmonella shigella chloeraSalmonella shigella chloeraGiardia lambliaGiardia lambliaCryptosporidiumCryptosporidium50% no cause found50% no cause found

Page 27: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

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

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TreatmentTreatment

Fluids onlyFluids only

Rehydration saltsRehydration salts

Antibiotics rarely neededAntibiotics rarely needed ciprofloxacinciprofloxacin

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Persisting diarrhoeaPersisting diarrhoea

Stool cultureStool culture

GiardiaGiardia

MetronidazoleMetronidazole

tinidazoletinidazole

Page 30: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make

Imported infectious diseasesImported infectious diseases

MalariaMalaria 20002000

Hep AHep A 10001000

TyphoidTyphoid 200200

ChloeraChloera a fewa few

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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%

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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

Page 33: TRAVEL MEDICINE. Medical insurance Don’t travel without adequate insurance Don’t travel without adequate insurance Make sure it covers repatriation Make