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Travel Medicine. Christopher Sanford, MD, MPH, DTM&H Acting Asst. Professor, Dept. of Family Med. Clinical Asst. Professor, Dept. of Global Health University of Washington Seattle, Washington, USA November 2010. Overview of pre-travel encounter:.
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Travel Medicine Christopher Sanford, MD, MPH, DTM&H Acting Asst. Educator, Dept. of Family Med. Clinical Asst. Educator, Dept. of Global Health University of Washington Seattle, Washington, USA November 2010

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Overview of pre-travel experience: 1) Intake questions: schedule, medicinal history incl. vaccinations, and so on 2) Advised inoculations 3) Malaria: PPMs, medicine. 4) Travelers\' looseness of the bowels: consume less calories, self-tx med 5) Everything else: urban medication: autos, exhaust cloud, and so forth.; assets.

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Intake questions Where to For to what extent For what reason Staying in what sort of place Guided or not Previous creating world travel or not

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Intake addresses Past restorative history Allergies History of antimalarial utilize if any Medications Medical issues History of sorrow, tension LMP, conception prevention None of antimalarials demonstrated safe in pregnancy Review of past vaccinations

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Immunizations Advised proposals: Routine Required Recommended

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Immunizations (cont.) 1. Schedule: Tdap (lockjaw + diphtheria +pertussis) MMR Influenza—regular Hepatitis A Hepatitis B Polio Varicella

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Tdap Give Tdap –start at age 11. At that point in 10 years pt gets normal Td. Tdap is an once/life antibody.

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Table 2-20. Nations with endemic diphtheria [2010 CDC Yellow Book] Africa: Algeria, Angola, Egypt, Niger, Nigeria, Sudan, and sub-Saharan nations Americas: Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Haiti, and Paraguay Asia/South Pacific: Afghanistan, Bangladesh, Bhutan, Burma (Myanmar), Cambodia, China, India, Indonesia, Laos, Malaysia, Mongolia, Nepal, Pakistan, Papua New Guinea, Philippines, Thailand, and Vietnam Middle East: Iran, Iraq, Saudi Arabia, Syria, Turkey, and Yemen Europe: Albania, Russia, and nations of the previous Soviet Union Pertussis: Risk for Travelers Pertussis stays endemic around the world, even in ranges with high inoculation rates.

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MMR 2 measurements, no less than 4 weeks separated Those conceived before 1957 thought to be insusceptible. Of the 127 U.S. occupants with measles in 2008, 7 were immunized, 21 had obscure inoculation histories, and 99 were not immunized. Of the 99 cases in unvaccinated U.S. occupants: 67% were among people unvaccinated as a result of their own or religious convictions. The greater part were import-related. http://www.cdc.gov/mmwr/PDF/wk/mm5754.pdf

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Measles passings in Africa Measles passings among youngsters under five years of age in Africa: 2000: 733,000 2008: 118,000 (United Nations information)

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Influenza Important: worldwide voyagers create flu more frequently than do people who stay at home. In calm locales in Southern Hemisphere (e.g., Australia) influenza season is April-November Near equator, flu is year-round.

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Hepatitis An Appropriate for each country in the creating scene. "The most continuous immunization preventable ailment in universal explorers." 2 measurements, no less than 6 months separated. Least age: 12 months. Try not to offer Ig to immunocompetent voyagers beyond one years old year. Lifetime insurance.

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Hepatitis B 3 dosages: at time 0, 1, and 6 months. An extensive extent of explorers have dangers. Twinrix: hepatitis A + hepatitis B Schedule: 0, 1, 6 months

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Polio One measurement as a grown-up on top of the typical pediatric arrangement. On the off chance that going to region with polio: Now in around 25 nations in Africa And the Indian subcontinent: India, Pakistan, Bangladesh None in the Americas

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Pakistan [2] Pakistan Date: Tue 13 Oct 2009 Source: IRIN [edited] < http://www.irinnews.org/Report.aspx?ReportId=86560 > Polio flare-up in Swat - - Health authorities say 13 instances of polio have been affirmed in  Pakistan\'s unstable Swat District in the course of recent months, mainly  in light of the fact that vaccinators have been not able get to youngsters there for more  than a year. Savage battling between government troops and Taliban  aggressors, which started in May [2009], has uprooted hundreds of  a large number of individuals from Swat. Prior to the armed force crusade in the area  which finished in July [2009], activists had avoided get to for  against polio groups.

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CDC Update Oct. 2010 Outbreak Notice Polio Outbreak in Tajikistan, Cases in Russia, Risk of Spread to other Central Asian Countries Updated: October 22, 2010

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Varicella Two measurements of varicella-containing immunization are presently prescribed for every single powerless individual more seasoned than one year without contraindications. The primary dosage ought to be controlled at 12–15 months of age and the second measurement at 4–6 years old. The base interim for youngsters more youthful than 13 years is 3 months. The ACIP now suggests that all others no less than 13 years old without proof of insusceptibility be immunized with two measurements of varicella immunization at an interim of 4–8 weeks In mild atmospheres, varicella has a tendency to be a youth illness, with pinnacle occurrence amid late winter and early spring. In tropical atmospheres, contamination has a tendency to happen at more established ages, bringing about higher weakness among grown-ups than in calm atmospheres. http://wwwnc.cdc.gov/travel/yellowbook/2010/part 2/varicella.aspx

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Immunizations (cont.) 2. Required: a short rundown. Yellow fever: tropical Africa tropical South America [none in Asia]

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Yellow fever: dispersion

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Yellow fever Required for section into: In South America: Bolivia, and French Guiana

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Yellow fever Required for passage into: Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote de I\'voire, Democratic Republic of Congo, Gabon, Ghana, Liberia, Mali, Mauritania (for stay more than 2 weeks), Niger, Rwanda, Sao Tome and Principe, Sierra Leone, and Togo. Not required for come back to U.S. despite past goal. Sponsor measurements required at ten year interims.

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Meningococcal: Required for Hajj (Muslim journey to Mecca) Must be tetravalent All meningococcal meningitis antibody given in the US is tetravalent Recommended for high hazard explorers Meningitis belt of sub-Saharan Africa Crowded living conditions, e.g. dormitory

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2009-2010: 2 nd and 3 rd required Hajj antibodies: regular and pandemic flu Ministry of Health of Saudi Arabia states: Seasonal flu immunization required Pandemic (H1N1) influenza required "if such inoculation is generally accessible" http://wwwnc.cdc.gov/travel/content/in-the-news/saudi-arabia-hajj-2009.aspx

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"meningitis belt"— the Sahel

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Immunizations (cont.) 3. Suggested Typhoid fever Consider: rabies Consider: Japanese encephalitis Cholera: No. Rabies shirking: never clasp hands with a gorilla.

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Typhoid fever Present all through creating world. Hazard in expanded in long-stay explorers, and those out of the way. Either oral (useful for a long time). Least age 6 years. 4 pills. One pill each other day. Alternately by means of infusion (useful for a long time). Least age 2 years. One measurements.

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Rabies Three measurements, more than 28 days. Costly. Rabies uncommon in explorers. Consider for delayed stay, explorers, spelunkers, others with huge hazard. Pre-introduction arrangement does not evacuate requirement for prompt post-presentation treatment.

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Japanese encephalitis Spread by mosquitoes, introduce all through South and Southeast Asia. Costly Rare- - country as it were. Connected with rice and pig cultivating. Antibody Older: JE-VAX. Three dosages: d. 0, 7, 30. New: Ixiaro. Two measurements, d. 0 & 28. For 17 y.o. furthermore, more seasoned. FDA endorsed March 2009.

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Live immunizations TOY MMR BSVI (oral typhoid, OPV, yellow fever, measles, mumps, rubella, BCG, smallpox, varicella, flu [intranasal]) Avoid in voyagers with immunocompromise, pregnancy. Safe to give in HIV-pos. voyagers with CD4 checks more than 400 (or more than 200, or more than 500—powers vary) (aside from BCG—never offer BCG to a HIV-constructive individual paying little respect to CD4 tally)

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Malaria Protozoan life form, vector is Anopheles mosquito. Sickness described by high fevers, sweats, chills. P. falciparum is the most pervasive species around the world; connected with huge mortality. There are approx. 100 nations in which intestinal sickness is endemic.

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PPMs (individual security measures) = BAM (bug evasion measures) Personal insurance measures are at any rate as critical as drugs. Likewise advantage for illnesses other than intestinal sickness, e.g. dengue fever.) DEET (20-35% not 100%) or picaridin (20%, not 6-9%) to uncovered skin. Permethrin to garments, once like clockwork. Bed net, ideally impregnated with permethrin Long sleeves/pants

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Malaria: drugs Chloroquine still successful in just a modest bunch of nations. Mexico, and Central America to west of Panama Canal Island of Hispaniola (Dominican Republic and Haiti) North Africa (prophylaxis not suggested)

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chloroquine-delicate territories chloroquine or Plaquenil once/week Schedule: begin one week before passage, take once/week while in intestinal sickness nation, take for four weeks after exit. In US, Plaquenil is one-fifth cost of chloroquine Dose chloroquine: 300 mg base = 500 mg salt once/week Plaquenil: 310 mg base = 400 mg salt once/week

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Chloroquine-safe nations 3 choices: doxycycline mefloquine (Larium) atovaquone/proguanil (Malarone)

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doxycycline Dose: 100 mg once/day. Begin one day preceding passage to intestinal sickness region, take once/day while, proceed for 28 days subsequent to leaving jungle fever territory. Modest. Approx. 16-20 pennies/pill. Symptoms: photosensitivity. Short of what one percent. esophageal disintegration. Try not to swallow tablet "dry"

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mefloquine (Larium) 250 mg (salt) once/week. Begin one week before passage into jungle fever territory, proceed once/week while ther

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