Oh, the Places You ll Go! A Primer on Travel Health and Immunizations August 2016 Tanya Chadwell FNP-BC

Transcription

1 Oh, the Places You ll Go! A Primer on Travel Health and Immunizations August 2016 Tanya Chadwell FNP-BC

2 Main Goals of Travel Medicine Mitigate risk of illness and disease by Education on Preventive Measures Immunizations and Medications Promote awareness of safety issues Be prepared for emergencies Balance risk awareness with the enjoyment and adventure of travel

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4 Travel Statistics The number of people traveling internationally has grown substantially in the last decade. In 2011, there were 990 million international tourist arrivals throughout the world. By 2030, it is projected that 1.8 billion people a year will travel internationally. In 2010, U.S. residents made almost 60 million trips outside of the U.S.A. (at least one overnight). Centers for Disease Control (CDC), World Tourism Organization

5 Why Do We Travel? Tourism Business Study Abroad/Research Adventure/Ecotourism VFR (Visiting Friends and Relatives) Mission Work Medical Tourism Disaster Response International Adoption But.what can happen?

6 Incidence of Illness During Travel to the Developing World* 1. Travelers diarrhea 20-40% 2. Acute respiratory infection 5-20% 3. Skin disorders 5-20% 4. Fever 1-5% 5. Animal bites 0.3% *Incidence based on destination, duration of travel, and activities.

7 The Leading Cause of Preventable Death in U.S. Citizens Abroad is.? a. Typhoid Fever b. Malaria c. Hepatitis A d. Injury

8 Teaching Topics to Reduce Health Risks Food & Water Safety Vaccines Malaria Prevention (includes medication options) STIs Medical Evacuation Air Transportation Issues Accident Prevention Personal Safety/S.T.E.P. Animal Avoidance Insect Bite Prevention Sun Protection Extreme Temperatures Altitude Pollution Motion Sickness

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10 Food & Water Safety Boil it, Cook it, Peel it, or Forget it! Fecal/oral contamination cycle. No ice! Only bottled/canned/boiled beverages. Avoid street vendors/buffets. Eat only cooked veggies and fruits that YOU peel. Carry self-treatment Rx for T.D. (Traveler s Diarrhea).

11 Insect Bite Prevention Personal Protective Measures (PPM) Mid-range DEET is best! (keep off the face). Dress in dark colors versus light colors? Permethrin on clothing, hats, nets. Leave perfumes/cologne at home. Day time versus night time biters?

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14 Animal Avoidance Rabies risk is HIGH in most developing countries. Dog bites account for >95% of potential exposures in travelers. In the majority of cases, the traveler initiated contact with the animal. Children at increased risk.

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16 Sexually Transmitted Infections (STI) Vacation travel is often associated with an increase in risky behavior. 5-50% of short-term travelers report sex with a new partner (often without condom). HIV rates at destination can be times greater than in home country.

17 Personal Safety Be aware of advisories: Smart Traveler Enrollment Program (S.T.E.P.) Dress to blend in, not stand out. Leave expensive ornamentation at home. Travel in pairs or groups. Wallet in front pocket/purse strap across shoulder. S mart Traveler Enrollment Program A SERVICE OF THE BUREAU OF CONSULAR AFFAIRS U.S. Department of State

18 Travel Immunizations What might you need? Required (Destination based) Yellow Fever Meningococcal Recommended Hepatitis A Hepatitis B Twinrix (Hep A and Hep B) Typhoid Influenza Polio (Can be required for entry/exit certain destinations) Rabies Japanese Encephalitis UTD Routine immunizations:tdap, MMR, Varicella, etc Routine, Required & Recommended Vaccines

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20 Yellow Fever Vaccine (YF) Geographic Maps of Yellow Fever Risk Required for travel to a country under International Health Regulations (2005) and/or Recommended because of risk during travel to an endemic area. Risk - in parts of Africa and South America. Must be an approved Yellow Fever center to administer the vaccine. Official documentation. WHO CDC International Certificate of Vaccination or Prophylaxis (ICVP) = yellow card. CDC Yellow Book, 2014

21 Meningococcal Vaccine Prevents bacterial meningitis, an airborne pathogen. Meningococcal Vaccine (serotype, A, C, Y, W-135) Routine for adolescents 2 doses. Required for Hajj and Umrah pilgrimage (Saudi Arabia). Recommended for Meningitis Belt - Africa, December to June.

22 Meningitis Belt of Africa Seasonal Outbreaks of Meningitis

23 Recommended Vaccines (Food and Water Borne Illness) Hepatitis A Typhoid Polio *depends on destination country, length of stay, itinerary etc.

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25 Recommended Vaccines for Specific Populations or Destinations Hepatitis B: (Routine for kids, Catch up adults) Hepatitis A & B combined (Twinrix): Rabies: At risk population, Pre exposure 3 doses Japanese Encephalitis: 2 dose series in US. Travel to parts of Asia, usually > 4 weeks, rural, seasonal.

26 MALARIA

27 Malaria Chemoprophylaxis Section II: Medications (Adult) Medication Directions Category Comments Chloroquine (Aralen) 500 mg Once a week Weekly: 1 week before travel, during travel and for 4weeks post Category C May be used in pregnancy Caution G6PD Limited geographic use Atovaquone & Proguanil combo (Malarone) 250/100mg daily Daily: 1-2 days before travel, during travel and 7 days post Category C Contraindicated: pregnancy, lactation, kidney disease Well tolerated Wide geographic range; Can use in young children Mefloquine (Larium) 250 mg Once a week Weekly: 1-2 weeks before travel, during travel and for 4 weeks post Category B Yes in pregnancy Caution : scuba divers, mountain climbers Black Box Warning: CNS and psych effects Some locations with resistance Doxycycline 100mg (Vibramycin) daily Daily: 1-2 days before travel, during travel and for 28 days post Category D Contraindicated in pregnancy, lactation and children under 8 Photosensitivity, Yeast infections, GI side effects

28 Travelers Diarrhea (TD) Medications for Self Treatment Over the Counter (OTC)- antimotility Pepto Bismol tablets Imodium AD Probiotics Antibiotics (Short Term Rx) Azithromycin Ciprofloxacin *see your travel medicine provider/pcp

29 High Altitude Illness Affects 50% of people visiting altitudes greater than 10,000 feet (Cuzco, La Paz). Especially if the ascent is rapid. Acetazolamide (Diamox) Dexamethasone (Decadron) *see your travel medicine provider/pcp

30 Motion Sickness Prevention: Dramamine (OTC), Transderm-Scop (Rx).

31 The Post Travel Visit Who should have it?

32 Who should be seen/evaluated after travel? Persons with unexplained fever People who are sick/have health complaint after travel Long-term travelers to developing countries Close interaction with local population Those with significant chronic disease

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34 Resources How Do I Find a Travel Clinic? Check with hospital, outpatient clinics, public health department and private medical practices. CDC web site: ISTM Web site: asp

35 Resources: The Places You ll Go For More Info! Centers for Disease Control and Prevention. CDC Health Information for International Travel New York: Oxford University Press; (The Yellow Book). CDC Web Site for Travelers Travelers Health International Association for Medical Assistance to Travellers (IAMAT) International Society of Travel Medicine (ISTM) US Department of State: Travel World Health Organization

36 Travel well and be healthy