Pre- Travel Case Studies (*with Key Pads)

Transcription

1 Pre- Travel Case Studies (*with Key Pads) Judi Piasecki, RN, BN Dana Male, RN, BN Pam White RN, BN Certificate in Travel Health

2 A. Which year was the first Manitoba Travel Health Conference?

3 A. Which year was the first Manitoba Travel Health Conference?

4 B. A 60 year old client travelling to Kenya on safari for 2 weeks states he has tried Mefloquine in the past with no problems but has since started taking Paxil. He indicates as well, he has a history of febrile seizures as a child. What would you recommend for malaria prophylaxis? 1. Doxycycline 2. Malarone 3. Chloroquine 4. Mefloquine 5. Doxycycline or Malarone

5 B. A 60 year old client travelling to Kenya on safari for 2 weeks states he has tried Mefloquine in the past with no problems but has since started taking Paxil. He indicates as well, he has a history of febrile seizures as a child. What would you recommend for malaria prophylaxis? 1. Doxycycline 2. Malarone 3. Chloroquine 4. Mefloquine 5. Doxycycline or Malarone

6 C. A 33 year old client travelled to Tanzania. Two weeks after returning to Canada she developed a fever of 39 degrees Celsius and diarrhea. What would you advise? 1. Take Imodium; increase fluids and rest, as it s most likely a food borne illness and is self-limiting. 2. Take Imodium and Ciprofloxacin 3. Seek immediate medical attention and ask for malaria testing. 4. Stop taking anti-malarial medications, as fever is a common side effect.

7 C. A 33 year old client travelled to Tanzania. Two weeks after returning to Canada she developed a fever of 39 degrees Celsius and diarrhea. What would you advise? 1. Take Imodium; increase fluids and rest, as it s most likely a food borne illness and is self-limiting. 2. Take Imodium and Ciprofloxacin 3. Seek immediate medical attention and ask for malaria testing. 4. Stop taking anti-malarial medications, as fever is a common side effect.

8 D. A mother, born in 1976, is travelling in 2 weeks to Nigeria for one month with her 3 year old son and 7 month old daughter. Their immunization records show the mom and son have both had one dose of MMR vaccine. What would you recommend with regards to MMR vaccine? 1. A second MMR for the son and mother. The infant is too young to receive MMR. 2. A second MMR for the son and mother. Infant should receive an early MMR now, as well as 2 doses after her first birthday. 3. Offer no further MMRs to the mom and son, as one each is sufficient according to CIG. 4. A second MMR for the mom only, as both children are too young for their appropriate dose.

9 D. A mother, born in 1976, is travelling in 2 weeks to Nigeria for one month with her 3 year old son and 7 month old daughter. Their immunization records show the mom and son have both had one dose of MMR vaccine. What would you recommend with regards to MMR vaccine? 1. A second MMR for the son and mother. The infant is too young to receive MMR. 2. A second MMR for the son and mother. Infant should receive an early MMR now, as well as 2 doses after her first birthday. 3. Offer no further MMRs to the mom and son, as one each is sufficient according to CIG. 4. A second MMR for the mom only, as both children are too young for their appropriate dose.

10 E. Yellow fever is also a risk in Nigeria. What would your recommendations be for this family, regarding yellow fever vaccine? 1. The mom, son and daughter should receive the yellow fever vaccine and MMR on the same day, anytime before departure. 2. The mom, son, and daughter should receive the yellow fever vaccine and MMR on the same day, at least 10 days before departure. 3. While both vaccines need to be given to all three, the timing of the vaccines in relation to each other is not important, as long as the yellow fever vaccine is given at least 10 days before departure. 4. The mom and son should receive the yellow fever vaccine with the MMR, at least 10 days before departure. The infant is too young to receive yellow fever vaccine.

11 E. Yellow fever is also a risk in Nigeria. What would your recommendations be for this family, regarding yellow fever vaccine? 1. The mom, son and daughter should receive the yellow fever vaccine and MMR on the same day, anytime before departure. 2. The mom, son, and daughter should receive the yellow fever vaccine and MMR on the same day, at least 10 days before departure. 3. While both vaccines need to be given to all three, the timing of the vaccines in relation to each other is not important, as long as the yellow fever vaccine is given at least 10 days before departure. 4. The mom and son should receive the yellow fever vaccine with the MMR, at least 10 days before departure. The infant is too young to receive yellow fever vaccine.

12 F. A 25 year old client received two doses of Twinrix vaccine 5 years ago. He is now travelling to Vietnam for three weeks. What would you recommend? 1. Give the third dose of Twinrix now, as you never have to restart a vaccination series. 2. Start the series over again because the protection from the two doses 5 years ago is no longer valid. 3. Just recommend hepatitis A vaccine, as you are not concerned about hepatitis B risk in Vietnam. 4. Do serology to assess for immunity. If hep A IgG is positive and anti HBs > 10 IU/ml, he is protected and does not need another dose.

13 F. A 25 year old client received two doses of Twinrix vaccine 5 years ago. He is now travelling to Vietnam for three weeks. What would you recommend? 1. Give the third dose of Twinrix now, as you never have to restart a vaccination series. 2. Start the series over again because the protection from the two doses 5 years ago is no longer valid. 3. Just recommend hepatitis A vaccine, as you are not concerned about hepatitis B risk in Vietnam. 4. Do serology to assess for immunity. If hep A IgG is positive and anti HBs > 10 IU/ml, he is protected and does not need another dose.

14 G. A twenty-three year old client is travelling to South Africa in March for one month but will be stopping in Uganda for a four day safari. Which meningococcal meningitis vaccine would you recommend? 1. Menjugate C 2. Menomune 3. Menactra 4. None of the above

15 G. A twenty-three year old client is travelling to South Africa in March for one month but will be stopping in Uganda for a four day safari. Which meningococcal meningitis vaccine would you recommend? 1. Menjugate C 2. Menomune 3. Menactra 4. None of the above

16 Meningococcal Meningitis Belt

17 Countries in the African Meningitis Belt (Endemic Countries) (Most recent outbreak date included) Benin (2008) Cote d Ivoire (2008) Gambia (2002) Niger (2009) Sudan (2008) Burkina Faso (2009) Eritrea, western Guinea (2008) Nigeria, northern (2009) Togo (2008) Cameroon, northern (2007) Ethiopia (2008) Guinea Bissau Senegal (2002) Chad (2009) Ghana (2008) Mali (2009) Somalia (2002) Countries outside the meningitis belt in which epidemics have been reported in the last 2-3 years (Most recent outbreak date included) Central African Republic (2008) Democratic Republic of Congo (2008) Uganda (2009)

18 H. It is September and your 54 year old client with a history of GBS is travelling to Saudi Arabia for 4 weeks in November for the Hajj. Which would you recommend? 1. Tdp, MMR, Typhoid, Menactra, Twinrix and Chloroquine. 2. Tdp, Typhoid, Menomune, Twinrix and a first-line antimalarial drug. 3. Td, Typhoid, Menomune, Twinrix and a first-line antimalarial drug 4. Td, Typhoid, Menomune, Twinrix and Yellow fever

19 H. It is September and your 54 year old client with a history of GBS is travelling to Saudi Arabia for 4 weeks in November for the Hajj. Which would you recommend? 1. Tdp, MMR, Typhoid, Menactra, Twinrix and Chloroquine. 2. Tdp, Typhoid, Menomune, Twinrix and a first-line antimalarial drug. 3. Td, Typhoid, Menomune, Twinrix and a first-line anti-malarial drug 4. Td, Typhoid, Menomune, Twinrix and Yellow fever

20 Countries in the African Meningitis Belt (Endemic Countries) (Most recent outbreak date included) Benin (2008) Cote d Ivoire (2008) Gambia (2002) Niger (2009) Sudan (2008) Burkina Faso (2009) Eritrea, western Guinea (2008) Nigeria, northern (2009) Togo (2008) Cameroon, northern (2007) Ethiopia (2008) Guinea Bissau Senegal (2002) Chad (2009) Ghana (2008) Mali (2009) Somalia (2002) Countries outside the meningitis belt in which epidemics have been reported in the last 2-3 years (Most recent outbreak date included) Central African Republic (2008) Democratic Republic of Congo (2008) Uganda (2009) Special Consideration Saudi Arabia Upcoming Dates of the Hajj: Nov 25-28, 2009 Nov 14 17, 2010 Nov 4 7, 2011 Proof of meningococcal meningitis immunization with the quadrivalent vaccine (serogroups A, C, Y, W-135) is required by the local authorities as a condition of entry for arrivals coming to the Umrah or Hajj.

21 I. Travellers who take proton pump inhibitors (e.g., Losec, Prevacid), or H2 receptor antagonists (e.g., Ranitidine) are at increased risk for 1. Travellers diarrhea 2. Typhoid fever 3. Meningococcal meningitis 4. Malaria 5. Travellers diarrhea and Typhoid fever

22 I. Travellers who take proton pump inhibitors (e.g., Losec, Prevacid), or H2 receptor antagonists (e.g., Ranitidine) are at increased risk for 1. Travellers diarrhea 2. Typhoid fever 3. Meningococcal meningitis 4. Malaria 5. Travellers diarrhea and Typhoid fever

23 J. If the above patient was also taking a course of antibiotics, which type of typhoid fever vaccine would you recommend? 1. Oral 2. Injectable 3. Either Oral or Injectable

24 J. If the above patient was also taking a course of antibiotics, which type of typhoid fever vaccine would you recommend? 1. Oral 2. Injectable 3. Either Oral or Injectable

25 Algorithm For Oral Typhoid Vaccine and Antibiotic Use Long acting Antibiotic 7 days Before First Dose Oral After Last Dose Short Acting Antibiotic 48 hours typhoid (liquid or 24 hours Antibiotic Malaria pills 8 hours capsules) Ty21a 10 days Malarone Dukoral 8 hours 8 hours Dukoral

26 K. Your patient is travelling to a rural border area in Northwest Thailand for 2 months in June. Which of the following infections are you most concerned about? 1. Yellow Fever 2. Japanese Encephalitis 3. Malaria 4. Japanese Encephalitis and Malaria

27 K. Your patient is travelling to a rural border area in Northwest Thailand for 2 months in June. Which of the following infections are you most concerned about? 1. Yellow Fever 2. Japanese Encephalitis 3. Malaria 4. Japanese Encephalitis and Malaria

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29 L. Where is Schistosomiasis not a concern? 1. Central America 2. Africa 3. South, East, and Southeast Asia 4. Northeastern South America 5. None of the above

30 L. Where is Schistosomiasis not a concern? 1. Central America 2. Africa 3. South, East, and Southeast Asia 4. Northeastern South America 5. None of the above

31 M. In your pre-travel counselling, which disease would you be teaching about with the following symptoms: fever, chills, headache, nausea, vomiting, pain in your joints that may last for months, rash, lethargy and lower back pain? 1. Malaria 2. Chikungunya 3. Dengue Fever 4. Japanese Encephalitis

32 M. In your pre-travel counselling, which disease would you be teaching about with the following symptoms: fever, chills, headache, nausea, vomiting, pain in your joints that may last for months, rash, lethargy and lower back pain? 1. Malaria 2. Chikungunya 3. Dengue Fever 4. Japanese Encephalitis

33 N. A 30 year old male with Addison s Disease is travelling to Paraguay. He is on Hydrocortisone 300 mg OD and Fludrocortisone 0.15 mg OD. He is in need of Yellow Fever vaccine and MMR. You would: 1. Give him the yellow fever and MMR vaccines. 2. Not give either vaccine (and offer him a Certificate of Medical Contraindication for yellow fever) as he is immunocompromised.

34 N. A 30 year old male with Addison s Disease is travelling to Paraguay. He is on Hydrocortisone 300 mg OD and Fludrocortisone 0.15 mg OD. He is in need of Yellow Fever vaccine and MMR. You would: 1. Give him the yellow fever and MMR vaccines. 2. Not give either vaccine (and offer him a Certificate of Medical Contraindication for yellow fever) as he is immunocompromised.

35 O. Which statement is true about the asplenic traveller? 1. They should avoid receiving live viral vaccines 2. They should be offered immunization against Haemophilus Influenzae type b (Hib), meningococcal meningitis, and pneumococcal pneumonia, regardless of travel 3. They should be discouraged from travelling to areas where babesiosis is a risk 4. Two & Three

36 O. Which statement is true about the asplenic traveller? 1. They should avoid receiving live viral vaccines 2. They should be offered immunization against Haemophilus Influenzae type b (Hib), meningococcal meningitis, and pneumococcal pneumonia, regardless of travel 3. They should be discouraged from travelling to areas where babesiosis is a risk 4. Two & three

37 P. An individual with a mild Sulfa allergy is flying from Lima, Peru, to La Paz, Bolivia (elevation 3658 m). Which of the following is appropriate advice regarding prevention of acute mountain sickness? 1. See a physician for a prescription for Diamox 2. Rest and acclimatize for a few days while at altitude 3. Drink lots of fluids 4. All of the above

38 P. An individual with a mild Sulfa allergy is flying from Lima, Peru, to La Paz, Bolivia (elevation 3658 m). Which of the following is appropriate advice regarding prevention of acute mountain sickness? 1. See a physician for a prescription for Diamox 2. Rest and acclimatize for a few days while at altitude 3. Drink lots of fluids 4. All of the above