Risk Consultation and Assessment Please find product Prescribing Information at the end of this presentation UK/VAC/0047/16b Date of preparation: July 2016
The pre-travel risk consultation When to do it? 1 THE OBJECTIVES To identify and reduce the risks to the traveller To provide vaccination advice, chemoprophylaxis advice in the case of malaria, and other advice and measures to minimise travel health risks Ideally 4 8 weeks before the journey Earlier for longterm overseas travel or work Should be carried out even if right before travel Last minute is better than not at all 1. WHO. International travel and health - Medical consultation before travel. Available at http://www.who.int/ith/precautions/medical_consultation/en/. Accessed April 2016. UK/VAC/0047/16b Date of preparation: July 2016
The risk consultation A two-step process Using a broad brush approach for all travellers is no longer acceptable Step 1. Risk assessment Identify potential health risks and travellers who may be at particular risk Step 2. Risk management Provide individual tailored advice and strategies to reduce travel health risks such as the need for disease awareness information, vaccinations, anti-malarial prophylaxis and other appropriate preventative measures UK/VAC/0047/16b Date of preparation: July 2016
Step 1: Risk assessment When doing the risk assessment on the traveller, consider : Traveller s Details Age Gender XX F, M Medical history Immunisation history Activities the traveller may undertake whilst travelling Accommodation & budget UK/VAC/0047/16b Date of preparation: July 2016
Step 2: Risk management Provide tailored risk management advice for the traveller, based upon Step 1 Based upon Step 1, advise on: Vaccination and anti-malarials Traveller s Details Insect repellents Age and XX other preventative Gender F, M measures Medical history Immunisation history Activities the traveller may undertake whilst travelling Accommodation & budget Risk management checklist Medical risks Transport risks Environmental risks Safety risks Food and water-borne risks Vector-borne risks Air-borne risks Sexual health and blood-borne viral risks Skin health Psychological health UK/VAC/0047/16b Date of preparation: July 2016
What to consider when assessing health risks Consider: The likelihood of the traveller acquiring a disease and how serious Based upon this might be for them Step 1, advise Availability on: of prophylactic measures Risk management with consideration checklist of possible side effects and suitability to the traveller Vaccination and Medical risks anti-malarials - Applies to both vaccinations and anti-malarials Associated public health risks if the Transport traveller refuses risks the vaccine Insect repellents and or anti-malarial other preventative Environmental risks measures Medical facilities at destination Safety risks If the traveller has travel insurance Self-treatment during travel, including Food an and assessment water-borne of any risks medical kit contents Vector borne risks If the traveller will be taking any other medication Air-borne risks Sexual health and blood-borne viral risks Skin health Psychological health UK/VAC/0047/16b Date of preparation: July 2016
Medical preparation advice for the traveller Travellers are recommended to carry : Personal Travel Medical Kit including medication for self-treatment of minor illness A letter from their prescribing physician for chronic/repeat prescriptions Note details of any medication you are taking Purchasing the medical kit in the UK is recommended Know when and how to use the contents of the medical kit Adequate travel insurance Adequate supplies of personal medication
Travel insurance advice for travellers 1 All travellers should be advised to have adequate travel insurance The main purpose of travel insurance is to cover individuals for the potentially high cost of medical treatment and repatriation, if they are injured or fall ill abroad Healthcare is not free in most countries Adequate travel insurance 1. Travel Health Pro. Travel Insurance factsheet. Available at http://travelhealthpro.org.uk/travel-insurance-guidance-for-health-professionals/. Accessed April 2016.
ROUTES OF TRANSMISSIONof travel-related disease Air-borne E.g. meningitis, pertussis, diphtheria Oral-faecal route E.g. hepatitis A, cholera, typhoid Vector-borne E.g. malaria, dengue fever, ZIKA Blood-borne E.g. HIV, hepatitis B Sexuallytransmitted E.g. HIV, hepatitis B
Food and water advice for travellers 1 Many illnesses are spread by food and water contaminated with human waste. Travellers should follow advice on food and water hygiene, and ensure good personal hygiene: WASH HANDS After visiting the toilet Before preparing or eating food Diarrhoea is one of the most common health problems experienced by travellers, affecting up to 60% of those travelling to high-risk areas overseas 1. National Travel Health Network and Centre. Food and water hygiene. Feb 2016. Available at http://travelhealthpro.org.uk/food-and-water-hygiene/. Accessed April 2016.
Sexual health advice for travellers 1 Travellers are at risk of contracting many sexually transmitted infections (STIs) and advice should be given to minimise this risk: Hepatitis B is a particular risk when travelling to endemic areas HIV and Hepatitis B can be contracted even if the partner has no symptoms Travellers are also at an increased risk of contracting STIs when: The Zika virus has been shown to be present in semen, though the risk of sexual transmission is thought to be low 2 Using commercial sex workers Having multiple sexual partners Conducting certain sexual practices (such as anal sex) Advise adult travellers about safe sex practices 1 Urge them to take appropriate protection, to use condoms correctly and to check expiry dates 1. Lowry J. Raising awareness of the risk of sexually transmitted infection among overseas travellers. Nurs Times 2010; 106(8):20-2. 2. Public Health England. Zika virus: updated travel advice for pregnant women. Available at https://www.gov.uk/government/news/zika-virus-updated-travel-advice-for-pregnantwomen. Accessed April 2016.
Travellers needing special consideration Some travellers require careful consideration throughout the risk assessment Infants and young children The elderly Those with underlying medical conditions Pregnant and breastfeeding women Those visiting friends and relatives (VFR)
Infants and young children Good planning is necessary when flying and travelling with infants or young children. Provide the following information and guidance for parents and guardians: They are sensitive to sudden changes in altitude and UV radiation They have special requirements with regard to vaccination and anti-malarials They become dehydrated more easily They are at an increased risk of sunburn and accidents They are more susceptible to infections Children should be made aware of hygiene and taught to wash hands Air travel is inadvisable for infants < 48 hours old and premature infants
Elderly travellers They are more susceptible to respiratory infections and related complications It is advisable to see elderly travellers in good time before their departure date to guide them through protecting their health They are at an increased risk of complications resulting from gastrointestinal illness They are more likely to have pre-existing medical conditions They are at an increased risk of accidents They are less adept at adapting to different environments They are at an increased risk of sun damage and its consequences They are at an increased risk of adverse events following yellow fever vaccination
Travellers with underlying medical conditions This group of travellers are strongly advised to consult a healthcare professional well in advance of travel to ensure that medical requirements are met. Provide the following guidance for this group: Carry all necessary medication in carry-on luggage for the entire duration of the journey Ensure there is sufficient medication to cover the entire travel period Obtain a physician s letter certifying the necessity for medication
Pregnant travellers 1 Against travelling to certain areas, such as those with endemic disease e.g. Zika virus With careful preparation, most pregnant women are able to travel without experiencing health problems. Pregnant women should be advised: Against travelling to high altitudes over 3,500m or to remote areas On the right time to travel Air travel should be restricted in late pregnancy For travel over four hours, pregnant women should mobilise their legs at regular intervals and wear compression socks On specific recommendations for use of anti-malarials during pregnancy Pregnant women with a complicated obstetric history, a newly diagnosed medical condition, or a high-risk pregnancy require individual guidance and may be advised against non-essential travel 1. NaTHNac, Travel Health Pro Factsheet - Pregnancy. Available at http://travelhealthpro.org.uk/pregnancy/. Accessed April 2016.
Travellers visiting friends and relatives 1,2 VFRs refers to migrants (first or subsequent generation) who have settled in the UK, and who travel overseas to visit friends or relatives in their country of origin The risk of travel related infectious disease is disproportionately higher in VFR travellers Why are VFRs at an increased risk? Usually travel for longer periods of time Believe their risk to be low as the destination is familiar to them Stay with families or friends so become part of the community. Results in a different risk profile to tourist travellers Don t always seek travel health advice and may not adhere to advice May mistakenly believe they are immune to diseases Health professionals should adopt a proactive approach to advising this group and enquire about travel plans during any routine consultations with them 1. Public Health England. Health protection guidance. Travel to visit friends and relatives: migrant health guide. https://www.gov.uk/guidance/travel-to-visit-friends-and-relatives-migrant-healthguide. Accessed April 2016. 2. Public Health England. Migrant information guide on VFRs. Available at http://www.hpa.org.uk/migranthealthguide/healthtopics/infectiousdiseases/traveltovisitfriendsandrelatives/visitingfriendsandrelatives. Accessed April 2016.
Vaccination compliance Other illnesses memory, visual acuity, allergies, mobility problems Cultural beliefs, language difficulties Physician s perception of risk Age Complexity of regimen Traveller s perception of risk Cost Clinical setting Lack of family/social support Availability of travel health services Past experience Needle Phobia Time
The traveller s vaccination record Each traveller should be given a written record of any vaccinations administered The record can be used to remind patients about any booster or future doses that may be required Advise the traveller to keep documentation safe and take it to future travel health consultations
Disease education series for HCPs on travel health Learn about the following diseases and the types of vaccinations available for travellers Malaria Typhoid Hepatitis B Hepatitis A Rabies Meningococcal Disease ACWY