Summary Travel medicine

Travel Medicine

Travel Risks

 Illness – food borne pathogens, endemic diseases, insect bites, trauma,
exacerbation of pre-existing conditions, STIs and respiratory infections
 Death – lack of accessible medical help, sporting activities, extreme
environments, alcohol and being male (4x)

Traveller’s Diarrhoea

 Epidemiology:
 Enteroviruses, ETEC, Salmonella, Campylobacter, Cryptosporidium and Giardia
are common pathogenic causes
 Shigella, S.typhi, V.cholerae and Paratyphi are more severe and common in poor
countires
 Risk:
 More common in poor countries (20-50%)
 Very young, elderly and co-morbidities increases risk
 Transmission:
 Contaminated foods and water
 Inactivated at 60oC
 Other causes change in diet, increased alcohol and hot weather
 Symptoms:
 3 or more liquid stools in 24h with abdo pain, fever or N&V
 Usually first week lasting 3-4 days
 Treatment:
 ORT or 8 teaspoons of sugar, ½ teaspoon of salt in 1L of clean water
 Loperamide – CI in under 12 years and active IBD
 Antibiotics – used in severe or those with comorbidities, Ciprofloxacin 500mg
stat or Azithromycin if resistance Campylobacter
 Medical advice – if don’t improve in a few days, passing blood, high fever, elderly
or immediately for children with these symptoms

First Aid and Sun Protection

 First aid kit:
 Simple – plasters, calamine lotion, sun-cream and EHIC card in Europe
 Comprehensive – sterile with advanced and complete equipment
 Sun related illness:
 Prickly heat – sweat glands blocked treat with 1st gen antihistamines
 Heat exhaustion – heavy sweating, tiredness, headache and N&V more common
in elderly and HT
 Heat stroke – medical emergency
 Sun protection:
 Babies, children and elderly at highest risk
 High SPF and UV rating
 Avoid sun 11am-3pm
 Cover up
 Sunscreen 30mins before exposure and reapply every 4-5h or after water


DVT and PE

,  DVT:
 Symptoms – pain, swelling and heavy feeling
 Usually in calf below knee
 Occurs after long-haul flight
 Reduce risk – stop smoking, healthy weight, stay hydrated, wear loose clothes
and compression stockings
 PE:
 Result of DVT
 Symptoms – chest pain, coughing up blood and loss of consciousness

Vaccination

 Boosters unless CI
 CI:
 Previous anaphylactic reaction (egg protein in yellow fever and influenza)
 Pregnant or immunocompromised
 Acutely unwell

Advise For Pre-existing Conditions

 Inform their insurance company
 Talk to GP about travel
 Carry a doctor’s note and Pxs
 Ensure medication is legal in destination
 DM:
 Can make diagnosis of malaria complicated
 Travelling east shortens the day (reduce food and insulin) and west lengthens
the day (increase food and insulin)
 Adjust medication accordingly and get advice
 Splenectomy:
 Avoid malaria endemic countries as illness more severe if contracted
 Epilepsy:
 Well controlled shouldn’t have an issue
 Limited in malaria prophylaxis as Chloroquine and Mefloquine CI
 Doxycycline half life may be reduced by barbiturates, Carbamazepine and
Phenytoin
 Psychiatric illness:
 Mefloquine CI if history of depression and anxiety
 Immunocompromised:
 Seek further advice on chemo-prophylaxis and immunisation
 P&B:
 Increased risk of several malaria
 Refer to GP
 Chloroquine and Proguanil are safe
 Chloroquine resistance = bite avoidance measures
 Mefloquine is safe in 2nd and 3rd trimester
 5mg folic acid supplement needed with Proguanil
 Doxycycline is CI as secreted in breast milk
 In breastfeeding Mefloquine shouldn’t be taken by both mother and baby
 Liver and renal impairment:
 Similar to immunocompromised
 Refer to a specialist
 CVD: