1 UNITED STATES TRAVELERS 1) 25 Million each year 2) 5 Million to developing nations a) ¼ - ½ get...
-
Upload
anthony-gallegos -
Category
Documents
-
view
219 -
download
1
Transcript of 1 UNITED STATES TRAVELERS 1) 25 Million each year 2) 5 Million to developing nations a) ¼ - ½ get...
1
UNITED STATES TRAVELERS
1) 25 Million each year
2) 5 Million to developing nationsa) ¼ - ½ get some illness (2.5 million)
b) 1/100 – 1/1000 get serious illness (25,000 – 250,000) – malaria and filariasis
2
SCOPE OF THE TRAVEL INDUSTRY
1. A trillion dollar industry
2. Over 7 million jobs
3. In developing nations, often the major
source of foreign currency
3
DEFINITION OF A TRAVELER
Someone who goes from an area of the world slightly fecally contaminated to an area where contamination is moderate to severe.
4
THE FECAL VENEER
5
International TravelMay be Required: Yellow Fever Cholera
May be Recommended: Typhoid Plague Measles Polio Rabies Hepatitis A Hepatitis B
6
Required Immunizations for Travel
A. Yellow Fever- Every 10 years for travel to areas infected with yellow fever and to rural areas endemic for yellow fever –equatorial SouthAmerica and Africa.
B. Cholera- New serotype Vibrio cholera 0139 now affecting Indian
subcontinent and Asia. For most travelers, risk remains low.- no country now requires vaccination for direct travel from
the United States.- no vaccine will protect against V. cholerae 0139.
7
Yellow Fever
Attenuated live virus vaccine Administered at designated centers Only one injection required Protection afforded for 10 years Areas of risk: Equatorial Africa, Central and
South America
8
Cholera Vaccines
Inactivated, parenteral
- poorly protective (50%) for only a few months
- uncomfortable side effects
- rarely recommended
Experimental
A. Inactivated oral vaccine-Whole cell (WC) and B subunit/whole cell (BS/WC)
B. Attenuated, live oral vaccine-CVD 103-HgR
9
CHOLERA
Vaccine of limited usefulness Risk to U.S. travelers is low (10 cases since
1961, 7 had been vaccinated) Indicated if passing through endemic regions One injection meets international
requirements Full series of 3 shots for select patients Boosters may be required every 6 months
10
Polio
The Americas have now (9/29/94) been declared polio-free!
A. Inactivated, parenteral – enhanced (elPV)- should be used in adults (≥ 18 yrs) never previously
immunized
B. Attenuated, live oral – OPV- can be used to boost previously immunized adults
- risk of paralysis 1/1.4 million with first dose;
1/41,500,000 in previously immunized
11
The Global Effort to Eradicate Polio by 2000 Before vaccines, 500,000 people a year were
paralyzed or died from contracting polio.
In 1996, 400 million children were vaccinated against polio.
Since 1988, cases of polio have dropped 90 percent.
12
TYPHOID
• Attenuated, live oral-Ty 21a mutant of S. Typhi (Vivotif Berna)
- well tolerated, 60-70% effective
• Inactivated, parenteral-Vi polysaccharide of S. Typhi (Typhim Vi)
- well tolerated, 64-72% effective, single dose
13
Japanese B Encephalitis
Consider travel for > 1 month in rural areas (particularly with rice and pig farming) in Far East
Adverse reactions include local in≈20% and systemic in 10%
Hypersensitivity reactions in 0.01% to 1% which may occur after any dose and be delayed up to 10 days
In passive surveillance by Connaught, none of these reactions have been reported in 200,000 doses distributed
14
TETANUS & DIPHTHERIA
EVERYONE SHOULD RECEIVE A PRIMARY SERIES
TETANUS-DIPHTHERIA TOXOID BOOSTER IS INDICATED EVERY 10 YEARS
TdAP
15
MMR
1) Live attenuated measles, mumps, rubella
2) Two dose regimen
3) Avoid Gamma Globulin
16
OTHER VACCINES
Hepatitis A – most common in developing world
Hepatitis B
Meningococcal
Rabies
17
Uncommon or Unavailable Vaccines
1) Smallpox
2) Typhus
3) Anthrax
4) BCG
18
Resurgence of Malaria
Risk in over 100 countries 300 million cases with 3 million deaths
annually Major problem in Africa and Oceania Marked increase in drug resistance Deaths from malaria each year = those from
AIDS in the past decade
19
MALARIA
1. Prevention-mosquito control
2. Prophylaxis-depends on geography
3. Therapy-two principles
A. Decrease parasite load
B. Then eradicate parasite
20
PLASMODIA
1) Falciparum-malignant
2) Vivax-has liver phase
3) Ovale-has liver phase
4) Malariae-chronic
21
MALARIA-CLINICAL
1) Fever, chills, ha, myalgias, nausea
2) Diarrhea, abdominal pain, fatigue, confusion
3) Fevers become cyclic
4) Complications-DIC, splenic rupture, anemia
22
MOSQUITO PROTECTION
1. DEET
2. Appropriate Clothing
3. Permethrin
4. Screens
23
ANOPHELES MOSQUITO
1) Silent
2) Night Biting
3) Female
24
Table 1. Drugs used in the prophylaxis of malaria
Drug Adult DoseChloroquine 300 mg base (500 mg salt)phosphate orally, once/week (Aralen*)
Hydroxychloroquine 310 mg base (400 mg salt)sulfate orally, once/week (Plaquenil*)
Malarone 250 mg Atovoquone/100 mg Proguanil, daily
Mefloquine 228 mg base (250 mg salt)(Lariam*) orally, once/week
Doxycycline 100 mg orally, once/day
Primaquine 15 mg base (26.3 mg salt) orally,_______________________________________________________________________________
The dose (250 mg for an adult) should be taken once each week for 4 weeks, followed by one dose everyother week
25
HYGIENE ABROAD
a) Water Acquisition
b) Other Beverages
c) Food Precautions
d) Restaurant Evaluation
26
Travelers Diarrhea – The Litany
Aztec Two Step-Delhi Belly-Rome Runs
La Turista-Greek Gallop-Sumatra Spurts
Hong Kong Dog-Turkey Trots
Cairo Crud-Montezuma’s Revenge
27
Etiology of Travelers’ Diarrhea
1. E. Coli 50%
2. Shigella/Salmonella 10%
3. Campylobacter 8%
4. Viral 10%
5. Parasites 2%
6. Unknown 20%
28
Infectious Doses of Enteric PathogensShigella 10-100
Campylobacter 1000-100,000
Salmonella 100,000
E. Coli 100 million
Cholera 100 million
Giardia 10-100
Amoebas 10-1000
29
Travelers’ Diarrhea Precautions
1. Water Precautions
2. Food Precautions
3. Common Sense
30
Water Precautions:Avoid
1. Tap water if not treated2. Ice cubes3. Fresh milk4. Bottled water with broken seal
Safe1. Bottled H²O, seal intact2. Water at facility w/purifier3. Soft drinks4. Beer & wine5. Coffee & tea if H²O boiled
31
Water Precautions (2)
- Alcohol will not disinfect water- Be leery of how glassware, dishes & utensils
have been handled and washed- Don’t gargle or brush your teeth with water
you wouldn’t drink- If in doubt, draw a glass of HOT water and let
it cool, having passed through a hot water heater, it will be pasteurized
32
FOOD PRECAUTIONS
Safe:
Meat and fish dishes well done & eaten hot.
Vegetables that are thoroughly cooked.
Nuts, fruits & vegetables to be peeled, shelled or skinned if purchased intact with no breaks in shell or skin.
Chinese restaurants enjoy a reputation of serving safe tasty food worldwide.
33
FOOD PRECAUTIONS
Avoid:
Raw eggs Steak tartare
Raw meats Undercooked meats
Cold Platters Custards
Pastries Raw vegetables
Salads Dairy products
Raw shellfish Certain seafood
34
RESTAURANT GUIDE
Presence of window and door screens
State of trash containment
Status of the Restrooms
Presence of roaches & flies
Chinese restaurants
35
TRAVELERS’ DIARRHEA SYMPTOMATIC TREATMENT
1) Dietary restrictions
2) Pepto Bismol
3) Immodium
4) Lomotil
5) Lactobacillus
36
Oral Therapy for Acute Diarrhea Developed in 1950’s-Glucose and electrolytes
Misconception about hypernatremia
1960’s-Coupled transport of sodium and glucose
Clinical studies with cholera showed efficacy
Subsequent studies worldwide
37
TRAVELERS’ DIARRHEA PROPHYLAXIS
1) Generally not advised
2) Short trips only
3) Complications
4) Resistant organisms
38
TRAVELERS’ DIARRHEA PROPHYLAXIS
1) Pepto Bismol
2) Antibiotics
a) Quinolones
b) Rifaximin
39
EARLY TREATMENT OF TRAVELER’S DIARRHEA
1) Effective and proven
2) Short course – 3 Days
3) Pepto Bismol – Less effective
4) Antibiotics
a) Quinolones
b) Rifaximin
c) Azithromicin
40
Special Risks of Travel
1) Motor vehicle accidents
2) Motion sickness
3) High altitude
4) Bites/stings/sun
5) Jet lag
41
ACUTE MOUNTAIN SICKNESS HEADACHE WEAKNESS & LASSITUDE GI DISTRESS DIZZINESS SHORTNESS OF BREATH ANOREXIA DISTURBED SLEEP
42
OTHER INFECTIOUS DISEASE RISKSa) STD’s
b) HIV
c) Schistosomiasis
d) Lepto-spirosis’
e) Dengue
f) Plague
g) Sleeping sickness
h) Parasites