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TM: Travel Medicine (i) (Killed/Inactivated vaccines (toxoids (diphtheria)…
TM: Travel Medicine (i)
Causes of death in travellers
CVD
Unintentional injury
medical
cancer
others/unkown
suicide/homocide
infectious disease
Intro
infection from: food, humans (STIs), zoonoses, environment
environmental problems from: sun, heat, cold, altitude (good for patient to be aware if they are planning to climb), marine, humidity, hygiene + sanitation, poor medical facilities, clean water scarcity, transportation
trauma from RTAs
common: travellers' diarrhoea, malaria, influenza A/B, dengue, Hep A, typhoid
info required from travellers
countries to be visited
type + style of travel
length of stay
rural vs urban
age
current health
PMH
vaccination hx
vaccine/malaria prophylaxis contraindications
psychological hx
immunosuppression
epilepsy
allergies
antibiotics
vaccine ingredients (egg, aluminium, thiomersal)
lots of travel info available, e.g. WHO, CDC
pre-travel consult
immunisations
malaria prevention
insect precautions
food + water precautions
STIs
environmental risks
travellers with special needs
advice for self tx
continue interrupted or incomplete vaccine courses as it interval had not occurred
several vaccines can be given on same day (different sites)
Live vaccines
OPV sabin (oral polio)
yellow fever
oral typhoid
BCG
MMR
varicella
contraindications
pregnancy
allergies
immunosuppression
if patient on biologic agents: recommend them not to travel
HIV = relative contraindication (you can give if viral load undetectable)
can give live vaccines together or 3 wks apart
avoid oral typhoid + oral polio simultaneously
Killed/Inactivated vaccines
conjugated vaccines
genetically engineered vaccines
toxoids
diphtheria
Hib
Hep A+B
Japanese B encephalitis
Polio salk
meningococcal meningitis (ACWY mandatory for Hajj in Saudi Arabia
typhoid
tickborne encephalitis
tetanus
rabies
influenza
Vaccine contraindications
acute febrile illness
hx of severe local or general reaction to a previous dose of the same vaccine
local
extensive area of redness + swelling that becomes infiltrated
involves most of anterograde-lat surface of thigh/arm involved
general
fever >/= 88.5 within 48hrs of vaccine
anaphylaxis
broncho/laryngeal spasm / general collapse (esp in children)
travel vaccines
update routine vaccinations
consider vaccination for travel to countries with poor hygiene
typhoid
hep A
if travelling outside NW Europe, N America, Japan, Australia + New Zealand
consider geographical requirements
consider compulsory vaccines
consider vaccines for special risks
routine vaccines
update polio + tetanus
consider diphtheria booster
age 15
long term voluntary work
travelling to old USSR incl ukraine + baltic states
influenza
pneumococcal
meningococcal
MMR
Hep B
Typhoid (salmonella typhi) vaccines
polysacc Vi vaccine
inactivated
low incidence of SEs
efficacy 80%
lasts 3 yrs
oral typhoid
live
low incidence of SEs
efficacy 80%
lasts 1 yr unless resident in epidemic area
not for children under 6