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TRAVEL MEDICINE Medical insurance Don’t travel without adequate insurance Make sure it covers repatriation In Europe have E 111 as well In 2nd/3rd world countries have IV kit Take your own medicines Death’s abroad 69% CVS MI etc 21% Accidents 4% Infectious diseases Behaviour Drink more Take more risks Unfamiliar surroundings Less supervision of children Immunisation Risks balanced against incidence of disease Risk of japanese encephalitis 1 in 1x10 6th Risk of anaphylaxis due to vaccine 1 in 40,000 Risk of vaccine greater than risk of disease Immunisation Arrange immunisation 8 weeks before travel Up to date advice available from special web site Advice Drink bottled water Avoid ice in drinks Peel or wash fruit and veg Clean teeth with bottled water Be careful where you eat Avoid ice cream Sun Cover up with tightly woven cotton clothes Wear hat with large brim Sit in shade Stay out of sun either side of noon Use high spf and uva protection creams Apply thickly before going out Reapply after swimming Dehydration Drink fluids ++++ Carry water round Add salt to food Malaria 3,500 new cases per year 10 deaths Malaria 50% cases in visiting friends and relatives 19% visitors to UK 16% tourists 11% immigrants 5% expats Diagnosis Must think of it Has the pt malaria Falciparum or one of the others From a chloroquine resistant area Mild Moderate or severe History Travel upto a year Fever with rigors Flu like illness Jaundice Diarrhoea Malaria Signs Fever Splenomegally Investigations Blood films 95% thrombocytopaenia +_ anaemia Wbc normal Prevention B prevent Bites C Compliance with medication A Awareness of risk D Diagnose early Risk Place Activity Travel Length of stay Effectiveness of prophylaxis Countries Africa = Falciparum West Africa v high risk of catching low drug resistance = few deaths East Africa lower risk of catching high drug resistance = large no of deaths India Pakistan Thailand = Vivax Prevention Mosquito nets repair holes Tuck into mattress Impregnated with pyrethroid Prevention Clothing after dark Long trousers Long sleeved shirts/blouses Tuck trousers into socks Prevention Use appropriate insect repellent Close windows if lights on after dusk Use knock down spray or coils Prevention Chemoprophylaxsis Use most effective for country Start 1 week before travelling Continue for 4 weeks after return Away from medical help carry quinine Resistance East Africa Mefloquine 90% protection Proguanil/chloroquine 70% protective ME vs PC Similar nos serious advers effects Similar nos discontinue ME better compliance ME 3x no of neuropsychiatric effects Doxycycline main adverse effect photosensitisation Malarone licensed for 28 days only Remember Risk proportional to length of stay The longer the stay the greater the need to take prophlaxsis Adverse effects occur early on Travellers diarrhoea Tunisia 70% Kenya 50% Egypt 50% Spain 7% Infectious agents Rota virus E coli Campylobacter Salmonella shigella chloera Giardia lamblia Cryptosporidium 50% no cause found Avoidance Wash fruit and veg Drink bottled water No ice cubes in drinks Clean teeth with bottled water No ice cream Be wary of where you eat Hand washing Treatment Fluids only Rehydration salts Antibiotics rarely needed ciprofloxacin Persisting diarrhoea Stool culture Giardia Metronidazole tinidazole Imported infectious diseases Malaria 2000 Hep A 1000 Typhoid 200 Chloera a few Imported fever - causes Malaria 42% Non- specific viral 25% Viral dengue 6% Viral Hep A 3% Investigation of fever Thick and thin blood films FBC Dipstick urine Blood cultures – typhoid CXR Serology – toxoplasma hep A low platelets – malaria dengue