Post travel health consultation
Download
1 / 37

Post-Travel Health Consultation - PowerPoint PPT Presentation


  • 296 Views
  • Updated On :

Post-Travel Health Consultation. Dr Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM Associate Professor School of Public Health and Tropical Medicine James Cook University & Visiting Professor School of Public Health University of the Witwatersrand. About the author.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Post-Travel Health Consultation' - LeeJohn


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Post travel health consultation l.jpg

Post-Travel Health Consultation

Dr Peter A. Leggat

MD, PhD, DrPH, FAFPHM, FACTM, FFTM

Associate Professor

School of Public Health and Tropical Medicine

James Cook University &

Visiting Professor

School of Public Health

University of the Witwatersrand


About the author l.jpg
About the author

  • Dr Peter Leggat has co-ordinated the Australian postgraduate course in travel medicine since 1993. He has also been on the faculty of the South African travel medicine course, conducted since 2000, and the Worldwise New Zealand Travel Health update programs since 1998. Dr Leggat has assisted in the development of travel medicine programs in several countries and also the Certificate of Knowledge examination for the International Society of Travel Medicine.


Objectives of the session l.jpg
Objectives of the session

  • Review statistics

  • Briefly review the sorts of problems travelers have abroad

  • Examine why it may be important to see travelers if they are unwell on return and what policies may be applicable in practice

  • Document some important aspects of the post-travel history and examination


Some references l.jpg
Some References

  • Steffen et al. Manual of Travel Medicine and Health. Decker, 2003 Sec 4.

  • Leggat et al. Primer of Travel Medicine. ACTM Publications, 2002 Ch. 19.


Slide5 l.jpg

The Continuum of Travel Medicine

Preventive Medicine

Pre-Travel

Visitors

ContingencyPlanning

During Travel

Treatment & Rehabilitation

Post-Travel


The good news l.jpg
The Good News

  • Most travelers report no major problems whilst travelling and most are asymptomatic on return



Swiss travelers l.jpg
Swiss Travelers

  • 15-50% of travelers to developing countries report some illness or injury

  • 8% in the study of 10,000 Swiss travelers consulted a medical officer

  • 1% required hospitalization and 3% had time off work


Insured australian travelers l.jpg
Insured Australian travelers*

  • Approx 20,000 policies issued each year (incl. Exec. Gold)

  • About 1600 claims (8%)

  • 400 claims for emergency assistance (2%)

  • 80 ER or clinic referrals (0.4%)

  • 46 Hospital admissions (0.2%)

  • 10 Aeromedical evacuations (0.05%)

*Leggat et al (2005) Emergency assistance provided abroad to insured travellers from Australia. Travel Med Inf Dis 3: 9-17


Common things occur commonly l.jpg
Common things occur commonly

  • Gastrointestinal-diarrhoeal diseases effecting 20-40% or more of short term travelers

  • Respiratory tract infection

  • Cutaneous infections

  • Trauma and injuries (accidents- commonest cause of preventable death)

  • Sexually transmitted infections

  • Dental problems

  • Others (remember malaria)


Post travel consultation l.jpg
Post-Travel Consultation

  • Many travel related problems are self-limiting

  • Why might it be important to see travelers who have an illness post-travel?


The traveler may have a life threatening infections l.jpg
The traveler may have a life threatening infections

  • Malaria due to P. Falciparum

  • Viral hepatitis

  • Typhoid

  • Amoebiasis/Amoebic liver abscess

  • Legionnaire’s disease

  • Melioidosis

  • Rabies

  • Others


Travelers may have infections that pose a risk to public health l.jpg
Travelers may have infections that pose a risk to public health

  • Dengue (2-5 days)

  • Lassa, Ebola and others (3-21 days)

  • Japanese Encephalitis (3-7 days)

  • Yellow fever (3-6 days)

  • Typhoid (1-2 days)

  • Malaria (Pv-10 days to year-relapses; Pf 10-28 days)

  • SARS (2-10 days)

  • Others


It is important to develop policies in travel medicine l.jpg
It is important to develop policies in travel medicine health

  • Policy and procedures, including

    • Policy of follow-up of travelers

    • Policy on notifiable diseases

    • Policy on reporting adverse reactions

    • Policy on “eradication” treatment


Policy on follow up of travelers l.jpg
Policy on follow-up of travelers health

Do you see travellers

  • Symptomatic on return?

  • Symptomatic whilst aboard?

  • Asymptomatic abroad and asymptomatic now?

  • To complete immunization courses?


It is important that the clinic have a written policy l.jpg
It is important that the clinic have a written policy health

  • It is essential that travellers who become ill on return seek medical attention as soon as possible

  • The traveller should be advised to inform the clinic that they have been or are currently traveling

  • It is also important to ask if patients: “Have you been traveling recently?”


Policy on reporting notifiable diseases and adverse reaction l.jpg
Policy on reporting notifiable diseases and adverse reaction health

  • Is it a notifiable disease? Early liaison concerning suspected cases and formal notification to public health units

  • Keep a list of notifiable diseases and reporting forms

  • Document and report any possible serious adverse reactions to immunisations and chemoprophylaxic and other medications experienced by traveller whilst abroad

  • Is the traveler part of a clinical trial?


Slide18 l.jpg
Travel medicine has assumed a major role in monitoring global trends in infectious disease, especially emerging infectious diseases


Travel medicine networks l.jpg
Travel medicine networks global trends in infectious disease, especially emerging infectious diseases

  • GeoSentinel (ISTM/CDC)

    • May provide early warning of outbreak amongst travelers returning to disparate locations

  • TropNet Europ

  • WHO

  • Local networks

  • Other networks


Eradication policy l.jpg
Eradication Policy global trends in infectious disease, especially emerging infectious diseases

  • Do you prescribe empiric “eradication” treatment?

  • If so, what groups of travelers?


Eradication treatment l.jpg
Eradication “Treatment” global trends in infectious disease, especially emerging infectious diseases

  • Malaria - primaquine (check G6PD deficiency), (tafenoquine)

  • Deworming agent for soil transmitted “roundworms” (consider strongyloides)

  • Deworming agent for “flatworms”- praziquantel

  • Deworming agent for filariasis - albendazole

  • Antiprotozoal agent - giardiasis

  • Others (?)


Groups where eradication treatment may be considered l.jpg
Groups where eradication treatment may be considered global trends in infectious disease, especially emerging infectious diseases

  • Medium to long term travelers or overseas workers

  • Those travellers at high risk of infection

  • Those where diagnosis suggestive but investigations inconclusive

  • Where required by authorities-refugees

  • Even when on preventive measures!


Occasionally preventive measures do fail l.jpg
Occasionally preventive measures do fail global trends in infectious disease, especially emerging infectious diseases

  • Immunizations and chemoprophylactic agents and personal protective measures are not 100% protective

  • Variable compliance with preventive advice

  • Incorrect/insufficient advice/health intelligence


Post travel consultation24 l.jpg
Post-travel Consultation global trends in infectious disease, especially emerging infectious diseases

  • History

  • Examination

  • Investigations


Screening history l.jpg
Screening History global trends in infectious disease, especially emerging infectious diseases

  • Are they symptomatic now or have been?

  • Risk assessment - leading to specific history of possible exposures, e.g. schistosomiasis, zoonotic disease, sexual history, recently been diving, have they been bitten?

  • Is there correspondence in relation to treatment abroad?

  • Travel history can be important in terms of working out possible incubation period and differential diagnosis


Screening history26 l.jpg
Screening History global trends in infectious disease, especially emerging infectious diseases

  • Prophylaxis and compliance - was the prophylaxis appropriate?

  • Could it be a pre-existing condition?

  • Could it be related to an occupational/recreational exposure?


Screening examination l.jpg
Screening Examination global trends in infectious disease, especially emerging infectious diseases

  • Post-travel physical examination for most short term travelers is usually unremarkable for disease, but may be useful for assessment of injuries

  • Signs of “tropical” disease can be subtle and can be missed unless specifically looked for, e.g. rashes, eschar, jaundice

  • Abnormalities unrelated to travel


Look for the spot diagnosis l.jpg
Look for the “spot” diagnosis global trends in infectious disease, especially emerging infectious diseases

  • Hookworms and cutaneous larva migrans: tracking lesions on the foot (or other body areas in contact with sand/soil)


Look for the spot diagnosis29 l.jpg
Look for the “spot”diagnosis global trends in infectious disease, especially emerging infectious diseases

  • Leishmaniasis: non-healing skin ulcers/lesions, especially on exposed areas and been to endemic areas

  • Eschars-may be associated with rickettsial infectious such as scrub typhus

  • Skin infection: bacterial and fungal (ask for occupational and recreational history)

  • Others


Screening examination30 l.jpg
Screening Examination global trends in infectious disease, especially emerging infectious diseases

  • When sending specimens to lab, document current medications, history, what you think

  • Liaise with lab if unsure what tests available

  • Stool microscopy M/C/S, O/C/P-most diarrhoeal disease bacterial>>parasitic>viral

  • Urine tests-dipstick urinalysis, “terminal” urine for ova of S. haematobium

  • Full Blood Count and differential- eosinophilia, anaemia, thrombocytopenia


Screening examination31 l.jpg
Screening Examination global trends in infectious disease, especially emerging infectious diseases

  • Rapid tests, e.g. Immunochromographic tests (ICT)-often used for initial screening for malaria, Bancroftian filariasis, (dengue), etc

  • Serological investigations, e.g. schistosomiasis, filariasis

  • Blood films for malaria

  • HIV/STI serology

  • TB screening-useful if you can compare with pre-travel


Does the traveler have diarrhea l.jpg
Does the traveler have diarrhea? global trends in infectious disease, especially emerging infectious diseases

  • Most travelers’ diarrhea is brief, self-limiting and non-inflammatory (about 4 days in duration)

  • About 20% of travelers have fever and/or bloody diarrhea

  • Enterotoxigenic Escherichia Coli is probably the most frequent pathogen in about 40-75 of cases


Travelers diarrhea l.jpg
Travelers’ diarrhea global trends in infectious disease, especially emerging infectious diseases

  • Inflammatory diarrhea may be caused by Campylobacter, Shigella or Salmonella infection

  • Fever, cramping abdominal pain, pus and/or blood in the stool

  • Quinolone antibiotics often employed (some resistance)

  • Remember amoebic dysentery and giardiasis


Travelers diarrhea34 l.jpg
Travelers’ diarrhea global trends in infectious disease, especially emerging infectious diseases

  • Persistent diarrhea may be giardiasis, which may need treatment with tinidazole or metronidazole

  • Chronic diarrhea may need further investigation and referral


Does the traveler have fever l.jpg
Does the traveler have fever? global trends in infectious disease, especially emerging infectious diseases

  • Possible serious infectious disease causes in travelers returning from tropical regions:

    • Malaria-great mimicker

    • Hepatitis A

    • Enteric fever (incl typhoid)

    • Dengue fever

    • Others


Has the traveler been injured abroad l.jpg
Has the traveler been injured abroad? global trends in infectious disease, especially emerging infectious diseases

  • Need to document extent of injuries

  • Are they covered by any insurance or superannuation policy?

  • Arrange for any further treatment and follow-up

  • Liaise with airlines if further travel required

  • Arrange for assessment for rehabilitation as necessary


Post travel consultation37 l.jpg
Post-Travel Consultation global trends in infectious disease, especially emerging infectious diseases

  • It is important to elicit a history of travel.

  • Many short term travelers will present with illness when they get back, following the incubation period.

  • Investigation and management of some post-travel illnesses will be urgent because they are life threatening and/or a threat to public health.


ad