1. TRAVEL MEDICINE

2. 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

3. Death’s abroad • 69% CVS MI etc • 21% Accidents • 4% Infectious diseases

4. Behaviour • Drink more • Take more risks • Unfamiliar surroundings • Less supervision of children

5. 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

6. Immunisation • Arrange immunisation 8 weeks before travel • Up to date advice available from special web site

7. 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

8. 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

9. Dehydration • Drink fluids ++++ • Carry water round • Add salt to food

10. Malaria • 3,500 new cases per year • 10 deaths

11. Malaria • 50% cases in visiting friends and relatives • 19% visitors to UK • 16% tourists • 11% immigrants • 5% expats

12. Diagnosis • Must think of it • Has the pt malaria • Falciparum or one of the others • From a chloroquine resistant area • Mild Moderate or severe

13. History • Travel upto a year • Fever with rigors • Flu like illness • Jaundice • Diarrhoea

14. Malaria • Signs • Fever • Splenomegally • Investigations • Blood films • 95% thrombocytopaenia • +_ anaemia • Wbc normal

15. Prevention • B prevent Bites • C Compliance with medication • A Awareness of risk • D Diagnose early

16. Risk • Place • Activity • Travel • Length of stay • Effectiveness of prophylaxis

17. 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

18. Prevention • Mosquito nets • repair holes • Tuck into mattress • Impregnated with pyrethroid

19. Prevention • Clothing after dark • Long trousers • Long sleeved shirts/blouses • Tuck trousers into socks

20. Prevention • Use appropriate insect repellent • Close windows if lights on after dusk • Use knock down spray or coils

21. Prevention • Chemoprophylaxsis • Use most effective for country • Start 1 week before travelling • Continue for 4 weeks after return • Away from medical help carry quinine

22. Resistance • East Africa • Mefloquine 90% protection • Proguanil/chloroquine 70% protective

23. 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

24. Remember • Risk proportional to length of stay • The longer the stay the greater the need to take prophlaxsis • Adverse effects occur early on

25. Travellers diarrhoea • Tunisia 70% • Kenya 50% • Egypt 50% • Spain 7%

26. Infectious agents • Rota virus • E coli • Campylobacter • Salmonella shigella chloera • Giardia lamblia • Cryptosporidium • 50% no cause found

27. 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

28. Treatment • Fluids only • Rehydration salts • Antibiotics rarely needed ciprofloxacin

29. Persisting diarrhoea • Stool culture • Giardia • Metronidazole • tinidazole

30. Imported infectious diseases • Malaria 2000 • Hep A 1000 • Typhoid 200 • Chloera a few

31. Imported fever - causes • Malaria 42% • Non- specific viral 25% • Viral dengue 6% • Viral Hep A 3%

32. Investigation of fever • Thick and thin blood films • FBC low platelets – malaria dengue • Dipstick urine • Blood cultures – typhoid • CXR • Serology – toxoplasma hep A