Transcript Travel Health Update - Public Health Wales

Travel Health Update
Carolyn Driver
Independent Travel Health and Immunisation Specialist Nurse
March 2008
Aim of Session
• Look at RCN Competencies
• Malaria Update
• Last minute travellers
• Extended stay travellers
Risk assessment in Travel Health
• Travel Health is an Important but time
consuming clinical area
• Appropriate time must be allocated for a
full risk assessment
• Reliable resources should be available to
the healthcare professional offering the
service
• Informed consent must be obtained for all
vaccines administered
• Correct identification of malaria
prophylaxis and explanation of regime
must be given at the consultation
• Staff who are expected to run a travel
health service should be encouraged to
attend training courses
http://www.rcn.org.uk/__data/assets/pdf_file/0006/78747/003146.pdf
Risk Assessment
HAZARD
vv
RISK
The presence of a disease in a country or
region does not necessarily imply that
the traveller is at risk of developing the
disease
A disease may be low hazard but high risk e.g. an upper
respiratory infection many travellers will develop it but it will not
cause much harm
A disease may be high hazard but low risk, e.g. rabies
It is a very dangerous disease but few travellers will develop it
Information required for a Risk
Assessment
• Characteristics of traveller
• Previous history (medical &
immunisations)
• Departure date & length of stay
• Destination & full itinerary
• Mode of travel
• Budget & accommodation
• All planned activities
Activities
• Exposure to heat & sun
• Exposure to cold
• Water activities & other high risk sporting & leisure
activities
• Alcohol & drugs
• Health care
• Voluntary workers
• Sex tourism
www.nathnac.org
Malaria
• Need to know exactly
where in a country the
traveller is going to
establish risk
• Use good resources to
then advise the traveller
about appropriate
preventive measures
• Must regularly check live
(internet) resources for
any changes that may
have recently occurred.
www.malaria-reference.co.uk
Plasmodium Knowlesi recently identified in
humans in Malaysia and Thailand - previously
only thought to occur in monkeys
Preventive strategies are the same as for the other 4
types of malaria
The Late Presenter
• It is never too late to give advice
• Ensure that Patients aren’t turned away when planning
a last minute break.
• Boosters work very quickly so it is appropriate to give
boosters even on day of departure.
• Hepatitis A is also effective at the very last minute.
• Vaccines that normally require a 3 dose course – if 2
doses can be given probably worthwhile – if only one –
may be better to give preventive advice rather than
one vaccine unless they can continue the course whilst
away – or can complete course between journeys
Malaria and the late presenter
• Both Doxycycline and Malarone can be started just a day or so
before departure.
• Someone who has taken Mefloquine before without problem
need only start a week before departure – if they present less
than a week before and this is their drug of choice – could still
be used as long as they agree to use good bite avoidance
measures and are alert to any potential malaria symptoms a
week after they have arrived at their destination.
• Similarly Chloroquine and Proguanil are ideally started a week
before travel but the most important time is during and after a
potential exposure. So if this is the drug of choice and the
individual accepts the slightly increased risk of breakthrough
infection – it can be used in late presenters.
Extended Stay Travellers
Problems with long stay travellers in high risk environments:
• Greater potential exposure to pathogens
– More insect bites
– More chance of relationships with local population
– More chance of need for medical intervention
– More risk taking activities
• Increased likelihood that they will become complacent about
preventative strategies
• Need to ensure they have an appropriate insurance policy
Extended Stays
Vaccines – Clearly they should be encouraged to
have all the vaccines recommended for their
destination/s
Also need to consider any other travel they may
plan to undertake while away
• Even if Staying in a city – worth considering
rabies and (if living in SE Asia) Japanese
Encephalitis as they will have opportunity to
travel more remotely when on leave etc.
Extended Stays
• Psychological issues
Have they thought about;
isolation/communication with home/culture
shock/boredom
• Females –
contraception/menstruation/pregnancy
Marie Stopes, IPPF, travel stores such as Nomad –
have advice and equipment that could be useful .
Malaria and Extended Stays
Extended Stays
Before they go
• Dental Check up
• Smears/Family planning check etc
• If on regular medication chick availability at
destination and take adequate supply for
initial period.