Transcript Travel Medicine

Travel Medicine
Updates
Rushabh Shah
Regis University
PharmD Candidate Class of 2014
7/18/13
Outline
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Travelers’ Health Epidemiology
Traveler Assessment
Risk to the traveler
Travel Disease Updates
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Malaria
Japanese Encephalitis
Typhoid
Rabies
• Future Research
• Hepatitis C
US Residents Traveling Abroad
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2006
2007
2008
2009
2010
2011
1. US Department of Commerce: Office of Travel and Tourism Industries
tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf
2012
Where do US Residents Travel?
40
35
30
25
20
15
10
5
0
1. US Department of Commerce: Office of Travel and Tourism Industries
tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf
Travelers Assessment
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Age Specific Issues
Underlying Illness, immunosuppression
Systems Review
Medical History
Medication Use
Vaccination History
Allergies
Contraindication to vaccines and medications
Reproductive
• Pregnant
• Breast-feeding
• Preconception
Infectious Disease Risks to the
Traveler
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Malaria
Diarrhea
Rabies
Meningococcal Meningitis
Measles
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Tuberculosis
Typhoid Fever
Polio
Yellow Fever
Japanese Encephalitis
Malaria
• Disease spread through Mosquito bites
• Most common P. falciparum and P. vivax
• Symptoms
• High Fever
• Shaking Chills
• Flu- like illness
• Prevention
• Prevent Mosquito bites
• Medications
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Malarone
Chloroquine
Mefloquine
Primaquine
Doxycycline
Hydroxychloroquine (Second Line)
1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria
Dosing Schedule
Reasons to
Consider this
Medication
Reasons to Avoid
this Medication
Cost (July
2013)- 7 Day
trip
Malarone
(Atovaquone
- proguanil)
1 Tab (250mg/100mg)
DAILY
Begin 1-2 Days Prior to
travel
Stop after 7 days of
leaving such area
- Last Minute
Traveler
- Short Trip
- Well
Tolerated
$110.49 for
Pregnancy/Breastfee quantity of 15
ding
- Renal Impairment
(CrCl<30 mL/min)
Chloroquine
Phosphate
500 mg Once WEEKLY
Begin 1-2 Weeks Prior
to travel
Stop after 4 Weeks of
leaving such area
- Long Trip
- Resistance
- Last minute
travelers
Mefloquine
250 mg Once WEEKLY
Begin ≥2 Weeks Prior
to travel
Stop after 4 Weeks of
leaving such area
- Long Trip
- Pregnancy
- Resistance
$50.51 for
- Psychiatric
quantity of 8
Conditions
- Cardiac Conduction
Abnormalities
- Last Minute
Travelers
$26.66 for
quantity of 7
1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria
Dosing
Schedule
Reasons to
Consider this
Medication
Reasons to Avoid
this Medication
Cost (July 2013)
Primaquine
(26.3 mg
primaquine
phosphate=15
mg
primaquine
base)
30 mg (Base) 2
tablets DAILY
Begin 1-2 Days
Prior to travel
Stop after 7
days of leaving
such area
- Most effective
for P. vivax
- Last Minute
Travelers
- Short Trip
- G6PD Deficiency
- Expensive Test
- Pregnancy/
Breastfeeding
- Upset Stomach
$44.15 quantity of
30
Doxycycline
100 mg DAILY
Begin 1-2 Days
Prior to travel
Stop after 4
Weeks of
leaving such
area
- Last Minute
Traveler
- Pregnancy
- Children<8 Years
Old
- Increased Sun
Exposure
- Upset Stomach
- Back-order
$75.42 quantity of
30
1. Malaria. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/malaria
Malaria Future Research
• Malaria
• RTS,S (Mosquirix)
• Phase III Trial
• Infants 6-12 weeks, protects against P.falciparun
• 33% fewer episodes of clinical and severe malaria over 12 months of
follow up
• No increase in Serious Adverse Events
• Long term efficacy
1. Malaria Vaccine. http://www.malariavaccine.org/about-overview.php
Typhoid Fever
• Spread through contaminated food and water
• Symptoms
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High fever
Weakness
Stomach Pain
Headache
Loss of Appetite
• Vaccines
• Inactivated IM Injection (Typhim Vi)
• 1 Dose, 2 weeks prior to travel
• Booster dose needed every 2 years
• Live, Weakened, Oral Vaccine (Vivotif)
• 4 doses, 1 week prior to travel
• Booster dose needed every 5 years
1. Typhoid Fever. CDC resources page Center for disease Control. http://wwwnc.cdc.gov/travel/diseases/typhoid
Japanese Encephalitis
• Disease spread through mosquito bites
• Symptoms
• Fever
• Headache
• Vomiting
• Difficulty moving
• Prevent mosquito bites
• Vaccine
• IXIARO® *Change in Recommendation*
• ≥2 months to <3 years old- 0.25mL IM
• ≥3 Years old- 0.5mL IM
• 2 doses (Day 1; 28 Days after dose 1), 7 days prior to
travel
1. Japanese Encephalitis. CDC resources page Center for disease Control.
http://wwwnc.cdc.gov/travel/diseases/japanese-encephalitis
Rabies
• Viral disease that causes acute encephalitis in warm- blooded
animals
• Symptoms
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Malaise
Headache
Fever
Violent Movement
Uncontrolled excitement
Depression
• Vaccine
• Preventive Exposure 3 doses (0,7, 21 or 28)
• Post-Exposure, Not Vaccinated 4 doses (0,3,7,14)
• Post Exposure, Vaccinated 2 doses (0,3)
1. Rabies. CDC resources page Center for disease Control http://wwwnc.cdc.gov/travel/diseases/rabies
Future Research
• Hepatitis C
• Multi- antigen DNA vaccine covering Hepatitis C virus genotypes
1a and 1b and antigen NS3/4A as well as NS4B/5A
• Phase I/IIA clinical study
• Strong NS3- specific interferon-Γ (IFN-Γ)
• Robust CD4 and CD8 T cell proliferation
• Induction of polyfunctional T cells
• HIV
• AIDSVAX/RV144
• Targeted GP120
1.
2.
3.
Hepatitis C Vaccine. http://ir.inovio.com/2013-01-09-Inovio-Pharmaceuticals-to-Initiate-ClinicalTrial-for-its-Hepatitis-C-Therapeutic-Vaccine-INO-8000-Later-this-Year
Thai Phase III HIV Vaccine Clinical Trial. www.hivresearch.org/research.php?ServiceID=13
N Engl J Med (366) 1275-1286. April 5, 2012
Travel Medicine
Rushabh Shah
Regis University
PharmD Candidate Class of 2014
Acknowledgment to Dr. Christy Harmon
Questions?
Citations
• US Department of Commerce: Office of Travel and Tourism Industries
tinet.ita.doc.gov/outreachpages/download_data_table/2011_US_travel_Abroad.pdf
Accessed July 16, 2013
• Malaria. CDC resources page Center for disease Control.
http://wwwnc.cdc.gov/travel/diseases/malaria Accessed July 16,2013.
• Japanese Encephalitis. CDC resources page Center for disease Control.
http://wwwnc.cdc.gov/travel/diseases/japanese-encephalitis Accessed July 16,2013.
• Typhoid Fever. CDC resources page Center for disease Control.
http://wwwnc.cdc.gov/travel/diseases/typhoid Accessed July 16,2013.
• Rabies. CDC resources page Center for disease Control.
http://wwwnc.cdc.gov/travel/diseases/rabies Accessed July 16,2013.
• Malaria Vaccine. http://www.malariavaccine.org/about-overview.php Accessed July 16,
2013
• Hepatitis C Vaccine. http://ir.inovio.com/2013-01-09-Inovio-Pharmaceuticals-to-InitiateClinical-Trial-for-its-Hepatitis-C-Therapeutic-Vaccine-INO-8000-Later-this-Year. Accessed
July 16, 2013
• Thai Phase III HIV Vaccine Clinical Trial. www.hivresearch.org/research.php?ServiceID=13
• Haynes B.F., Gilbert P.B., McElrath M.J., et. al. Immune- Corraletes Analyses of an HIV-1
Vaccine Efficacy Trial. N Engl J Med (366) 1275-1286. April 5, 2012