ADVICE TO TRAVELLERS

PROPHYLACTIC IMMUNIZATION
• Based on official requirements and risk of
infection
• Pre-travel vaccines needed
Cholera- 5 days
Plague- 6 days
Yellow fever- 6 days
 Require int. certificate of vaccine
 Effective after 10th day of administration
 Efficacy for 10 years
 Recommended and required
vaccinations
• Vaccines
Meningococcal meningitis-to KSA during
pilgrimage
Diphtheria-to KSA from states of former USSR
Hep A, B
Cholera
Rabies
Measles-to US
• High-risk group
 Health personal
 Research workers in labs
 Foreign aid workers
 Homosexuals, drug addicts
 Adventurous life style during the trip
 Remote areas where health care is far away
 Countries where sp, type of vaccine is not available
 Long stay-6 mo or >
 unvaccinated
 EMERGENCY PROPHYLACTIC
MEASURES
• Refers to the accelerated protocol to those
who need rapid cover
Hep B- days 0, 28, 56 (mo 0, 1, 6)
Japanese encephalitis-days 0, 7, 14 (days 0,
7, 30)
Rabies – days 0,7, 21-28 (days 0, 28, 56)
 HUMAN NORMAL Ig
• Not a vaccine
• Safe and effective in pregnancy, immuno-
compromised, last min travellers
• Deep IM inj. In gluteal region
• Effect starts after 24 hours
• Coverage is dose dependent
• No C/I
• Not recommended for <1yr
CHEMOPROPHYLAXIS
 MALARIA
• Chloroquine S –> C
• Chloroquine R low risk –> C+P
• Chloroquine R high risk –> C+P,M,D
 TRAVELLERS’ DIARRHEA
• Defined as the occurrence of 3 or >
watery/unformed stools per day in a traveller
• Any no. of such stools with fever, abd. Cramps
and vomiting.
• Depends on
Host factors- susceptibility, immune status,
mode of travel, diet
Geographical factors- remote and rural areas
Environmental- climate, season, sanitation,
water quality, sewage disposal
• Caused by
Bacteria - E. coli, shigella, salmonela,
campyobactoer jejuni
Parasites – ent.histolytica, g,lamblia
Viruses - rota
• Prevention
Hand and food hygeine
Safe water drinking
Bismuth subsalicylate
• No prophylactic benefit of
antibiotic
Antimotility drugs
BEHAVIOURAL MODIFICATIONS
 MEASURES AGAINST FECO-ORAL
DISEASE
• Dietary mistakes
Ice cubes
Salads
Fruits juices
Inadequately heated milk
Sandwiches with cold meat
• Measures for prevention
Safe potable water- boiled
If not boiled- saturated crystalline iodine or
tetraglycine hydroperiodide
 PROTECTION AGAINST BITES AND
STINGS
• Insect repellents
DEET – mosquito bite ( malaria, lymphatic
filariosis, arboviroses)
Ethylhexanediol
• Mosquito nets
• Special footwear (snake bites)
• Pyrethrum-based insecticides
 ENVIRONMENTAL HEALTH RISKS
• Altitude
• Temperature
• Humidity
• Exposure to unfamiliar species of animals and
insects
 HEAT AND HUMIDITY
• Dehydration- heat exhaustion, heat stroke
 Maintain adequate fluid intake
 Add little salt to fluids (unless C/I)
• Skin irritation, fungal infections(tinea pedis)
 Shower daily
 Wear loose cotton cloths
 Apply talcum powder
 UV RADIATION FROM SUN
• Includes UVA and UVB – damage skin and eyes
• Intensity indicated by Global Solar UV index
• Adverse effects
 sunburn, sunstroke (UVB)
 Eyes – acute keratitis/snow blindness, cataract
 Skin–
 carcinoma, malignant melanoma (UVB)
 ageing (UVA)
 Drug interactions causing photosensitivity( OCP.
Prophylactic antimalarials, some AB)
 Suppression of immune system, risk of infections,
decrease efficacy of vaccines
• Precautions
Avoid sun exposure in the middle of the day
Wear summer clothing to cover the exposed
parts
Wear UV protective sunglasses
Apply broad-spectrum sunscreen with SPF
15+
 SWIMMING
• Death by drowning
• Bathing in fresh anf stagnant water
Schistosomiasis
Primary amoebic meningoencaphalitis
Leptospirosis
Melioidosis
Bathers’ dermatitis
Otitis externa
SPECIAL GROUPS OF TRAVELLERS
 FEMALES
• Menstrual cycle:
 can be delayed for max 10 days by using monophasic pill
• Pregnancy:
 thrombo-embolic diseases
 UTIs
 Antimalarial prophylaxis with M and D is C/I
 Vacinations C/I
 Absolute: yellow fever, poliomyelitis, oral typhoid
vaccine, meningococcal
 Relative: inj. Typhoid fever, hep A, japanese
encephalitis
 CHILDREN
Basic and scheduled vaccinations are mandatory
Vaccine against rabies
Personal protective measures
 Bottled/boiled water
 Strict abstinence from dietary errors
 Mosquito nets
 Protection from sun and heat
Dehydration-ORS proper and timely use
Fever- dec temp, using plenty of drinks and tepid
sponging
 ELDERLY
• Risk of thrombo-embolism
Regularly stretch legs during flight
Elevate the feet keeping pillows under
Keep head slightly lower
Take flights with transits instead of one long
flight
 DIABETIC TRAVELLER
• For hyperglycemia
Keep 2x the required dose of insulin with
syringes
Glucometer
Oral hypoglycemic tablets
• For hypoglycemia
Dry food – biscuits, refined sugar, nuts, juice
packs
 SELF-TREATMENT KIT
• Chemoprophylactics – travel sickness, malaria, TD
• Common medications – analgesics,
antispasmodics, antacids, antihistamines, ORS
• OCT- to avoid unwanted pregnancy
• Condoms – to protect STDs
• Articles of personal hygiene – water sterilization
tablets, antiseptics, sunscreens, sunglasses,
repellents, mosquito nets
• Dressings and bandages