TD, Food, Water, Diseases

Monday, May 25, 2015

6:05 PM

Traveler's Diarrhea
http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/travelers-diarrhea

Azithromycin main treatment for TD

Bac: E. coli, campylobacter, shigella
Virus: norovirus
Parasites: take longer to develop, short trip, wont get sx while on trip (weeks/months
later)
If pt has diarrhea, always ask if have travelled outside of US. Even if months ago
Severity
Mild TD: few loose stools, self-limiting, not much cramping, NV (24 hrs after)
If NV few hours after eating (food poisoning)
Moderate TD: cramping, many stools, watery
Severe TD: hypotension, blood in stool, dehydration
Tx: not greasy food, stay hydrated, no brat diet (bc from pathogen)
2nd tier: Antimotility agents: loperamide, BSS (pepto bismol) pass thru better, 3rd
tier: azithromycin 3 500 mg tabs take 1
Cipro, possibly take, self-treat uti (don't want to take cipro and azithro)

Food, Water
http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-2-the-pre-travel-consultation/water-disinfection-fortravelers

Bac like spicy food too

Boil it, peel it, or forget it
Heat (boil water is the best, but problem is having fuel source, water tastes bad so
may require pumping thru carbon filter for better taste)
filtration (life straw, will not get out viruses)
halogens (we halogenate with Cl which is why it tastes bad), chlorine dioxide,
UV (if water is murky, wont kill as good; use filter first and then UV to remove
viruses; needs to be in clear water)
Most filters 0.1 or 0.2 micron, everything taken out except for viruses
More adhesive if says that it takes viruses, but not true; need to boil water
HepA
Most efficacious inactivated vaccine
Incubation period is longer than how long it takes for HepA vaccine to start
working; single dose very effective
1st dose: immediate immunity, lasts 10 years
2nd dose: 6 months later, to boost memory response, vaccine gives lifelong
immunity
Twinrix (hepA/B combo): accelerated, but needs booster dose; has lower hepA in it, so
if dont complete series dont know equivalent immunity to it
Cannot vaccinate at birth bc mother Ab interference, wait til 1 yr
Polio
http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter -3-infectious-diseases-related-to-travel/poliomyelitis
Waterborne
3-4 shots childhood series, 1 booster; usually in dTAP
Cannot vaccinate at birth bc mother Ab interference, wait til 6 weeks
Vaccinated can be carrier and transmit
Typhoid
Via food and water, don't typically get diarrhea, need bone mineral biopsy to isolate
organism, invasive
Gradual increase (vs TD is quick onset)
Rose colored spots
Salmonella typhy and paratyphy, vaccine not good against paratyphy which is why only
50% efficacious
Vaccinations
Vivotiff: oral vaccine, 4 doses
CONSULT: live vaccine so needs to be refrigerated (temp sensitive, before
dispensing, and when pt gets home), heat liable (if take with any liquid above

Travel Health Page 1

Cannot vaccinate at birth bc mother Ab interference:

HepA, polio

dispensing, and when pt gets home), heat liable (if take with any liquid above
room temp will kill it, so take with cool liquid), take without food, 4 capsules
every other day 1, 3, 5, 7
If dose is delayed, must restart series!! Only one that requires
NOT taking antibiotics with anything else
Lasts 5 years, must be 6 yrs old
Typhim (polysaccharide vaccine): Injectible, 1 shot, 1 time, but get every 2 yrs if
travel
Suggested bc know that pt will get, vs dont know if pt will take vivotiff
correctly
Cholera
Easily treated, does not need antibiotic therapy, but requires rehydration therapy
Make sure have adequate zinc intake
Vaccine effective in 50% so most in safe food and water
High end hotels will not be any better, bc people who work there are still from the area of
infection. So still need to take precaution.

Travel Health Page 2