Manual of Travel Medicine

441 Pages·2011·7.346 MB·English

by  Yung, A. and Leder, K. and Torresi, J. and Ruff, T. and O’Brien, D. and Starr, M. and Black, J.

MANUAL OF TRAVEL MEDICINE
Third Edition
Dedication
Allen Yung has been the principal driver of all three editions of this Manual
and the several versions of the guidelines for Fairfield Infectious Diseases Hospi-
tal registrars which preceded it. For all the authors of this Manual – and for
many others besides – Allen has been a friend and mentor of the kind that
everyone should have. Within a year of publication of this edition of the Manual
in printed form, Allen died. His co-authors dedicate this edition to Allen, with
deep gratitude.
Allen left China as a child, and came eventually to Tasmania, benefitting from
the Friends’ School in Hobart, which has contributed to the life journeys of
many remarkable people. For several decades at Fairfield, until it closed in 1996,
and then at the Royal Melbourne Hospital, Allen taught succeeding genera-
tions of infectious disease physicians. He was the consummate clinician, astute,
patient, focussed, a pre-eminent listener, bringing extensive experience to bear,
but always willing to be surprised and to learn. His golden rules abide the test of
time. He is fondly remembered around Australia and beyond.
We salute a great physician and teacher, and a fine, compassionate, gentle, and
humble man.
Karin Leder, Joseph Torresi, Tilman Ruff, Daniel O’Brien, Mike Starr, Jim Black
MANUAL OF TRAVEL MEDICINE
Third Edition
Allen Yung
Karin Leder
Joseph Torresi
Tilman Ruff
Daniel O’Brien
Mike Starr
Jim Black
IP Communications
Melbourne
2011
IP Communications Pty Ltd
PO Box 1001,
Research, Victoria, 3095
Australia
Phone: [phone]
Email: [email protected]
www.ipcommunications.com.au
© Allen Yung, Karin Leder, Joseph Torresi, Tilman Ruff, Daniel O’Brien, Mike Starr and
Jim Black
First published 2011.
This book is copyright. Subject to statutory exemption and to the provisions of relevant
collective licensing agreements, no reproduction of any part may take place without the written
permission of IP Communications, P/L.
ISBN: 978-0-9808649-6-0 (printed book)
ISBN: 978-0-9872905-7-1 (ebook)
National Library of Australia Cataloguing-in-publication data
Title: Manual of travel medicine/Allen Yung … [et al.]
Edition: 3rd ed.
ISBN: 9780980864960 (pbk.)
Notes: Includes bibliographical references and index.
Subjects: T ravel—Health aspects—Handbooks, manual, etc.
Communicable diseases—Prevention—Handbooks, manuals, etc.
Tropical medicine—Handbooks, manuals, etc.
Other Authors/Contributors: Yung, Allen P.
Dewey Number: 613.68
Edited by Gillespie & Cochrane, Pty. Ltd., Melbourne
Text design by Club Tractor Production Services, Melbourne
Typeset by Desktop Concepts Pty. Ltd., Melbourne
Cover design by Phillips & Father Printing, Melbourne
Cover photograph © Manfred Gottschalk, Lonely Planet Images
Indexed by Gillespie & Cochrane, Melbourne
Printed by BPA Print Group, Pty. Ltd., Melbourne
Disclaimer: Medicine is ever changing. While every effort has been made to check that the
information and medication dosages contained in this publication are correct, readers should
ensure they are familiar with the most current recommendations, including dosage and schedule,
before any medication is administered. ‘Medication’ is taken to include vaccines and other
biologicals.
Contents
Dedication ii
Vaccine terminology and abbreviations xiii
Preface xix
About the Authors xxiii
Chapter 1 Principles of Pre-travel Health Care 1
1.1 Understand the epidemiology of travel and travel-related conditions 2
1.2 Provide up-to-date information and advice 3
1.3 Start early 3
1.4 Allow sufficient time for the consultation 4
1.5 Individualise advice 4
1.6 Identify high-risk travellers 5
Travellers with chronic conditions 5
1.7 Encourage personal responsibility for safe behaviour 6
Food and drink 7
Insects 7
Environmental exposures 7
Animal bites 8
Substance abuse 8
Sex 9
Oral contraceptive pill 9
Injury 9
Blood-borne infections 11
1.8 Consider costs 12
1.9 Provide written information 12
1.10 Recommend a medical kit 13
1.11 Recommend health insurance 13
Key readings 16
Chapter 2 Immunisation 17
2.1 Introduction to pre-travel vaccination 17
Categories of vaccines 18
Delay in vaccine doses 22
Simultaneous administration of different vaccines 22
Interaction between vaccines and tuberculin skin test 23
Interaction between vaccines and antimalarials 24
Interaction between vaccines and blood products 24
Interchangeability of vaccine products 25
Practical aspects of immunisation 26
Key readings 28
2.2 Cholera 30
Disease 30
v
vi CONTENTS
Epidemiology 30
Vaccine 30
Recommendations 31
Key readings 32
2.3 Diphtheria and tetanus 32
Background and epidemiology: diphtheria 32
Background and epidemiology: tetanus 32
Diphtheria- and tetanus-containing vaccines 33
Key readings 36
2.4 Hepatitis A 36
Disease 36
Epidemiology 36
Hepatitis A immunisation 38
Recommendations 42
Combined hepatitis A and B immunisation 45
Combined hepatitis A and typhoid immunisation 48
Choice of hepatitis A vaccine 49
Immunoglobulin 49
Key readings 50
2.5 Hepatitis B 51
Epidemiology 52
Vaccines 52
Recommendations 58
Testing for immunity after immunisation 59
Management of non-responders 59
Key readings 60
2.6 Influenza 61
Epidemiology 61
Vaccine 61
Recommendations 63
Key readings 65
2.7 Japanese encephalitis 67
Disease 68
Epidemiology 68
Vaccines 70
Recommendations 73
Key readings 74
2.8 Measles, mumps and rubella 77
Background and epidemiology 77
Vaccine 77
Recommendations 78
Immune response and efficacy 78
Key readings 79
2.9 Meningococcal infection 80
Disease 80
Epidemiology 80
Vaccines 82
Recommendations 87
Key readings 88
2.10 Pertussis 89
Background and epidemiology 89
Vaccines 89
Recommendations 90
CONTENTS vii
Immune response and efficacy 91
Adverse effects 91
Key readings 92
2.11 Pneumococcal infection 92
Background and epidemiology 92
Vaccines 93
Key readings 97
2.12 Poliomyelitis 98
Epidemiology 98
Inactivated poliomyelitis vaccine (Salk-type or IPV) 99
Live oral poliomyelitis vaccine (Sabin-type or OPV) 101
Recommendations for travellers 103
Key readings 103
2.13 Rabies 104
Disease 104
Epidemiology 105
Vaccine 106
Pre-exposure vaccination 107
Recommendations 110
Post-exposure treatment 112
Key readings 116
2.14 Rotavirus infection 116
Background and epidemiology 116
Vaccines 117
Recommendations 117
Key readings 118
2.15 Tick-borne encephalitis 119
Disease 119
Epidemiology 120
Austrian and German vaccines 121
Russian and Chinese vaccines 123
Recommendations 123
Key readings 124
2.16 Tuberculosis 124
Disease 124
Epidemiology 124
Vaccine: BCG 126
Recommendations for BCG for travellers 130
Role of chest X-ray as a screening test 131
Summary 131
Key readings 132
2.17 Typhoid 132
Disease 132
Epidemiology 133
Vaccines 134
Recommendations for use of typhoid vaccines 140
Key readings 141
2.18 Varicella 142
Background and epidemiology 142
Vaccines 143
Recommendations 144
Immune response and efficacy 144
Key readings 147
viii CONTENTS
2.19 Yellow fever 147
Disease 147
Epidemiology 147
Yellow fever vaccine (Stamaril) 148
Inactivated yellow fever vaccine 153
Recommendations 153
Key readings 156
Chapter 3 Malaria Prevention 158
3.1 Introduction 158
3.2 Preventive measures 160
Awareness of risks 160
Early diagnosis and treatment 162
Minimising exposure to mosquitoes 163
3.3 Prophylactic drugs 164
General considerations 164
Drugs 166
How to choose malarial prophylaxis 179
Special situations 185
Recommendations 186
3.4 Standby emergency self-treatment 190
Drugs used for standby emergency
self-treatment 192
Steps to take when prescribing SBET 194
3.5 Summary 195
Key readings 196
Chapter 4 Travellers’ Diarrhoea 198
4.1 Incidence 198
4.2 Aetiology 199
4.3 Prevention 199
General measures 201
Water treatment 201
Vaccination 203
4.4 Management 204
Fluids 204
Food 204
Self-treatment 205
Treatment for prolonged diarrhoea 208
4.5 Chemoprophylaxis 211
Key readings 212
Chapter 5 Non-vaccine-preventable Infections 214
5.1 Destination 214
5.2 Types of activities 214
Infections acquired via ingestion 215
Vector-borne diseases 215
Diseases transmitted via recreational and occupational activities 215
Diseases transmitted via sexual or parenteral exposure 218
5.3 Specific infections 218
African trypanosomiasis (‘sleeping sickness’) 218
American trypanosomiasis (Chagas’ disease) 220
Amoebiasis 221
Brucellosis 222
CONTENTS ix
Chikungunya virus 222
Ciguatera 224
Cutaneous larva migrans (CLM) 225
Dengue fever 226
Hepatitis E 227
Legionellosis (Legionnaires’ disease) 228
Leishmaniasis (cutaneous and visceral) 228
Leptospirosis 229
Lyme disease 230
Lymphatic filariasis, loiasis and onchocerciasis 231
Melioidosis 232
Myiasis (cutaneous) 233
Q fever 234
Rickettsial infections 235
SARS (severe acute respiratory syndrome) 236
Schistosomiasis (‘bilharzia’) 237
Strongyloidiasis 239
Viral haemorrhagic fevers 240
West Nile fever 240
Key readings 241
Chapter 6 Non-infectious Problems 243
6.1 Fitness to fly 243
Air travel 243
Health effects of flying 244
6.2 Motion sickness 245
Incidence and risk factors 247
Symptoms and progression 247
Prevention 248
Medications 248
Recommendations 251
Treatment of established symptoms 252
6.3 Jet lag 254
Preparation 254
During the flight 255
On arrival 255
Melatonin 256
Key readings 257
6.4 Venous thrombosis and travellers 257
Background 257
Possible predisposing factors 257
What are the risks? 258
Recommendations for prophylaxis 258
Key readings 259
6.5 Altitude sickness 260
What is altitude sickness? 261
Incidence of altitude sickness 261
Normal symptoms at altitude 263
Acute mountain sickness (AMS) 263
Severe altitude sickness 264
Warning signs for travellers 265
Prevention 265
Drugs 266
Treatment 268
Altitude sickness in children 270