cases with thymus surgery

37 year old Nigerian man going to Nigeria for 3 weeks leaving in 5 days.
VFRs
history of Thymus Surgery
history of Seizures
no vaccince reccord
Allergy: itching after taking chloroquine(itching is not a alllergic action,it's just a common side effect)
_________________________
analysis: VFR, immune defect, allergy for chloroquine. short duration. stay with local people.
thymus surgery: yellow fever, typhoid oral, MMR, Varicella. should not get any live vaccine.
history of seizures, should not be given DTP and MMR(major in babies). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC320893/
_______________
Vaccines:
routine: Tdap
recommendation: hepA,  flu, typhoid(ViCPS), MCV4, Rabies, IPV
required:no

malaria
High risk and chloroquine resistant area
Malarone (short duration)

Mefloquine is contraindicated for use by travelers with a known hypersensitivity to mefloquine or related compounds and in persons with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorder, or seizures.

Diarrhea
arithromycin
Ciprofloxacin

case about drugs Contraindications

63 year old woman traveling to Peru . Lima , Cuzco, Macchu Pichu, Amazon. 2 week trip. Leaves in 2 weeks.
Past Medical History: Osteoporosis, Rheumatoid Arhtritis
Medications: Alendronate, 70mg once weekly
                    Methotrexate 20mg once weekly
     Allergies: Sulfa Drugs
Vaccine History: No vaccines for 20yrs.
________________________
Vaccines?
1.Flu shot  (first recommend)
2. Hepatitis A( second recommend)
3. typhoid(food related bacteria, the third recommend)
4. pneumococcal polysaccharaide vaccine(PPV23) (for all adults >=65 yrs of age and for persons 2-64 yrs of age with underlying medical conditions)

no requirement vaccine
routine vaccine
1. Td(if there is a baby around less than 2 months, should get Tdp)
2. MMR

Antimalaria?
mefloquine is best chocie for long term travel.
malarone should be used for the short duration. prophylaxis should begin 1-2 days before travel to malarious areas and should be taken daily, at the same time each day, while in ther malarious areas, and daily for 7 days after leaving the area.

Traverler's Diarrhea
ciprofloxacin should be avoid to use.
Renal tubular transport of methotrexate may be inhibited by concomitant administration of ciprofloxacin potentially leading to increased plasma levels of methotrexate. This might increase the risk of methotrexate associated toxic reactions. Therefore, patients under methotrexate therapy should be carefully monitored when concomitant ciprofloxacin therapy is indicated. (http://www.rxlist.com/cipro-drug.htm)


arithromycin

Other Recommendations
altitude sickness
Acetazolamide should not be given to pregnant women or those with a history of sulfa allergy.
Dexamethasone is very effective for prevention and treatment of AMS and HACE, and perhaps HAPE as well. 4mg every 6 hours for adults.

WHO travel health resouces

International travel and health

http://www.who.int/ith/chapters/en/index.html

http://www.who.int/ith/en/index.html

Influenza


http://www.who.int/topics/influenza/en/index.html
Yellow fever


http://www.who.int/topics/yellow_fever/en/index.html

International certificate of vaccination or prophylaxis

http://www.who.int/ihr/travel/icvp/en/index.html

International Health Regulations (IHR)

http://www.who.int/ihr/en/index.html
 
Malaria


http://www.who.int/mediacentre/factsheets/fs094/en/index.html
 

case:Nigeria

37 year old Nigerian Man is going to Nigeria for 3 weeks and leaves in 5 days.
History of thymus surgery
history of seizures
no vaccine record
no medications
allergy itching after taking chloroquine

tip:
VFR
immune system problem, cannot use live vaccine.
seizures:Mefloquine is contraindicated for use by travelers  with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures.

itching is not an allergy symptom.

Vaccine:
HepA, Flu, typhoid(injection), MCV4, IPV
Malaria?
Malarone
Diarrhea?
ciprofloxacin
 Others
insect repellent
rabies

Travel to west Africa

west Africa

yellow fever
 no risk: Western Sahara, Algeria, Morocco,north of Mauritania, north of Mali, north of Niger

malaria
fitfortravel edition
no malaria:Morocco,Western Sahara
low risk area: northwest of Mauritania, Algeria

cdc edition
no malaria: Morocco, algeria

chloroquine sensitive:Western Sahara



meningitis

• Epidemics there occur in the dry season (December to June), dying out during the intervening rainy season
• Epidemics usually take place in irregular cycles every 5-12 years
• Serogroup A meningococci account for about 80-85 percent of all cases
• In 2002 there was a major outbreak of meningococcal meningitis in Burkina Faso with about 80 percent of cases due to serogroup W-135

Risk area: south of Gambia, guinea Bissau, Guinea, south of Mali, north of Cote dlvoire, north of Ghana,

polio 
polio endemic area: Nigeria

insect-borne infections 

• Filariasis

The areas in red indicate the geographic distribution of lymphatic filariasis.

• West Nile virus (transmitted by night-biting Culex mosquitoes)

dengue

japanese encephalitis with pregnant women

Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses
Reproductive Toxicology, Volume 21, Issue 4, May 2006, Pages 446-457
Asher Ornoy, Alexander Tenenbaumhttp://www.fp.ucalgary.ca/FMResidentSecure/Articles/Virus%20review.pdf

J Travel Med. 2007 Mar-Apr;14(2):117-28.

Congenital infections associated with international travel during pregnancy.
McGovern LM, Boyce TG, Fischer PR.
Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2006.00093.x/pdf

Japanese Encephalitis Vaccines

Recommendations of the Advisory Committee on Immunization Practices (ACIP)

March 12, 2010 / 59(RR01);1-27

Inactivated Vero Cell Culture-Derived JE Vaccine (IXIARO [JE-VC])

Vaccination of Women During Pregnancy and Breastfeeding

FDA classifies JE-VC as a "Pregnancy Category B" medication (14). No controlled studies have assessed the safety, immunogenicity, or efficacy of JE-VC in pregnant women. Preclinical studies of JE-VC in pregnant rats did not show evidence of harm to the mother or fetus. No data exist on the safety or efficacy of JE-VC in breastfeeding women.

Inactivated Mouse Brain--Derived JE Vaccine (JE-VAX [JE-MB])

Vaccination of Women During Pregnancy and Breastfeeding

FDA classifies JE-MB as a "Pregnancy Category C" medication (146). No specific information is available on the safety of JE-MB in pregnant women, and animal reproductive studies have not been conducted with JE-MB. In addition, no data exist on the safety or efficacy of JE-MB in breastfeeding women.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5901a1.htm
_______________________________________________________

Travelers' Health - Yellow Book

Chapter 2The Pre-Travel Consultation

 Japanese Encephalitis (JE)

No specific information is available on the safety of JE vaccine in pregnancy. Therefore, the vaccine should not be routinely administered during pregnancy. Pregnant women who must travel to an area where risk for JE is high should be vaccinated when the theoretical risk for immunization is outweighed by the risk for infection.

 http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/japanese-encephalitis.aspx#816
 _______________________________________________________

JAPANESE ENCEPHALITISVACCINE
JE-VAX®
Pregnant women should generally not get JE vaccine. But if you are pregnant, check with your doctor. It could be recommended under certain circumstances.
http://www.immunize.org/vis/je_vax.pdf
 _______________________________________________________
 Guidelines for Vaccinating Pregnant Women

Vaccine		Should be considered if otherwise indicated	Contraindicated during pregnancy	Special/Conditional Recommendation (see text)
Routine	Hepatitis A			See Hepatitis A text
	Hepatitis B	X
	Human Papillomavirus (HPV)			See HPV text
	Influenza (Inact.)	Recommended
	Influenza (LAIV) *		X
	Measles*		X
	Meningococcal (MCV4)			See Meningococcal text
	Mumps*		X
	Pneumococcal			See Pneumococcal text
	Polio (IPV)			See Polio text
	Rubella*		X
	Tetanus - Diphtheria	X
	Tetanus - Diphtheria - Pertussis (Tdap)			See Tdap text
	Varicella		X
Travel & Other	Anthrax			See Anthrax text
	BCG*		X
	Japanese Encephalitis			See Japanese Encephalitis text
	Meningococcal (MPSV4)	X
	Rabies	X
	Typhoid (Parenteral & Oral*)			See Typhoid text
	Vaccinia*		X	See Vaccinia text
	Yellow Fever*			See Yellow Fever text
	Zoster*		X

Japanese Encephalitis (JE)

• No specific information is available on the safety of JE vaccine in pregnancy .Vaccination poses an unknown but theoretical risk to the developing fetus, and the vaccine should not be routinely administered during pregnancy.

 http://www.cdc.gov/vaccines/pubs/preg-guide.htm#16

 

 

Recommendations and Reports

consultation case: travel with pregnancy

http://www.pregnanttraveler.com/

a. 22 yr female with pregnant first trimester
b. destination: Burma, cambodia, vietnam, Thailand for 3 weeks, Rural and urban, leaves in 4 weeks
c. no vaccination for 10 yrs.
d. no medication
e. past history negative.

vaccine:
routine:Tdp
reccommedation: Flu, typhoid(injection), hepatitis B(0,7,14), Heptitis A, Japanese encehalitis, rabies
requirment: no

Malaria:
malarone(begin 1-2days before travel and taken same time daily while in the risk areas, and daily for 7days after leaving the area)

Diarrhea

ORS
other disease
dengue fever

others tips
1. food and water
2. carrying  hand sanitizing solutions
3. take insect repellent
4.jetlag