11. Travel Health Lecture

7/23/2019 11. Travel Health Lecture

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Travel HealthMPharm II – PHAY 2001

Louise Brown



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Learning Objectives and

Agenda• By the end of these lectures you

will have:

–Learnt about the role of thePharmacist in travel health

–Considered the different types oftraveller and their needs

–Learnt about advice related to arange of travel related healthconditions



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What common conditions dopeople get when they travel?

Why should people get adviceon travel health before they

leave the country?



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Why is a request for travel

advice and / orproducts different?What generic questions should

we be asking each time?



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Group Work

• Look at the scenario–What information is missing?

–What questions should you beasking?

–What are the major treatment areas?

–What would you recommend and

why?–What additional advice or referrals

would you make?



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Scenario One• Max and Sanjay are 21 yrs old and just

finishing their business degrees at uni

• They come into your Pharmacy and ask

about what they need to get sortedbefore they travel on their 1 month tripto Thailand

• They are leaving in 3 weeks and are

taking no other medicines• They have checked out some internet

web sites for info but they found someof the info unclear, so thought they

might as well talk to someone



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Scenario Two

• Mrs Gleeson is a regular customer. She comesinto your Pharmacy to ask whether she needs

malaria tablets to travel to Egypt with herfamily

• They are a family of 2 adults and 2 children

• She is very excited as they have never

travelled this far from home and she loveshistory so cant wait to see the pyramids

• She is keen for you to give her any advice youcan as she wants to feel totally prepared



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Role of the Pharmacist in

travel health• To give effective health promotion

to the travelling public

• To raise important and currentissues in travel medicine

• To discuss and provide

pharmaceutical and non – drugadvice and supplies to travellers



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Why might people belikely to get ill when they

travel ?



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Different types of travellers

and associated risks• Short trips to westernised destinations

• Trips to developing countries

• Independent travellers



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Insect bites and stings

• Can be the cause of many

diseases

• Treatments

– Corticosteriod cream eg ?

– Oral antihistamines eg ?

– If at risk – adrenaline or corticosteriodtablets

Care if at risk of jelly fish, sea urchins orsnake bites



Bite prevention

• Use an insect repellent containing DEET.• Remember to reapply insect repellent frequently and to

follow the manufacturer’s recommendations, particularlywhen applying repellents to young children.

• Cover up with trousers and long-sleeved clothes after

sunset.• Treat clothing with insecticides.

• Use knockdown sprays or coils to kill any mosquitoesbefore you go to bed.

• Sleep in a properly screened, air conditioned room orunder a mosquito net that has been treated withinsecticide.

• Homoeopathic or herbal remedies, electronic buzzers,garlic and vitamins do not protect against mosquito bites.

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Travellers Diarrhoea• Has an infective origin eg Enterotoxigenic E

Coli (30-50% people suffer from this)

• Passage of 3+ unformed stools in 24 hours

• Often with n+v, abdominal cramps, fever,faecal urgency, passage of blood or mucusin stools or blood alone



http://www.travellersdiarrhoea.co.uk/

Content/HCPS/Epidemiology.aspx

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Travellers Diarrhoea• Why don’t patients often seek medical

advice?

• What are the main issues for patients?

• What are the main methods of contraction?



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Travellers Diarrhoea• Most cases last less than 3 days and so is self limiting

• But eg Giardia – can last for wks/ months if untreated

• Initial treatment – rehydration eg clean water and Diorolyte(care with elderly / children/ immuosuppressed)

• Secondary treatment – loperamide (how does it work?)

• Doses?– Adults -

– Children –

• Too much – constipation – new problem

• Antimicrobials are usually not needed

• Unless long trips to developing countries eg Ciprox /Met



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Food advice

• What advice could you give yourpatients about avoiding contaminatedfood and drink?



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Water purification• Treat tap water by boiling for 5 mins or chemical

sterilisation eg chlorine or iodine or Katadyn silver• Purtitabs – Chlorine based – diff strengths

• Iodine tincture Alcoholic BP – 5d / L (12)

• Micropure – Katadyn – no change in taste, can be

stored once treated for several months, leave for 2hours

• Must understand directions and follow closely

• For surface water – iodine is best

• If the water is cloudy – must filter eg cloth• Large water purifiers – inconvenient

• No system is 100% effective for bacteria/ viruses/protozoa



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Jet Lag

• Common problems

• Multiple time zones

• Symptoms - ?

• Non drug advice• Melatonin

• Bright light exposure



DVT

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DVT• Stands for?• Related to long haul flights and low cost

travel

• Results in?

• Risk groups ?

• Treatments– Keep mobile before getting on the flight

– Avoid long sleeps during the journey– More water, less caffeine and alcohol

– Exercise regularly

– Compression hosiery

– Aspirin 150mg



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Motion sickness

• Very common esp 2- 12yrs

• Cause not clearly known

• Symptoms ?

•

• Anticholinergics eg hyoscine – tablets /patches

• Antihistamines eg cinnarizine,promethazine

• Choice is related to age, length oftravel, previous effectiveness

• Non drug advice



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Sun Protection

What can happen to us if we don't protect ourskin from the sun?



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Sun Protection

Basal Cell Carcinoma



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Sun Protection

Solar Keratosis & Malignant melanoma



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Sun Protection• Burning of the skin results from overexposure

to ultraviolet light

• UVC- filtered out by the ozone layer

• UVA – results in skin tanning - melanin

• UVB – results in sunburn - melanin• As well as giving a tan it protects the skin but

its production is slow and skin damage mayhave occurred already - inflammatory

response• There is a direct link between the incidence ofcancers and long term skin damage

• Long term problems also are skin ageing



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Prophylaxis

• Prevention is better than treatment.

• Use of sunscreens – many available

• Some are classified as to whether theyprotect against UVA or UVB or ratio

• Most are classified according to SPF or5 star ratings

• Also use of after sun preparations.

• Designed to cool down the sun andreduce the impact of the burn



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SPF• What does it stand for?

• It indicates how effective a product is atprotecting the skin

•Compares the amount of time needed toproduce minimal skin reddening withsunscreen to the amount to time taken toproduce the same amount of redness with outsunscreen

• Eg if you burn after 20 mins withoutprotection an SPF 2 product will protect youfor 40 mins (x2)

• Assumes that the sunscreen will not bewashed off or sweating and that enough was

applied.



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5 Star ratings• What do you know about it already?



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Types of sunscreen

• Chemical–Absorb UVA and UVB energy

–Combinations of different ingredients–Some allergic reactions

• Physical

–Reflect UVA and UVB radiation–E.g. zinc and titanium oxide

–Often cosmetically unacceptable



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Advice on application of

sunscreen• S

• H

• A• D

• E

• What other advice?• What about different skin types?



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Type IOften burns, rarely tans. Tends tohave freckles, red or fair hair, blue or

green eyes.

Type IIUsually burns, sometimes tans.

Tends to have light hair, blue or

brown eyes.

Type

IIISometimes burns, usually tans.

Tends to have brown hair and eyes.

Type

IV

Rarely burns, often tans. Tends to

have dark brown eyes and hair.

Type V Naturally brown skin. Often has dark

brown eyes and hair.

Type

VI

Naturally black-brown skin. Usually

has black-brown eyes and hair.



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http://sunsmart.org.uk/UV-the-sun-and-skin-

cancer/when-do-i-need-to-protect-myself/



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Treatment for sunburn

• What do you see?

• What can you recommend?

• What is Prickly heat ?



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Signs of potential skin

cancer – skin changes• Early detection is vital

• Look for small lumps, waxy, smooth,bleed or develop a crust

• Flat red spots which can be scaly andcrusty

• Firm red lumps which are usually

painless and tend to grow slowly• Lumps with a scaly or horny top

• GP - Dermatologist



Travel and Diabetes

• Chronic potentially life threatening

• Type 1 and Type 2

• What might the potential issues befor these patients?

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General Meds & Medical Kits

• Things to consider?• Packaging

• Controlled drugs – advice from HomeOffice

• General 1st aid items

• OTC medicines – obtain before youleave

• POM - obtain before you leave• Flying? Needles and Liquids

• Specialist trips eg diving, climbing – getspecialist advice from trip organisers



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Vaccinations• See BNF for summarised information

• Use up to date NPA Factsheet

• All depends on destination country and lengthof travel.

• Should be given in good time – 3 months• USA/ Europe/ Australia and NZ

– No special requirements except upto datetetanus, polio and childhood vaccines

• The rest of the world– This varies according to the location and

must be checked.



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Vaccinations• Common vaccines are

– Polio, BCG (TB), Typhoid and Hepatitis A/B

• Yellow fever – needs a certificate ofInternational vaccination

• Some need booster shots• Some GPs provide this

free, or attend a specialist

clinic or a Pharmacy

providing

that service.



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Role of the Pharmacist?Resources:• www.dh.gov.uk

• www.fco.co.uk

• www.fitfortravel.nhs.uk• www.who.int/ith/en

• http://www.nhs.uk/Livewell/TravelHealth/Pages/Travelhealthhome.aspx

• http://sunsmart.org.uk/UV-the-sun-and-skin-cancer/when-do-i-need-to-protect-myself/

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11. Travel Health Lecture

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