Travel Consult

Travel Medicine Consult Destination: Thailand (Bangkok, Chiang Mai), Vietnam (Hanoi, Ha Long Bay), Cambodia (Siem Reap) Duration: 3 weeks Departure: 1 November 2024 Plans during trip: - Backpacking tour across Southeast Asia, including cultural visits, hiking, and some rural village stays. --- Summary of Recommendations: - Recommended vaccinations: Hepatitis A, Typhoid, Japanese Encephalitis, Rabies (pre-exposure). - Non-vaccine recommendations: Malaria prevention (chemoprophylaxis for rural Cambodia/Vietnam), safe food and water practices, carrying a comprehensive gastrokit, travel insurance with medical evacuation, insect bite prevention for dengue/chikungunya risk areas, sun protection, and a basic first-aid kit. --- ### Comprehensive Travel Consult Notes Past Medical History: - Mild well-controlled asthma, otherwise healthy. No known drug allergies. Past Vaccination History: - Tetanus/Diphtheria/Pertussis (Tdap) last booster 5 years ago. - Measles, Mumps, Rubella (MMR) childhood vaccinations. - Hepatitis B series completed 10 years ago. - COVID-19 primary series + 2 boosters (last booster 8 months ago). - No adverse reactions to previous vaccinations. --- ### Risk Assessments COVID and Influenza: - Advice provided: Patient was advised to consider an updated COVID-19 booster due to upcoming travel and potential for varied healthcare access. Advised on continued mask-wearing in crowded indoor settings and good hand hygiene. - Patient was eligible for a COVID vaccination. - Patient accepted the recommendation for a COVID vaccination. - Advice provided: Patient was advised to receive the current season's influenza vaccine due to travel during peak flu season in some destinations. - Patient was eligible and suitable for an influenza or flu vaccination. - Patient accepted the recommendation for an influenza or flu vaccination. Hepatitis A: - Hepatitis A risk is high in all listed destinations due to varying sanitation standards and food preparation practices. Risk increases with consumption of street food and unbottled water. - Advice provided: Vaccination strongly recommended to prevent infection from contaminated food or water sources. - Vaccination was recommended. Typhoid Fever: - Typhoid fever risk is moderate to high in all listed destinations, particularly with consumption of street food and travel to rural areas. - Advice provided: Vaccination strongly recommended. Also advised on strict hand hygiene and avoidance of uncooked foods and unpeeled fruits. - Vaccination was recommended. Gastroenteritis: - Risk summary: High risk of Traveller’s Diarrhoea (TD) and other gastroenteritis from contaminated food and water across all destinations, particularly in street food markets and less developed areas. - Advice given about Traveller’s Diarrhoea: Patient advised on proactive measures including 'boil it, cook it, peel it, or forget it' rule, frequent hand washing, and use of alcohol-based hand sanitiser. Discussed symptoms of TD and when to seek medical attention. - Safe food/water guidelines shared: Detailed guidance on choosing safe food vendors, avoiding ice, and only drinking bottled or purified water. Advised on rehydration solutions. - Patient opted to take a gastrokit, including loperamide and a course of azithromycin for severe cases. Dengue Fever and Other Mosquito Borne Illnesses: - Risk detail: High risk of Dengue fever in all urban and rural areas of Thailand, Vietnam, and Cambodia, especially during the rainy season. Chikungunya also present. - Insect precautions and clothing advice provided: Advised on continuous use of DEET-containing insect repellents (30-50%), wearing long-sleeved clothing and trousers, particularly at dawn and dusk, and sleeping under mosquito nets if accommodation is not air-conditioned or screened. Malaria: - Risk level: Low to negligible risk in major urban areas (Bangkok, Hanoi, Siem Reap). Moderate risk in rural areas of Cambodia (e.g., near Thai and Laotian borders) and some rural areas of Vietnam, specifically the Mekong Delta region and central highlands. Low risk in most of Thailand. - Advice provided on prevention and symptoms: Patient advised on 'ABCDE' of malaria prevention (Awareness, Bite avoidance, Chemoprophylaxis, Diagnosis, Emergency treatment). Explained symptoms of malaria and importance of seeking immediate medical attention if fever develops during or after travel. - Chemoprophylaxis was recommended for travel to rural Cambodia and specific rural areas of Vietnam. - Prophylactic medication: Atovaquone/Proguanil 250mg/100mg once daily, starting 1-2 days before entering risk area, continued throughout stay, and for 7 days after leaving risk area. Japanese Encephalitis: - Risk and vaccine discussion based on destination: Japanese Encephalitis (JE) is endemic in rural areas of Thailand, Vietnam, and Cambodia, particularly during the monsoon season. Risk is low for short-term travellers mainly visiting urban centres, but increases significantly with rural exposure and prolonged stays. - Vaccination decision noted: Patient is planning rural village stays and extensive outdoor activities, therefore JE vaccination was strongly recommended and accepted. Rabies: - Rabies vaccination discussion: Patient advised that rabies is endemic in all travel destinations, with stray animals common, particularly dogs and monkeys. Pre-exposure prophylaxis was discussed given plans for rural treks and potential animal exposure. - Patient accepted vaccine. - Discussed post-exposure protocol: Patient educated on immediate wound washing and importance of seeking medical attention for post-exposure prophylaxis (PEP) regardless of pre-exposure vaccination status. Yellow Fever: - Risk based on country entry: No Yellow Fever risk in Thailand, Vietnam, or Cambodia. No vaccination required for entry from South Africa. Patient has not travelled from or transited through any Yellow Fever endemic zones. - Advice provided: Explained that Yellow Fever is not a risk for this itinerary. - Vaccination recommendation or waiver: Not required. Mpox (Monkeypox): - Comment on travel to outbreak zones: No specific Mpox outbreaks currently identified as high risk in the planned travel destinations. - Advice provided: Patient advised on general hygiene, avoiding contact with sick animals (especially primates), and avoiding contact with individuals who have a rash or fever. - Vaccination recommendation: Not recommended based on current risk assessment for this itinerary. --- Vaccinations were administered by the practice nurse with thanks. Patient was asked to remain in the clinic for 15 minutes post-vaccination to monitor for hypersensitivity reactions.