Travel Med

[Medical student attendance acknowledged, use of AI Scribe Software acknowledged.] Travel Medicine Consult: Destination: Thailand, Cambodia Duration: 21 days Departure: 10 November 2024 Plans during trip: - The patient is seeking advice for travel to Thailand and Cambodia for a 3-week holiday. - The patient will be staying in a mix of hotels and hostels. - The patient is concerned about food safety and mosquito-borne illnesses. Summary of Recommendations: - Diphtheria, Tetanus, acellular Pertussis (DTAP) vaccine: Accepted - Hepatitis A vaccine: Accepted, booster recommended in 6 months - Typhoid vaccine: Accepted - COVID vaccine: Accepted - Influenza vaccine: Accepted - Japanese Encephalitis vaccine: Risk identified in destination, vaccination Accepted, booster recommended in 2 years - Rabies vaccine: Risk identified in destination, vaccination Declined - Shingles (Shingrix) vaccine: Declined - Respiratory Syncytial Virus (RSV) vaccine: Declined - Measles, Mumps, Rubella (MMR) vaccine: Accepted - Tick Borne Encephalitis vaccine: Declined - MPox vaccine: Risk identified in destination, vaccination Declined - Malaria Prophylaxis: Risk identified in destination, prophylaxis Accepted, Malarone 1 tablet daily, starting 1 day before travel, continuing for 7 days after return (28 tablets prescribed) - GastroKit (Azithromycin, Gastrostop & Hydrolyte): Accepted - Yellow Fever vaccine: Declined - Discussed the importance of safe food and water practices. - Advised on insect repellent use and mosquito bite avoidance. Comprehensive Travel Consult Notes: Past Medical History: - Asthma Past Vaccination History: - Childhood vaccinations up to date. - Flu vaccine last year. - No adverse reactions to previous vaccinations. Risk Assessments: Hepatitis A: - Hepatitis A risk is moderate in Thailand and Cambodia. - Advised on food and water precautions and the importance of vaccination. - Hepatitis A vaccination was recommended for this trip. Typhoid Fever: - Typhoid Fever risk is moderate in Thailand and Cambodia. - Advised on food and water precautions and the importance of vaccination. - Typhoid Fever vaccination was recommended for this trip. Gastroenteritis: - Gastroenteritis risk is high in Thailand and Cambodia. - Advised on food and water precautions and the importance of hand hygiene. - Advised on the use of Gastrokit. - Patient agreed to take a “Gastrokit” with them. Dengue Fever and Other Mosquito Borne Illnesses: - Dengue Fever, Zika, and Malaria are endemic to Thailand and Cambodia. - Advised on the use of insect repellent, wearing long sleeves and pants, and using mosquito nets. Malaria: - Malaria risk is present in certain areas of Thailand and Cambodia. - Advised on the importance of chemoprophylaxis and mosquito bite avoidance. - Malaria Chemoprophylaxis was recommended for this trip. - Malarone was recommended, 1 tablet daily, starting 1 day before travel, continuing for 7 days after return (28 tablets prescribed). Japanese Encephalitis: - Japanese Encephalitis risk is present in certain areas of Thailand and Cambodia. - Advised on the importance of vaccination and mosquito bite avoidance. - Japanese Encephalitis vaccination was recommended for this trip. Rabies: - Advised on the risk of rabies from animal bites. - Rabies vaccination was not recommended for this trip. - Advised on post-exposure prophylaxis for rabies prone wounds. COVID and Influenza: - Advised on the importance of staying up to date with COVID vaccinations. - Patient was eligible for a COVID vaccination. - Patient accepted the recommendation for a COVID vaccination. - Advised on the importance of influenza vaccination. - Patient was eligible and suitable for an influenza or flu vaccination. - Patient accepted the recommendation for an influenza or flu vaccination. Yellow Fever: - Yellow Fever risk is not present in Thailand or Cambodia. - Advised that Yellow Fever vaccination was not required for this trip. - "Explained that Yellow Fever Vaccine (Stamaril) is a live vaccine and confirmed that the patient does not have any immune compromising conditions or contraindications to having live vaccines." MPox: - Mpox risk is low in Thailand and Cambodia. - Advised on the importance of avoiding close contact with people who are sick. - Mpox vaccination was not recommended for this trip. Tick Borne Encephalitis: - Tick-borne encephalitis (TBE) is a viral infection affecting the central nervous system - it is caused by three different virus sub-types: European, Far eastern and Siberian and is endemic in many regions of Eurasia - Ticks are commonly found low in the undergrowth - Incubation period for this mode of transmission ranges from 7 - 28 days - Infection can also be acquired by consuming unpasteurised dairy products from infected cows, goats or sheep - four days is the average incubation period in these cases - Vaccination: Inactivated viral vaccine - Schedule: Day 0, 1 - 3 months, 5 - 12 months after the second dose (*If no ongoing risk of exposure 3rd dose may not be required) - Efficacy: over 90% after the second vaccination and above 97% after the 3-dose primary series - Boosters: First booster after 3 years, then at 5-year intervals if at risk - every 3 years for people over 60 years - Side Effects: Mostly mild and transient - Swelling, redness and pain at the injection site, headache, fatigue, malaise, nausea, muscle pain - Recommendation: Based on itinerary and nature of travel I have recommended the TicVac vaccine - Explained to patient that due to the cost and need for us to order the vaccines, they must pay for the 2 primary doses in advance today and we will notify when they are available - SAS Application to be done upon supply, via the SAS portal using Category C (M89) indication pathway for which prior approval is not required copy of receipt to be added to file once received. Vaccinations were administered by the practice nurse with thanks Patient was asked to stay in the practice for 15 minutes post vaccination to ensure no immediate hypersensitivity reactions occurred. Note created with the assistance but not reliance on Scribing software "Heidi AI" by Heidi Health - patient verbal consent obtained prior to activation of transcription - no audio recordings obtained or retained with either Heidi AI or in our system - In Heidi AI patient info is de-identified and encounter is labelled with first last name initial only for future reference - All transcription records are deleted after 48 hours by default setting All vaccine costs discussed with patient during consult and a copy of the vaccine costs schedule including dose regime was provided for their reference during the consult