TRAVEL CLINIC Stacey Tay Kiat Hong

TRAVEL CLINIC
Stacey Tay Kiat Hong
The general practitioner is often questioned on the precautions required when a family
goes travelling, especially to countries with endemic infectious diseases such as
malaria and cholera. He will have to tailor advice for the family based on the following
points:
1. Where the travel destination is
2. What diseases are endemic in the country e.g. malaria, cholera
3. Whether the family will be travelling to a rural area
4. What are the sanitation and clean water facilities available
5. What is the composition of the family, i.e., how old the children are.
We often prefer the patient to visit the doctor or the travel clinic 4 weeks before
departure.
Bulletin 11; January 2000
MITA (P) No: 251/06/2000
1

HOW TO STAY HEALTHY
The family will need simple advice on how to avoid illness, food poisoning and
accidents. The following should be recommended:
Food
• Do not eat food purchased from street vendors.
• Do not eat raw seafood or rare meat
• Do not eat dairy products unless you know they have been pasteurized.
• Wash hands often with soap and water.
A simple piece of advice is to eat nothing unless one can “boil it, cook it, peel it or
forget it”. That is, eat only thoroughly cooked food or fruits and vegetables that the
traveller has peeled and prepared himself.
Water
• Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or
bottles.
• Avoid tap water, fountain drinks, and ice cubes.
• Make water safer by both filtering through an "absolute 1-micron or less" filter
and adding iodine tablets to the filtered water. "Absolute 1-micron filters" are
found in camping/outdoor supply stores.
Clothing
• Protect the family from insects by remaining in well-screened areas, using
repellents (applied sparingly at 4-hourly intervals), and wearing long-sleeved
shirts and long pants from dusk through dawn. Wear light coloured clothing.
• Reduce problems related to sun exposure by using sunglasses, wide-brimmed
hats, sunscreen lotions and lip protection
• Apply repellents that contain DEET (N,N-diethyl-meta-toluamide) to clothing
and exposed skin. The strength of DEET should be 30 – 35 % for adults and 6
– 10 % for children. Avoid applying repellents to portions of children's hands
that are likely to have contact with their eyes or mouth. Never use repellents on
wounds or irritated skin.
Accidents and activities
• Swim only in well-maintained, chlorinated pools or ocean water known to be
free from pollution.
• Do not swim in fresh water in certain areas of Cambodia, Indonesia, Laos,
Philippines, and Thailand to avoid infection with schistosomiasis.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not
go barefoot.
• Don’t handle animals, especially stray animals like monkeys, dogs, and cats, to
avoid bites and serious diseases such as rabies and plague.
Bulletin 11; January 2000
MITA (P) No: 251/06/2000
2

• Because motor vehicle crashes are a leading cause of injury among travellers,
walk and drive defensively. Avoid travel at night if possible and always use
seat belts for adults and car seats for the children.
Routine vaccinations
• Carry medical and vaccination records. Ensure that the child has received the
appropriate vaccinations according to schedule.
For travellers over 2 years of age the following immunizations normally given during
childhood should be up to date.
• Measles, Mumps, and Rubella (MMR) Vaccine
• Diphtheria, Tetanus, and Pertussis (DTP or DTPa) Vaccine until age 7, then
DT Vaccine
• Polio (OPV) Vaccine
• Hepatitis B (HB) Vaccine
• Haemophilus Influenza B (HbCV) Vaccine (recommended but not mandatory)
Special vaccinations
• Allow at least 4–6 weeks before the trip to give time for vaccinations to take
effect.
• The type of vaccinations depends on the age of the child, the child’s medical
history, proposed itinerary, duration of stay and purpose for travelling
• Cholera and Meningococcus vaccinations are mandatory for travel to Mecca.
Parents must be reminded that malaria can be fatal. If the child develops fever or flulike
symptoms and medical care is not available in 24 hours, then one dose of Fansidar
(pyrimethamine-sulfadoxine) may be used. The dosage for weight is:
• 5-10 kg: 1/2 tablet
• 11-20 kg: 1 tablet
• 21-30 kg: 1 1/2 tablets
• 31-45 kg: 2 tablets
• >45 kg: 3 tablets
Parents need to be informed that they must bring their child to medical attention if he
or she develops fever or flu-like symptoms during travel to the malaria-risk area and up
to 1 year after leaving the area.
Parents should also be educated on simple mosquito-bite prevention strategies such as
wearing light-coloured long-sleeved clothing, using insect repellents such as DEET and
using a mosquito net for the child’s sleeping area. For greater protection, spray clothing
with and soak bed nets in the insecticide permethrin. Permethrin will repel insects for
several months.
Bulletin 11; January 2000
MITA (P) No: 251/06/2000
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Medications to bring along
Bring an adequate supply of all prescription medication as well as any necessary
personal hygiene items, including a spare pair of eyeglasses or contact lenses if
necessary.
Other useful medication:
• Oral rehydration preparations
• Anti-diarrheal and anti-emetic medication
• Paracetamol or similar antipyretic medications
• Antihistamines or cough mixtures
• Topical antiseptic cream
• First aid kit with plasters
• Thermometer
• Insect repellant spray (DEET)
For more information, useful web sites to access are:
http://www.cdc.gov/travel/index.htm
http://www.ttsh.gov.sg/medical/frame.htm
http://www.who.int/
Bulletin 11; January 2000
MITA (P) No: 251/06/2000
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Bulletin 11; January 2000
MITA (P) No: 251/06/2000
Malaria chemoprophylaxis for children
Drug Usage Dosage Side effects Comments
Mefloquine - In areas with - 45 kg: 1
disorders or
tab/week
abnormalities
of cardiac
Doxycycline -An alternative to >8 years of age: GIT upset,
conduction
Contraindicated
Mefloquine
2 mg/kg photosensitivity, in children

Vaccine Indication Type Rou
te
Typhoid
TAB Visit for > 6 Whole
weeks to place cell
with
killed
unsanitary include
conditions paratyph
(Africa, Asia i A & B
Vi polysaccharide
and Latin
America)
Polysacc
haride
Oral
Ty21a
Cholera Extended visit
(>3 months)
in a place with
unsanitary
conditions
(Africa, South
America,
Asia)
Hepatitis
A
Japanese
B
encephali
tis
Yellow
Fever
Meningococcus
A+C
Visit to a
place with
unsanitary
conditions
(Rural areas in
developing
countries)
Visit > 30
days to Asia,
West Pacific
and India
South
America,
Africa
Bulletin 11; January 2000
MITA (P) No: 251/06/2000
Live
(Vivotif
Berna)
Travel vaccines
Age of
1 st
vaccinat
ion
No. of
injections
IM > 2
years
1 -
Inter
val
IM 1 - Nil
(lasts 3
years)
Ora
l
Killed SC/
IM
Killed
whole
virus
Havrix
(SKB)
Vaqta
(MSD)
SC/
IM
3 oral doses eod Not < 3
years
> 1 year 1 - 6
monthl
y
Havrix
> 1 year
Vaqta >
2 year
Killed SC < 3
years
0.5 ml
> 3
years
1 ml
Killed SC/
IM
Middle East Polysacc
haride
vaccine
Rabies Africa, Asia,
Latin America
Influenza Areas of
outbreak
SC/
IM
Killed SC/
IM
Killed
SC/
IM
- 15 yr
needs 1x0.5
ml dose
- 17 yr 50
units
1
mont
h
2 1-2
week
s
Booster Reactogenicity Contraindicati
ons
& Comments
After 6
– 12
months
- < 17
yr 6 –
18
months
- > 17
yr 6
months
Every 4
years
> 1 year 1 - 10
years
> 3
months
A
> 18
months
C
1 - After 3
– 5
years,
then 5
yearly
All ages 2 1
mont
h
All ages 1 1
year
Affected by
concurrent
antibiotics or
antimalarials
Local and
systemic
Take 2 weeks
before travel
Infants < 6
months
Mild Use Hepatitis
A Immune
Globulin
(0.06 ml/kg
or 10 mg
IgG/kg IM)
for infants
less than 12
months
Mild
1 year Mild
Fever, myalgia
and rarely
encephalitis
Egg allergy
Vaccination
certificate
required
Local rare Safe in
infancy but
protection
may not be
complete
when the
child is < 2
years old
- Fever, mild
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