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Risk Management: 

Risk Management Food and water precautions: “Boil it, cook it, peel it, or forget it” Drink bottled/canned carbonated beverages without ice; coffee and tea are also safe Boil or filter and chemically disinfect untreated water Avoid unpasteurized dairy products Avoid uncooked/undercooked foods (e.g. hamburger, shellfish, raw unpeeled veggies) Avoid food from street vendors Wash/sanitize hands before eating/drinking Canada Communicable Disease Report. Vol. 27 (ACS-3), 15 Mar. 2001.

Hepatitis A: Risk Areas: 

Hepatitis A: Risk Areas Risk in non-immune travellers to developing countries is estimated to be 3 - 5/1,000 per month; cases 1.6 times higher in males than in females Risk is up to six times higher for low-budget travellers eating in poorer hygienic conditions Avaxim® Product Monograph. Sanofi pasteur, June 2003. Map: Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p. 204

Hepatitis B – Risk Areas: 

Hepatitis B – Risk Areas Vaccine-Preventable Diseases. Public Health Agency of Canada. www.phac-aspc.gc.ca. Among long-term residents of endemic areas, the incidence rate of symptomatic HB ranges from 0.2 per 1,000 per month (Africa, Latin America) to 0.6 (Asia) Advise avoidance of unprotected sex or unnecessary exposure to sharps, blood or blood products

Typhoid Fever: Risk Areas: 

Typhoid Fever: Risk Areas Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p.433

Travellers’ Diarrhea: Risk Areas: 

Travellers’ Diarrhea: Risk Areas Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. Enterotoxigenic E. coli (ETEC) is the primary cause of up to 50% of Travellers’ Diarrhea

Travellers’ Diarrhea & 5-Star Resorts: 

Travellers’ Diarrhea & 5-Star Resorts It’s the sanitary practices of the food handlers, the procedures in the kitchen and /or the patrons at the buffet which can be problematic Travelers’ Diarrhea can occur even in “top-notch” resorts There are numerous opportunities for food contamination, such as: unhygienic food handling practices inadequate storage/transport of food unreliable refrigeration Shlim DR. Understanding Diarrhea in Travelers. CIWEC Clinic Travel Medicine Center, 2004.

Prevention of Travellers’ Diarrhea: 

Prevention of Travellers’ Diarrhea Oral, inactivated Travellers’ Diarrhea and cholera vaccine (DUKORAL®)2 The only Travellers’ Diarrhea vaccine currently available that protects against Travellers’ Diarrhea caused by ETEC Confers protection against both cholera and ETEC-induced Travellers’ Diarrhea 1. DUKORAL® Product Monograph. sanofi pasteur, February 2003.

Cholera – Risk Areas: 

Cholera – Risk Areas Spread through fecal-oral route - contaminated drinking water, ice, vegetables, raw fish/shellfish1 Linked to overcrowding, poor sanitation, untreated water1 Similar precautions as Travellers’ Diarrhea1 Isolated cases of cholera imported in Canada every year 1. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p.158. 2. Canada Communicable Disease Report Vol. 24 (ACS-5) 1 December 1998. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/98vol24/24sup/acs5.html

Malaria: Risk Areas: 

Malaria: Risk Areas More than 15,000 cases of malaria are imported to non-endemic countries yearly (likely an underestimate)1 Additional unknown number of cases treated abroad1 Endemic in >100 countries visited by more than 125 million travellers/year2 About 400 imported cases reported in Canada each year (also underestimate)3 1. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p.268. 2. International Travel and Health 2005 (Chapter 7). World Health Organization. www.who.int/ith. 3. PHAC. Disease Information: Malaria. February 2001. http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html

Malaria Chemoprophylaxis: 

Malaria Chemoprophylaxis Strategy that uses medications before, during and after the exposure period to prevent disease caused by Malaria parasites. Suppress symptoms caused by blood stage parasites. Presumptive anti-relapse therapy (terminal prophylaxis) prevents delayed onset Malaria caused by hypnozoites (dominant liver stages) of P. vivax or P. ovale. P. vivax and P.ovale parasites can persist in the liver and cause relapses for as long as 4 years or more.

Malaria: Resistance: 

Chloroquine Sensitive Chloroquine Resistant Malaria: Resistance

Yellow Fever: 

Yellow Fever Acute viral illness1 Transmitted by mosquito bite2 Infection with virus may cause1: Potentially lethal pansystemic disease with fever, jaundice, renal failure and hemorrhage. 1. YF-VAX® Product Monograph. Aventis Pasteur, January 2005 2. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p.456.

Japanese Encephalitis: 

Japanese Encephalitis Transmitted by mosquito bite1 Occurs only in Asia1 Risk of infection for short-term travellers is very low, but cases do occur1 Most (99.5%) infections are asymptomatic1, but clinical illnesses have a fatality rate of 25%2 Vaccine: JE-VAX®, sanofi pasteur2 3-dose schedule Shorter/accelerated schedules are available Booster dose may be given after 2 years 1. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. pp.244-245. 2. JE-VAX® Product Monograph. Aventis Pasteur, March 1996.

Rabies: 

Rabies Transmission via bites (LICKED or scratched) by an infected animal1 Dogs/cats are infective 3-14 days before onset of clinical signs1 Occurs worldwide1 1. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. p.348.

Meningitis: 

Meningitis Humans are the only natural reservoir - disease is transmitted by aerosol/secretions1 Broad clinical picture: transient fever to fulminant meningitis and septicemia1 Different serogroups1: A (Asia, Africa) B (Europe, Americas) C (Asia, Africa, Europe, Americas) Y (United States and Canada) W-135 (Africa and Middle East) 1. Steffen R, DuPont HL, Wilder-Smith A. Manual of Travel Medicine and Health. 2nd Ed. BC Decker Inc., 2003. pp.319-321.

Altitude Sickness: 

Altitude Sickness Traveling to a higher altitude faster than the body can adapt to that new altitude. Risk at altitudes >1,829 (6000 ft) e.g. Cuzco, Peru (3,000m; 11,000 ft) La Paz, Bolivia (3,444m; 11,300 ft); and Lhasa, Tibet (3,749 m; 12,500 ft). 3 syndromes Acute mountain sickness High altitude cerebral edema (HACE) High altitude pulmonary edema (HAPE) With HAPE and HACE descent to a lower altitude is indicated. No screening test available to determine to predict someone’s risk for altitude illness.

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