Travelers - Diseases transmitted through contaminated food & water

32 important questions on Travelers - Diseases transmitted through contaminated food & water

Because 80% of TD cases are bacterial, what is the main pathogen?

E.coli

If trying to avoid TD, is it okay to eat food that has been sitting on a buffet?

NO, avoid.

Prophylaxis with what can reduce the incidence of TD by 50%?

Bismuth subsalicylate (BSS), the active ingredient of Pepto-Bismol
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Do not use BSS in what patients?

Aspirin allergy, pregnancy, renal insufficiency, gout, taking anticoagulants

BSS is FDA-approved for OTC use in children >12 years, but cannot be used inn younger children if they recently had viral infection, why?

Due to the risk of Reye's syndrome

In what people can antibiotic prophylaxis for TD be given?

High risk of developing complications of TD-- immunocompromised or those with travel performance reasons

What is the preferred antibiotic for TD prophylaxis?

Rifaximin

What is essential in treating all TD cases?

Hydration with increased fluid & salt intake
PO rehydration soln is preferred in elderly.

What is used to treat mild TD?

Loperamide (Imodium A-D) 4mg after 1st stool, 2 mg after each stool after.
OTC max: 8 mg/day
Rx max: 16 mg/day
  

How does loperamide work?

Anti-motility & antidiarrheal- decreases frequency and urgency of bowel movements

For up to how many days can loperamide be taken for self-treatment?

2 days

What is another option to treat mild TD?

Bismuth subsalicylate (BSS)

How does BSS work?

Reduce stools passed by 40% by antisecretory and anti-diarrheal properties

What is treatment for moderate TD?

Loperamide +/- antibiotics

What abx are preferred in treatment for moderate TD?

Azithromycin
quinolone if low resistance 

What is an alternative abx in treating moderate TD?

Rifaximin

What is the treatment for severe TD including dysentery?

Abx +/- loperamide

What is the preferred abx for severe TD with dysentery?

Azithromycin

What are alternative treatments for severe TD with dysentery?

Quinolone or riifaximin

What bacteria causes typhoid fever?

Salmonella typhi

How is typhoid fever spread?

Through food or water contamination by feces of someone with acute infection or from a chronic asymptomatic carrier

Is there a vaccine for typhoid fever?

Yes & recommended, but not very effective

Even if vaccinated for typhoid fever, what precautions should traveler's take?

Safe food and water precautions and wash hands frequently

What is the PO, LIVE typhoid fever vaccine?

Vivotif
completed >/= 1 week before travel 

What is the IM, inactivated typhoid fever vaccine?

Typhim Vi
give >/= 2 weeks before expected exposure 

What bacteria causes cholera?

Vibrio cholerae

What is the most common symptom of cholera?

Watery diarrhea "rice-water stools"

What is recommended if traveling to region with active cholera transmission?

Food & water precautions
PO, LIVE liquid given at least 10 days before travel for ages 2-64 years (Vaxchora)

Even though most people in U.S. receive polio vaccine, because the virus is not eradicated worldwide, what does the CDC recommend?

A single lifetime booster dose of inactivated vaccine at least 4 weeks before travel to regions with circulating poliovirus, for adults that have completed polio vaccine series

What people are at highest risk of Hepatitis A?

People from developed countries traveling to developing countries

How is Hepatitis A spread?

Food-borne

What are the diseases spread through contaminated food & water?

Travelers diarrhea
Typhoid fever
Cholera
Polio
Hepatitis A 

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