Makindo Medical Notes

Travel health advice involves preparing individuals for safe travel abroad by minimising risks of infectious disease, accidents, and environmental hazards. Clinicians should provide tailored advice based on the traveller’s destination, activities, duration of stay, and personal health conditions.

🧾 Pre-Travel Consultation

• 🗺️ Destination: Rural vs urban, endemic diseases (e.g. malaria, yellow fever).
• 🕒 Duration & season: Longer stays and monsoon seasons increase risk.
• 🏕️ Activities: Trekking, swimming in freshwater (schistosomiasis), animal contact (rabies).
• 💊 Medical history: Pregnancy, immunosuppression, chronic illness, allergies.
• 📜 Documentation: Vaccination records, insurance, emergency contacts.

💉 Vaccinations

• 🟢 Routine vaccines: Ensure up to date (MMR, tetanus, polio, influenza, COVID-19).
• 🌍 Destination-specific:
  • Yellow fever (certificate often required).
  • Typhoid, hepatitis A, cholera (food and water risks).
  • Japanese encephalitis, rabies (high-risk rural or long-term stays).
• 🛑 Contraindications: Live vaccines avoided in immunocompromised/pregnant patients (seek specialist advice).

🦟 Malaria & Vector-Borne Illnesses

• 🧭 Risk varies by region – consult current UK malaria maps (NHS Fit for Travel, NaTHNaC).
• 🦟 Bite prevention: Insect repellent (DEET), mosquito nets, covering skin, permethrin-treated clothing.
• 💊 Chemoprophylaxis: Atovaquone-proguanil, doxycycline, or mefloquine depending on destination/resistance.
• 🦠 Other vector illnesses: Dengue, Zika, chikungunya → focus on bite prevention (no vaccine widely available).

💧 Food & Water Safety

• 🚱 Avoid untreated tap water, ice, raw seafood, unpasteurised dairy.
• 🥤 Use bottled/boiled water or chlorine tablets for drinking and brushing teeth.
• 🍽️ Hand hygiene before meals reduces risk of traveller’s diarrhoea.
• 💊 Consider standby antibiotics (e.g. azithromycin) in remote destinations with poor healthcare access.

🏥 Other Travel Risks

• ✈️ Venous thromboembolism (VTE): Encourage mobilisation, hydration, compression stockings on long flights.
• ☀️ Sun exposure: Use sunscreen, avoid dehydration, hats/clothing protection.
• 🏔️ Altitude sickness: Gradual ascent, acetazolamide prophylaxis if high-risk.
• 😷 Respiratory risks: Tuberculosis, influenza, COVID-19 in crowded areas.
• 🐕 Animal bites: Rabies risk → wash wound + urgent medical care.

📊 Red Flags & Urgent Advice

• 🌡️ Fever after travel to malaria-endemic area = malaria until proven otherwise.
• 🩸 Persistent diarrhoea or dysentery after return → consider parasitic infection.
• 🤕 Severe headache, rash, or bleeding illness → rule out arboviruses.
• 🧠 Confusion, seizures, or altered consciousness after tropical travel requires urgent admission.

✅ Take-Home Messages

• Always individualise travel advice to the person and itinerary.
• Update routine vaccines and give destination-specific immunisations.
• Malaria prevention = bite avoidance + chemoprophylaxis.
• Safe food, water, and VTE precautions are essential.
• On return: any fever post-travel = urgent malaria screen.

Cases

• Backpacker to Thailand (4 weeks): Offer Hepatitis A (± Typhoid); consider rabies pre-exposure if animal contact possible. Emphasise daytime bite avoidance for dengue/chikungunya (repellent, long sleeves). Provide standby azithromycin for severe traveller’s diarrhoea; discuss insurance and heat hydration.
• Visiting Family in Nigeria (3 weeks): High malaria risk—choose atovaquone–proguanil, doxycycline, or mefloquine. Yellow fever vaccine/certificate usually required; add Hep A/Typhoid (consider Hep B). Stress bite prevention and the rule: any fever on return → urgent assessment within 24h.
• Hajj/Umrah Pilgrim (with T2DM): MenACWY vaccine/certificate mandatory. Optimise diabetes and foot care; ensure influenza and COVID boosters. Teach respiratory hygiene, heat-illness prevention, and DVT measures for flights.
• Peru Trek to 4,200 m (Andes + brief Amazon): Hep A ± Typhoid; yellow fever only if entering Amazon (check UK NaTHNaC). Prevent AMS via gradual ascent; consider acetazolamide 125 mg bd if rapid itinerary or prior AMS. Reinforce mosquito avoidance in lowlands and safe water to avoid giardiasis.
• 13-Week Medical Elective in India (hospital placement): Ensure MMR×2, Td/IPV booster, add Hep A/B and Typhoid; consider rabies pre-exposure (limited RIG access). Region-specific malaria prophylaxis. Agree needlestick plan, documentation, and comprehensive medical insurance.
• Pregnant Traveller to Jamaica (24 weeks, resort-based): Avoid areas with Zika advisories; if travel proceeds, strict daytime bite avoidance. No routine malaria chemoprophylaxis for Jamaica. Ensure pertussis (pregnancy) and influenza are up to date; advise flight DVT measures and confirm maternity cover.