医学课件health while

Health While Abroad Dr. Eva TK Au MBChB, MRCP(UK), DPD(Cardiff) Prepare for your journey, see a doctor at least 4 weeks before travel. Why? For What? Travel medical consultation 1. Are you fit enough for travel? 2. Prevent infectious diseases 3. Prepare for self treatable illness 4. Be prepared if you need medical help Fitness for Travel Heart diseases Heart attack within a month Unstable chest pain Heart failure CABG in 2 weeks Lung diseases Asthma, recent hospitalization Active respiratory infection Pneumothorax within 2 weeks Pleural effusion within 2 weeks Major chest surgery within 2 weeks 1. Fitness for Travel Gastrointestinal diseases Surgery within 2 weeks Gastrointestinal bleeding within 24 hours Colonoscopy within 24 hours Diabetes Mellitus Liable to infection Prepare physicians letter stating need for all equipment (syringes, glucose meter) 1. Fitness for Travel Chronic medical diseases Provide a physicians letter Pack medications in their original containers In carry-on luggage Extra quantities in case of unexpected delays 1. Fitness for Travel Pregnancy Safest time to travel 18-24 weeks Most airlines refuse the boarding of women of over 32 weeks maturity Increased risk of Deep Vein Thrombosis 1. Fitness for Travel Immunocompromised traveler Cancer patient Chronic diseases Chronic renal disease Chronic liver disease After removal of spleen Diabetes mellitus On drug treatment which can weaken immune system HIV Prone to infectious disease Immunisation is important 2. Prevent infectious diseases A. Immunisation a) Routine immunisation b) Mandatory immunisation c) Other B. Drug prophylaxis C. Vector prevention A. Immunisation Routine Immunisation Poliomyelitis 小 兒 麻 痺 Hepatitis B 乙 型 肝 炎 Pneumococcal 肺炎球菌 Tetanus, Diphtheria, Pertussis 白 喉 、 破 傷 風 、 百 日 咳 Measles, Mumps, Rubella 麻 疹 、 流 行 性 腮 腺 炎 及 德 國 麻 疹 Why these routine immunisation is important? These diseases are serious or deadly These diseases are still common in places where vaccine coverage is low Adults should check their immunization records: Some adults were never vaccinated as children Newer vaccines were not available when some adults were children Immunity can begin to fade over time Example 1)Poliomyelitis 小 兒 麻 痺 Acquired by fecal-oral transmittion 病毒經糞便入 口而傳播 Initially fever, headache, sore throat, vomiting, diarrhoea or constipation 輕微症狀如發燒、頭 痛、喉痛、嘔吐、肚瀉、或便秘 Progress to muscle pain and weakness in the limbs and face 肌肉疼痛，和四肢及面部的肌肉無力 Affect breathing and swallowing function 呼吸和 進食功能受到影響 Death 死亡 Example 2) Measles麻疹 Highly contagious, transmitted via respiratory droplets Red blotchy rash, cough, runny nose, eye irritation, fever, ear infection, diarrhea Pneumonia, brain inflammation Death 2 in 1000 in developed countries 150 in 1000 in developing countries Example 2) Measles麻疹 Measles outbreak in the past six months Philippines: 699 cases in 2nd week of Feb South Africa: Outbreak since 2009, 7099 cases Bulgaria: Outbreak since May 2009, 4561 cases, 9 died Example 3) Mumps腮腺炎 Swollen salivary glands, fever, headache Painful swelling of testicles and ovaries Deafness, meningitis Current Mumps outbreak: USA (New York & New Jersey): 1521cases in Jewish communities Israel (Jerusalem): 850 cases 2. Prevent infectious diseases A. Immunisation a) Routine immunisation b) Mandatory immunisation c) Other B. Drug prophylaxis C. Vector prevention Mandatory Immunisation Yellow fever 黃熱病 Some countries require YF vaccine for travellers from all countries Transmitted by bite of infected mosquits經由蚊咬轉播 Myalgia, pyrexia, headache, nausea and vomiting 發高熱 、頭痛、發冷、噁心、嘔吐和肌肉疼痛 Bleeding from the mouth, eyes, ears, and stomach 內出血 Shock, deterioration of major organ function肝腎衰竭 20-50% died死亡 中、南美洲和撒哈拉沙漠以南的非洲國家的熱帶地區 Yellow Fever Vaccine in HK Travel Health Centres, Department of Health Hong Kong Room 26, 18/F Wu Chung House, 213 Queens Road East, Wan Chai (Nearest MTR: Wan Chai Station) Kowloon 1/F Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Sham Shui Po (Nearest MTR: Sham Shui Po Station) Mandatory Immunisation Annual pilgrimage to Mecca 麥加朝聖 Required certificate of vaccination against meningococcal meningitis流 行性腦脊髓膜炎 2. Prevent infectious diseases A. Immunisation a) Routine immunisation b) Mandatory immunisation c)Other vaccines B. Drug prophylaxis C. Vector prevention Other Vaccines Hepatitis A甲型肝炎 Typhoid 傷寒熱 Meningococcal 流行性腦膜炎 Japanese Encephalitis日本腦炎 Rabies 狂犬病 Hepatitis A甲型肝炎 transmitted from person to person and through food or drink that has been contaminated with the stool of someone with hepatitis A infection.人與人之間傳播，也 可由進食及飲用被甲型肝炎患者的糞便 污染了的食物及飲品而傳播 fever, malaise, upper abdominal discomfort, loss of appetite and nausea, followed within a few days by yellow discoloration of skin and eyes 發燒、疲倦、上腹疼痛、食慾不振 及作嘔；接著眼白及皮膚會呈現黃色 Hepatitis A Recent outbreak Australia 200 cases being reported in Victoria, associated with semi-dried tomatoes France 55 cases, dried tomatoes from Turkey Netherlands, Sweden Hepatitis A Vaccine甲型肝炎疫 苗 two doses six months apart.注射兩劑疫 苗，兩劑相隔六個月。 Protection against hepatitis A begins four weeks after the first dose 免疫能力於第 一次注射後四個星期便產生。 Highly effective 十分有效 Protection lasts for more than 10 years有 效期則長達十年或以上 Typhoid Fever傷寒熱 bacterium Salmonella typhi 沙門氏菌類 spread through food and water contaminated by stool and urine of patients and carriers經由一些 受到病者或帶菌者的糞便或尿液所沾染的飲 食 Fever, malaise, loss of appetite, severe headache, enlargement of spleen, and constipation or diarrhoea.發熱、疲倦、食慾不振、嚴重頭痛 、脾臟脹大、便秘或肚瀉的情況出現 One out of ten patients may die if untreated。如 缺乏醫治，死亡率可能達十份之一 Typhoid Fever傷寒熱 High risks areas: Most developing countries warm climates and underdeveloped sanitary facilities for sewage disposal and water treatment. Risk is highest in Nepal, India, Bangladesh, and SE Asia. Current outbreak: Fiji 斐濟 (112 cases), Haiti海地 , Mozambique莫桑比克 (435 cases, 43 death) Typhoid fever vaccine One dose last for 3 years Vaccination should be completed at least one week before you travel. Japanese Encephalitis日本腦炎 Culex mosquitoes 庫列蚊叮咬而傳播 breed where there is abundant water such as rice paddies and feed mainly on domestic animals such as pigs庫列蚊主要在 水源豐富的地區 (如稻田 ) Most infections are asymptomatic大部分受感染人士並沒 有任何徵狀。 headache, fever, nausea and vomiting.頭痛、發燒、噁心和 嘔吐 Severe cases may progress to confusion and coma. The mortality can be as high as 35%. About 30% of those who survive may have severe nervous system damage like paralysis. 。情況嚴重的會進一步惡化以致昏迷及神志不清。死亡 率會高達百分之三十五。即使生存下來的人士，約有百 分之三十會有神經系統損壞如癱瘓。 Japanese Encephalitis日本腦炎 rural and agricultural areas 鄉村及農業地域 Over 50,000 cases are reported annually from Southeast Asia, India, China, Japan and Korea. 每年在東南亞、 印度、中國、日 本 及 韓國 共有超過五萬宗病例。 China, Japan and Korea - April to September 溫帶地區如 中國 、 日本 及 韓國 等，高危期間為四月至九月 Northern India and Nepal - June to November.北印度 及 尼泊爾 ，高危期則為 六月至十一月。 Japanese Encephalitis日本腦炎疫 苗 mainly for persons spending 30 days or more in a rural agricultural endemic area during the transmission season.在高危時 期前往疫區的鄉郊和農村、而又逗留 超過三十日的人士應接受疫苗。 3 doses on days 0, 7 and 30皮下注射三 針，分別於 0, 7 及 30天注射。 Prevent Infectious Disease Vaccines Oral Drug Vector prevention Malaria瘧疾 bite of an infective female Anopheles mosquito.瘧蚊叮咬而傳播 chills, fever, sweating, headache, muscle aches, and tiredness.發冷、發燒、冒汗、 頭痛、肌肉痛和疲倦。 mental disturbances, convulsions and various blood and kidney disorders. Can lead to death within 24 hours.影響中央神經系統 - 神智不清、抽筋、血液和腎臟問題，患 者可於 24小時內死亡。 2002 西太平洋區瘧疾疫情資料 國家 確診病例 瘧疾死亡 巴布亞新磯內亞 79,822 647 所羅門群島 74,865 61 越南 47,807 50 柬埔寨 46,902 457 菲律賓 37,005 71 中國 25,520 42 老撾 21,384 195 瓦努阿圖 14,339 4 馬來西亞 11,053 38 韓國 1,763 0 總人數 360,460 1,565 Malaria Disease Risk Rural disease Less common above 1500 meter, none above 3000 meter Less in dry seasons Less in air-conditioned accommodations Infected mosquito feed at night Malaria - Prevention預防瘧疾 Prevent mosquito bite Medications Chloroquine, mefloquine, malarone, doxycycline Differences: drug resistance, regime, side effects Timing Malaria when to seek help Fever after travel Inform hour doctor that you might be at risk Request rapid tests or “thick and thin blood films” Prevent Infectious Diseases Vectors Prevention Insects (eg. Mosquitos) Food and water Human contact Insect Precautions Mosquitos can spread Dengue Fever Malaria Japanese Encephalitis Yellow Fever Sanflies白蛉 can spread Leishmaniasis利甚曼病 Bartonellosis巴爾通體 Ticks蜱 can spread Typhus斑疹傷寒 Lyme disease萊姆病 Encephalitis腦炎 Insect Precautions 1. Stay in air-conditioned rooms or those protected by screens. 2. Dress in pale colors, cover as much skin as possible, and wear socks and shoes (not sandals). 3. Insect repellent DEET ( N , N-Diethyl -3-toluamide) 30% - 6 hours Picaridin 20% 4. Mosquito net over the bed 5. Avoid being outdoors during mosquito feeding times Malaria night time Dengue day time Food and water hygiene Contaminated food and water can transmit Travellers diarrhoea Hepatitis A Typhoid Cholera Food and water hygiene Boil it, cook it, peel it or forget it! Drink only boiled water or bottled drinks by reputable companies, and pasterurised milk or dairy products. Avoid drinks with ice Avoid peeled fruits and raw vegetables Animals In areas of endemic Rabies, even domestic dogs and cats should not be petted. Avoid contact with wild animals, especially bats, jackals and monkeys. Avoid dangerous Human Contact Beware of the dangers of casual sex while you are abroad Hepatitis B & C, HIV, gonorrhea, syphilis, chlamydia Travelers who have a higher likelihood of risky encounters: 1. young men 2. long-term travelers 3. men who have sex with men 4. individuals traveling alone or with partners other than their families, 5. business travelers. A single exposure is sufficient to transmit the HIV virus or other sexually transmitted diseases Prevent Sexually Transmitted Diseases Travel with your partner Abstain from sexual activity Use high quality condom correctly Limit consumption of alcohol Be aware of the possibility of rape Travel medical consultation 1. Are you fit enough for travel? 2. Prevent infectious diseases 3. Prepare for self treatable illness 4. Be prepared if you need medical help Prepare for self-treatable diseases Travelers diarrhoea Sudden onset of relatively uncomfortable diarrhoea Ciprofloxacin 500mg every 12 hours for 1 day (2 doses) Anti-diarrhoea drug (eg. Loperamide, lomotil) Drug for abdominal pain (eg. Buscopan, holopon) Oral rehydration solution Prepare for self-treatable diseases Altitude Sickness Human body take time to adjust to lower level of oxygen in high altitude Appears within a few hours of ascent to above 2,500 meters Airport in high altitude 城市 高度（米） 中國 四川省 九黃機場 2900 黃龍 3300 稻城 , 亞丁 3700 雲南省 香格里拉 3300 玉龍下雪山大索道 4500 青藏高原 青海湖 3200 拉薩，貢嘎機場 3600 阿里地區，那曲地區 4500 珠穆朗瑪 大本營 5200 尼泊爾 Nepal 陸拉機場 Lukla airport 2800 馬南格 Manang 3500 菲里奇 Pheriche 4300 薩加瑪塔大本營 Sagarmatha base camp 5400 沙巴 Sabah 神山 Mount Kinabalu 4095 Altitude Sickness Mild Symptoms Headache In