158 Infectious Disease and Foreign Travel Emergencies
Common Imported Diseases of Travellers
(i) PEP is a combination of human rabies immunoglobulin (HRIG)
and rabies vaccine, and should be given within 48 h of the bite:
(a) category I exposure – no further treatment required
(b) category II exposure – administer rabies vaccine i.m.
(c) category III – administer rabies vaccine and HRIG i.m.
(ii) Depending on the vaccine type, PEP in the non-immune includes
rabies vaccine 1 mL i.m. in the deltoid muscle to a total of five
doses over four weeks on day 0, 3, 7, 14 and 28–30. In addition,
HRIG 20 IU/kg is infiltrated around the wound site on the first
day.
5 Determine and manage the local wound infection risk.
(i) A low risk wound seen within 8 h not involving a tendon or joint
that can be adequately debrided and irrigated requires no further
treatment.
(ii) A high risk wound includes delayed presentation (8 h or more),
a puncture wound unable to be debrided adequately, a wound
on the hand, feet or face and a wound with underlying structures
involved (e.g. bone, joint or tendons)
(a) give amoxicillin 875 mg and clavulanic acid 125 mg one
tablet orally b.d. for 5 days.COMMON IMPORTED DISEASES OF TRAVELLERS
● Ask any patient who has been travelling abroad specifically about the time,
place and type of travel. Ask how long they spent in each foreign country and
when they arrived back.
● Enquire specifically about malaria prophylaxis and whether it was taken for
4 weeks after leaving a malarial zone, and about immunizations before going
abroad.
● The CDC Travellers’ Health website (see http://wwwnc.cdc.gov/travel/) has
information to assist travellers and their healthcare providers in deciding on
the vaccines, medications, and other measures necessary to prevent illness
and injury during international travel. It covers all aspects of foreign travel,
including lists of recent disease outbreaks, and information on illnesses in
alphabetical order from African sleeping sickness to yellow fever.
● Remember that the returned traveller may well have a condition that is not
considered ‘tropical’, such as an STD including HIV infection, meningococcal
infection, pneumonia, pyelonephritis, and enteric infection other than travel-
ler’s diarrhoea.
● Some of the tropical diseases discussed below can be endemic, but mostly are
contracted abroad.