FEVER IN RETURNED TRAVELERS: PRE-TRAVEL PREPARATION
Pre-travel immunizations and chemoprophylaxis taken during travel must be determined, since these will influence the probability of acquiring infections. These interventions vary in efficacy. The proper administration of vaccines against hepatitis A, hepatitis B, and yellow fever effectively rules out each of these infections as a cause of a patient’s illness. However, vaccines against typhoid fever or use of immunoglobulin for the prevention of hepatitis A is only 70% to 80% effective, so these infections should still be considered among patients who have been immunized. Childhood immunizations against diseases such as polio, diphtheria, and measles may not provide adequate protection in adults unless a booster has been administered or natural disease reported. Immigrants from developing countries may not have received routine immunizations.
For travelers to malaria-endemic areas, the use of personal protective measures (insect repellents, bed nets) and chemoprophylaxis must be assessed. Note that no antimalarial chemoprophylactic regimen is completely protective. Furthermore, poor compliance with antimalarials among travelers is a well-documented cause of failure.
The health of the patient prior to travel is also of importance. The presence of underlying medical conditions (cardiopulmonary diseases, immunosuppression, asplenia) may increase susceptibility to various infections. Knowledge of the medications taken for treatment of a patient’s illness prior to and during travel is also essential, since these may alter the presentation of certain diseases.
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