CE/CME
The Challenges of Normal Pressure Hydrocephalus: A Case-Based Review
Although accreditation for this CE/CME activity has expired, and the posttest is no longer available, you can still read the full article.
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PATIENT EDUCATION
Vaccination
Vaccines are not available for dengue fever, malaria, or chikungunya. However, researchers have been working on a vaccine for malaria for decades, and presently, more than 20 vaccine constructs are being tested and researched in preclinical trials.28 Similarly, efforts to develop an effective vaccine for chikungunya have been under way since the 1970s.15
Chemoprophylaxis
There are no chemoprophylaxis options available for dengue or chikungunya. The most effective measures to prevent dengue are strategies aimed at avoiding mosquito bites (ie, vector control and individual protections like repellants).16 One group of authors notes that developing a larger network of research laboratories capable of prompt diagnosis of arbovirus infections would help to better control chikungunya.
Multiple options for malaria chemoprophylaxis are available, and these vary by country of travel. Chemoprophylaxis options include doxycycline, mefloquine, atovaquone/proguanil, chloroquine, and primaquine.8 For dormant forms of malaria residing in the liver, primaquine is the only effective treatment.8
It is important to remember that no antimalarial drug is 100% protective. Malaria chemoprophylaxis reduces the risk for malaria, but it is often taken inadequately, which can delay symptom onset and lead to a false-negative result on initial blood films.5 All patients with fever who have visited a tropical country within one year of presentation should be screened for malaria.5 It is incorrect and dangerous to assume that a patient who received malaria chemoprophylaxis does not have malaria. Diagnosis of malaria requires a high index of suspicion, and clinicians must remember that malaria can occur even with perfect prophylaxis.7 Unfortunately, malaria parasites are becoming resistant to some commonly used antimalarial drugs. Resistance patterns are being tracked by the CDC.8
Pretravel visit with clinician
Many illnesses related to travel can be prevented with vaccination, chemoprophylaxis, and patient education. However, many travelers do not visit a health care professional before travel (even among those traveling to perceived “risky” destinations, such as Sub-Saharan Africa).29 In a study of ill returned travelers, Leder and colleagues found that only 40% had sought pretravel advice from providers. Interestingly, many of those ill patients who obtained a pretravel consult did not receive appropriate vaccines, such as hepatitis A or influenza vaccine. Some of these patients were diagnosed with preventable conditions.29
Open and thorough communication between clinicians and patients is paramount to protect travelers from disease and illness. Clinicians have the opportunity to greatly impact the health of their patients by recommending a pretravel consultation. What may take extra time and effort on the front end of the trip may save significant time and energy on the back end, and even save lives.
Mosquito bite avoidance
One of the most important patient education discussions in pretravel consultation is mosquito bite avoidance. Travelers should be advised to find accommodations with air conditioning and screened windows and doors.14 To avoid mosquito bites, they should cover their arms and legs adequately with proper clothing. Standing water (such as in flower pots), which can encourage mosquito breeding, should be avoided as well. Travelers should use insect repellents and insecticides, especially in cool, dark areas (eg, closets and bathrooms) where mosquitoes hide.14
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