Travel Vaccination Recommendations

Travel Consult

Nurse Consult Reviewed

• Pre-travel health consultation and vaccine review prior to departure on 15/11/2023.
• Peru (Lima, Cusco, Machu Picchu, Puerto Maldonado in Madre de Dios region) and Bolivia (La Paz, Uyuni).
• Peru: 14 days; Bolivia: 7 days (total 3 weeks).
• Leisure holiday, backpacking, staying in hostels and eco-lodges, including a 3-day Amazon basin jungle trek.

Medical History

• Mild intermittent asthma, appendicectomy (2015).
• Salbutamol (Ventolin®) 100 mcg INH PRN, combined oral contraceptive pill (levonorgestrel 150 mcg / ethinylestradiol 30 mcg) 1 tab PO OD.
• NKDA. No egg allergy.

Vaccinations

• Childhood schedule complete (including 2x MMR), Boostrix (dTpa) 12/05/2018, Havrix 1440 (Hep A) first dose 10/03/2022.

NaThNaC / Vaccine Recommendations Relevant to Patient

• Hepatitis A (booster dose to complete course), Typhoid, Yellow Fever, Rabies (pre-exposure prophylaxis discussed, declined by patient due to cost), Tetanus (up to date).

Malaria

• Low to no risk in Lima, Cusco, Machu Picchu, and highlands of Bolivia. Malaria risk present in Puerto Maldonado (Amazon basin) below 2,000 m.
• Atovaquone 250 mg / proguanil 100 mg (Malarone®) 1 tab PO OD discussed and selected; start 1–2 days prior to entering endemic area (Puerto Maldonado), take daily while there, and continue for 7 days after leaving the risk area.

Yellow Fever

• Yellow fever vaccine risks, entry requirements, and indications were reviewed in detail; the WHO up-to-date country list (updated 3.1.23) was checked.
• Recommended for travel to areas east of the Andes below 2,300 m, including Puerto Maldonado. International Certificate of Vaccination or Prophylaxis (ICVP) required for entry into Bolivia after visiting Peru.
• Risks of vaccination, including YF-AND and YF-AVD, were discussed along with the increased risk associated with age. The risk of yellow fever infection and its age-related increase were also covered. The NaThNac YF checklist was completed with the patient.

Travel Advice

• Drink bottled, boiled, or treated water only; avoid ice in drinks, raw salads, and unpeeled fruits; ensure street food is freshly cooked and piping hot.
• Use 30–50% DEET insect repellent, wear long loose-fitting clothing (especially at dawn and dusk), and sleep under permethrin-treated mosquito nets in the jungle.
• Altitude sickness (acute mountain sickness) prevention discussed for Cusco and La Paz: gradual ascent where possible, rest on arrival, avoid alcohol for first 48 hours, and recognise red flag symptoms (HAPE/HACE). Rabies post-exposure action plan explained (wash wound for 15 mins with soap/water, seek urgent medical care for RIG and vaccine).

Plan

• Administer today: Stamaril® (Yellow Fever) 0.5 mL SC left deltoid, Typhim Vi® (Typhoid) 0.5 mL IM right deltoid, Havrix 1440® (Hep A) 1 mL IM right deltoid.
• Atovaquone 250 mg / proguanil 100 mg (Malarone®) 1 tab PO OD (12 tablets supplied); acetazolamide (Diamox®) 125 mg PO BD for altitude sickness prophylaxis (20 tablets supplied); azithromycin 500 mg PO OD for 3 days as standby treatment for severe travellers' diarrhoea (3 tablets supplied).
• Oral rehydration salts (ORS), loperamide (Imodium®) 2 mg PO PRN for non-dysenteric diarrhoea, paracetamol 500 mg PO QID PRN.
• Advised to secure comprehensive travel insurance covering high-altitude trekking and medical evacuation.
• "mosquito-bite prevention was discussed, including mosquito repellent advice, rabies prevention and management, and a brief review of areas with malaria risk"
• "other travel-health guidance was reviewed, with advice to seek medical assessment when needed"
• "a link to travel websites was provided, along with guidance on locating routine travel information and checking alerts and news"

Follow-Up

• Remain in waiting room for 20 minutes post-vaccination. Seek prompt medical attention if febrile illness develops within 1 year of return from malaria-endemic area.