Travel Medicine, Vaccines, and Pre/Post-exposure Prophylaxis
Core concepts
Know travel vaccines: yellow fever (required for some countries; live-avoid in immunocompromised/pregnancy), typhoid (Vi polysaccharide or Ty21a live), hepatitis A/B, rabies, Japanese encephalitis, and meningococcal (required for Hajj). Malaria prophylaxis: atovaquone-proguanil, doxycycline, or mefloquine (avoid in neuropsychiatric history).
Must-know prophylaxis
Rabies post-exposure: wound care + rabies immune globulin + vaccine series. Tetanus: booster every 10 years; TIG for dirty wounds if under-immunized. Hepatitis B: vaccine series; HBIG for perinatal exposure. HIV PEP: 28 days, start within 72 hours.
Traps
Yellow fever vaccine is contraindicated in severe immunocompromise and pregnancy (unless high risk). Mefloquine neuropsychiatric contraindications. Doxycycline for malaria prophylaxis-start 1-2 days before, continue 4 weeks after. Live vaccines (MMR, varicella, yellow fever) avoid in pregnancy and immunocompromised.
Worked rule of thumb
For a traveler to sub-Saharan Africa with no contraindications, recommend yellow fever vaccine (if required), malaria prophylaxis with atovaquone-proguanil, and hepatitis A/traveler's diarrhea counseling.