Please note that these are not real patients and are designed purely as a training aid. This is a fairly NEW SECTION: Work in progress!! I am intending to make more 'suggested answer materials' relating to these cases so watch this space.

The information given in these scenarios are intended to reflect the recommendations (on Travel Health Pro) at the time of writing but please exercise caution with 'right' and 'wrong' answers over time - we all know how changeable travel health can be (and also how individual interpretations and clinical judgment can be variable too).

Read the vaccine histories carefully in each scenario and have Travel Health Pro open to consult while completing the questions. Once you have had a go click on their images for suggested answers.

Graham

Thailand and Laos

Graham (25) has just split up with his partner of 2 years. He did not initiate the break up. He also lost his job during lockdown. He has been very low in mood and feeling quite isolated since lockdown and has not been getting out much. He thinks COVID-19 is all a bit of nonsense, not been vaccinated and refuses to wear a mask. He has a history of anxiety and depression which has worsened since the break up and COVID-19 pandemic.

He has decided to travel to Thailand (Bangkok, Chiang Mai, and Koh Samui) and Laos (Vang Vienne) for 3 weeks to help him ‘get over’ the breakup. He plans to meet some new people, 'let his hair down', and will attend a full moon party on one of the islands. He will be staying in budget accommodation, most likely hostels and dorms throughout. Mixture of city and rural. He will travel in December. He is flying via Dubai (2 hour stop, not leaving airport).

Previous Medical History: He has never had MMR. He had his school Diphtheria, Tetanus, Polio (dT/IPV) booster along with Meningococcal ACWY age 14. He has Asthma. He's been offered the influenza vaccine every year but has always declined it. No history of Dengue.

• What are your vaccine recommendations?

• Is he at risk of malaria? What is your advice there?

• What 'other risks' are listed for his destination?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set him?

• Which Travel Health Pro factsheets could you provide him with?

Simon & Hellen

Mexico

Simon and Hellen are off to Mexico in 1 month. The holiday is in a 5* resort and will be for 2 weeks. Hellen tends to stick to the sunbed, but Simon likes to venture off the beaten track a bit when on holiday, so will be doing some day trips to other areas including nature reserves. He also fancies some mountain climbing and will be going for a run every morning.

Both have received seasonal influenza vaccines for this year. They have both been to Mexico a few times now and enjoy going. They both had Hepatitis A first doses 4 years ago but haven't returned for the second dose until now. They also had TDP boosters then too and Typhoid vaccinations. Both have had MMR 2 doses in the past. Neither have ever had rabies vaccinations. Simon got bitten by a cat on the last trip to Mexico 5 years ago but never sought treatment.

They are not flying via any yellow fever zones. Neither of them have ever had a confirmed Dengue diagnosis. They are in the process of trying to conceive their first child.

What would you recommend?

• What are your vaccine recommendations?

• Are they at risk of malaria? What is your advice there?

• What 'other risks' are listed for this destination?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set them?

• Which Travel Health Pro factsheets could you provide them with?

Adankwo

Nigeria

Adankwo is a 62 year old lady who is planning on taking her 6-year-old granddaughter Mia, to visit her family in Nigeria for 5 weeks (35 days), setting off in 4 weeks. She will be staying in the family home just outside Lagos. She was born in Nigeria but has lived in the UK for 16 years. She visits Africa every year but is quite sporadic about getting travel health advice before going.

She lives with type one diabetes and is insulin dependent. She had yellow fever vaccine 16 years ago in Nigeria and still has her ICVP. She last had Hepatitis A vaccine 5 years ago and this was her first dose. She has Typhoid vaccine every three years and had Vivotif last year. She last had a tetanus diphtheria booster 4 years ago. She was vaccinated at the airport with live oral polio on exit last year. Given the International Health Regulations around the PHEIC this is a concern for her, and by the time she exits Nigeria on this trip it will have been more than 12 months since she had it. She has no issues with immunosupression. She has her influenza vaccines whenever she is called up. She has had this years vaccine. She has never had any Hepatitis B, MMR or meningitis vaccines.

What are your recommendations for Adankwo and her granddaughter?

• What are your vaccine recommendations?

• Are they at risk of malaria? What is your advice there?

• What 'other risks' are listed for this destination?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set them?

• Which Travel Health Pro factsheets could you provide them with?

Bismah

Saudi Arabia - Hajj

Bismah (45) is super excited. She’s off to do her first pilgrimage for Hajj in Saudi Arabia in 2 months time (September time). She has waited all her life to do this trip. It was very expensive and she has been saving up. She’s now a little short of cash.

She is a type one diabetic, insulin dependent. Well managed. No other PMH. She has a BCG scar. She has had 1 dose of MMR as a child. Her friend advises her she needs to get a vaccine for Meningitis ACWY for the visa. She has come to clinic specifically to source the vaccine.

She has never travelled out of Europe before. She has kept up with her COVID-19 vaccines. Not had a flu vaccine yet for this coming season as it is not available yet.

What are your recommendations?

• What are your vaccine recommendations?

• Is she at risk of malaria? What is your advice there?

• What 'other risks' are listed for this destination?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set her?

• Which Travel Health Pro factsheets could you provide her with?

Janet & Jean

African safari

Janet (69) and Jean (72) have been a couple for 20 years and are ‘feeling their age’. They are working through their ‘bucket list’. They have decided to travel to Africa, they fancy doing a safari and seeing the Big 5. They also want to visit some orphanages and donate some supplies. They haven’t been much further than Europe before because Janet has had lots of health issues. Following a bad CVA, Janet is now very weak down her left side and uses a wheelchair to compensate for her poor mobility. Janet takes PRN paracetamol for a long standing back injury. Jean is medically well, no medical conditions, but carries an EpiPen due to an allergy to peanuts. Jean has had 3 anaphylactic reactions in the past.

Neither have had any travel vaccines before, they have consistently declined influenza and COVID-19 vaccines. Last TDP vaccines were 30 years ago. Never had MMR. Both have had BCG vaccines as children. They are going for 4 weeks in October (which is 3 months away) and are going to Kenya first (Masai Mara) and then Tanzania.

Neither of them have ever had a confirmed Dengue diagnosis.

What are your recommendations?

• What are your vaccine recommendations?

• Are they at risk of malaria? What is your advice there?

• What 'other risks' are listed for their destinations?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set them?

• Which Travel Health Pro factsheets could you provide them with?

Madonna

World Tour

Madonna (born 16/09/1958) is about to do a world tour as a performer in multiple venues with large audiences. She will be going to South America, United Arab Emirates, Sub Saharan Africa (Kenya, Nigeria and DRC) and some parts of South East Asia, ending the trip in Austria. She will be away for 3 months over the UK winter period. She is unable to tell you all her precise destinations as ‘her agent keeps track of all that’. She’s going to do some travel by air and some by cruise. She will have most meals provided on the trip, but is a self-confessed foodie and is looking forward to trying lots of international cuisine. She is also keen to explore while out there.

She is leaving in a week. She is away for a while and is very tempted to get some top up lip and eye fillers along the way. She has had a niggling pain coming from her left upper molar which she has been taking codeine for. She had a Tetanus Diphtheria Polio vaccination last week after a gardening injury. She had one dose of MMR 10 years ago. She has a BCG scar. She declined flu, shingles and pneumococcal vaccinations at the surgery recently. But she had a COVID vaccine privately 1 month ago.

What are your recommendations?

• What are your vaccine recommendations?

• Is she at risk of malaria? What is your advice there?

• Are there any other risks not listed on Travel Health Pro that you would want to address?

• What 'homework' will you set her?

• Which Travel Health Pro factsheets could you provide her with?

More Consultation Scenarios

Please note that these are not real patients and are conducted purely as a training aid to demonstrate the way consultations can go. The information given in these scenarios reflected the evidence at the time of recording.

Also - you do you. Everyone has their own style.

The Adeyemi Family

Practice with incomplete immunisation and a bit of travel and occupational health vaccines for those who want some practice there too.

Simon & Hellen go to Mexico

Some travel health activities to have a go at.