--- module: 060-01 language: en chapter: 60 title: "Occupational, Travel, and Population Infection Risks" module_title: "Foundations" source_sha256: 85254498c184d44a8585800006d87a1def12c662a5762ce1004390b83d5b63d7 --- # Occupational, travel, and population infection risks ## Orientation ### Where people live, work, travel, gather shapes illness ### Exposure links patient to environment and conditions ### Same symptom, different differential #### Mining, farming, displacement, flight, freshwater ### Protect individual, recognise clusters ## Occupational history ### Job title is insufficient #### Tasks, materials, dusts, fumes, organisms ### Intensity, frequency, duration, latency ### Relation to work or leave ### Inhalation, skin, ingestion, inoculation ### Listed limits do not prove safety ### Work worsens common disease ### Objective documentation and consent #### Income, compensation, other workers affected ### Elimination and substitution outrank protection ## Occupational respiratory disease ### Irritant fumes: bronchospasm, pulmonary oedema ### Occupational asthma: sensitisation or irritation #### Serial peak flow at work and away #### Early sensitiser removal improves prognosis ### Silica: nodular fibrosis #### Autoimmunity, cancer, tuberculosis ### Asbestos disease after long latency #### Smoking multiplies lung-cancer risk ### Fibrosis generally irreversible #### Exposure control and surveillance ### Hypersensitivity pneumonitis to inhaled antigens #### Antigen avoidance is central ## Skin, musculoskeletal, and physical hazards ### Irritant dermatitis: cumulative barrier injury ### Allergic dermatitis: delayed hypersensitivity #### Distribution and timing guide patch testing ### Gloves can occlude, irritate, cause allergy ### Musculoskeletal: force, repetition, posture, recovery #### Prolonged complete rest worsens recovery ### Noise: irreversible high-frequency loss ### Vibration: blanching, neuropathy ### Radiation: time, distance, shielding, dosimetry ## Needlestick and biological exposure ### Wash, irrigate, no squeezing, report ### Fluid, route, device, source status ### Human immunodeficiency virus prophylaxis promptly #### Continue or stop after expert reassessment ### Hepatitis B: vaccine, immunoglobulin by antibody ### Hepatitis C: no prophylaxis, follow-up testing ### Safety devices, no recapping, vaccination ### Healthcare respiratory and aerosol exposures ## Pre-travel assessment ### Risk by destination, season, activity, health ### Start early for vaccine series ### Live vaccines unsafe in pregnancy, suppression ### Malaria: bite avoidance plus chemoprophylaxis #### No regimen completely protective #### Fever is an emergency until excluded ### Day-biting vectors: dengue, chikungunya, Zika ### Dengue: leak and shock around defervescence #### Avoid non-steroidal drugs until excluded ### Diarrhoea: oral rehydration first #### No antimotility drugs with invasive dysentery ### Altitude: gradual ascent #### Ataxia or confusion: cerebral oedema #### Descent and oxygen are priorities ## The returned traveller ### Itinerary, dates, exposures, prophylaxis ### Incubation narrows the differential ### Fever: malaria, dengue, enteric fever, others ### Eosinophilia may be absent early ### Alert laboratory for high-consequence pathogens ### Diarrhoea beyond two weeks: protozoa ### Travel label must not hide universal disease ## Migration, displacement, and inequity ### Country of origin is not a diagnosis ### Trained interpreters ### Screen by individual risk with consent ### Trauma-informed care without forced disclosure ### Infection control must not become stigma ## Outbreaks and public health ### Exceeds expected; one rare case may act ### Case definition, person, place, time ### Isolation separates infectious cases ### Quarantine restricts exposed people ### Notify public health promptly ### Least restrictive effective measure ### One Health: human, animal, environment