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  <head>
    <title>060-02 Exposure reconstruction, travel syndromes, worker protection, and public-health action</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Exposure reconstruction, travel, and public-health action">
      <outline text="Reconstructing exposure">
        <outline text="Exposure, not job title or destination">
          <outline text="Same employer, different hazard"/>
          <outline text="Same country, different season, altitude, contact"/>
        </outline>
        <outline text="Agent, route, intensity, duration, timing"/>
        <outline text="Change away from the environment"/>
        <outline text="Actual tasks, trade names, processes"/>
        <outline text="Timeline: pre-employment, process change, leave"/>
        <outline text="Confidentiality, independent of return pressure"/>
      </outline>
      <outline text="Hazard control and surveillance">
        <outline text="Protective equipment is the least reliable barrier">
          <outline text="Eliminate, substitute, engineer, administer"/>
          <outline text="Depends on selection, fit, training, use"/>
        </outline>
        <outline text="Surveillance detects change, not unfitness">
          <outline text="Group decline: investigate the process"/>
        </outline>
        <outline text="Normal test does not justify exposure"/>
        <outline text="Return to work addresses re-exposure and control"/>
      </outline>
      <outline text="Respiratory hazards">
        <outline text="Occupational asthma: sensitiser or irritant">
          <outline text="Weekend improvement lost once persistent"/>
          <outline text="Delay leaves permanent hyperresponsiveness"/>
        </outline>
        <outline text="Silica activates macrophages">
          <outline text="Nodular fibrosis, tuberculosis, autoimmunity"/>
          <outline text="Dry cutting of engineered stone"/>
        </outline>
        <outline text="Asbestos disease after decades">
          <outline text="Smoking multiplies lung-cancer risk"/>
        </outline>
        <outline text="Primary prevention beats surveillance"/>
        <outline text="Hypersensitivity pneumonitis">
          <outline text="Precipitins show exposure, not disease"/>
          <outline text="Ask about humidifiers, pets, hobbies"/>
        </outline>
      </outline>
      <outline text="Skin, noise, and vibration">
        <outline text="Irritant: wet work, solvents, glove occlusion"/>
        <outline text="Allergic: delayed T-cell, spreads past edge">
          <outline text="Patch testing, not skin-prick"/>
        </outline>
        <outline text="Noise: hair-cell loss is irreversible">
          <outline text="Speech in background noise fails first"/>
        </outline>
        <outline text="Source control outranks hearing protectors"/>
        <outline text="Audiometry detects but does not prevent"/>
        <outline text="Vibration: blanching, numbness, dexterity loss"/>
      </outline>
      <outline text="Needlestick exposure">
        <outline text="Wash, irrigate, report, characterise"/>
        <outline text="Prompt human immunodeficiency virus prophylaxis"/>
        <outline text="Hepatitis B by vaccination and antibody"/>
        <outline text="Hepatitis C: early follow-up allows cure"/>
        <outline text="Negative source may miss recent infection"/>
        <outline text="Follow-up timing follows marker biology"/>
        <outline text="Blame-free reporting learns from near misses"/>
      </outline>
      <outline text="Pre-travel planning">
        <outline text="A risk plan, not a vaccine transaction"/>
        <outline text="Routine immunisation before destination vaccines"/>
        <outline text="Live vaccines in pregnancy, immune suppression"/>
        <outline text="Medicines in original packaging, in surplus">
          <outline text="Drugs dangerous during dehydration"/>
        </outline>
        <outline text="Postpone if chronic disease unstable"/>
      </outline>
      <outline text="Travel syndromes">
        <outline text="Malaria prophylaxis before and after travel">
          <outline text="Before: tolerance and therapeutic levels"/>
          <outline text="After: parasites emerging from the liver"/>
        </outline>
        <outline text="Dengue: leak around defervescence">
          <outline text="Warning: haematocrit up, platelets down"/>
          <outline text="Titrate fluid: shock versus overload"/>
        </outline>
        <outline text="Diarrhoea: oral rehydration first">
          <outline text="Loperamide not alone with dysentery"/>
          <outline text="Beyond two weeks: Giardia, other protozoa"/>
        </outline>
        <outline text="Rabies: wash wound, never delay treatment">
          <outline text="Symptomatic rabies almost uniformly fatal"/>
        </outline>
        <outline text="Altitude illness: hypobaric hypoxia">
          <outline text="Gradual ascent permits adaptation"/>
          <outline text="Descend; sedatives and ascent dangerous"/>
        </outline>
      </outline>
      <outline text="The returned traveller">
        <outline text="Immediate threat and isolation first"/>
        <outline text="Fever with thrombocytopenia differential"/>
        <outline text="Jaundice: hepatitis, haemolysis, leptospirosis"/>
        <outline text="Isolate and protect from point of entry"/>
        <outline text="Sepsis care parallel to specific diagnosis"/>
        <outline text="One negative test does not close disease"/>
        <outline text="Transit, funerals, caves, animals, sex"/>
      </outline>
      <outline text="Migration and outbreaks">
        <outline text="Migration history not a proxy for biology"/>
        <outline text="Interpreters and individual evidence"/>
        <outline text="Cluster recognition prevents for many">
          <outline text="One rare case may require action"/>
          <outline text="Notify before complete confirmation"/>
        </outline>
        <outline text="Case definition, line list, exposure map"/>
        <outline text="Isolation versus quarantine"/>
        <outline text="Genomic similarity supports, not proves"/>
        <outline text="One Health: animals, food, climate, water"/>
        <outline text="State known, unknown, action, next update">
          <outline text="Case counts need denominator and method"/>
        </outline>
      </outline>
    </outline>
  </body>
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