SAVANNAH GA RICHARD S. ROTH M.D. Clinical Assistant Professor - - PowerPoint PPT Presentation

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SAVANNAH GA RICHARD S. ROTH M.D. Clinical Assistant Professor - - PowerPoint PPT Presentation

Mar 07, 2023 258 likes •1.21k views

SAVANNAH GA RICHARD S. ROTH M.D. Clinical Assistant Professor Dept. of Internal Medicine Mercer University School of Medicine RICK Senior AME ATP & Lear 60 Typed , Gulfstream G550 Typed 4000+ flt hours (1000+ turbine)

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SAVANNAH GA

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RICHARD S. ROTH M.D.

Clinical Assistant Professor

  • Dept. of Internal Medicine

Mercer University School of Medicine

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RICK

 Senior AME  ATP & Lear 60 Typed , Gulfstream G550 Typed  4000+ flt hours (1000+ turbine)  Director of ID Training at MHUMC  Past President of Savannah Aviation Association  Honorary Medical Commander for 165th Airlift Wing  Married 23 years!...9/24/14  Must love dogs!!  Sleep deprived

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INFECTIOUS DISEASE AND AVIATION UPDATE

 Vaccination  Malaria Prophylaxis  HIV and Aviators…..Stage…CD4 cts…..HIV PCR

  • V. Load

 HIV Meds….Cognition....Support Networks  Contagion in the Airframe…

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VACCINATIONS

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VACCINE TOOL BOX

 Influenza 2017 “Aged Impacts”…..Quadravalent…..High Dose  Pneumococcal vax. Prevnar…..Pneumovax  MMR…..Live and Two Doses if no prior Documentation  Tetanus…Diptheria…Pertussis…..Tdap,,,Q Decade  Hepatitis A & B….Havrix…Recombivax….Twin Rix…0, 2, & 6  Varicella…..Varivax…..ZostaVax(2006)…..single dose….live

ShingRix: Oct. 2016 Two doses particulate/adjuvant

 Polio….Inject.IPV…single dose  Typhoid….oral(live)….Inject.  Yellow Fever…..certification…extended stays…entry requirements

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GOT ZOSTAVAXYET??

 Fifty years and older  Non-compromised hosts…it’s a LIVE virus  Prior shingles  No steroids on board > 1-2 months  No HIV nor Active Oncologic hosts  Secondary contagion to household contacts are “academic”

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MALARIA UPDATE

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MALARIA PROPHYLAXIS

 Primaquine  Doxycycline  Mefloquine  Chloroquine  Quinine  Malarone

Combo Agent…Atavoquone+Proguanil Single Tablet formulation 250/100 1-2 days BEFORE then 7 days post travel

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HIV MARKERS…SURROGATES

CD4 counts AIDS defining below 200 OI window likely below 400 HIV PCR Quant.

Viral Load…limits of detection

Undetectable….<20….<400…”blips” HIV Screening HIV ½…..EIA…West. Blot Indeterminants

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HIV MEDS

 nRTIs……AZT….3TC….DDI…D4T….etc  nnRTIs……Efarinez…Viramunne….Sustiva  PIs…….Reyataz….Kaletra….Prezista….Crixivan…Norvir  Combo “backbones”…..Combivir….Epzicom….TRUVADA  HAART…..2 plus 1……equals “HAART”  IDSA….NIH….2012 Initiation Guidelines….EVERYONE STARTS!  Single Tabs HAART….ATRIPLA>>COMPLERA>>>STRIBILD

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SUSTIVA…..ATRIPLA

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SUSTIVA & ATRIPLA

 Efiranez…..nnRTI…..non-nucleoside  CNS effects  Sedation  Cognitive “fog”  PM qHS dosing without food  Truvada + Sustiva == ATRIPLA  Viread + Emtriva === Truvada  Viread + Emtriva + Sustiva == ATRIPLA  NOT in COMPLERA nor STRIBILD

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POST EXPOSURE ISSUES

 Seroconversion Data  Needle Stick from known source 1 in 400…hollow bore data  Post Exposure Prophylaxis…Basic…expanded  High Risk Negative HIV host….chronic prophylaxis  Serologic Survey:

 Baseline…..Hepatitis Profile….RPR…LFTS….HIV Screen  Six Weeks…..95%  Three months……..99%  Six months……………….100%  Barrier protection duration

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RICK.ROTH@FLIGHTSAFETY.COM 912-308-8424

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GREY BIRD 333 (GIII)

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EBOLA OCTOBER 2014

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AIR QUALITY AND CONTAGION

 10-50% of cabin air circulated mixed with outside air since 1980s  Recirculated Air filtered 20-30x/hour  FYI…Negative Pressure Hospital Room SIX changes/hour  Newer models use HEPA filtration…ie-0.1-0.3 microns  Airflow now is in “limited banding” on commercial airframes

 ie-banding prevents longitudinal airflow  Larger commercial airframes are NOT conducive to spread contagion

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PRIVATE AIRFRAMES AND CONTAGION

 Outflow valves usually in cockpit (frontward) location  High bleed air requirements may cost more in performance  Part 91 –vs- Part 135 or 121 decontamination/cleaning policies  MRSA and supplemental Oxygen mask rules at Flight Levels  International variability….exotic locale…..medical transport  Poor infection control standardization  Blood and Body Fluid exposures

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MRSA

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DECOLONIZATION

 Hibeclens (Chlorhexidine)  Bactroban/Muciprocin  Altabax/Retapamulin  Household items  Hand hygiene  IQ  Pets

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CASE REPORTS

 SARS……20 pts from one center isle index case  Norovirus….potable water sources  Bioterrorism hypotheticals  Emerging Concerns…EBOLA…Pertussis….Measles…Polio  Active TB case……PPD conversion….no smear + sequelae

 HIV+ with Cavitary Smear + Disease  US attorney Smear + MDR-M.Tb  Contact Tracing…..PPD….IGRA Screening very effective

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“RIP”

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EBOLA TIMELINE 1976---2014

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“BAT MEAT” SOUP

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NOT AIRBORNE (AT PRESENT)

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FACTS –VS-FEAR

 Fear spreads quicker than Infection!!  No Airborne transmission documented  Sherriff north of Dallas that was in Duncan’s apt….Neg PCR  Canine acquisition does occur…..carrier state only…Bats…etc

 Excaliber..12 y/o rescue euthanized 10/8

 Case Fatality Ratio near 80% even in the best facility  Biologics and Anti-Virals in rapid R & D phase  Infectious Pathogens don’t follow politics!!!

 US response remains in flux and reactive in nature

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