Post on 03-Jul-2020
Consensus October 2019New Belgian recommendations in travel medicine
Dr Ula Maniewski
umaniewski@itg.be
Consensus October 2019
Vaccines:
Yellow fever vaccination
Interval between yellow fever vaccination and measles vaccination
Polio
Rabies
Zika: recommendations+ testing policy
Malaria map
Yellow fever
But…
Immunorespons is less in some subgroups
In several publications, neutralizing antibodies decline over time
Quid non responders?
Few cases of “breakthrough infections” have been documented
None of them in vaccinated travellers
Most of the life attenuated vaccines are administered 2x
Most neighboring countries leave a door open/ recommend a second dose:
Yes: French; UK, Swiss, CDC
No: Netherlands
WHO: “Questions and answers”
Q: Does this amendment to the IHR (2005) affect what measures States
Parties can implement for the protection of their own populations or
what doctors may advise their patients concerning vaccination against yellow fever, including potential boosters?
A: No. The amendment only affects what countries may require of
international travellers as a condition of entry in terms of vaccination
against yellow fever and related IHR international certificates of
vaccination. Countries and health care providers continue to be free
to make requirements on vaccination, revaccination or boosters for
their own populations, or patients, respectively.
WHO: “Questions and answers”
Q: On new certificates, what term should be entered in the space on
the certificate(see above) indicating the period of validity?
A:“While the IHR do not specify the exact words to include on the
certificate to indicate lifetime validity of the certificate, WHO
encourages countries to use words which clearly and
unambiguously indicate that the validity of the certificate is for life of the person vaccinated…”
https://www.who.int/ith/annex7-ihr.pdf?ua=1
Consensus
A second dose will be offered to travellers to endemic regions
This dose can be offered at any time (min 1 month after the first dose)
Refer to leaflet at the last page of the certificate (available at
www.travelhealth.be ---> info for professionals)
° The reinforcing vaccination can be administered at any time after the first dose (months or years, one does not have to wait 10 years anymore), but at least 1 month after the first dose.
Example: first dose, no special condition
• Validity: “lifelong”, but
advise to get second dose
at the occasion of a future
travel.
• Refer to leaflet in the back
• One can add “first dose”
Example: second dose
• Validity: “lifelong”,
• one can add “second
dose”
Example: first YF vaccine
-and pregnant
-OR together or < 28d interval with measles
-OR child between 1 and 2 years
• Validity: 1y
• Boost before next
exposure
Example: child <1y- child born on 1/12/2018
Validity until
2nd birthday
Example: HIV patient
Validity : 10y
What changes can we expect in the
near future?
Advice about boostervaccination in young children
Country requirements South Africa
What changes?
Travellers to South Africa:
Yellow fever vaccination NOT
recommended anymore for
visitors of Victoria Falls.
It remains recommended for
travellers with transit in Ethiopia
NB: More an more travellers to
Namibia stop in Luanda → offer YF
vaccine
Type name department in window
Extra poliovaccine OBLIGED
in case of >4 weeks
Measles
• Interval yellow fever/ measles
vaccination
• Early measles vaccination
Interval: Review data-THX Dr. Charlotte Martin Type
study
Country of
study
n/ children
or adults
Vaccines
coadministrated
Results GMT
Nascimento RCT Brazil 1769 child. YFV/MMR
together vs ≥30d
YFV 70% vs 87% 3xhigher
Goujon Retro cc France 131 child. YFV/M(MR) together vs 1-27d
vs >27d
96% immunog, non
inf/4 together
no
Michel Prosp obs Senegal
(Fguyana)
284 child. M/YFV together vs 7-28d 93% vs 90.7% Same
GMT
Lancet Global
Health-Clarke
Prosp Gambia 1500 child. IPV/MR/YFV apart or 2/2 Same immunog for
YFV
Lower
GMT
Huang Random
open
Taiwan 550 child. JEV/MMR together vs 6wks 97-100% d42/d365 no
Nasveld Prosp RCT Australia 108 adu YFV/JEV together vs 30d 100% Same
GMT
Conclusions
Mainly data in children: consistent trends in several
studies
Administrer Yellow fever and measles vaccine
>28days apart
If not possible: same day, different limp
If not possible: any time
Early measles vaccination
Early vaccination in children 6< 12 months when travelling to a
region with an outbreak, mainly Africa, Asia and East-Europe
Vaccine needs to be repeated at 12m
List on www.travelhealth.be
Flanders: this vaccine can be given for free with vaccine from
Vaccinnet
Early second dose?
Breakthrough infections after 1st vaccine
“late” second vaccine in Belgian vaccination schedule
but this is not “for free” (needs to be prescribed)
Rabies vaccine Oct 2019
After many stock ruptures, Rabipur
is available again in officina
Prep: D0-D7 or D0-DX
ID and IM interchangeable
When ID use, write 4 lines in
certificate of vaccination
When can we offer testing for zika?
Symptomatic patients
after traveling to endemic region
or having sex with someone coming from endemic region
In case of fever: PCR on blood/ urine can be tested
No fever anymore: serology
Asymptomatic people with possible exposure (travel to endemic region)
In case of pregnancy or male partner of pregnant women: Screening by
serology 3 weeks after return
Preconception
screening: not recommended anymore
© Pirre Pluymers
THX for your attention!