Travel VaccinationTravel Vaccination

Dr. Samra A Yasin

Petersfield Surgery

15th September 2000

Important notesImportant notes Each travel vaccines should be given 10 days (preferrably

3 weeks) from another in order to identify a source of reaction (if any)

Live vaccines must be administered atleast 3 weeks apart or on the same day

Inactivated vaccines can be given simultaneously with another vaccine but only at a different site (pain, adverse reaction..)

Vaccination course must be complete before travel in order for the immunity to develop (Japanese encephalitis vaccines – 4 weeks for immunity)

VaccinesVaccines Live Vaccines

– Measles }– Mumps } and MMR– Rubella }– Oral Poliomyelitis– Oral Typhoid– BCG (TB)– Yellow Fever

• Inactivated Vaccines• Diphtheria Toxoid }and • Tetnus Toxoid }combination

• Pertussis }vaccines

• Poliomyelitis (Injectable)

• Haemophilus influenza b (HIB)

• Influenza

• Hepatitis A

• Typhoid Injectable

• Meningococcal Meningitis

• Tick borne Encephalitis

• Hepatitis B

• Rabies

• Cholera

Pregnancy and ImmunisationPregnancy and Immunisation MMR

– NO Yellow fever and Polio

– Only if substantial risk of exposure (2nd and 3rd trimester only)

Influenza– Inactivated vaccine safe during any stage of pregnancy

Inactivated viral or bacterial or toxoid (Hep A & B, Rabies,

Injectable Typhoid, meningococcal, pneumococcal, tetnus – diphtheria toxoid)– No evidence of risk to unborn babies

Yellow feverYellow fever Acute viral illness, transmitted by mosquito Incubation period ( 3 – 6 days) Synmptoms

– Fever, Headache, Bleeding gums, Jaundice Who needs protection

– Age > 9 m, Travelling through endemic areas– NB: a valid certificate of vaccination is compulsory for entry into certain countries

Vaccine– Can only be administered in designated centres– Live attenuated vaccine– Protection starts 10 days after injection, Certificate valid for 10 years.

Dose– 1 dose of 0.5mL (sc)

Who not to vaccinate– Children < 9m, Pregnancy and breast feeding, Hypersensitivity to Egg protein– Acute febrile illness, Immunosupression e.g. HIV and malignancy

TyphoidTyphoid Danger Areas

– Indian subcontinent, Central and South America, Eastern Europe

Vaccine– Injectable

2 doses 4-6 wks interval between doses, reinforced after 3 years 1-10 yrs: 0.25mL sc / im >10 yrs: 0.50 mL sc / im

– Oral 3 doses of 1 capsule on alternate days Reinforced annually

Hepititis AHepititis A

Acute viral infection– Incubation period: 15-40 days

Dose– 2 doses of 0.5mL im at 2-4 wk. intervals– Single booster after 6-12 m of initial course

gives immunity for 10 years

Hepititis BHepititis B

Viral infection– Incubation period: 40 - 160 days

Dose– Up to 12 yrs: 3 doses 0.5mL im, at 0, 1 and 6m

1 booster at 3-5 years

– > 12 yrs: 3 doses 1.0mL im, at 0, 1 and 6m 1 booster at 3-5 years

Tick-borne encephalitisTick-borne encephalitis

Viral Infection– Transmitted by the bites of infected ticks– Endemic in the forest part of Europe and Scandinavia

Dose– No lower age limit– 4 doses of 0.5mL sc or im at 0, 4 and 12 weeks, then 9 -

12 months– Booster after 3 years

Unlicenced vaccine

RabiesRabies

Serious Viral infection Transmitted by the bite of rabid animal Dose:

– No lower age– 3 doses of 1.0ml sc or im or 0.1ml id– Interval between doses at 0, 7 and 28 days– Booster after 2 –3 years if contnued exposure is

required

BCGBCG

Is given only if no BCG scar and skin test is negative Dose

– Single dose of 0.1mL sc

TetanusTetanus Toxin from clostridium tetani Who Needs

– All adults and children who have not previously received immunisation should receive a primary course

– Patients without a booster dose in the last 10 years– Additional booster doses may be required for travellers to remote areas

specially if taking part in high risk activities– Road Traffic accidents– Penetrating or deep wounds

Dose– 3 doses at 4 weeks interval– At school entry (3 years after last dose)– At school leaving (10 years after primary course)– Further booster after 10 years

PoliomyelitisPoliomyelitis Enterovirus Who

– Patients who have not received primary immunisation– Booster doses for adults travelling to endemic areas e.g.

Asia, Africa, E Europe– After primary immunisation, protection is life long– People at special risk may receive booster every 10 years

NB:– If necessary to administer more than 1 live vaccine they

must be given simultaneously at different sites – or (in theory) be separated by a period of 3 weeks

Meningococcal InfectionMeningococcal Infection

Endemic areas– Tropical Africa, Asia, Saudia Arabia

(certificate required)

Dose– > 2m: One dose 0.5mL sc or im– Booster every 3 years

DiphtheriaDiphtheria

Travellers who have not received the vaccine in the last 10 years

Japanese encephalitisJapanese encephalitis

Viral encephalitis, transmitted by the bite of infected rice field breeding mosquito, infected birds and animals specially pigs as a reservoir for the arbovirus

Endemic in South East Asia and the Far East Dose

– < 3 yrs: 3 doses of 0.5mL sc at 7, 14 and 28 days Booster after 2 – 4 years

– > 3 years: 3 doses of 1.0mL sc at 7, 14 and 28 days Booster after 2 – 4 years

MalariaMalaria Malignant Malaria (P. Falciparum)

– In most parts of the word is resistent to Chloroquine– Quinine, Mefloquine, Malarone (Proguanil) can be given instead

Benign Malaria (P.Ovale, P.Malariae, P.Vivax)– Chloroquine is the drug of choice– P.Malariae: Chloroquine alone is adequate– P.Vivax and P.Ovale: Primaquine is required for radical cure to kill the parasite in the liver

Length of prophylaxis– Should be started 1 week (preferrably 2-3 wks for mefloquine) before travel into endemic

area.– If not then must be 1-2 days before travel– Should be continued after arrival back in UK

Pregnancy– Avoid travel during pregnancy, otherwise Chloroquine and Proguanil may be given in usual

doses– Mefloquine must be avoided in the first trimester

The EndThe End