Travel Vaccination

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Travel Vaccination

• Dr. Samra A Yasin
• Petersfield Surgery
• 15th September 2000

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Important 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)

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Vaccines

• 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

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Pregnancy 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

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Yellow fever

• Acute viral illness, transmitted by mosquito
• Incubation period ( 3 6 days)
• Synmptoms
• Fever, Headache, Bleeding gums, Jaundice
• Who needs protection
• Age gt 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 lt 9m, Pregnancy and breast feeding,
  Hypersensitivity to Egg protein
• Acute febrile illness, Immunosupression e.g. HIV
  and malignancy

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Typhoid

• 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
• gt10 yrs 0.50 mL sc / im
• Oral
• 3 doses of 1 capsule on alternate days
• Reinforced annually

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Hepititis 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

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Hepititis 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
• gt 12 yrs 3 doses 1.0mL im, at 0, 1 and 6m
• 1 booster at 3-5 years

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Tick-borne encephalitis
Unlicenced vaccine

• 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

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Rabies

• 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

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BCG

• Is given only if no BCG scar and skin test is
  negative
• Dose
• Single dose of 0.1mL sc

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Tetanus

• 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

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Poliomyelitis

• 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

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Meningococcal Infection

• Endemic areas
• Tropical Africa, Asia, Saudia Arabia (certificate
  required)
• Dose
• gt 2m One dose 0.5mL sc or im
• Booster every 3 years

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Diphtheria

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

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Japanese 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
• lt 3 yrs 3 doses of 0.5mL sc at 7, 14 and 28
  days
• Booster after 2 4 years
• gt 3 years 3 doses of 1.0mL sc at 7, 14 and 28
  days
• Booster after 2 4 years

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Malaria

• 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

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The End