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Travel Vaccination

Travel Vaccination. Dr. Samra A Yasin Petersfield Surgery 15 th September 2000. 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)

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Travel Vaccination

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  1. Travel Vaccination Dr. Samra A Yasin Petersfield Surgery 15th September 2000

  2. 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)

  3. Vaccines • 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 • Live Vaccines • Measles } • Mumps } and MMR • Rubella } • Oral Poliomyelitis • Oral Typhoid • BCG (TB) • Yellow Fever

  4. 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

  5. Yellow 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

  6. 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 • >10 yrs: 0.50 mL sc / im • Oral • 3 doses of 1 capsule on alternate days • Reinforced annually

  7. 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

  8. 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 • > 12 yrs: 3 doses 1.0mL im, at 0, 1 and 6m • 1 booster at 3-5 years

  9. 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

  10. 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

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

  12. 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

  13. 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

  14. Meningococcal Infection • Endemic areas • Tropical Africa, Asia, Saudia Arabia (certificate required) • Dose • > 2m: One dose 0.5mL sc or im • Booster every 3 years

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

  16. 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 • < 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

  17. 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

  18. The End

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