travel vaccination dr. samra a yasin petersfield surgery 15 th september 2000
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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