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

4. 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)

5. 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

6. Pregnancy and Immunisation MMR – NO Yellow fever and Polio – Only if substantial risk of exposure (2 nd and 3 rd 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

7. 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

9. 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

10. 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

11. 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

12. Tick-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

13. 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

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

15. 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

16. 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

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

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

19. 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

20. 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

21. The End