CBM - Travel Vaccines

Question 1

Travel Vaccines

What to ask a patient travelling abroad

Answer 1

• Country visiting – some diseases common in certain parts of the world/less common in others
• At what time of year travelling – some diseases are more common at certain times of the year; eg, during rainy season
• Where staying – in general, more at risk of disease in rural areas than in urban areas, if backpacking and staying in hostels or camping, more at risk than if on a package holiday/ hotel
• Length of stay in each destination – the longer their stay, the greater the risk of being exposed to diseases
• What doing during their stay – e.g. spending a lot of time outdoors, such as trekking or working in rural areas, working in a hospital, around animals, aid worker

Question 2

Travel Vaccines

The Vaccines

Hepatitis A/Typhoid

Answer 2

Must be up to date with all UK vaccinations:

• Diphtheria, polio, tetanus combined booster is recommended before travelling

Hepatitis A

• Type of vaccine: Inactivated
• Disease: Infection of the liver caused by the hepatitis A virus
• Spread via: Contaminated food and water, especially shellfish. Risk is higher where personal hygiene and sanitation are poor
• Administration: Administered IM to the upper arm
• Schedule: Two doses, 6-12 months apart with the first dose usually a booster of Hep A and Typhoid (or Hep A and Hep B) as risk areas cross over

Typhoid

• Type of vaccine: Inactivated
• Disease: Typhoid causes systemic infection which may present as fever, headache, confusion and vague abdominal pain. Constipation is common in adults. Salmonella Typhi is the causative organism
• Spread via: Faecal-oral route – food and drink contaminated with human faeces
• Administration: Administered IM to the upper arm
• Schedule: Single dose gives three years of immunity. Booster doses required after this. ​

Question 3

Travel Vaccines

The Vaccines

Cholera

Answer 3

Cholera:

• Type of vaccine: Inactivated
• Disease: Cholera is an acute diarrhoeal illness caused by a bacteria. The disease infects the small bowel and causes painless, watery diarrhoea**.
• Spread via: Infected water that has been contaminated by faeces
• Administration: Oral suspension (disgusting)
• Schedule: Two doses 1-6 weeks apart then a booster after two years
• Specifically recommended to: Volunteers, aid workers or medical personnel in disaster relief situations. Those travelling to work in refugee camps. Very crowded unsanitary places

Question 4

Travel Vaccines

The Vaccines

Hapatitis B

Answer 4

Hepatitis B

• Type of vaccine: Sub-unit
• Disease: Acute liver infection
• Spread via: Contaminated blood via sexual intercourse, needle sharing, blood transfusions and injections Administration: IM
• Schedule: Became part of childhood vaccination schedule in August 2017. For adults, vaccination at 0, 1 and 2 months is used for most travellers.
• Specifically recommended to:-People participating in contact sports -People undertaking relief aid work -People who Inject drugs -People engaging in unsafe sexual activity

Question 5

Travel Vaccines

The Vaccines

Japanese Encephalitis

Answer 5

• Type of vaccine: Inactivated
• Disease: Japanese encephalitis is a viral disease found in South-East Asia and the Indian subcontinent. It causes headache**, convulsions, encephalitis and meningitis. 33% of those who develop serious symptoms will die from the disease.
• Spread via: The infection is spread by the bite of an infected mosquito, uses pigs and birds as reservoir host so infection more common in rural areas with these around
• Administration: IM
• Schedule:T**wo doses

Question 6

Travel Vaccines

The Vaccines

Tick-borne Encephalitis

Answer 6

Tick-borne encephalitis

• Type of vaccine: Inactivated
• Disease: TBE produces clinical features similar to those of many other types of meningitis and/or encephalitis
• Spread via: Transmitted to humans by a bite from an infected tick. Most human infections are contracted during outdoor leisure pursuits such as forestry working, camping, rambling and mountain biking, during tick season.
• Administration: IM
• Schedule: 3 doses and then booster every 3 years

Question 7

Travel Vaccines

The Vaccines

Rabies - Pre-exposure

Answer 7

• Rabies Pre-exposure
• Type of vaccine: Inactivated
• Disease: Rabies an acute viral infection that causes inflammation of spinal cord and brain. Incubation period usually between 20-60 days, may range from 5 days to 1 year in some cases. Headache, fever, general weakness and numbness or tingling around the wound site. Progresses to muscle spasms, hydrophobia (fear of water) and convulsions. Death is the usual outcome if infected with rabies virus.If bitten, must seek urgent medical attention (whether vaccinated or not, to complete a post-exposure vaccination course.
• Spread via: Infected bite or scratch from a rabid animal, commonly through a dog bite
• Administration: IM
• Schedule:3 doses: Day 0, 7, and 28 Specifically recommended to:**-Unlikely to have access to reliable, prompt, safe medical care following a potential exposure -Engaging in activities which can increase the risk of animal bites. -Working with or in close contact with animals (e.g. veterinarians, zoologists)

Question 8

Travel Vaccines

The Vaccines

Tuberculosis

Answer 8

Tuberculosis (BCG)

• Type of vaccine: Live attenuated
• ​​​Disease: Bacterial infection of the lungs
• Spread via: Inhaling tiny droplets from the coughs or sneezes of an infected person
• Administration: IM (leaves scar)
• Schedule: 1 dose lasts for 20 years
• Specifically recommended to:Rarely given to adults over 35 as efficacy is low. It is, however, given to adults aged 16 to 35 who are at risk of TB through their work, such as some healthcare workers.

Question 9

Travel Vaccines

The Vaccines

Yellow Fever

Answer 9

Yellow fever

• Type of vaccine: Live attenuated
• Disease: Symptoms - sudden onset of fever, backache, generalised muscle pain, nausea, vomiting and jaundice. Infection with yellow fever results in lifelong natural immunity in individuals who recover. 60% of those infected will die. Spread via: By the bite of an infected mosquito which mainly bites during daylight
• Administration: IM
• Schedule: 1 dose for life long protection – those vaccinated more than 10 years ago, need a booster.
• Specifically recommended to: Those travelling to a country which requires proof of vaccination, an International Certificate of Vaccination or Prophylaxis (ICVP)
• Common side effects: 1-2 weeks of flu like symptoms is very common

Question 10

Travel Vaccines

The Vaccines

Malaria Prophylaxis

Answer 10

Malaria prophylaxis

Advise patients of ABCD:

• A – Aware– be aware of the malarial risks of where you are travelling
• B – Bites– Keep mosquito bites to a minimum using DEET, mosquito nets, long clothes
• C – Correctly– Take anti-malarials correctly
• D – Doctor– Report any feverish symptoms to a doctor

Atovaquone/proguanil– most common option Doxycycline– cheapest option, makes patients more sensitive to the sun Mefloquine (Larium) – dearest option, taken once a week, can cause very lucid dreams

Other travel points to consider:

• HIV/AIDS
• Schistosomiasis
• Dengue fever
• Human African Trypanosomiasis (sleeping sickness) 
• Zika virus