Travel Vaccines

Question 1

Typhoid Vaccine

Answer 1

• Oral live - Vivotif, Inactivated IM - Typhim VI
• Prevents typhoid fever caused by salmonella typhi
• Complete at least 1 week before potential exposure for oral vaccine; 2 weeks prior for injection
• Oral: Store in fridge, take on an empty stomach with cold or lukewarm water
• Injection: store in fridge, give IM

Question 2

Japanese Encephalitis Vaccine

Answer 2

• Ixiaro
• Give if spending 1+ months in endemic area, especially if traveling to rural/outdoor areas
• 2 doses, 28 days apart, completed 1 month before travel
• Store in fridge, give IM

Question 3

BCG Vaccine

Answer 3

• For tuberculosis, live vaccine
• Not used often in US
• False positive reaction with TB skin test

Question 4

Yellow Fever Vaccine

Answer 4

• YF-VAX
• Live vaccine
• CI with severe allergies to eggs/gelatin, immunosuppression, <6 mo old, breastfeeding/preggo
• Avoid donating blood 2 weeks post-vaccine
• ICVP (“yellow card”) provided post vaccination, valid for 10 years
• Store in fridge, reconstitute with provided diluent, don’t shake, give SQ

Question 5

Cholera Vaccine

Answer 5

• Vaxchora
• Live vaccine
• Given to 18-64 yo traveling to area with active Vibrio cholerae transmission
• Complete 10+ days prior to exposure
• Store in freezer, use quickly once reconstituted

Question 6

Typhoid

Answer 6

• Caused by contaminated food or water by feces of acutely infected or chronic asymptomatic carriers
• Vaccine, washing hands, and water/food precautions recommended
• Incubates 6-30 days, fever/fatigue increasing over 3-4 days

Question 7

Cholera

Answer 7

• Caused by Vibrio cholerae
• Causes “rice water stools”
• Usually mild/asymptomatic but can cause life-threatening dehydation

Question 8

Polio

Answer 8

• Endemic in many countries, most US children receive vaccination in childhood
• CDC recommends single lifetime booster of inactivated polio virus for adult traveling to poliovirus circulation areas

Question 9

Hepatitis A

Answer 9

• Usually occurs in people in developed countries traveling to underdeveloped countries
• Fecal-oral transmission from contaminated food/water
• Vaccination should be considered when traveling to most underdeveloped regions of the world

Question 10

Hepatitis B

Answer 10

• Contaminated blood or bodily fluids
• Generally travelers not participating in high-risk behavior have low chances of transmission
• Important to receive vaccine if planning to receive medical care, volunteering to provide medical care, or having unprotected sexual encounters in these countries
• Avoid piercings/tattoos in these areas as well
• 3-dose series, complete as many as possible prior to traveling and complete series upon return

Question 11

Avoiding Insect Bites

Answer 11

• Stay/sleep in screened/air conditioned rooms and use bed nets
• Cover exposed skin with long sleeves/pants
• Use mosquito repellant that is 20-50% DEET on exposed skin
• Use permethrin on clothing/bedding, NOT on skin

Question 12

Dengue

Answer 12

• Transmitted by mosquitos (protection essential!)
• Dengvaxia - live-attenuated recombinant vaccine only recommended to those with past dengue infection
• Most are asymptomatic, but 5% are severe and cause shock, severe bleeding, and organ failure

Question 13

Japanese Encephalitis

Answer 13

• Transmitted by mosquitos (protection essential!)
• Ixiaro only recommended for travelers 2 mo+ who are going to have extended exposure outdoors or stay 1+ months in endemic areas during JE transmission season

Question 14

Malaria

Answer 14

• Spread by Anopheles mosquitos (protection essential!)
• Multiples in liver cells then spreads to RBC and destroys them
• Sxs: shaking, chills, high fever, flu-like illness
• P.vivax causes 50% of malaria cases in India and is becoming increasingly resistant
• P. falciparum is the most deadly species
• Prophylactic medications are recommended and are region specific (find on CDC website)

Question 15

Daily Malaria Prophylaxis

Answer 15

• Doxycycline (Vibramycin), Atovaquone/proguanil (Malarone), or Primaquine
• Avoid in pregnancy
• Cause nausea, take with food, water, or milk
• Don’t use Doxycycline in children < 8 yo, stop 4 weeks after travel (preferred in hiking/camping due to coverage)
• Don’t use Malarone in BF or renal insufficiency, stop 1 week after travel
• Don’t use Primaquine in G6PD deficiency, stop 1 week after travel

Question 16

Weekly Malaria Prophylaxis

Answer 16

• Chloroquine, Mefloquine, Tafenoquine
• First two safe in pregnancy and children (Tafenoquine CI in preggo/BF)
• Chloroquine causes renal toxicity/vision changes and should be stopped 4 weeks after travel
• Mefloquine can cause underlying psychiatric conditions/seizures/arrhythmias, should start >2 weeks before and stop 4 week after travel
• Tafenoquine shouldn’t be used in G6PD deficiency (only okay in BF if infant tested for deficiency too)

Question 17

Yellow Fever

Answer 17

• Transmitted by mosquitos (prevention essential!)
• Aspirin and NSAIDs can’t be used for analgesic/antipyretic relief due to bleeding risk
• ICVP (“yellow card”) given to those vaccinated and is required for entry into some countries
• Must complete vaccination at least 10 days before arrival
• CI in those allergic to eggs/gelatin and immunocompromised
• Serious adverse effects so only recommended in those at high risk for exposure or needed to travel

Question 18

Zika Virus

Answer 18

• Tranmitted by mosquito, sexual encounters, and possible blood transfusions (contaminated)
• Most are asymptomatic but pregnant women with virus can give birth to infants with microencephaly
• No vaccine so avoidance and using condoms in key
• CDC recommends against pregnant women traveling to areas with Zika virus and using protecting with those who just traveled to an area with Zika

Question 19

Altitude Sickness

Answer 19

• Primary prophylaxis is acetazolamide (Diamox)
• Start the day before ascent preferably
• Can increase dose to treat altitude sickness
• SE: polyuria, photosensitivity, etc.
• CI: sulfa allergies