TRAVEL VACCINATIONS

Vaccinations are a fundamental part of pre-trip planning but, as with all medications, are not to be relied on solely.  Vaccinations may reduce the risk of infection but not all completely eliminate it.  The risk of contracting a water-borne pathogen, for example, is already greatly reduced by diligent personal hygiene and being careful of what you eat and drink.   PPE will reduce the risk of contracting a blood borne pathogen.  With this in mind a holistic approach should be applied to infection control; being vaccinated does not necessarily mean you are safe and protected.

 

Sources of information

Before you travel, as an absolute minimum find out about the health and security risks in the area you are traveling to.  The following are reliable sources of current information:

Foreign & Commonwealth Office - First port of call for up-to-date travel, health and safety advice searchable by country.

Travel Health Pro - More detailed country-based travel health information and outbreak surveillance from the National Travel Health Network and Centre (NaTHNaC)

World Health Organisation - Comprehensive health and medical advice for travellers

Know Before You Go - Basic travel safety advice.


Maintaining records

Keep a record of you vaccinations:  Some will last a lifetime some will last as little as 12 months.   At the very least enter the expiration dates to your vaccinations into your cloud based calendar three months before they expire.   Some vaccinations require a series of doses spread over a set period of time whilst other require an incubation period to develop full efficacy.  Don't leave to to the last minute.

In addition to your calendar, keep a spreadsheet of your vaccinations, the dates they were adminsitered and when they expire.  This can be useful if:

  • You plan to travel or work abroad for an extended period of time - will your vaccinations expire while you are abroad?
  • You need to provide dates of vaccinations to your employer before deployment.

This is a simple Excel Spreadsheet for you to download.  If you enter the details of your immunisations the rows will change to yellow if they are past their expiration date.  (This form can be edited - instructions supplied.   Save this file to a cloud based storage service such as Google Drive or DropBox so you can access and maintain it from your phone when you need it.


Travel Related Diseases

Vaccine

Description

Schedule

Period of
protection

Cholera

Cholera is a bacterial infection spread through contaminated water, as such it is most often associated where there is poor sanitation such as sub-Saharan Africa, south and south-east Asia, the Middle East, central America and the Caribbean.

Symptoms include severe vomiting and diarrhoea and stomach cramps.

The Cholera vaccination Dukarol is given as two or three drinks given at six week intervals.­1

80-85% Effective at 6 months.

63% effective at 3 years.2

Diphtheria

An upper respiratory tract illness caused by Corynebacterium diphtheriaebacteria. It is characterized by sore throat, low fever, and a greyish adherent membrane on the tonsils, pharynx, and/or nasal cavity.

Diphtheria is spread by both direct contact with and air-born contamination from infected individuals.

Received in childhood

Booster recommended if travel to high risk areas3

10 years

Encephalitis -
Japanese

Japanese encephalitis is a type of viral brain infection that is spread through mosquito bites. It's most common in rural areas throughout South East Asia, the Pacific islands and the Far East, but is very rare in travellers.

Domestic pigs and wild birds (herons) are reservoirs of this virus; transmission to humans is most prevalent via mosquitoes Culex tritaeniorhynchus and Culex vishnui.

Severe rigors mark the onset of this disease in humans. Fever, headache and malaise are other non-specific symptoms of this disease which may last for a period of between 1 and 6 days. Signs which develop during the acute encephalitic stage include neck rigidity, cachexia, hemiparesis, convulsions and a raised body temperature between 38–41 °C (100.4–105.8 °F). Mental retardation developed from this disease usually leads to coma.

0 and 28 days

1-2 years

Encephalitis -
Tick Borne

Tick-borne encephalitis is a viral infection,
Initial symptoms of TBE are similar to flu and can include a high temperature, headache, tiredness and muscle pain. These symptoms usually last for up to eight days, after which point most people make a full recovery.

Some people may go on to develop more serious symptoms caused by the virus spreading to the layer of protective tissue that covers the brain and spinal cord (meningitis) or the brain itself (encephalitis). These ‘second-stage’ symptoms can include altered mental state, seizures, sensitivity to bright light, an inability to speak or paralysis.

If TBE reaches this stage, you will usually need to be admitted to hospital. These symptoms tend to get slowly better over a few weeks, but it may take several months or years to make a full recovery and there is a risk you could experience long-term complications.

Around one in every 100 cases of TBE is fatal.

3 injections

0, 1-3 and 5-12 months

or

0, 2 weeks, 5-12 months4

3 years

Hepatitis A

Hepatitis A is a type of viral liver infection spread by through faeces. Initial symptoms of hepatitis A are similar to flu and include low grade fever, joint pain, nausea and vomiting. This may then be followed by symptoms related to the liver becoming infected, such as jaundice, dark coloured urine and pale faeces, abdominal pain and itchy skin.

The three types of vaccine that protect against hepatitis A infection are:
monovalent vaccine, which provides protection against hepatitis A
combined hepatitis A and hepatitis B vaccine – hepatitis B is another type of liver infection most common in China, Africa and southeast Asia
combined hepatitis A and typhoid fever vaccine – typhoid fever is a serious type of bacterial infection

Single injection ideally given 2 weeks before departure for travel

1 year

A booster received after 6 - 12 months can provide protection for up to 20 years.

Hepatitis B

Hepatitis B is a type of virus that can infect the liver. Symptoms can include sickness and nausea, loss of appetite, flu-like symptoms, and jaundice.

Hepatitis B is blood borne and through other body fluids.

Many people don’t realise they have been infected with the virus, because the symptoms may not develop immediately, or even at all. It takes between 40 and 160 days for any symptoms to develop after exposure to the virus.

0, 1 and 6 months5

5 years

A single booster at 5 years is believed to provide 25 years protection but boosters at 5 years are recommended for those at risk6

Hepatitis C

Hepatitis C is a blood borne virus that can infect the liver. If left untreated, it can sometimes cause serious and potentially life-threatening damage to the liver over many years.
However, with modern treatments it's often possible to cure the infection and most people with it will have a normal life expectancy.

No Vaccine

Hepatitis D

Hepatitis D is only present in people already infected with hepatitis B. Chronic hepatitis D can increase the risk of cirrhosis developing. Cirrhosis is more likely to develop in someone with chronic hepatitis B becoming infected with hepatitis D (superinfection). It is much rarer when both infections occur together (co-infection).

Requires Hep B Vaccine

Hepatitis E

Generally a mild and short-term infection.
It is caught by putting something in your mouth that has been contaminated with the faeces of someone with hepatitis E. Person-to-person transmission is rare.

No Vaccine

Influenza - Domestic

An annual Influenza vaccine is available for those at risk (such as children, elderly or those with weak immune systems). Vaccination could be considered when traveling to areas of high levels of outbreak. The normal influenza vaccine is not effective again Asian Bird Flu (H5N1 or H7N9).

1 injection

1 year

Meningococcus

Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis (also termed meningococcus). It carries a high mortality rate if untreated. While best known as a cause of meningitis, widespread blood infection is more damaging and dangerous. Meningitis and meningococcemia are major causes of illness, death, and disability in both developed and under developed countries worldwide.

The disease is transmitted through saliva and occasionally through close, prolonged general contact with an infected person.

Men ACWY Combined Vaccine

3-5 years7,8

Meningitis B

0 and 1 month for adults9

Life

Polio

Poliomyelitis is an acute, viral, infectious disease spread from person to person, primarily via the fecal-oral route but also through open wounds leading to inflammation of the spinal cord’s grey matter.

In about 1% of cases, the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis.

Received in childhood

Life

Rabies

A viral disease that causes acute encephalitis in warm-blooded animals. The disease is zoonotic, meaning it can be transmitted to humans from another species (such as dogs), commonly by a bite from an infected animal. Rabies is nearly always fatal in humans if post exposure prophylaxis is not administered before the onset of severe symptoms. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death.

0, 7 and 21 days
or


0, 7 and 28 days

2-3 years10

Tetanus

Tetanus, also known as lockjaw, is a disease caused by the bacterium clostridium tetani which enters the body through open wounds and releases a poison called tetanospasmin. This is a potentially deadly disease because the poison attacks the nervous system blocking nerve signals from the spinal cord to and from the muscles.

Received in childhood

10 Years

Typhoid

A common worldwide bacterial disease transmitted by the ingestion of food or water contaminated with the faeces of an infected person.

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. Over the course of these stages, the patient becomes exhausted and emaciated before death.

Vaccines are either injected or taken orally, both with a 50%-80% efficacy.

One dose

3 years

Yellow Fever

The yellow fever virus is transmitted by the bite of female mosquitoes and is found in tropical and subtropical areas in South America and Africa, but not in Asia. The only known hosts of the virus are primates and several species of mosquito.

Yellow fever presents in most cases in humans with fever, chills, anorexia, nausea, muscle pain (with prominent backache) and headache, which generally subsides after several days. In some patients, a toxic phase follows, in which liver damage with jaundice can occur and lead to death. Because of the increased bleeding tendency (bleeding diathesis), yellow fever belongs to the group of haemorrhagic fevers. The World Health Organization estimates that yellow fever causes 200,000 illnesses and 30,000 deaths every year in unvaccinated populations; today nearly 90% of the infections occur in Africa.

One dose

10 years

References

1.       http://www.netdoctor.co.uk/medicines/infections/a8605/dukoral-cholera-vaccine/

2.       http://www.medsafe.govt.nz/profs/datasheet/d/Dukoralsusp.pdf

3.       http://www.nhs.uk/Conditions/Diphtheria/Pages/Prevention.aspx

4.       http://www.nhs.uk/Conditions/Tick-borne-encephalitis/Pages/Beforeyougopage.aspx

5.       http://www.nhs.uk/conditions/vaccinations/pages/hepatitis-b-vaccine.aspx

6.       Joint Committee on Vaccination and Immunisation (2006). "Chapter 18 Hepatitis B". Immunisation Against Infectious Disease 2006 ("The Green Book") (3rd edition (Chapter 18 revised 10 October 2007) ed.). Edinburgh: Stationery Office. p. 468. ISBN 0-11-322528-8.

7.       https://www.medicines.org.uk/emc/PIL.26513.latest.pdf

8.       https://www.medicines.org.uk/emc/PIL.27358.latest.pdf

9.       http://www.medicines.org.uk/emc/PIL.28408.latest.pdf

10.   http://www.nhs.uk/Conditions/Rabies/Pages/Prevention.aspx

11.   http://www.nhs.uk/Conditions/Typhoid-fever/Pages/Prevention.asp