TRAVELER’S VACCINATION GUIDE

PATIENT’S GUIDE ON TRAVELER’S VACCINATIONS

Vaccination before traveling is essential to ensure an enjoyable journey. Everyone is encouraged to complete a course of these vaccinations.

Studies have shown that between 50-70% of short travelers to the tropics or subtropics encounter some health impairment or problems.

It is best for travelers to plan vaccination about eight weeks before the departure date.

If you have less than 4 weeks before departure, you should still see your doctor. You may still benefit from shots or medications and other information about how to protect yourself from illness and injury when traveling.

The following are recommended vaccinations for all travelers prior to traveling.

  • Hepatitis B / Influenza / Hepatitis A / Chickenpox / Typhoid / Cholera

Additional vaccinations for students studying abroad:

  • MMR (measles, Mumps, Rubella) / Meningococcal Meningtis / DT (Diphtheria, Tetanus)

HEPATITIS A

HOW IS HEPATITIS A TRANSMITTED?

Hepatitis A is transmitted through the oral-faecal route, e.g. via cintaminated food and water.

WHAT ARE THE SYMPTOMS OF HEPATITIS A?

It attacks the liver cells causing acute inflammation of the liver which may lead to hospitalization and patients with serious disease can suffer acute liver failure leading to encephalopathy and coma. This is completely preventable through vaccination.

COUNTRIES WITH HIGH HIPATITIS A INFECTION RISK

Hepatitis A vaccine is highly recommended for travelers visiting countries like Africa, the Middle East, South America and Asia where the disease is prevalent and transmission rate is high.

CAN I GO  FOR VACCINATION IF I AM NOT SURE WHETHER I HAVE IMMUNITY?

Hepatitis A vaccine can be given safely even to those who has previously contracted the disease.  Thus it is possible to vaccinate even though the immune status is unknown.

WHEN SHOULD I GET THE VACCINATION PRIOR TO THE TRIP?

The effective immunity is reached in 2 weeks’ time and the maximum effect is four weeks after a single dose. Thus it should be given 2 weeks prior to the trip.


HEPATITIS B

HOW IS HEPATITIS B TRANSMITTED?

Hepatitis B is transmitted through body fluid and blood products via sexual contact, blood transfusion, needle prick, and mother to baby transmission during labour. A significant portion of hepatitis B infection is contracted during travel.

WHAT ARE THE SYMPTOMS OF HEPATITIS B?

The hepatitis B attacks the liver cells and may lead to chronic inflammation, scarring and hardening of the liver (cirhrosis) and increase risk of liver cancer by more than 200 fold! Chronic hepatitis B infection although treatable, will require close monitoring and high cost of treatment.

COUNTRIES WITH HIGH HEPATITIS B INFECTION RATE

The risk is highest in sub-Saharan Africa and in parts of South East Asia and South America where the prevalent rate is high but this too will depend on the exposure risk of particular individuals.

WHO SHOULD BE GET VACCINATED?

Vaccination is recommended for long-term travelers, people who visit endemic areas, high risk group e.g. those engaging in unprotected sexual activities, health workers and anyone who may need medical or dental procedures where the risk of contracting this disease is high.

HOW AND WHEN SHOULD I GET THE CVACCINATION?

The routine vaccination schedule consists of three doses at 0, 1 and 6 months interval, given through the intramuscular route. However rapid immunization is possible with four doses at 0, 1, 2 and 12 months apart. An accelerated course (for adults over 18 years only) consists of four doses at 0, 7 and 21 days and 12 months, can also be applied when needed.

TYPHOID

HOW TYPHOID IS TRANSMITTED?

Typhoid fever is contracted through consumption of contaminated food, milk or water. The organism involve is Salmonella typhi.

WHAT ARE THE SYMPTOMS OF TYPHOID?

The disease causes diarrhea or constipation and may lead to high grade fever, rashes. It may spread to the brain, lungs, blood, bone, intestines and other parts of the body. The mortality rate in developing countries can be as high as 30%! The disease can be treated with antibiotics.

WHICH AREA HA A HIGHER INCIDENT OF TYPHOID?

Vaccination is recommended for travelers to areas where hygiene may be poor particularly in India, sub-Saharan Africa and part of South America.

HOW AND WHEN IS TYPHOID VACCINE GIVEN?

It is given through the intramuscular route and confers around 70% protection which may last up to 3 years. The vaccine takes effect in about 10 days. Thus vaccination is recommended 2 weeks before travel.

CHOLERA

HOW IS CHOLERA TRANSMITTED?

It is spread through contaminated water and food by human faeces. It is caused by the organism called Vibrio Cholerae.

WHAT ARE THE SYMPTOMS OF CHOLERA?

Cholera is an acute diarrhea disease that can in matter of hours, result in profound dehydration and death. It causes a sudden onset of painless water diarrhea that is often described as ‘rice water’. Progression is usually rapid and unless promptly treated, death will ensue. Fever is usually absent and muscle cramp is common.

WHO ARE AT RISK FROM CHOLERA?

The prime risk factor is being in an area which has endemic cholera or poor water and sewage facilities.  Careless travelers to such areas do have an increased risk, and regularly bring the disease home.

WHO SHOULD GET VACCINATED AGAINST CHOLERA?

Currently, no country or territory requires vaccination against cholera as a condition for entry. In some circumstances, local authorities may require documentation of this vaccination. A single dose or oral vaccine will satisfy local requirements. It is an oral vaccine (e.g. Dukoral) given orally and confers around 50% protection that may last from a few months to 3 years.


INFLUENZA

HOW IS INFLUENZA TRANSMITTED?

Influenza is a highly contagious airborne disease that occurs worldwide. Outbreak are recorded virtually every year. It is caused by influenza viruses classified as influenza A and B. The propensity of the H and N antigens of influenza A enables it undergo periodic antigenic variation. Therefore pandemics can occur resulting in substantial mortality.

WHO SHOULD GO FOR THE VACCINATION?

Influenza vaccination is recommended for individuals below 6 months of age who are at increase risk of complications, especially those with chronic heart or lung disorders (e.g. asthma, COPD), residents of  nursing home and other chronic care facilities, health care workers, the elderly above 65years old and patients with diabetes, renal disease, hemoglobinopathies or immunosuppression.

HOW FREQUENT SHOULD I GET VACCINATION?

Inactivated influenza vaccine is given through intramuscular route and confers around 50-80% protection. It should be repeated annually to maintain immunity against the most current strains of influenza virus.

CHICKENPOX

HOW IS CHICKENPOX TRANSMITTED?

Chicken pox is caused by Varicella zoster virus. It is transmitted through direct contact of the fresh skin lesions or through airborne transmission.

WHO SHOULD GO FOR THE VACCINATION?

Chickenpox vaccine is now included in the standard childhood vaccination programs in many countries. It is recommended for all those who have not been vaccinated and have not contracted the disease before.


MMR

HOW ARE MEASLES, MUMPS AND RUBELLA TRANSMITTED AND WHAT COMPLICATIONS DO THEY CAUSE?

Measles, mumps and rubella spread through airborne transmission.

Measles is a highly contagious disease that causes high fever, cough and spotty rashes all over the body. It may also causes complications e.g. ear infection, lung infection and may involve the liver, heart and brain leading to progressive mental deterioration and fatal outcome.

Mumps cause painful swelling of the salivary glands. It can cause meningitis and infertility in males.

Rubella (German measles) is a mild disease but it has worldwide distribution and can be dangerous to pregnant women. It can cause miscarriage or congenital anomalies e.g. blindness and defect of the baby’s heart, mental retardation and deafness.

HOW IS MMR VACCINE GIVEN AND WHO SHOULD GO FOR THE VACCINATION?

MMR is live attenuated vaccine given through subcutaneous route. MMR vaccine is standard feature in most countries childhood vaccination program.

Adults of age 18 years and above going to further their studies in countries with specific requirement for this vaccination should get another dose of MMR, 2 doses, separated for at least 28 days are recommended for all travelers who have not been vaccinated previously.

WHEN SHOULD I GET VACCINATED?

It provides protection 7-10 days after 1st dose and 7 days after 2nd dose. Protection may last for a longtime. Thus vaccination is possible 10 days prior to travel.


YELLOW FEVER

WHAT IS YELLOW FEVER?

It is caused by the Yellow fever virus. It is transmitted through mosquito bites.

WHAT ARE THE COMPLICATIONS?

It will lead to fever with bleeding and severe liver ells damage.

WHICH AREA HAS THE HIGHEST INCIDENT OF YELLOW FEVER?

Certain parts of Africa and South America.

WHO SHOULD GET VACCINATED?

Vaccination are suitable for everyone except infants less than 1 year old. Vaccination is highly recommended for travelers to high risk areas. A vaccination certificate is required for entry into many counties, particularly for travelers arriving in Asia from Africa or South America.

WHEN SHOULD I  GET VACCINATED?

The protective effect occurs within one week in 95% of the people vaccinated. A single dose of vaccine provides protection for 10 years and probably for life.

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