| Many countries require pre-departure vaccinations to immunize you from a range of diseases and illnesses.
It is paramount that you find out which immunizations you require before departure to ensure a healthy trip.
Visit your local GP or health clinic, or check out the World Health Organisation
web site, NetDoctor or 24drtravel
- all of which provide a wealth of health information for travellers.
You should look into vaccinations as soon as you know where you are travelling, as certain vaccinations need to be taken
over several weeks in the lead up to departure.
The main diseases requiring pre-departure vaccination are Diphtheria, Malaria, Tuberculosis, Tetanus, Hepatitis A&B,
Meningitis A & C, Polio, Rabies, Typhoid & Yellow Fever.
Diptheria
Disease risk areas
Worldwide, although the disease has virtually been eliminated from the UK.
Transmission
By droplet infection and through contact with articles soiled by infected persons.
Recommendations for travellers
Travellers should have received the normal British Childhood Immunisation Schedule. Vaccination is especially
advised for visits to endemic areas when mixing with the local population (e.g. health workers or teachers) and these
groups should receive ten yearly boosters of the adult (low dose) vaccine.
Hepatitis A
High risk areas.
All countries outside Western Europe, Scandinavia, North America, Japan, New Zealand, Australia; particularly
those with poor sanitation and public hygiene.
Recommendations for travellers
Active vaccination with 'non-live' inactivated vaccine, is used to give longterm protection against hepatitis
A. Active vaccination can be used from one year of age. In children hepatitis A is usually mild but asymptomatic infected
children can spread virus to others.
Normal pooled Immunoglobulin (passive vaccination) is an alternative when active vaccination is contraindicated or when
insufficient time is available before departure (less than 2 weeks) for protection to have been achieved.
Hepatitis B
Disease risk areas
Present worldwide.
Vaccination for travellers
This should be considered for the following groups of travellers going to medium and high risk areas.
- Those staying for long periods (e.g. more than 3 months) and frequent travellers.
- Those at occupational risk (e.g. health care workers).
- Young children mixing with locals in poor hygienic conditions.
- Those with pre-exiting medical conditions who may need medical attention or surgical proceedures (e.g. if preganant).
- Those who may be at sexual risk or at risk of sharing percutaneous needles.
- Military personnel.
Meningococcal meningitis
Disease risk areas
The epidemic (type A) strains occur predominantly in Sub-Saharan Africa from Senegal and Gambia in the west to
Ethiopia and Somalia in the east. In recent years outbreaks have occurred as far south as Zambia, Malawi and Namibia.
North African countries along the Mediteranean coast are not normally involved.
Epidemics occur annually and are most likely towards the end of the dry seasons. There are occasional cases at other
times of year. Very large epidemics have occurred recently every 5-10 years. These larger epidemics tended to start in
West Africa and spread eastwards.
Outbreaks in Nepal, northern India and Brazil have occurred but have been localized and unpredictable.
Recommendations for travellers
Advised for those going to risk areas when going to be in close contact with the local population or staying for
long periods. On this basis the risk is usually small for package tourists.
Although epidemics tend to occur during the dry seasons in Africa we usually hear of outbreaks only after they are established.
'Close contact with locals' seems a more practical way of assessing risk than advice relating to seasons or the start
of the outbreaks themselves.
Polio
Disease Risk Areas
The disease is endemic in many Asian and African developing countries. In countries with an high immunisation
coverage the disease occurs only rarely. The Americas (North, south, central and the Caribean Islands) and have been declared
poliomyelitis free. Europe and the Asia-Pacific regions are not far behind.
Primary immunisation of children
Recommended for infants from 2 months of age.
Live oral polio vaccine(OPV) is normally used in Britain and given at the same time as Diphtheria, Tetanus and Pertussis.
Primary immunisation can be given earlier, which is the policy in some countries where poliomyelitis is common.
Boosters for children
Given 5 years after the primary course and 10 years later (usually mid-teens).
In endemic areas the primary course may include extra doses (e.g. up to 5) because response may be poor in those with
gut parasitic infections or in those who are malnourished. Boosters may be continued every 10 years through adult life.
Primary immunisation of adults
As for children.
Boosters for adults
Ten yearly boosters are advised for those travelling to endemic areas. Extra adult boosters are not normally given for
life in Britain except for health care workers at possible occupational risk.
Rabies
Disease Risk Areas
Occurs in all continents except Australasia. Some countries are thought to be normally "rabies-free".
Pre-Exposure Vaccination
This can be considered for:
(a) to those travelling to countries where rabies is present and who intend to have regular contact with animals (e.g.
veterinarians or zoologists)
(b) to those travelling to countries where rabies is endemic and if who will be more than 24 hours away from a reliable
source of post-exposure vaccine and (ideally) rabies specific immunoglobulin.
Although pre-exposure vaccination is likely to give excellent protection post-exposure boosters (usually 2 doses) should
still be sought as soon as possible after an exposure to ensure maximum protection.
Post-Exposure Vaccination is also very effective if a reliable vaccine is commenced according to manufacturer's instructions
within 24 hours.
Those not previously vaccinated (or up to date with boosters) should also ideally receive rabies hyperimmunoglobulin to
give immediate passive protection.
Immunoglobulin is unlikely to be of benefit more than 7 days after exposure (W.H.O).
The immunoglobulin dose is calculated by patient's weight and administered half around the wound and half intramuscularly.
Tetanus
Disease Risk Areas
Worldwide.
Primary immunisation of children
Given in Britain as "triple vaccine" (DPT) from 2 months of age. Immunisation is started as early as
1 month in some countries. If the pertussis component is contraindicated adsorbed Diphtheria/Tetanus vaccine should be
given.
Primary immunisation of adults
Absorbed tetanus vaccine given in 3 doses either at monthly intervals as for children, or the third dose can be
delayed for up to 6 months.
Boosters
Should be given 5 years after a primary course and then after 10 years. For life in Britain these 5 doses are
considered sufficient unless the unless the risk of contaminated injuries is considered to be likely.
If an injury occurs and a booster has not been received within 10 years, a booster should then be given, ideally with
tetanus hyperimmune globulin.
Travellers may warrent additional 10 yearly boosters if they are going to countries where specific tetanus immunoglobulin
will not be available and tetanus prone injuries are possible.
Typhoid
Disease Risk Areas
Worldwide, but predominantly in countries where water or food supplies are liable to faecal contamination, most
especially in countries in Africa, the Far East and South America.
Recommended for travellers to areas where food and water are likely to be contaminated. When the risk is small vaccination
may be limited only to those unable to maintain their own hygieme precautions or staying for long periods.
Yellow Fever
Disease Risk Areas
Countries currently reporting human cases to W.H.O.( Weekly Epidemiological record 1999/74/4. 29 January 1999)
In Africa: Angola, Benin, Burkina Faso, Cameroon, Democratic Republic of the Congo, Gabon, Gambia, Ghana, Guinea, Liberia,
Nigeria, Sierra Leone, Sudan.
In Americas: Boliva, Brazil, Colombia, Ecuador, French Guyane, Peru, Venezuela.
Countries where yellow fever occurs in the monkey host - See 'Yellow Fever Infected Countries'
Recommendations for travellers
Vaccination is normally recommended for travel to areas where yellow fever is present in the monkey host.
Many of these countries require certificates of vaccination before entry. Some other countries require certificates
from those arriving from "infected areas" because they have the mosquito vector and have the potential to become
"infected". For country specific advice see the country concerned.
(Source: www.24drtravel.com)
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