miércoles, 15 de mayo de 2019

Travel Vaccinations - Worldwide Travel Information

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By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Dr. Jennifer Logan, MD, MPH

Vaccines are essential for any person looking to travel to another part of the world. Thanks to advances in medicine, safe and effective vaccines are now available for many infectious diseases. Getting vaccinated not only benefits the person who is traveling, but their family, friends and those in the community too, as it prevents the spread of infection.

This article describes the most common infectious diseases and the corresponding vaccinations that Western travelers should receive before leaving their home country.

Which vaccinations do I need?

The number and type of vaccinations that you will need will depend on the country that you reside in, whether you have been exposed to any infectious agents before and the country that you are traveling to. For example, you may have already received some of the required vaccinations as part of your national health program. Whether or not you need some vaccinations will also depend on the region that you are visiting, as in some cases, vaccinations are only required for rural regions.

The number and type of vaccinations that a traveler will need may also depend on whether they have any pre-existing health conditions. If a traveler is pregnant or has certain illnesses or a weakened immune system, they may require additional vaccinations.

How far in advance do I need to book my vaccinations?

You should aim to receive your vaccinations no later than 4 – 6 weeks prior to your departure, although some vaccinations may need to be given further in advance. The reason for this is to allow your body to build up an immune response to the infectious agent, meaning that if you do come into contact with the disease, your immune system is able to recognize the pathogen and initiate an immune response immediately.

Another reason to plan your vaccinations in advance is that some vaccines require multiple doses spread over a few weeks.

What are the main vaccinations that most travelers will need?

Routine vaccinations, such as those directed against measles, mumps, and rubella (MMR); diphtheria, tetanus, and pertussis; varicella (chickenpox); polio; rotavirus; and influenza are important for travelers and non-travelers. These vaccines are particularly important when traveling, as these diseases still occur commonly in many parts of the world.

Common infectious diseases and corresponding vaccinations

In addition to routine vaccines, specific vaccinations are needed for different destinations. The selection of such vaccines depends on the country you are visiting, duration of stay, and the purpose of the visit. The following list describes the vaccination needed for popular destinations.

Hepatitis A

A viral infection of the liver that is highly prevalent in developing countries

How is hepatits A spread?

Contaminated food and water (including ice cubes and fresh produce that has been washed in local water)
Raw or undercooked shellfish
Bodily fluids (including sexual intercourse or the sharing of contaminated needles)

Which destinations require vaccination against hepatitis A?

Africa
The Carribean
Russia and some parts of Europe
America, especially South America
Central Asia
Countries in the Middle East

Which destinations do not require the hepatitis A vaccination?

Hepatitis occurs less frequently in Canada, Western Europe and Scandinavia, Japan, New Zealand, and Australia.

How many doses do I need?

Two doses of hepatitis A vaccine given 6 months apart have been shown to be 100% effective in preventing the infection.

Typhoid

Typhoid fever is an infection caused by the bacterium Salmonella Typhi that can spread throughout the body and have life-threatening effects.

How is typhoid spread?

Typhoid is spread through contaminated feces that enters the water system and/or contaminates food items.

Which destinations require the typhoid vaccination?

South Asia
Africa
South America
The Carribean
Countries in the Middle East
Europe

Which destinations do not require the typhoid vaccination?

The prevalence of typhoid is very low in the United States, Canada, Western Europe, Australia, and Japan.

How is the typhoid vaccine administered?

Both injectable and oral vaccines are available, and your healthcare practitioner will advise you which one is suitable for your trip. However, the efficacy of this vaccine is only 50 – 80% so you should try to ensure that you only eat and drink from safe and clean sources even after being vaccinated.

How many doses of the typhoid vaccine are needed?

The dose of oral vaccine varies from country to country. In Australia and Europe, three doses of the vaccine (days 0, 3, and 5) are repeated every year for those traveling from non-endemic to endemic countries.

For typhoid shots, a single dose of vaccine is injected intramuscularly, and revaccination is recommended every 3 years for better efficacy. In high-risk countries, the vaccine efficacies are 72% and 50% after 1.5 years and 3 years of vaccination, respectively.

Hepatitis B

Hepatitis B is a viral infection of the liver which is transmitted through the sharing of body fluids such as blood or semen.

Which destinations require vaccination for Hepatitis B?

Asia
Africa
South America
The Caribbean

Which destinations do not require the hepatitis vaccination?

Hepatitis B is less prevalent in North and Central America, Europe and Antarctica. However, vaccination is recommended for travelers who may engage in high risk activities such as unprotected sex, getting a tattoo, or the use of intraveous drugs where needles may be shared.

How is the hepatitis B vaccine administered?

The hepatitis B vaccine consists of 3 doses wherein the second and third doses are given 1 month and 6 months after the first dose, respectively. The efficacy of the vaccine is almost 90%, and boosters are generally not required.

Rabies

Rabies is a life-threatening viral disease which is transmitted through the saliva of infected animals.

Where is rabies prevalent?

Cases of rabies can be found all over the world, but the risk of infection is significantly higher in:

Africa
Asia
Central America
South America

Which destinations do not require the rabies vaccination?

Rabies vaccination is not generally recommended for The United States, Europe, Japan, Canada, and Australia. However, travelers who engage in a lot of outdoor activities, especially those who may come into contact with wild or domestic animals or are performing work or research in endemic areas are at higher risk of contracting the infection and may choose to receive the vaccine.

How is the rabies vaccine administered?

The vaccines for rabies are of two types: pre-exposure vaccine and post-exposure prophylaxis.

The pre-exposure vaccine is given before travel to protect travelers who are at higher risk of exposure to rabies. It consists of 3 doses that are injected intramuscularly on days 0, 7, and 21 or 28.

The post-exposure prophylactic vaccine is given to prevent the development or rabies if a traveler is bitten or scratched by an infected animal. Such vaccination is given through intramuscular (deltoid muscle) or intradermal injections.

The intramuscular vaccine consists of either 4 or 5 doses. The four-dose vaccine is given as two doses on day 0 followed by days 7 and 21 whereas the five-dose vaccine is given on days 0, 3, 7, 14, and 28.
The intradermal vaccination is administered on days 0, 3, 7, and 28 using the two-site intradermal method.

Japanese encephalitis

Japanese encephalitis is a mosquito-borne disease that has a high fatality rate.

Who should receive the Japanese encephalitis vaccine?

Anyone who is traveling to the following destinations should receive the Japanese encephalitis vaccine:

India
Korea
Sri Lanka
Thailand

The risk of contracting Japanese encephalitis depends on the destination you are traveling to, as well as the nature of activity, time of year and duration of the trip. In northern Asia, the risk is higher in the summer and fall; whereas in tropical and subtropical countries, the risk remains high throughout the year.

How is the Japanese encephalitis vaccination administered?

The Japanese encephalitis vaccine consists of two doses that are given 4 weeks apart. The last dose should be administered at least 10 days before traveling. A booster dose is recommended after 1 year of primary vaccination.

Meningococcal disease (Meningitis with septicemia)

Meningococcal disease is a disease caused by the bacterium Neisseria meningitides. It occurs when the bacterium, which causes meningitis, enters the bloodstream. This results in a systemic, life-threatening infection known as sepsis.

Who should receive the meningococcal vaccination?

The incidences of this disease can be found all over the world, but vaccination is mainly recommended for those traveling to Sub-Saharan Africa and countries in the Middle East.

The disease is highly prevalent during the dry season in Sub-Saharan Africa and in Saudi Arabia during Hajj pilgrimage.

Meningococcal vaccination is also routinely given to teens in the US, because crowded conditions in college dormitories or on military barracks increase the likelihood of outbreaks.

How is the meningococcal vaccine administered?

Meningococcal vaccines are of three types: bivalent, trivalent, and tetravalent. A booster dose is recommended 5 years after the primary vaccination. These single-dose vaccines take at least 7 – 10 days to start working. I

n Saudi Arabia, a proof of recent vaccination (tetravalent vaccine) is required to enter the country during Hajj pilgrimage.

Cholera

Cholera is a bacterial disease spread by contaminated food and water.

Who should receive the cholera vaccine?

The cholera vaccination is recommended for those traveling to:

Haiti
The Dominican Republic
Africa
Asia (some regions)

What does the cholera vaccine consist of?

The cholera vaccine comprises two oral doses given 7 – 14 days apart. If the second dose is delayed by more than 6 weeks, vaccination should be repeated. The vaccine takes 1 week to start working, and the efficacy is almost 90%. A booster dose is recommended after 2 years of primary immunization.

Tick-borne encephalitis

Tick-borne encephalitis is a viral infection spread by small insects known as ticks.

Who should receive the tick-borne encephalitis vaccination?

The prevalence of tick-borne encephalitis is high in several parts of Europe and Asia, including:

Czech Republic
Estonia
Germany
Hungary
Latvia
Lithuania
Poland
Slovenia
Sweden
Switzerland
China
Japan
Mongolia
South Korea
Russia.

The most likely time to become infected is the early and late summer when ticks are abundant in forest areas.

How is the tick-borne encephalitis vaccine administered?

The tick-borne encephalitis vaccine is only recommended for high-risk travelers, such as those who will be spending a lot of time in wooded areas.

In Western Europe, the vaccine consists of three doses that are given intramuscularly at intervals of 4 – 12 weeks between 1st and 2nd doses and 9 – 12 months between 2nd and 3rd doses.

In Russia, three doses of the vaccine are given at intervals of 1 – 7 months between 1st and 2nd doses and 12 months between 2nd and 3rd doses.

Yellow fever

Yellow fever is a mosquito-borne viral disease that can lead to serious complications, such as shock, organ failure, or even death.

Where is yellow fever prevalent?

Sub-Saharan Africa
Tropical regions of South America

There was also a recent outbreak of yellow fever in Brazil. Proof of vaccination at least 10 days prior to travel is required to enter specific countries where the disease is endemic.

How is the yellow fever vaccine administered?

The yellow fever vaccine is a single-dose vaccine given subcutaneously or intramuscularly. The efficacy of the vaccine is 100%, and it generally provides protection for life. However, for some people, a booster dose may be required after 10 years.