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Immunization in Travelers by Dr Puja Dhupar

Petals Children Hospital

Immunization in Travelers by Dr Puja Dhupar

INFLUENZA - Most common VPD of travellers with attack rate of 8.9 per 100 person months of travel

HEPATITIS A -Risk for non-immune travellers has attack rate of 3.5 cases per 100,000 travellers to endemic regions

TYPHOID AND PARATYPHOID - risk of 3 cases per 100,000 travellers per month on Indian sub-continent

RISK OF YELLOW FEVER - Maybe high in area with current epidemic transmission

General Recommendation

  • Dedicated immunization history should be available
  • Vaccine- type, dose, date, manufacturer, lot number & site of administration should be recorded
  • Document if the patient declines to receive any recommended vaccine
  • Non immunized or incompletely immunized -get routine vaccinations as per national immunization schedule
  • Simultaneous administration of all indicated vaccines is encouraged
  • Inactivated vaccines can be given anytime or with live viral vaccine
  • If two live viral vaccine not administered on same day allow 4 weeks interval between administration
  • Time intervals for vaccines requiring more than one dose should be followed
  • Slight variation can be made to accommodate need of travellers
  • Significant shortening of intervals is not recommended
  • Interruption in vaccination schedule does not require restarting
  • Ideally, vaccination has to be started early, to minimize adverse effects at time of departure & to allow sufficient time for adequate immunity to develop.

Factors to be Considered:

Time between the initial presentation to departure

Date and destination

Length of stay

Type of accommodation

Previous vaccination status

TRAVEL VACCINES can be divided into following Categories-

  1. Routine vaccines for review before traveling
  2. Vaccines recommended for certain destinations
  3. Vaccine demanded by certain countries

Routine Vaccines

Part of most national childhood immunization programs

  • Diphtheria tetanus pertussis
  • Hepatitis B
  • Haemophilus influenza type b
  • Influenza
  • MMR
  • HPV  
  • Pneumococcal
  • Polio
  • Rotavirus
  • Tuberculosis  
  • Varicella

Vaccine Recommended for Certain Destinations

Provides protection against diseases endemic in country of origin or destination

  • Cholera
  • Hepatitis A/E
  • Japanese encephalitis
  • Meningococcal
  • Typhoid fever
  • Yellow fever
  • Rabies
  • Tick born encephalitis

Vaccines Demanded by Some Countries

Some countries require proof of vaccination to enter or exit the country

  • Yellow fever
  • Polio vaccine
  • Meningococcal vaccine

Important Points to Be Noted

  • No single vaccination schedule suits all travellers
  • It must be Personalized
  • Pre-travel consultation is a good opportunity to review routine immunization
  • Always consult travel medicine practitioner 4-8 weeks before departure to have optimal time to complete vaccination
  • Try to complete vaccination at least 2 weeks before departure
  • Combination and co administration of vaccines should be preferred
  • Routine country requirements for international travellers are updated on ITH page of WHO website