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Travel Vaccines for Holiday

Vaccine Preventable Diseases & Travel

Vaccines for travellers include:

Note: This information is for general information purposes only and should not be used as a replacement for consultation with a health professional.

Details of primary immunisation schedules for various countries can be found at MASTA: Childhood vaccination regimes

 

Cholera

 

Cholera is a bacterial infection of the gut. Most persons infected with do not become ill. When illness does occur, more than 90% of episodes are mild or moderate and are difficult to distinguish from other types of travellers' diarrhoea. Simple rehydration is the treatment for these cases. Cholera can cause copious, painless, watery diarrhoea 'rice water stools'; those who are malnourished or immuno-suppressed are more likely to develop these symptoms.

 

Transmission

Cholera is acquired primarily by ingesting contaminated water or food; person-to-person transmission is rare. Raw or undercooked seafood from polluted water has also been associated with outbreaks. The incubation period ranges from less than one day to five days.

 

Occurrence

Occurs mainly in poor countries with inadequate sanitation and lack of clean drinking water and in war torn countries where the infrastructure may have broken down. Many developing countries are affected particularly those in Africa and Asia , and, to a lesser extent, those in central and south America . Disease outbreaks tend to be associated with slum areas or refugee camps where there is overcrowding, no safe disposal of faeces and no access to clean water.

 

Risk for Travellers

Cholera is a disease associated with slums and extreme poverty, it is unusual for travellers to take water or food from these areas, the risk of disease is therefore low and travellers are not considered to be at significant risk.

 

Risk Reduction

The risk of infection is reduced by taking hygienic precautions with all food, drink and drinking-water consumed when travelling.

 

Vaccination

Vaccination is not recommended for most travellers due to the low risk but may be recommended for those at particular risk including those working in slum areas, refugee camps or hospitals in endemic areas. Those visiting friends and family in areas reporting cholera cases, military personnel in conflict zones and travellers visiting rural areas currently or recently reporting an outbreak of cholera may also benefit from vaccination.

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Diphtheria

 

Diphtheria causes a moderately sore throat with a greyish membrane over the infected area. In severe cases the neck tissue may become very swollen. In tropical countries the infection may occur in skin ulcers. After 2-6 weeks, severe muscle weakness develops, mainly affecting the muscles of the head and neck. Inflammation of the heart muscle may cause heart failure.

 

Transmission

Transmission is from person to person, through close physical contact (particularly kissing, sharing bottles/glasses etc) and / or droplet infection and is increased in overcrowded and poor socioeconomic conditions. The incubation period is 1 to 9 days.

 

Occurrence

Diphtheria is found worldwide, although it is not common in industrialized countries because of long-standing public health vaccination programmes. Recently, large epidemics have occurred in several east European countries. Diphtheria currently mainly occurs in parts of eastern Europe, Russia and several other states of the former Soviet Union , and parts of Africa and Asia .

 

Risk for Travellers

Incompletely immunised travellers to endemic areas may be at risk depending on activities.

 

Risk Reduction

The risk of infection can be reduced by avoiding close contact with people in crowded and enclosed places.

 

Vaccination

All travellers should have had the primary course of vaccination. Travellers to areas where Diphtheria is still common should have had a booster in the last 10 years particularly if they are likely to be in close (face to face) contact with local populations.

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Hepatitis A

 

This is a viral disease of the liver. Symptoms include fever, chills, weakness, loss of appetite, nausea and abdominal discomfort, followed within a few days by jaundice (yellowing of the skin and eyes). Urine becomes dark and stools pale. Many infections, particularly in children, are often without specific symptoms. In others, jaundice may be severe and prolonged

 

Transmission

Virus is acquired directly from the infected person by the faecal - oral route or by close contact, or by eating and drinking contaminated food and water. Food outbreaks are often linked to raw or undercooked shellfish and raw vegetables.

 

Occurrence

Hepatitis A is found worldwide but most common where sanitation conditions are poor and the safety of drinking water and food preparation is not well controlled.

 

Risk for Travellers

Travellers from industrialized countries are likely to be susceptible to infection. While people travelling to rural areas of developing countries are at particularly high risk of infection, in practice most cases occur among travellers staying in resorts and good-quality hotels.

 

Risk Reduction

The risk of infection is reduced by taking hygienic precautions with all food, drink and drinking-water consumed when travelling.

 

Vaccination

Immunisation is usually advised for those going to areas where the standards of food and water hygiene are lower than the UK . People born and raised in developing countries, and those born before 1945 in industrialized countries, have often been infected in childhood and are likely to be immune. For such individuals, it may be cost-effective to test for anti-HAV antibodies so that unnecessary vaccination can be avoided. If time is short, it is safe to receive hepatitis A vaccine.

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Hepatitis B

 

Hepatitis B is viral infection affecting the liver usually has an insidious onset of vague abdominal pain, nausea, vomiting and loss of appetite which often progresses to jaundice (yellowing of the skin and eyes). The urine is dark.

 

Recovery takes about 28 days but may sometimes be more prolonged. Long lasting or chronic infection occurs in 0.5-20% of cases. An estimated 15-25% of those with chronic infection can develop cirrhosis or liver cancer.

 

Transmission

The virus is transmitted through contaminated blood and blood related body fluids thus it may be acquired by transfusion with infected blood, the use of unsterilised needles and syringes (e.g. IV drug users and tattooists) and by unprotected sexual intercourse. The incubation period is 2 weeks to 6 months.

 

Risk for Travellers

While only certain categories of traveller are clearly at risk because of their planned activities, any traveller may be involved in an accident or medical emergency that requires surgery.

 

Risk Reduction

Adopt safe sexual practices and avoid the use of any potentially contaminated instruments for injection or other skin-piercing activities e.g. tattooing.

All travellers to resource poor areas should consider taking a sterile medical equipment pack.

 

Vaccination

The vaccine should be considered for virtually all travellers potentially involved in high risk activities e.g. health care that entails direct exposure to human blood, and / or to areas with poor medical facilities where HIV is endemic (particularly for repeat / long stay travellers). A course of three vaccinations is required; the preferred schedule for maximum efficacy being vaccination at 0, 1 and 6 months. However, an accelerated course can be given for "long stay high risk" travellers but an additional dose will be required 6-12 months later.

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Japanese Encephalitis (JE)

 

This is a viral disease which can cause a severe flu-like illness with headache, neck stiffness, confusion and coma. Most cases are asymptomatic; In those that do develop symptoms of disease (approximately 1 in 200 infections become clinically apparent), mortality may be greater than 30% and long-term effects on the nervous system are common.

 

Transmission

JE is spread by night time biting, rural area (Culex) mosquito which breeds in rice (paddy) fields and mainly bites animals particularly pigs and some wild birds. The incubation period is usually 5-15 days.

 

Occurrence

JE occurs in a number of countries in Asia and occasionally in northern Queensland , Australia .

 

Risk for Travellers

The risk of infection with (JE) for travellers to South-East Asia is low but varies with the season (being higher during the monsoon), the type of accommodation and the duration of exposure. Short stays in good hotels with limited likelihood of mosquito bites result in very low levels of risk. In contrast, campers in rural areas may be at high risk. No more than one case per year is diagnosed in civilian travellers worldwide.

 

Risk Reduction

Avoid mosquito bites. As the mosquitoes tend to feed outside rather than indoors any type of accommodation offers protection. Avoid sleeping outdoors near large concentrations of animals especially pigs.

 

Vaccination

Vaccination is only advised for those going to risk areas for periods of a month or more. Travellers who are thought to be at very high risk e.g. working near pig farms / paddy fields may be recommended this vaccination for shorter stays.

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Measles

 

Measles is a highly contagious infection which presents with fever, red rash and runny nose. Common complications include middle-ear infection and pneumonia.

 

Transmission

The measles virus is transmitted by close contact with infected persons and / or airborne respiratory droplet infection.

 

Occurrence

Measles occurs worldwide, although it is rare in industrialised countries due to immunisation programmes. Transmission increases during the late winter and early spring in temperate climates, and after the rainy season in tropical climates.

 

Risk for Travellers

Measles is still common in many countries and travel in densely populated areas may favour transmission.

 

Risk Reduction

The risk of infection can be reduced by avoiding close contact with people in crowded and enclosed places.

 

Vaccination

All travellers should have had their primary course of vaccination.

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Meningococcal Meningitis

 

 

Meningitis is the infection of the membrane lining of the brain and spinal cord. Most infections do not cause clinical disease; instead the infected person becomes a "carrier". Symptoms have a sudden onset of intense fever with severe headache, neck stiffness, photophobia and a blotchy rash is common.

It can occur in epidemics, especially where large crowds are gathered, as. The onset is usually sudden and progression to coma is often rapid if treatment is not started.

 

Transmission

Transmission occurs through direct person-to-person contact including inhalation of bacteria in droplets coughed or sneezed into the air by infected persons or carriers. In general susceptibility decreases with age, although there is a small increase in risk in adolescents and young adults. The incubation period is usually 3-4 days.

 

Occurrence

Sporadic cases are found world wide. In temperate zones most cases occur in the winter. Localised outbreaks occur in enclosed crowded spaces e.g. dormitories. In parts of sub-Saharan Africa (meningitis belt) large outbreaks and epidemics occur during the dry season (November-June).

 

Risk for Travellers

The risk is considered to be generally low, however is increased for those in crowded conditions or who take part in large population movements e.g. pilgrimages in the "meningitis belt". Long-term travellers living in close contact with the indigenous population in risk areas may be at greater risk of infection.

Localised out breaks in travellers normally occur in young adults in camps / dormitories.

 

Risk Reduction

Avoid overcrowding in confined spaces and close contact with local population.

 

Vaccination

Vaccination is not recommended for most travellers unless the risk of exposure is considered to be significant.

Vaccination is mandatory for pilgrims and seasonal workers visiting Mecca , Saudi Arabia .

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Pertussis

 

Pertussis (whooping cough) is a highly contagious acute bacterial disease involving the respiratory tract. Although pertussis can occur at any age, most serious cases and fatalities are observed in early infancy and mainly in developing countries.

 

Transmission

Pertussis transmitted by respiratory droplet infection i.e. close contact with infected persons.

 

Occurrence

90% of cases occur in developing countries.

 

Risk for Travellers

Adults are generally considered to be at low risk.

 

Risk Reduction

The risk of infection can be reduced by avoiding close contact with people in crowded and enclosed places.

 

Vaccination

All travellers should have had their primary course of vaccination. Pertussis vaccine is not generally recommended beyond 7 years.

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Polio

 

Polio is a viral infection of the gut the initial symptoms of which are fever, headache, nausea and vomiting. The virus then invades the blood stream and nervous system and may result in permanent paralysis (this risk increases with age).

 

Transmission

Transmission is mainly via the faecal - oral route although rare outbreaks caused by contaminated food or water have occurred. The incubation period is 7-14 days.

 

Occurrence

Wild poliovirus transmission has ceased in all industrialized countries and much of the developing world however still occurs in non developed countries.

 

Risk for Travellers

Travellers to endemic areas are at risk if they have not been fully immunised. Infected travellers are also potent vectors for transmission and possible re-introduction of the virus into polio-free zones now that worldwide eradication is near.

 

Risk Reduction

The risk of infection is reduced by taking hygienic precautions with all food, drink and drinking-water consumed when travelling and by avoiding direct contact with polluted recreational waters.

 

Vaccination

Travellers to endemic areas should avoid overcrowded environments e.g. All travellers should be up to date with vaccination against poliomyelitis. Any un-immunised individuals intending to travel to such an area require a complete course of vaccine.

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Rabies

 

Rabies is a viral disease primarily affecting animals but humans can also be infected. The virus travels from the site of entry (the bite or scratch) via the nerves to the brain and spinal cord and eventually spreads to the salivary glands. Symptoms start with itching and tingling at the site of the healed bite and then rapidly progresses to include headache, fever, spreading paralysis, confusion and aggression and hydrophobia (fear of water).. Unfortunately, once symptoms have developed, rabies is fatal.

 

Transmission

Rabies is usually transmitted by the bite of an infected animal as the virus is present in the saliva. Dog bites are by far the most common source of infection, particularly in developing countries, however cats, bats, foxes, skunks, raccoons, monkeys and many other animals can also be carriers. Animals may be infectious for five days before they develop symptoms

A scratch to the skin, a lick on a fresh skin break or contact of the infected saliva with intact mucous membranes may also transmit rabies - all such "suspect contacts" should be treated with caution.

It may take many weeks or months for symptoms to develop although it is usually 2-8 weeks (but can in rare circumstances be a short as 4 days)

 

Occurrence

Asia , Africa and South America report more than 99% of the deaths. India alone reports 30,000 deaths annually - and many cases may not be reported. The World Health Organisation estimate there are 50,000 human deaths from rabies, and more than 10 million people receive post exposure vaccination each year. As rabies is not a notifiable disease in many countries, this is regarded to be an underestimate.

 

Risk for Travellers

Travellers may be at risk if there is contact with wild and domestic animals in rabies-endemic areas

 

Risk Reduction

Never approach or handle animals you don't know, particularly if they are acting strangely.

Take care not to carry food when visiting temples where monkeys are present. Monkeys can scratch as they try and grab food from you.

Do not "adopt" or feed local / stray animals

If bitten by a potentially infected animal, or following any suspect contact, immediately clean the wound with soap and water and disinfectant (or 70% proof alcohol) and seek medical assistance immediately: see the OHS advice leaflet "Rabies Post-Exposure Treatment" for further information.

 

Vaccination

Pre-exposure immunisation against rabies is recommended for long-stay travellers/residents, those who intend to travel to rural and remote areas and those countries where modern rabies vaccines are not available. In the event of a bite, your body's responses could be quickly activated by booster doses of vaccine.

The disease can almost always be prevented, even after exposure, if vaccine is administered without delay. Travellers should seek one of the modern vaccines however these can be difficult to obtain abroad and if necessary, the British Embassy or consulate should be contacted for a supply. Some countries are using less effective locally produced vaccines that have to be administered into the abdomen; these are best avoided if possible.

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Tetanus

 

This anaerobic bacterial infection produces a toxin which circulates in the body to cause severe and painful muscular contractions and spasms which often lead to death through respiratory problems and exhaustion.

 

Transmission

Tetanus spores ( Clostridium tetani) are present in soil and may be introduced into the body during injury through a puncture wound, burn or trivial, unnoticed wounds. The incubation period is 4-21 days, commonly about 10 days.

 

Occurrence

Tetani spores are found worldwide.

 

Risk for Travellers

Dirty wounds can become infected with the tetanus spores anywhere in the world. Almost any form of injury, from a simple laceration to a motor-vehicle accident, can expose the individual to the spores.

 

Risk Reduction

The risk of infection can be reduced by protecting the skin from direct contact with soil in places where soil-transmitted infections are likely to be present e.g. by using personal protective equipment (gloves etc) and appropriate clothing.

 

Vaccination

All travellers should have had the primary course of vaccination . Five doses of tetanus containing vaccine are thought to provide life long cover. However, human tetanus immunoglobulin (HTIG) may be given for high risk injuries even if a full course of vaccine has been received in the past. Travellers to areas with potentially poor medical facilities who have not had a tetanus vaccine in the last 10 years should receive a booster dose (even if they have already had 5 doses) as HTIG may not be available.

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Tick-borne Encephalitis

 

Tick-borne encephalitis (TBE) is caused by members of the flavivirus family that can affect the central nervous system. It can cause inflammation of the brain (encephalitis), and non-specific flu-like illness, with fatigue, headache, malaise and fever.

 

Transmission

Transmission in humans is mainly through the bite of an infected tick with introduction of the virus via the tick saliva. It can also be less commonly transmitted by ingestion of unpasteurised milk from infected animals, especially goats.

 

Occurrence

Occurs in forested areas of Central, Eastern and Northern Europe, Russia Northern and Eastern areas of China, Japan and Siberia.

 

Risk for Travellers

Infections are mostly caused by leisure activity such as hiking and camping. The incidence peaks in spring and early summer, but can occur throughout the year for those travelling to rural endemic areas.

 

Risk Reduction

Cover up and wear long sleeves and trousers (tucked into socks) to prevent ticks entering the skin. Apply insect repellent to other exposed areas of the skin. Check the body for ticks regularly and if seen remove with a pair of tweezers or tick remover.

 

Vaccination

Immunisation is advisable those travelling to endemic areas, forestry workers and campers. A course of three vaccinations is required at 0, 1 - 3 months and 5 - 12 months. The second dose can be accelerated by a two week interval for those travelling at short notice.

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Tuberculosis (TB)

 

TB is a bacterial disease has a slow onset and presents with general malaise, weakness and weight loss. Prolonged close exposure may lead to infection but in 90% of cases, the disease remains inactive or without symptoms for the person's lifetime (latent TB). Approximately 10% of infected individuals go on to develop active disease; those who are immuno-suppressed or malnourished are more likely to be in this group.

 

Occurrence

TB is found worldwide: the risk of infection differs between countries.

 

Transmission

TB is usually transmitted by prolonged close exposure to airborne droplets from a person with untreated pulmonary (lung) or laryngeal TB. 

TB may also be transmitted by unpasteurised milk and dairy products from infected cows (Bovine TB).

 

Risk for Travellers

Low for most travellers. Long-term travellers (over 3 months) to a country with a higher incidence of tuberculosis than their own may have a risk of infection comparable to that for local residents. As well as the duration of the visit, living conditions are important in determining the risk of infection: high-risk settings include health facilities, shelters for the homeless, and prisons.

 

Risk Reduction

Travellers should avoid close contact with known tuberculosis patients unless absolutely necessary (e.g. field work)

Never drink unpasteurised milk. If in doubt, boil before drinking.

 

Vaccination

BCG vaccination is recommended for travellers who will be spending one month or more in a high risk area and those planning close contact with the local population. Those who have not received BCG immunisation should be offered it (although the efficacy in adults is thought to be reduced) and the vaccine should be administered at least 6 weeks before departure to ensure a protective level of immunity.

 

Travellers who have already had the BCG vaccine do not require Heaf testing or further vaccination, as this has never been shown to provide additional protection.

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Typhoid

 

This bacterial infection causes a prolonged feverish illness with loss of appetite, lethargy and constipation. Constipation is more common than diarrhoea in adults


Without treatment the illness can be fatal, with perforation of the gut producing peritonitis or severe haemorrhage. Paratyphoid fever is a similar but less severe variant. Around 2-5% of those who contract typhoid fever become chronic carriers, as bacteria persist in the biliary tract after symptoms have resolved.

 

Occurrence

Typhoid is found worldwide but occurs most commonly in association with poor standards of hygiene in food preparation and handling and where sanitary disposal of sewage is lacking.

 

Transmission

Transmission is usually by consumption of contaminated food or water (including milk and milk products. ). Contamination can occur from flies, sewage-polluted shellfish beds, poor food hygiene etc. Raw fruit and vegetables are particularly risky due to the practice of "night soil" fertilization (fertilization with human sewage Occasionally direct faecal-oral transmission may occur. The incubation period is from 1-3 weeks.

 

Risk for Travellers

Generally low risk for travellers, except in parts of north and west Africa, in south Asia and in Peru . Elsewhere, travellers are usually at risk only when exposed to low standards of hygiene with respect to food handling, control of drinking-water quality, and sewage disposal.

 

Risk Reduction

The risk of infection is reduced by taking hygienic precautions with all food, drink and drinking-water consumed when travelling

 

Vaccination

Typhoid vaccines are often recommended for travellers going to areas where the standards of hygiene may be unreliable however do not provide 100% protection and do not protect against paratyphoid fever.

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Yellow Fever

 

Yellow fever is a viral disease is characterised by a severe flu-like illness in which a bleeding tendency and jaundice may develop. Case fatality rates for non immune travellers may be as high as 50%.

 

Transmission

Yellow fever is principally a disease of jungle areas (monkeys are the principal animal reservoir) but there are occasional small outbreaks in towns and cities. The disease is transmitted by the bite of infected daytime biting mosquitoes. Incubation period is 3-6 days.

 

Occurrence

The yellow fever virus is endemic in some tropical areas of Africa and central and south America. The number of epidemics has increased since the early 1980s. Other countries are considered to be at risk of introduction of yellow fever due to the presence of the vector and suitable primate hosts (including Asia , where yellow fever has never been reported).

 

Risk for Travellers

Travellers are at risk in all areas where yellow fever is endemic. The risk is greatest for visitors who enter forest and jungle areas.

 

Risk Reduction

Avoid mosquito bites during the day as well as at night.

 

Vaccination

Vaccination is highly effective in conferring immunity and lasts 10 years. Vaccination is highly effective in conferring immunity and lasts 10 years.

Vaccination is mandatory in some countries for visitors. The initial vaccination must be given 10 days before travel if the international certificate is to be valid, but re-vaccination may be given at any time before expiry of the certificate and is effective immediately.

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