Health Topic: Travel Medicine

by Dr. Wilbur Kuo, MD
March 24, 2016


Today's topic: Vaccinations

- Depending on where you travel you may need vaccinations before travel
- You can check cdc.gov/travel or Massachusetts General Hospital http://gten.travel/trhip/trhip
- Most vaccinations need a month to work so plan your travel vaccinations accordingly
- You will also want to make sure your routine vaccinations are up to date. This includes flu, tetanus, measles, mumps, rubella, polio, and chicken pox (varicella)
- If you need travel vaccines call our office ahead of time so we can order the appropriate vaccines for you

Yellow fever
- For travel to Equatorial Africa and South America
- Mosquito borne illness
- Causes fever and muscle pains which progress to liver and kidney failure, shock, and death
- Vaccine is grown in chicken embryos
- Live attenuated virus; cannot be given if you have immunodeficiency
- Takes effect in 10 days and is good for 10 years
- Some countries require documentation of yellow fever vaccination to enter the country

Meningococcus
- Causes life-threatening meningitis, an infection of the tissues around the brain characterized by severe headache, neck pain, fevers
- Mostly for travel to sub-Saharan Africa
- Travelers to Saudi Arabia during the Hajj are required to have a certificate of vaccination given at least 10 days and less than 3 years before entry
- This is type A meningococcus which is different than type B which is common in college dorms
- Give vaccine now and 3 yrs later and then every 5 years

Typhoid
- Causes severe diarrhea, fever, abdominal pain, and sometimes rash
- Asia, Africa, Latin America
- Vaccine given once now and once in 2 years
- Boosters recommended every 5 years

Hepatitis A
- can cause severe liver disease, characterized by abdominal pain, jaundice, diarrhea, nausea
- Advised for travel to Asia and developing countries
- Give one dose now and in 6 mos
- Single dose before travel is protective

Hepatitis B
- can cause severe liver disease
- Advised for travel to Asia
- Recommended for healthcare workers, adventure travelers, Peace Corps volunteers, missionaries, military personnel, and medical tourists
- Also anyone with contact with blood or bodily fluids, sexual contacts, those needing medical or dental procedures
- Given as shot now, in 1 month, and in 6 months
- Recommend starting vaccination at least 6 mos before travel. Some protection if only get one or two doses before travel

Rabies
- transmitted by animals: dogs, bats
- Asia, Africa, central and South America
- For travelers anticipating contact with animals and limited access to medical care
- Consists of 3 shots given over three weeks
- If get exposed to rabies, will still need two additional shots given over 3 days

Japanese encephalitis
- Asia and western pacific
- Causes fever, headache, diarrhea progressing to neurological deficits, confusion, and coma
- Highest risk in rural agricultural areas, in areas with rice production and flooding irrigation.
- 2 doses given over 28 days

Measles, mumps, rubella
- Should get if born in 1957 or later without evidence of immunity or without evidence of two doses of an adequate live vaccine at any time after age 1
- If born before 1957, vaccine recommended for unvaccinated people without evidence of immunity and who are traveling for humanitarian work
- Can't be given to pregnant or immunocompromised

Flu
- recommended for all travelers

Tetanus, diphtheria, pertussis
- recommended if tetanus has not been given in past 10 years
- Tetanus with pertussis vaccine (tDap) recommended if have not had as an adult

Polio vaccine
- Get polio virus booster between 4 weeks and 12 months prior to travel
- If never been vaccinated, should get a shot now, one in a month, and one in 6 months
- For long-term visitors (>4 weeks) Pakistan, Cameroon, Syria, Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria
- Some countries may require poliovirus vaccination documentation

Varicella
- Can cause chicken pox, pneumonia, brain infection
- recommended for all nonimmune adults and adolescents born after 1979

Immunocompromised patients
- should not get live vaccines
- Yellow fever vaccine
- Oral typhoid vaccine
- Nasal influenza vaccine
- Oral polio vaccine
- Measles, mumps, rubella
- Varicella vaccine
- Japanese encephalitis vaccine

As always, consult your physician before diagnosing yourself or making treatment decisions.
For more information check out the CDC travel website wwwnc.cdc.gov/travel or the Massachusetts General Hospital travel website gten.travel/trhip/trhip