TRAVEL VACCINATION. Acknowledgements: Dr Conrad Moreira

Transcription

1 TRAVEL VACCINATION Acknowledgements: Dr Conrad Moreira

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14 Measles Home grown measles eliminated in Australia Traveller risk not just third world countries 37,000 cases in Europe 2011 eg France Recently, Philippines and Bali Occasional cases after one MMR, virtually none after two doses Two doses - certified needed. If in doubt, give another dose!

15 Influenza Recommended as of benefit for all age groups Strongly recommended for higher risk >=65 years, ATSI >=15 years All at risk > 6 months inc Pregnant women Children < 9 years two doses Common in travellers Crowding: trains, aircraft, cruises etc - Persons travelling in flu season (to Southern or Northern hemispheres) 1. NHMRC. Australian Immunisation Handbook, 10 th edition

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18 Hepatitis A vaccines Travellers from low- to high-endemicity Serological testing not routinely recommended consider for persons born before 1950 or in endemic country Vaccines: Hep A: Vaqta, Havrix, Avaxim Hep A-typhoid: Vivaxim Hep A-hep B: Twinrix No need for >2 doses unless using Twinrix (dose 6 months) No need to restart if Dose 2 late

19 Typhoid vaccines Injectable Vi polysaccharide: Typhim Vi, Typherix registered > 2 yrs Vivaxim: Hep A + Vi registered for >16 years Oral Ty21a, live attenuated: Vivotif licensed for > 6 years pack of 3 capsules days 1, 3 and 5 Probably not worth effort contraindicated for age<6 years, antibiotics, immunocompromised, pregnant + multiple doses No increment in efficacy over Vi 1. Yung et al. Manual of Travel Medicine

20 Cholera vaccine Only one vaccine available Oral cholera vaccine (Dukoral, WC-rBs): Doesn t protect against O139 serogroup ~12-25% reduction in total risk of travellers diarrhoea Vaccinate? - Mostly due to reduction in ETEC up to 73% protective efficacy for 3 months likely exposure to cholera e.g. humanitarian workers, disaster relief,?visiting friends and relatives at risk from severe diarrhoeal disease (IBD, malabsorption, achlorhydria) 1. NHMRC. Australian Immunisation Handbook 10 th edition

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25 Pre-exposure prophylaxis? Prevalence of animal rabies at the destination Duration of risk Unusual risk of exposure to animal bites or licks Availability of good quality PEP Access to medical facilities Immunoglobulin Cell culture rabies vaccine Costly!?intradermal vaccination?vaccinate overseas

26 Hajj...

27 Meningococcal vaccines Conjugate ACWY preferred for any travellers for whom meningococcal vaccine indicated MCV4-DT (Menactra) - licensed for 2-55yrs - 10 th edition AIH = from 9 months of age MCV4-CRM 197 (Menveo) licensed for >=11 years - 10 th edition AIH = from 9 months of age More expensive

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30 Japanese Encephalitis 30,000-50,000 cases reported annually <1% symptomatic BUT 20-30% mortality; up to 50% residual disability Children at higher risk in endemic areas Wading birds are natural hosts; pigs amplifying hosts Humans are incidental hosts Culex spp; mainly active during twilight CDC: Overall risk in travellers to Asia: <1/1,000,000 Expats, intense exposure: up to 1/2,000/week

31 JE vaccines Recommend for travellers >1 year old: - >1 year in Asia - >1 month in rural areas, particularly: JESPECT (IXIARO): wet season; accommodation suboptimal; extensive outdoor activity expected, e.g. bike-riding, canoeing BUT note recent Aust case from Bali inactivated, 2-dose primary course AIH recommends can be given from 12 m PI says 18 years IMOJEV: live, attenuated, single-dose can use from 12 mths and older lower age likely to be relaxed and NB given to younger children in endemic areas

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33 Yellow fever vaccination Small risk of serious AEFI - viscerotropic disease <1:400,000 - >60 years, missing thymus Contraindications: - previous anaphylaxis (eggs or vaccine) - <9 months old - immunodeficient / immunosuppressed - thymus disorder or thymectomy Pregnant? - reconsider travel to YF area? - o/wise strongly advise to have vaccine

34 Yellow fever vaccine no boosters

35 What vaccines do I need? Epidemiology at destination Style of travel: Backpacker vs. Cruise on QEII Activities: zoologist vs businessman Itinerary: Big city vs rural village Eating habits: Cordon Bleu vs street food Duration of exposure: few days vs many months Access to PEP Season: dry vs wet What will be the impact of the illness?

36 Main Points Aim is to reduce risk in new and unfamiliar environments Focus on safe behaviours - not just vaccines Advice individualised: this person, this trip, this time Not sure / too difficult? Immunisation Handbook Websites PHU Talk to, or refer to, a travel medicine practitioner

37 Questions