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Vaccinations and Other Health Care Measures for Foreign Travel



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Am Fam Physician. 1999 Jun 1;59(11):3165-3168.

Taking precautions to avoid contaminated food and water, and receiving necessary vaccinations can minimize health risks when traveling to underdeveloped regions of the world. Rizvon and associates review the common issues and preventive measures for international travel.

The authors advise travelers to seek health care advice about foreign travel four to six weeks before departure. Health-related documents to take along on the trip include an updated vaccination certificate, a list of medications and a copy of any other important medical information, such as an electrocardiogram for patients with cardiac disease. In addition to a standard first-aid kit, which should include medications such as analgesics, antihistamines and motion sickness agents, prepackaged oral rehydrant solutions can be taken along to treat dehydration if travelers' diarrhea occurs. Health advice regarding food and water precautions and accessibility of health care abroad are essential. Patients should be advised to learn what their health insurance will cover. Coverage that includes evacuation insurance may be important.

Prophylaxis against malaria is important for travel to Mexico and Central America. Chloroquine, in a dosage of 500 mg once weekly, can be taken for malaria prophylaxis. Prophylaxis should begin one week before travel and continue for four weeks after return. Mefloquine, in a dosage of 250 mg once a week, can be used in patients who are traveling to areas of chloroquine-resistant disease. Doxycycline, in a dosage of 100 mg once daily, can be used as an alternative in patients who cannot take mefloquine. Mefloquine should be avoided in patients with a seizure disorder and in patients taking drugs that delay cardiac conduction.

Use of an insect repellent that contains 25 to 30 percent deet (N,N-diethyl-3-methyl-benzamide) can reduce the risk of acquiring malaria. Children, however, should use deet in a concentration of 10 percent or less. While it cannot be applied to skin, permethrin on clothing may help reduce exposure to mosquito bites.

The accompanying table summarizes vaccination recommendations for foreign travel. Hepatitis A vaccine, given in two doses, provides long-term protection, while immune globulin can be given for short-term protection. Yellow fever vaccine may be a consideration for travelers to tropical Africa or South America. Typhoid fever vaccine is available in both oral and injectable forms. Adhering to the precautions for avoiding contaminated food and water may also reduce the risk of exposure to typhoid. The cholera vaccine is rarely used in preparation for foreign travel. The risk of cholera in American travelers who follow food and water precautions is low, and the vaccine is only 50 percent effective. Vaccinations for meningococcal meningitis, Japanese B encephalitis, rabies, tick-borne encephalitis and anthrax are available for travelers visiting endemic areas. Other immunizations should include hepatitis B, poliovirus, measles-mumps-rubella (MMR), diphtheria and tetanus.

Vaccination Recommendations for Foreign Travel

Disease Vaccine dosing schedule Comments* Booster interval

Hepatitis A

Adults: Havrix, 1,440 El U IM; Vaqta, 50 units IM

Inactivated Havrix contains 2 phenoxyethanol as a preservative. With both vaccines, the most common side effects are mild and usually disappear within 1 to 2 days.

Adults: 6 to 12 months

Immune globulin: 0.02 mL per kg IM for <3-month stay; 0.06 mL per kg IM for >3-month stay

Avoid concurrent live vaccines.

Repeat every 5 months

Hepatitis B

Engerix B, accelerated: 3 doses at zero, 30 and 60 days; standard: 3 doses at zero, 1 and 6 months

Teenagers may not need vaccination since hepatitis B vaccination is included in the childhood immunization program.

Accelerated: 12 months Standard: Unknown

Yellow fever

0.5 mL SC at least 10 days before travel

Live attenuated virus; avoid in pregnancy, in patients with severe egg allergy and immunosuppressed patients.

Repeat every 10 years

Typhoid fever

Oral: 1 capsule every other day, 4 doses

Live attenuated strain ty21a strain; avoid in patients with acute febrile or gastrointestinal illness.

5 years

Injectable: ViCPS vaccine, 1 dose

Contains phenol; use with caution in patients with thrombocytopenia, coagulopathy, pregnancy (category C) and immunocompromised state.

2 years

IM inactivated (heat-phenol) injectable: 2 doses, 4 weeks apart

Reactions such as fever, myalgias and soreness at injection site are more common than with the single-dose ViCPS vaccine.

3 years

Poliomyelitis

Unvaccinated: 3 doses IM or SC, 1 month apart; completed vaccination: 1 booster dose

Enhanced-potency inactivated poliovirus vaccine preferred in pregnancy (category C); avoid in patients with hypersensitivity to neomycin, streptomycin or polymixin B.

Cholera

2 doses IM or SC, 1 or more weeks apart

50 percent efficacy; give at least 3 weeks after yellow fever vaccine.

6 months

Meningococcal meningitis

1 dose SC

Needed for travel to Saudi Arabia.

None, but 3 years later in high-risk groups


IM = intramuscularly; SC = subcutaneously.

*—Allergic reactions related to the vaccine component can occur. History of allergic reactions to vaccines should be evaluated before vaccination.

Reprinted with permission from Rizvon MK, Qazi S, Ward LA. International travel and vaccinations. West J Med 1999;170:97–103.

Vaccination Recommendations for Foreign Travel

View Table

Vaccination Recommendations for Foreign Travel

Disease Vaccine dosing schedule Comments* Booster interval

Hepatitis A

Adults: Havrix, 1,440 El U IM; Vaqta, 50 units IM

Inactivated Havrix contains 2 phenoxyethanol as a preservative. With both vaccines, the most common side effects are mild and usually disappear within 1 to 2 days.

Adults: 6 to 12 months

Immune globulin: 0.02 mL per kg IM for <3-month stay; 0.06 mL per kg IM for >3-month stay

Avoid concurrent live vaccines.

Repeat every 5 months

Hepatitis B

Engerix B, accelerated: 3 doses at zero, 30 and 60 days; standard: 3 doses at zero, 1 and 6 months

Teenagers may not need vaccination since hepatitis B vaccination is included in the childhood immunization program.

Accelerated: 12 months Standard: Unknown

Yellow fever

0.5 mL SC at least 10 days before travel

Live attenuated virus; avoid in pregnancy, in patients with severe egg allergy and immunosuppressed patients.

Repeat every 10 years

Typhoid fever

Oral: 1 capsule every other day, 4 doses

Live attenuated strain ty21a strain; avoid in patients with acute febrile or gastrointestinal illness.

5 years

Injectable: ViCPS vaccine, 1 dose

Contains phenol; use with caution in patients with thrombocytopenia, coagulopathy, pregnancy (category C) and immunocompromised state.

2 years

IM inactivated (heat-phenol) injectable: 2 doses, 4 weeks apart

Reactions such as fever, myalgias and soreness at injection site are more common than with the single-dose ViCPS vaccine.

3 years

Poliomyelitis

Unvaccinated: 3 doses IM or SC, 1 month apart; completed vaccination: 1 booster dose

Enhanced-potency inactivated poliovirus vaccine preferred in pregnancy (category C); avoid in patients with hypersensitivity to neomycin, streptomycin or polymixin B.

Cholera

2 doses IM or SC, 1 or more weeks apart

50 percent efficacy; give at least 3 weeks after yellow fever vaccine.

6 months

Meningococcal meningitis

1 dose SC

Needed for travel to Saudi Arabia.

None, but 3 years later in high-risk groups


IM = intramuscularly; SC = subcutaneously.

*—Allergic reactions related to the vaccine component can occur. History of allergic reactions to vaccines should be evaluated before vaccination.

Reprinted with permission from Rizvon MK, Qazi S, Ward LA. International travel and vaccinations. West J Med 1999;170:97–103.

Rizvon MK, et al. International travel and vaccinations. West J Med. February 1999;170:97–103.



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