Infectious Disease Book

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Travel Immunization

Aka: Travel Immunization, Vaccines for Travelers, Immunization in Travelers
  1. See Also
    1. Malaria Prophylaxis
    2. Travel Preparation
    3. Travel Resources
    4. Air Travel Restriction
    5. International Medical Concerns
    6. Traveler's Diarrhea Prophylaxis
    7. First Aid Kit
    8. Waterborne Illness Prevention
    9. Foodborne Illness Prevention
    10. Prevention of Vector-borne Infection
    11. Fever in the Returning Traveler
  2. Precautions
    1. Check CDC website at least 4 weeks before travel
      1. Contains specific recommendations per area of travel
    2. CDC Website
      1. http://www.cdc.gov
  3. Management: Update routine Immunizations
    1. Measles Mumps Rubella Vaccine (MMR)
      1. Documentation of 2 doses if born after 1956
    2. Tetanus ToxoidVaccine (Td)
      1. Consider booster if last dose more than 5 years ago
    3. Inactivated Polio Vaccine (IPOL)
      1. Consider booster if over age 65 years
      2. Booster if travel to endemic area
        1. India, Pakistan, Afghanistan, Egypt
        2. Nigeria, Niger, Somalia
    4. Hepatitis A Vaccine
      1. Consider in all travelers with age >1 year
    5. Varicella Vaccine
      1. Consider if not immune
    6. Pneumococcal Vaccine
      1. Age over 65 years
      2. Asplenia, Cirrhosis, Diabetes Mellitus
      3. Cardiopulmonary illness
      4. Prolonged travel to remote area
      5. Significant exposure to animals
    7. Influenza Vaccine
      1. Travel to northern hemisphere in November to March
      2. Travel to southern hemisphere in April to September
      3. Travel near equator, year round
  4. Management: Immunizations required for entry in some countries
    1. Meningococcal Vaccine
      1. Travel to "Meningitis belt" of Africa (band from Senegal and Guinea in the east, to Ethiopia in the west)
      2. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/meningococcal-disease
    2. Yellow Fever Vaccine
      1. Required in equatorial Africa and South America
      2. Vaccine certification form may be needed (or provide a waiver)
      3. Not recommended in pregnancy unless high risk area
      4. Women should try to delay travel until post-pregnancy
  5. Management: Special Vaccination Indications
    1. Contaminated food or water exposure
      1. See Waterborne Illness Prevention
      2. See Foodborne Illness Prevention
      3. Typhoid FeverVaccine
      4. Hepatitis A Vaccine
    2. Long-term travel
      1. Place Tuberculin Skin Test (PPD) for baseline
      2. Hepatitis B Vaccine
        1. Endemic travel
        2. Anticipating medical care abroad
        3. U.S. Immigrants returning to country of origin
      3. Rabies Vaccine
        1. Remote travel
        2. Young or disabled traveler
    3. Travel to India or southeast asia
      1. Japanese EncephalitisVaccine
  6. Management: Adult Immunizations Available
    1. Hepatitis A Vaccine
    2. Hepatitis B
    3. Japanese EncephalitisVaccine
      1. Travel to endemic regions of Asia and Western pacific (especially rural travel, or duration >1 month)
      2. Safe in HIV; avoid in pregnancy
    4. Measles Mumps Rubella Vaccine (MMR)
    5. Meningococcal Vaccine
    6. Polio Vaccine
    7. Rabies Vaccine pre-exposure
      1. Travel to Rabies enzootic regions (especially remote travel for extended periods)
    8. Tetanus Diphtheria Vaccine
    9. Typhoid Vaccine (Live oral or subcutaneous)
    10. Yellow Fever
    11. Cholera Vaccine
      1. Ages 18 to 64 years old traveling to Cholera affected areas to perform high risk activities such as healthcare
  7. References
    1. Re (2004) Am Fam Physician 70:89-104 [PubMed]
    2. Sanford (2016) Am Fam Physician 94(8): 620-7 [PubMed]

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