Travel Health: Vaccinations

Preferably start 6 weeks before departure

Keep a photocopy of your official “yellow vaccination booklet” at home !!

1. YELLOW FEVER

This deadly viral infection – transmitted by mosquitoes that bite during day time – occurs only in some countries of South-America and Africa. There is no medication against yellow fever, but there is a very effective vaccine that is well tolerated.

One injection in the arm – (price € 12.00) offers a protection for 100% during ten years. In 2 to 5 p.c. of the cases a slight influenza-like reaction may occur after a few days or up to a week after vaccination (take paracetamol if this happens).

Allergic reactions are very rare. However, during the last years life-threatening side effects have been reported very exceptionally and only at the first vaccination and in persons older than 65 years.

The extremely low risk, linked to the vaccine, never outweighs the risk of acquiring yellow fever in these endemic areas. It is the only disease for which a certificate (“yellow booklet”) is required of the traveller going to or coming from areas in which yellow fever occurs. 

A vaccination can only be obtained in centres that are recognised by the National Administration of Public Health. Children are vaccinated from the age of one, in exceptional cases from the age of 6 months.

The vaccine is usually not administered to pregnant women neither to immunosuppressive people; for them it is not recommended to travel to countries endemic to yellow fever.

2. TETANUS AND DIPHTERIA

Travel preparations are an ideal time to update your tetanus and diphtheria vaccinations. For most people and certainly for young people, a booster every ten years is sufficient (Tedivax pro Adulto. € 5.32).

If the last injection dates back to over 20 years, two injections with an interval of 6 months are recommended. If there are any doubts as to the completeness of the earlier inoculation, the schedule consists of two injections with a 1-month interval, followed by a third injection after one year.

3. POLIO

Since 1965 most citizens of developed countries have been vaccinated against polio (using an oral vaccine (Sabin®), since 2001 an injection). In most cases the inoculation ensures lifelong protection.

In contrast however, the disease is still prevalent in developing countries. Therefore, it is important that a booster should be considered before a short or long trip in less hygienically conditions.

Only one subsequent booster injection is required in case a complete vaccination cycle has been given before.

4. HEPATITIS A (JAUNDICE)

Hepatitis A is a contagious liver disease that is transmitted through food, drinks, or objects that have been contaminated either directly or indirectly with faeces.

Although hepatitis A is usually quite a mild disease, its evolution can sometimes be very slow. In the industrialised countries, the risk of infection is very low because of the high level of hygiene.

In developing countries the risk of infection is high, especially for people who go on adventure trips, or individuals undertaking a trip lasting over three weeks. Hepatitis A vaccination is recommended by the WHO for travellers to Africa, Latin America and Asia.

Individuals who have had the disease acquire a lifelong immunity and thus do not need vaccination. (This should be confirmed by a laboratory test). However, antibody screening after vaccination is absolutely not warranted.

Epaxal®, Havrix® : – after one injection there is nearly 100% protection for at least one year – after a 2° injection after 6 to 12 months, protection will be extended to at least 20 years, maybe lifelong validity – the price per dose : Epaxal® 39 € (from the age of 2 years); Havrix® € 45.66 (adults) and Havrix Junior® € 30.04 (1-15 years) (2x), these vaccines can be used together in one vaccination scheme

If vaccination against Hepatitis B is recommended (see below), a combination vaccine is used (Twinrix® : 3 injections : adults € 45.84 per dose, children up to 15 years € 30.24 per dose).

5. TYPHOID FEVER

Typhoid fever is a serious infection accompanied by high fever. Its transmission occurs through the intake of contaminated food or water.

Again, strict precautionary measures in order to prevent diarrhoea are important. The risk of infection is fairly low (and much lower than the risk of a hepatitis A infection), the risk is highest in Northern and Northwestern Africa, India and Peru.

Vaccination protects about 60-70% for three years and is recommended for all adventure journeys or those lasting for three weeks or more.

6. CHOLERA

Cholera is characterised by frequent watery stools which may cause rapid dehydration. Cholera is a disease which affects deprived people living in poor hygienic conditions and who are usually suffering from malnutrition.

However, for the healthy traveller who applies the preventive measures for diarrhoea mentioned above, the risk is as good as non-existent, even when travelling in an area where a cholera epidemic is occurring.

However, as the vaccine is not very efficient and often causes side effects, it was decided to discontinue its further use. Some African countries still require a vaccination certificate.

In order to avoid problems at frontier borders, such a certificate may be useful and can be provided by your doctor.

7. HEPATITIS B

(Engerix®B, HBVAXPRO® : € 28.98/dose, children up to 15 years € 17.42/dose , 3 injections, on day 1-30-180, or 4 injections on day 1-7-21-360) (Twinrix®: 3 injections : adults € 45.84 per dose, children up to 15 years € 30.24 per dose)

In principle a lifelong protection after a full vaccination is possible, though a check-up of antibody titre after 10 years is recommended. Vaccination is recommended :

(1) For people who frequently travel to Asia, Latin America and Africa, or stay there longer than 3-6 months, also for children who will be staying there (infection through direct or indirect contact with mucous membrane, eye membrane and skin lesions);

(2) For travellers (a) who may have sexual contacts or (b) may have to undergo medical or dental operations abroad; (c) also the adventurous traveller or the traveller who will practise dangerous sports activities, who are at risk of trauma and medical care in a hospital in poor hygienic conditions;

(3) In Europe Hepatitis B vaccination is (a) strongly recommended (if not mandatory) to people that are at risk through their profession; recently (b) it has also become part of the basic vaccination schedule for infants, children and adolescents.

8. MENINGITIS CAUSED BY MENINGOCOCCI A,C,W,Y (€ 27.79; 1 injection, booster every 3 years).

Vaccination is indicated for travellers to countries in the African sub-Saharan belt, who will be living in close contact with the local population (i.e. travelling by public transport, sleeping in local guesthouses, migrants who are travelling to their country of origin and who will be staying there with family members), or who will be staying there for more than 4 weeks.

Vaccination is mandatory for pilgrims to Mecca (should be administered ten days before departure).

9. RABIES (€ 19.63 X 3) 3 injections, on day 1,7,21 or 28; booster after 1 year and then every 5 years (map see further : http://www.who.int/ith/chapter05_m10_rabies.html

10. Japanese Encephalitis (Far East) (€ 53.30 X 3) 3 injections, on day 1,7,28; booster after 3 years – map : http://www.who.int/ith/chapter05_m07_japencepha.html

11. European tick-borne Encephalitis (€ 34.5; 3X); Measles-Mumps-Rubella; Influenza; Pneumococcal; TB)

CAUTION: The information provided here should not be used during any medical emergency or for the diagnosis or for the treatment of any medical condition. A licensed physician should be consulted for any and all medical conditions. Call 911 for all medical emergencies.