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It’s a Small World...
for Both You and Disease
Protect yourself before travelling
Travel to faraway places is becoming more inviting, affordable, and easy to manage. You can travel to anywhere in the world within 36 hours. Unfortunately, so can disease. Parasites, viruses and bacteria can hitch a ride in your bloodstream. While travel is an adventure, be aware of the risk of acquiring exotic diseases. Without precautions, you can become ill while away or after returning home. In many cases, you can protect your own health and that of others by getting immunized.
The Three Rs of Immunization: Routine, Required and Recommended
Routine
Growing up in North America, we have access to standard childhood vaccinations. They include diphtheria, tetanus, polio, pertussis (whooping cough), measles, mumps, rubella (often referred to as German measles), Hib (Haemophilus influenza type B), varicella (chickenpox), and hepatitis B for those born after 1982.
If you plan to take your children to countries with high risks of certain diseases, have them assessed by a travel doctor or public health nurse. Additional vaccinations, or modifications, may be needed, especially if children have not finished the routine series. Be aware that diseases like tetanus, polio and measles are common in less developed countries. They can cause severe disability or death.
Required
Meningitis
This specific travel vaccine protects against four different strains of bacteria. Travelers to Saudi Arabia for the Hajj and Omrah will not be issued a visa without proof of this vaccination from a travel clinic. It must be repeated every three years.
Certain countries in Africa and South America have mosquitoes that can carry this virus. The disease attacks the liver, causing the severe jaundice (yellowing of the skin and whites of the eyes) from which the name comes. The death rate from yellow fever is very high.
Yellow Fever
Some countries require proof of vaccination (a special certificate from a certified yellow fever centre) in order to enter the country. Many countries free of yellow fever will refuse entry to an unvaccinated traveler coming from a country that has this disease. The vaccine and the official certificate are valid for ten years. After that time, the shot must be repeated and a new certificate issued.
Yellow fever vaccine can be given to adults and children over nine months of age. It is a ‘live’ vaccine, containing minute amounts of weakened virus that stimulate the blood to form protective antibodies. These antibodies will destroy any new yellow fever viruses a nasty little mosquito might inject.
The vaccine is made in cultures (or growing environments) that include egg protein. Those with a severe egg allergy cannot take it. It is not given to pregnant women, or to anyone with severe problems of the immune system. Rare but serious side effects from the vaccine have also been reported in people over the age of 60.
On occasion, people unable to take the vaccine must travel to countries that require the certificate. In this case, an exemption letter can be given by a travel clinic that is designated as a yellow fever centre. The unvaccinated traveler must be aware, however, of the risk of getting the disease. As well, officials at the country’s border may choose not to accept the exemption letter, and refuse entry.
Discuss your risks and options with a doctor or travel nurse at a yellow fever centre. Remember that to provide protection and for the certificate to be valid, this vaccine must be given at least ten days before entering the country at risk.
Recommended
Where you go, for how long, and whether you plan to backpack through the jungle or stay in a five-star resort affect your risk and the vaccinations you should consider. As no vaccines (except oral typhoid) in this category are live, they can generally all be used in pregnancy and in children over the age of one or two.
Hepatitis A
From Calgary to Timbuktu, this is an extremely common virus. Asymptomatic carriers (those who have the virus but show no symptoms of it) can pass it on by handling food, water and ice cubes others then consume. You can get Hepatitis A whether you eat street food or in an expensive restaurant. The illness can vary from mild and flu-like, to severe with prolonged symptoms due to liver inflammation. Symptoms appear two to six weeks after infection. The virus is excreted in the stools of infected people. Its spread is related to lack of adequate hand washing. Infected children often do not get ill but spread the disease through less than hygienic toilet habits, or when diaper-changing caregivers don’t wash their hands. The vaccine is a series of two shots – the first gives excellent protection for a year or more, while the second gives lifelong immunity. Those who have had the disease are permanently immune. They cannot pass it on and do not need vaccination.
Hepatitis B
This serious disease can lead to death from liver failure or cancer. Transmission comes through contact with contaminated needles or body fluids. It can be passed through blood transfusions, IV drug use, tattoos with unclean needles, sharing personal items like toothbrushes, razors and nail clippers, or having sex with someone who is infected. Hepatitis B can also be transmitted from an infected mother to her baby during pregnancy. Infection rates are high in populations living in Asia, Africa and the Caribbean. Transmission is similar to that of hepatitis C and HIV, neither of which can be prevented by vaccinations. Once infected with hepatitis B, you may recover completely or carry the virus forever. If you carry it, you may not have symptoms but can still transmit the disease to others. You may also progress to liver failure and death.
After infection, symptoms do not usually appear for about six months. Symptoms are similar to Hepatitis A but more severe. Treatment can only support the disease, not heal it.
Since many people consider hepatitis B a lifestyle disease, they do not feel they are at risk. However, you can become ill or injured and require medical or dental treatment in a place where no clean needles are available (yes…that happens). Physical or sexual assault in areas of the world where hepatitis B is common can also expose you to the disease.
This vaccine is a series of three shots, with protection after the first two, and, commonly, lifelong immunity after the third. In Canada, most children born in the past 20 years should have received the vaccine in school, although the age at which it is given varies among the provinces. If they have had all three shots, they most likely have lifelong immunity.
Twinrix
This is Hepatitis A and B in one vaccine. It requires two shots for initial protection, and three for long-term immunity.
Tetanus/Diptheria
This vaccine comes with protection for both these diseases. Routine public health immunizations keep children up to date until their last shot at age 14. You will receive this shot if you step on a nail or have a dirty wound. Repeat it every five to ten years, depending on the location and type of travel you are doing. For adults requiring a booster, it is recommended to give Adacel, which provides protection against tetanus, diphtheria and pertussis.
Typhoid
Salmonella bacteria cause this nasty disease. Like hepatitis A, it can be transmitted to food and water by a healthy carrier. Raw or inadequately cooked shellfish, or water contaminated by sewage, can also transmit the disease.
The shot, which can be given to those over the age of two, provides protection for about three years. A live oral vaccine is also available for those over age six, and provides protection for five years.
Polio
Protection from childhood polio vaccinations gradually lessens with age. This is not a concern in North America, where we no longer have the disease. However, polio is still a serious problem in some parts of Africa and Asia. If you plan to travel in these areas, a polio booster (by needle) is recommended. One booster, for people over the age of 18 years, is felt to provide lifetime immunity. A new requirement for travel to Saudi Arabia is proof of polio vaccination for all travelers aged 15 years and under.
Meningitis
Besides the requirement for travelers to Saudi Arabia (see Required Vaccines), the meningitis vaccine may be recommended in certain situations. In many African countries, meningitis outbreaks occur regularly during the dry season (December to June). There are also periodic outbreaks in other countries around the world. Vaccine protection lasts about three years.
Different bacteria cause disease in different areas. You need to ensure that you receive a vaccine that covers four different types of bacteria if you are going to a risk area.
Influenza
Don’t forget your flu shot! Flu season is November to May in the northern hemisphere, April to September in the southern hemisphere, and year round in the tropics. Remember, your biggest risk of getting the flu is in an environment where there are a large number of people. This includes airports and planes. Since the flu virus changes every year, vaccines must be taken annually for protection. If you are planning travel to a risk area, consult a travel clinic for advice on personal protection.
Rabies
Any mammal, from aardvarks to zebras, can carry rabies. Most transmission in developing countries is from dogs – often wild, aggressive, and running in packs. Untreated rabies is 100 per cent fatal. Anyone (including children) at high risk can get a series of three shots of pre-exposure vaccine prior to travel.
Any animal bite or scratch that breaks the skin needs immediate medical attention. Those who have had pre-exposure vaccine will need two more shots. Someone who has not had pre-exposure vaccine requires the full series of post-exposure treatment.
Japanese Encephalitis
That pesky mosquito again! This virus causes severe inflammation of the brain, with a high risk of brain damage or death. It is not very common, but does occur seasonally in various parts of Asia. Despite the name, it is very rare in Japan. The offending mosquito likes to breed in rural rice paddies and fishponds. The vaccine requires two shots, with boosters every three years for those at risk.
Dukoral ™
Hooray – this one is not a needle! It is a two-dose oral vaccine that helps protect against travelers’ diarrhea caused by E. coli. It is effective for three months. Since other bacteria can also cause traveller’s diarrhea, the need for Dukoral™ is assessed on an individual basis. You still must be very careful with food and water outside North America and Europe. Dukoral also provides some protection against cholera, but this is mainly an issue for aid workers in refugee camps.
Malaria
This is mentioned here because many people think there is a shot for malaria. Sorry, not yet. Protection from malaria requires pills. Talk to a travel health professional to determine your risk and discuss the best medication.
The last word
Consult a travel clinic six to eight weeks before your trip.
Remember to allow time to get immunizations done. Some vaccines require more than one shot and some require a specific period of time before travel to be effective. If you can, consult a travel clinic six to eight weeks before your trip. Some vaccine schedules can be accelerated if time is short. Still, ‘better late than never’ applies here! The travel clinic can advise you on how to stay safe if there is not enough time for the vaccine. No two trips are alike and no two travelers are alike. Protecting yourself is a vital part of planning your trip.
Bon voyage!
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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