Home   Pathology Centre   Pathology Newsletters   Virology   Travel Vaccinations

Virology

Travel Vaccinations

Vaccinations for travel in Africa

We recommend that you visit a doctor or travel medicine provider four to six weeks before you embark on travel in Africa, as most vaccines take time to become effective. However, if you have fewer than four weeks before your date of departure, you will still benefit from receiving the vaccines as well as other health-related travel information.

All routine vaccinations should be up to date. These include:

  • Tetanus: a booster is recommended every 10 years.
  • MMR (measles, mumps and rubella): laboratory testing to determine immunity (IgG) is available for measles, mumps and rubella.
  • Hepatitis B: laboratory testing to determine immunity is available. An HBsAb level >10 mIU/ml is considered to be protective.
  • Influenza: vaccination is recommended of the period of travel occurs during your destination’s flu season.

Recommended vaccinations

A number of vaccines are recommended to protect you from infections present in certain areas and to prevent infectious diseases from being carried across international borders. The vaccines you need vary, depending on which area you are intending to visit and your previous vaccination history.

Yellow fever

According to International Health Regulations, this is the only vaccine needed for travel to certain countries in sub-Saharan Africa. A yellow fever certificate is needed for entry into and return from affected countries.

The yellow fever virus is spread by mosquito bites. Infection leads to a flu-like illness that can progress to hepatitis and organ failure.

yellow-fever-vaccination-reccomendations-in-africa-2011.gif

Vaccination is recommended for travellers older than nine months of age. A single dose provides protection for 10 years. A booster is recommended every 10 years if the traveller is likely to have continuous exposure. The vaccine should be administered more than 10 days prior to travel to an affected country. The vaccine is contraindicated (withheld) if there is a history of egg allergy or immunosuppression. HIV patients with a CD4+ count of less than 200 should not receive the vaccine.

Hepatitis A

Hepatitis A virus (HAV) is highly prevalent in sub- Saharan Africa. The virus is spread by the faecal-oral route. Infection is usually acquired through exposure to contaminated water and food.Two doses of the hepatitis A vaccine are needed, six months apart. Most people will develop detectable antibodies two weeks after the first dose of vaccination, so one dose should provide adequate protection for travel. The second dose is important to improve the durability of the immunity.

Testing for HAV IgG (immunity to HAV) can be considered prior to vaccination as many individuals living in high-prevalence settings (including South Africa) may have been previously infected without developing any symptoms of infection.

Polio

Polio vaccination is administered to children as part of routine immunisation. The polio virus is spread via the faecal-oral route. Although most people infected do not develop symptoms, those that do may develop paralysis which, if severe, can lead to death.

wild-poliovirus-infected-districts-oct-2011-apr-2012.gif

Adults travelling to areas where polio still occurs and who are unvaccinated, partially vaccinated or do not know their vaccination status should receive three doses of the inactivated polio vaccine (IPV - not the oral polio vaccine) given intramuscularly – the fi rst two doses are given four weeks apart, with the third dose after six months. Adults who have been previously vaccinated should receive a single dose of IPV. Alternatively, polio antibody levels can be tested to determine immunity.

Typhoid

Infection with the bacteria Salmonella typhi occurs following exposure to contaminated food or water. Vaccination against typhoid is available, but is not 100% effective. The best way to prevent infection remains the avoidance of contaminated food and water. The old saying, boil it, cook it, wash it or forget it still applies. Remember that you need to be able to wash the food in clean water and boil it for at least five minutes.

A single dose of the vaccine should be given at least two weeks before potential exposure. A booster is recommended every two years if there is to be ongoing exposure. The vaccine is not recommended for children under the age of two years.

Rabies

Rabies virus is spread by the bite of an infected animal. All mammal and bat bites should receive medical attention as infection with rabies is invariably fatal.

Vaccination may be recommended based on the prevalence of rabies in the country to be visited, the likelihood of contact with infected animals, the availability of appropriate medical care if an exposure occurs and the duration of stay. Three doses of the vaccine are required for preexposure vaccination on day 0, 7 and 21. Boosters are recommended every three to fi ve years if there is likely to be continuous exposure.

Meningococcal disease

Neisseria meningitidis is a bacterium found worldwide. It is transmitted by close contact with respiratory secretions. Infection can present with meningitis or sepsis which can be fatal. The incidence of meningococcal disease is highest in the "meningitis belt" in sub-Saharan Africa.

meningococcal-meningitis-countries-or-areas-at-high-risk-2011.gif

Vaccination is recommended for individuals who travel to countries in the "meningitis belt".

A single dose for individuals older than two years old should be given seven to ten days prior to travel. Individuals under the age of 16 should receive a booster dose, preferably at the age of 16 to18.

References

  1. http://wwwnc.cdc.gov/travel/page/yellowbook-2012- home.htm, accessed 13 April 2012
  2. http://www.phac-aspc.gc.ca/tmp-pmv/info/meningitis- eng.php, accessed 17 April 2012
  3. http://www.polioeradication.org/Dataandmonitoring/ Poliothisweek/Polioinfecteddistricts.aspx, accessed 17 April 2012
  4. http://www.who.int/ith/en/, accessed 17 April 2012

Download this article in PDF format - Travel Vaccinations