It’s Travel Season! What vaccines should I get?

- 13 December 2018

With end of year slowdowns at work (other than GSHealth!) a lot of people are starting to get ready for their upcoming domestic and overseas holidays.

Since we’ve had a lot of questions recently from patients about what they need before they head off for a well deserved break, I thought I’d break it down from the clinical point of view!

So what do I need before I go to XYZ?

Well there’s only a few vaccinations that are absolutely required to enter certain countries. Yellow Fever vaccination is the one that stands out as a lot of countries either a) won’t let you enter or b) Australia won’t let you re-enter unless you have a valid certificate of Yellow Fever vaccination.

A lot of other vaccines are highly recommended depending on where you’re travelling, how long you’ll be there, what you’ll be doing, and your previous vaccination history.

So tell me about Yellow Fever vaccinations

The good news is, most of the world now agrees that if you’ve had a single Yellow Fever vaccination – it counts for life.

In Australia Yellow Fever vaccinations can only be given by practices that are accredited in providing the vaccine, as certified by the Public Health Unit of each respective state or territory.
You’ll need to see a doctor at that clinic who will do a travel medicine consult to assess you if you’re eligible for the vaccine (some people can’t have it) and to discuss the risks (the rate of risk is low, but can be significant), before giving you the vaccine. This then needs to be recorded in the “Yellow Book” which is officially known as the International Certificate of Vaccination or Prophylaxis provided by the World Health Organisation.

International Certificate of Vaccination or Prophylaxis

For the vaccine to be considered effective, it needs to be given 10 full days before entering the area of Yellow Fever risk. You’ll also need to wait 30 minutes after your vaccination to ensure there are no side effects such as allergic reactions.

Yellow Fever in South America

Yellow Fever in central Africa

What about other vaccinations?

Ok, read on if you want to know about;

  • Influenza
  • Typhoid Fever
  • Hepatitis A
  • Malaria
  • Rabies
  • Japanese Encephalitis
  • Meningococcal ACWY
  • Cholera

Glad you asked. It all boils down to risk right? The thing you’re most likely to get is the one you should be protected against. And for me, that is Influenza. This is number 1, 2 and 3 in my books, and if you haven’t had a flu shot, then just get it done already. Think about exposure;

You’re at the airport with thousands of other people who are from all over the world, going all over the world. You cram into snaking queues, boarding areas, and if you travel a lot – airline lounges. Then you get onto a plane and share that air with the 5-8 people around you (imagine minesquare) if you’re flying economy. You arrive for your fantastic 2 week break, and come down with the flu. You’ll be right just in time to go home and go to work. So yes. Get the flu shot.

Next come the other most common infections. Typhoid fever (from Salmonella Typhi) and Hepatitis A. These come from contaminated food and water, and pretty much every area on Earth with the exception of USA, Canada, Western Europe and Scandinavia, Australia, New Zealand, Japan and Antarctica, has an increased risk of these illnesses.

Even if you’re staying at a 5 star resort in Bali, the food source, handling and preparation is the same. These things usually cause a week of vomiting, fevers, aches and pains – if not worse. So if you aren’t immune or it’s been 3 years since your last Typhoid shot – get these again.

After this comes Malaria. Since there’s no vaccination for this, your most important line of defence comes from mosquito bite prevention. Yes.. I know, laughable at best if you’re a walking talking mosquito magnet like myself. But every less bite is helping you avoid the risk of Malaria and other mosquito borne viruses. If you’re going to a really Malaria prone area, it can be worth taking prophylaxis that prevents your risk of contracting it even if you are eaten alive. Read here for more.

Another mosquito borne virus which is thankfully very rare, is Japanese Encephalitis. Recently there was a fake report of an outbreak in Bali which was aired on a lot of commercial news stations, resulting in lots of patients coming in for vaccines. Thankfully a nice consult and our experience showed there was no such outbreak and they didn’t need the vaccine. Some still opted to get it, which is great as it also is thought to provide long term protection. However Japanese Encephalitis vaccine is only typically required if you spend more than 1 month in a rural area of a country at risk.

Japanese Encephalitis endemic countries

Rabies vaccination seems to not only annoy patients, but also a lot of doctors seem to wave this one off as an unnecessary vaccine. In my opinion (and those of my colleagues at GS Health) this couldn’t be further from the truth.

I have to say we’re extremely fortunate in Australia that we don’t have rabies here. We have bat Lyssavirus which is kind of similar, but nothing like rabies around the rest of the world. Globally there are 59,000 deaths annually from rabies, with the majority occurring in Asia and Africa.

The countries in grey have no dog associated Rabies.

I often hear “Oh if i don’t pet any animals, then I’ll be OK”. Sure, but you can’t help it sometimes. The current Australian guidelines recommend that these two groups in particular should get rabies vaccination.

  1. People travelling for more than 30 days to a rabies endemic region
  2. People who are travelling and will be working with animals

I think (and the Medical Journal of Australia thinks) that these aren’t good enough. In a small study of 65 people that sought treatment in Australia after rabies exposure overseas, all were between 20-29, were on holidays for an average of 15.4 days, 34% were bitten without initiating contact with the animals (they didn’t go to pet them), and NONE were working with animals. Urban exposures were 35% and rural was 34%. Most were bitten, some were scratched, and all these exposures happened in Thailand and Bali.

Now, having the vaccine to rabies doesn’t make you 100% immune. But it buys you time to get boosted immunisation, referred to as Post Exposure Prophylaxis (PEP). Because if you do get infected with rabies, there’s no cure.

So get your Rabies shots. If you get bitten or exposed – seek medical attention immediately, and if it looks like they don’t have booster vaccines and Rabies Immunoglobulin (Rig) – call your travel insurance provider and fly on home (or the nearest centre of excellence they arrange for you – might be Singapore).

Meningococcus vaccine is now standard for all 12 month old children in Australia, but this only started late 2018. Some travel to central Africa, or those on pilgrimage to the Hajj will need this to satisfy their conditions of entry or visa requirements, as do some student visa’s to the USA if you’re living on campus. The reason being that Meningococcus spreads quickest in crowded conditions. Some may even consider vaccination if attending events such as the University Games or the FIFA world cup.

Meningitis belt of central Africa

Which brings us to Cholera. Whilst it’s a huge killer in the developing world, the risk of contracting cholera whilst travelling is incredibly low. In fact even if you travel to a cholera endemic area, you’re probably not going to get it (unless you start drinking the contaminated water source). BUT the vaccine does have one happy side effect. It reduces the chance of getting an E.Coli infection by about 67%, for 3 months. Now if you’re going to be backpacking through India, China or Africa, then this can be a real added layer of protection against food borne illness.

That’s so much information.. what do I do next?

Well, that’s what we’re for. Just because you can get all those shots doesn’t mean you have to every time. And even if a shot is recommended, you can say no.

The best thing to do when planning your trip is to make sure you’ve got travel insurance, packed all your required clothes, meds, essential items, then have a chat with either your regular doctor if you need things sorted out, or a clinic that specialises in travel medicine if you want to get all  your vaccines sorted.

I recommend coming in a month before a trip, because sometimes you need blood tests to see if you’re immune to things already – like measles – which we didn’t mention above. Otherwise most vaccines need about 2 weeks to have their maximum efficacy, but even if it is later than this we can get started.

Rabies needs 21 days to receive the full course – day 0, 7 and 21-28.

So if you’re heading away, I suggest finding out what vaccines you’ve had, try to confirm your itinerary, then book in for a travel consult online at GS Health and we can go through everything for you. We can even help you prepare a medical kit to take away.

 

Written by Dr Daniel Chanisheff, Thursday the 13th of December 2018.