Travel Vaccines

• Influenza remains the most frequent vaccine preventable illness. 
• In a recent review it has been stressed how this vaccine should particularly be recommended to those travelling in groups or on cruise ships.
• Obviously senior travellers are at greatest risk of complications by this infection.

Risk Factors

• Duration and Destination of Travel
• Diseases or Medications – esp immunosuppressives
• Dangerous/Planned Travel Activities

Recommended Immunizations Based on Current Epidemiology

1. Influenza: Most common vaccine-preventable disease in travelers. Consider for travel during flu season, in large groups, or for those at high risk.

2. Hepatitis A: Second most common, highly effective vaccine recommended for all non-immune travelers to areas with poor sanitation.

3. Typhoid: Targeting: High-risk travelers, especially to South Asia, or those exposed to poor sanitation for prolonged periods.

4. Other Vaccines

• Rabies and Japanese Encephalitis: Recommended for those with specific or prolonged exposures.
• Cholera: Considered mainly for high-risk individuals due to additional protection against E. coli, the commonest cause of travelers’ diarrhea.
• Yellow Fever: Certificate required from those coming from at-risk areas.
• Meningococcal Disease: ACWY vaccine needed for all pilgrims over 2 years old, administered at least 10 days before entry and valid for 3 years. Ciprofloxacin given at entry to those from the African meningitis belt.
• Polio: Visitors from polio-affected regions must show recent polio vaccination (within the last year) and receive OPV at Saudi borders.
• Routine Vaccines: Up-to-date vaccinations like (dTP and MMR) diphtheria, tetanus, pertussis, measles, and mumps are strongly recommended.
• Vaccine-Specific Considerations
  • National Immunisation Program (NIP): Travelers should check the latest NIP schedule and additional state-funded vaccines where applicable.
  • Q Fever: Evaluate immune status with skin and serum antibody testing before immunization due to the risk of hypersensitivity reactions.
  • BCG Vaccine: Pre-immunisation tuberculin testing typically recommended, except for infants under 6 months.

Vaccine Products and Interchangeability

• Multiple Options Available: For many diseases, there are various vaccines available from different manufacturers.
• Interchangeability Supported: Substantial evidence generally supports the interchangeability of vaccines for diseases like hepatitis B, diphtheria, tetanus, and rabies.
• Specific Vaccines:
  • Tetanus, Diphtheria, Polio (OPV and IPV), Hepatitis A, Rabies, MMR, Influenza, Hib: Interchangeable across different brands.
  • Meningococcal and Typhoid Vi Polysaccharide Vaccines: Can be used interchangeably for repeat immunization.
  • Hepatitis B: Generally interchangeable, though Engerix-B may perform better in those with reduced immunity and the elderly.
• Limited Data:
  • Pertussis Vaccines: Recommended to use the same vaccine for the first three doses due to limited data on mixed schedules.
  • Rotavirus, Pneumococcal Conjugate, HPV, Japanese Encephalitis: No firm data supporting interchangeability; use the same vaccine preparation if possible.
  • Varicella: Both vaccines in Australia use the same virus strain; interchangeability data lacking.

Practical Aspects of Immunisation

• Pre-Travel Consultation:
  • Seek advice at least 6 weeks before travel to complete primary schedules and necessary tests.
  • Ensure immunizations are completed about 2 weeks before travel for optimal immune response.
• Standard Vaccination Procedures:
  • Follow procedures from The Australian Immunisation Handbook, including readiness for anaphylaxis, obtaining informed consent, and post-vaccination observation.
• Cold Chain Management:
  • Maintain vaccines under optimal conditions to ensure potency.
• Record Keeping:
  • Record name, brand, batch number, date, dose, route, site of administration, and administrator’s name in both clinic and patient-held records.