Download See also advice sheets on

See also advice sheets on:
Diabetes Mellitus I Pregnancy I Air Travel, Disabilities I Relief Workers I Travel to remote
areas
Ideally, travellers should consult their GP, Practice Nurse or travel health clinic at least 6
weeks prior to departure to obtain advice on how to reduce travel-related health risks which
may include anti-malarial drugs and vaccines.
Last minute bookings for cheap package holidays are popular and also some people, such as
emergency relief workers and the military, may be forced to travel at very short notice, often
to areas which are dangerous, remote or affected by war or natural disasters
Our Nurses are all fully qualified and experienced; however they are not specialists in travel
health and therefore those patients with complicated itineraries will need to consult one of the
Private travel clinics for advice (see page 6)
VACCINATIONS



Some vaccines given to last minute travellers may not give effective protection even
after travellers have arrived at their destination (see TRAVAX record on how soon
vaccines become effective). This particularly applies to primary courses. If the
recommended booster dose interval has been substantially delayed the immune
response, while usually still adequate, may also be delayed.
Travellers leaving at short notice may not have time to complete the full course when
primary courses require two or more doses usually given at intervals of days or
weeks. Accelerated schedules (e.g. for hepatitis B and rabies) have been devised but
they may not offer as complete protection as the full course and may need to be
followed with an extra dose given before the normal first booster interval.
Some vaccines (e.g. Japanese B) may have delayed side effects which may be a
cause of concern if the traveller is departing within a few days.
Tetanus, diphtheria and poliomyelitis vaccinations should be kept up-to-date
according to the British Schedule in those likely to travel at short notice.

In the UK these are now normally given in a single combined vaccine. 10 yearly
boosters are advised for travellers going to high-risk regions.
Measles

A primary dose may be advised if there are reports of outbreaks at the travellers’
destination and if the traveller has never had measles or only received one dose as a
child.
Influenza

Advised for travellers who are at risk due to their work with local populations (e.g.
disaster relief), especially in the flu season (winter northern hemisphere, summer
southern hemisphere) and those who are advised to have annual flu vaccination due
to an increased risk of complications of flu.
BCG


Primary BCG will not provide protection for about 6 weeks after vaccination. This
makes it of doubtful value when a traveller must depart immediately (e.g. in the case
of aid workers).
A Tuberculin Skin Test alone can be checked before departure and rechecked after
return to detect conversion to positive in those that may have been exposed while
abroad. Treatment may then be indicated
Hepatitis B



The full primary course consists of 3 doses (days 0, 28 and 6 months).
Accelerated schedules (0, 7, 21 days or 0, 28 and 56 days) using Engerix B or
Twinrix (combined vaccine against hepatitis A and B) has been shown to provide
good protection. In these circumstances a fourth dose should be given after 12
months.
In those departing very soon, two doses, a week apart, is likely to give useful
protection. If possible the third dose should be given according to an accelerated
schedule when the traveller is abroad.
Rabies



The full course is three doses on days 0, 7 and 21 or 28.
If departure is imminent, some protection may be gained from one or 2 (1 ml) doses
given by the usual intramuscular route or alternatively 4 intradermal (ID) doses of
0.1ml each, one into each upper arm and each leg. The ID route results in a slightly
more rapid rise in antibody levels but must be given by someone proficient in the
technique
Last minute incomplete schedules cannot guarantee maximum protection so the need
for urgent medical attention after exposure must be emphasised.
o The normal post-exposure response in this instance is to start a full postexposure course on days 0, 3, 7, 14 and 28 plus immunoglobulin but the
antibody response to vaccine alone is likely to be more rapid than if no
previous doses had been received which can be reassuring if
immunoglobulin is not available
Japanese B encephalitis (JE)


The full vaccination course requires 3 doses and takes 2-4 weeks to complete (days
0, 7, 14 or 30). However, a 2 dose schedule (days 0, 7) has been shown to provide
seroconversion in around 60-80% of recipients which is likely to give short-term
protection (e.g. 3-6 months)) or make an illness milder.
Hypersensitivity reactions may rarely occur up to 10 days after vaccination which
ideally should be avoided while the recipient is travelling. For this reason, the vaccine
should not be given less than 10 days prior to departure unless possible benefit
clearly outweighs this risk.
Yellow Fever


Yellow fever is a mosquito borne disease and occurs most commonly in jungle areas.
It is therefore more likely in travellers going to remote areas.
A yellow fever vaccination certificate is necessary for crossing borders in many parts
of Africa and South America.
Vaccination takes about a week to become effective and a vaccination certificate is
not valid until 10 days after primary vaccination although it is valid immediately after
booster doses. ·
MALARIA PROPHYLAXIS

If the traveller has no experience of using antimalarials previously and departure is
within less than 7 days (giving no time to try out the tablets in relation to possible
side-effects), the daily dose drugs Malarone or doxycycline may be the best choices.
o Doxycycline and Malarone have the advantage that they are fully effective
when 1-2 days before departure started.
o Mefloquine, a weekly dose drug, should be started a week before departure
and, in those who have not used it before a three-week trial is wise to gain
confidence that the drug will be tolerated. This makes it a less useful choice
for last-minute travellers.
o Chloroquine, also a weekly dose drug, should also be started one week
before departure.