Ask the Expert

Question: My family and I will be traveling abroad.   Our minor children will be accompanying us on this vacation.   How should we prepare and how do we determine if we need any vaccines?

Answer:

We usually recommend coming in for a travel consult with your physician 4 weeks prior to departure.  This will ensure that your vaccine record is reviewed and that the standard vaccines for school attendance are all up to date.  The remaining vaccines required for your trip would be dependent upon when you are traveling, your destination, and your activities during your travel and your health status. 

Some of the additional vaccines that are recommended are:

Typhoid Vaccine

The Typhoid Vaccine is for the prevention of Salmonella Typhi. Salmonella Typhi infections are spread by contaminated food and water. The usual presentation of this infection is fever, abdominal pain, and headaches.   Salmonella can be shed in the fecal waste from 6 weeks to 3 months after exposure. 

Who should receive this vaccine?

There are two vaccines available.  Vivotif which is a 4 dose oral pill regimen that can provide protection for 5 years. This vaccine is available for children 6  years and older.  The Typhoid Vaccine which is an injection is available for children starting at age 2 and will provide protection for 2 years. 

Yellow fever is a viral illness spread by insect bites that present as fever, chills, loss of appetite, muscle pain in the back and headache.

Who should receive this vaccine?

It is a single-dose injectable vaccine given a minimum of 10 days prior to travel to children 9 months or older who are living in a high-risk country or traveling to a high-risk area. Only special licensed facilities can give this vaccine.  Travel to some countries requires an international certificate of vaccination for proof of vaccine. The certificate would not be considered valid until a minimum of 10 days after receiving the vaccination. 

Japanese Encephalitis is a viral illness spread through a mosquito bite and presents as fever, stiff neck, seizures or coma. This virus occurs mainly in rural parts of Asia.

The risk is very low for most travelers but is higher for people living in areas where the disease is common or people traveling for long periods of time.

Why vaccinate?

There is no treatment for Japanese Encephalitis and it is fatal in 20-30 percent of those who get the infection.  A third to a half of the survivors have some neurologic, cognitive or behavioral sequelae.

Have any US travelers been affected?

65 cases have been reported from 1973-2012: 59 adults and 6 children.

Who should receive this vaccine? 

Those who are planning to spend at least a month where JE occurs, going into rural areas and spending a lot of time outdoors. This vaccine is a 2 dose series given 4 weeks apart and the second dose needs to be completed ~ 1 week prior to travel. The CDC recommends this vaccine for children starting from ages 2months to 16 years of age traveling to an area that is endemic to the disease.  A booster dose might be needed for anyone 17 years or older who were vaccinated more than a year prior and is still at risk for the disease.

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal.  In 2010, 48 states and Puerto Rico reported over 6,000 cases of rabies in animals and 2 human cases to the CDC. The only state rabies-free is Hawaii.  Rabies is found worldwide, except in Antarctica. The numbers of deaths from rabies in the US has fallen from more than 100 per year to ~ 2-3 per year. The decline in morbidity is due to effective post-exposure treatment and vaccines. Although death from rabies in the US is rare, 16, 00-39,000 people come in contact with potentially rabid animals per year and require post-exposure prophylaxis each year 

Vaccination against rabies is used in 2 distinct situations: 

1. Pre-exposure to protect those who are at risk for exposure to rabies 

2. Post-exposure prophylaxis to prevent the development of the disease after exposure from an animal bite 

Who should receive this vaccine?

1. Pre Exposure Rabies vaccination

• Recommended for travelers spending a lot of time outdoors: campers and cavers
• Travelers with occupational risks: veterinarians and wildlife professionals 
• 3 dose series: days 0, 7 and 21 or 28 given prior to travel 

Rabies in dogs is still a problem and especially put children at risk because they often play with animals, might not report bites and are more likely to be bitten on the head and neck.

Some parts of the world, getting access to post-exposure treatment might be difficult. These areas include much of Africa, Asia, and Central and  South America.So if traveling to these areas and doing activities that put you at risk for exposure to dogs, cats, bats it is recommended.

It is important to know that even if you receive the pre-exposure vaccine you should still seek medical attention if bitten or scratched by an animal.

2. Post Exposure to potential Rabies Care 

• Wash the area well with soap and water
• Seek medical care immediately, even if it looks mild
• Get the post-exposure vaccination started immediately

The Treatment consists of:

• Rabies immunoglobulin 
• 4 doses of the vaccine: time 0,  day 3, 7 and 14

Immunity from the vaccine will last ~ 2 years following completion of the series.

The problem with rabies protection after exposure is : 

Adequate vaccination for exposure to rabies is NOT available in all parts of the world so need to be prepared to travel back to the US or another area. There is also a scarcity of Human Rabies Immunoglobulin. 

If you are bitten and did pre-exposure vaccines,  you will not need the Immunoglobulin just 2 additional doses of the rabies vaccines.

Hepatitis A is a viral liver disease that can be mild or severe. This virus presents as fever, malaise, loss of appetite, abdominal pain, nausea and diarrhea, dark urine and jaundice (yellowing of the eyes). This virus is transmitted by contaminated food and water or through direct contact with an infectious person. Once infected you will have lifelong immunity. The disease is diagnosed via a blood test.:  There is no specific treatment for Hepatitis A and the recovery is slow. It may take weeks to months. Patients need to avoid taking Acetaminophen (Tylenol) and medication against vomiting while recovering.

Who should receive this vaccine? 

Hepatitis A Vaccine has been available since 1992. A vaccine is not required in every state but required for daycare attendance in Georgia for every child born after 1/11/2006.  The vaccine is available in a 2 dose series: starting at 12 months of age and the second dose in 6 months.

Travel recommendations for Hepatitis A: 

Occurs worldwide but more common in regions with poor sanitation and lack of safe food and water.  It can also occur in urban areas. The regions with high risk for Hepatitis A: Africa, Asia and Central and South America. I generally recommend this vaccine for those traveling to these areas if they have not received it. 

Prevention of Hepatitis A: 

• Practice safe food and water precautions

I generally recommend no roadside food vendors, avoiding uncooked foods such as shellfish, fruits, and salads

• Washing your hands frequently with soap or warm water as often as possible 
• Using alcohol-based hand sanitizer if no soap or water is available  

Other Safety tips for travel:

• Consider travel health insurance when traveling abroad with small children and anyone with a known health condition.
• When you return, consider getting screened for Tuberculosis.

 I would recommend considering this after spending 2 or more weeks in area with known high rates of Tb: Africa, Asia, India, Eastern Europe and South and Central America

• Take all medication that you use even if it is as needed just in case. Examples would be asthma rescue medication or allergy medication. 
• Taking a medical kit is also a good thing to consider.   I usually recommend Motrin, Tylenol, and Benadryl for allergic reactions, Pepto-Bismol, Sunscreen with an SPF of 30 or higher and mosquito repellant.  30 Percent of DEET insect repellant is safe for use in anyone older than 2 months of age.  Safe mosquito repellant for children too young for DEET would contain Picaridin. 

Have fun and enjoy your family and friends during the trip!