Good travel health for your family (P2)

Immunizations

1.     Vaccinations provide protection against diseases you might meet along the way. For some countries no immunizations are necessary, but the further off the beaten track you go the more necessary it is to take precautions.
2.     It is important to understand the distinction between vaccines recommended for travel in certain areas and those required by law. Essentially the number of vaccines subject to international health regulations has been dramatically reduced over the last 10 years. Currently yellow fever is the only vaccine subject to international health regulations.
3.     Vaccination as an entry requirement is usually only enforced when coming from an infected area.
4.     All vaccinations should be recorded on an International Health Certificate, which is available from your physician or government health department.
5.     Plan ahead for getting your vaccinations: some of them require an initial shot followed by a booster, while some vaccinations should not be given together. It is recommended you seek medical advice at least six weeks prior to travel.
6.     Most children from Western countries will have been immunized against various diseases during childhood but your doctor may still recommend booster shots against measles or polio, diseases still prevalent in many developing countries. Apart from these, special vaccinations are not normally given to children under 12 months of age. Talk to your doctor.
7.     The period of protection offered by vaccinations differs widely and some are contra-indicated if you are pregnant or likely to become pregnant within three months of the vaccination.
8.     The possible list of vaccinations includes:

•         Smallpox: Smallpox has now been wiped out worldwide, so immunization is no longer necessary.
•         Cholera: Not required by law. Protection is poor and it lasts only six months. It is contra-indicated in pregnancy.
•         Tetanus & Diphtheria: Boosters are necessary every 10 years and protection is highly recommended.
•         Typhoid: Available either as an injection or oral capsules. Protection lasts from one to three years and is useful if you are traveling for long periods in rural, tropical area. You may get some side effects such as pain at the injection site, fever, headache and a general feeling of being unwell. A new single-dose injectable vaccine, which appears to have few side effects, is now available but is more expensive. Side effects are unusual with the oral form but stomach cramps may be one of these.
•         Infectious Hepatitis: The most common travel-acquired illness which can be prevented by vaccination. Protection can be provided in two ways - either with the antibody gamma globulin or with a new vaccine called Havrix. Havrix provides long-term immunity (possibly more than 10 years) after an initial course of two injections and a booster at one year. It may be more expensive than gamma globulin but certainly has many advantages, including length of protection and ease of administration. It takes about three weeks to provide satisfactory protection - hence the need for careful planning prior to travel. Gamma globulin is not a vaccination but a ready-made antibody which has proven very successful in reducing the chances of hepatitis infection. Because it may interfere with the development of immunity, it shouldn't be given until at least 10 days after administration of the last vaccine needed; it should also be given as close as possible to departure because it is at its most effective in the first few weeks after administration and the effectiveness tapers off gradually between three and six months.
•         Yellow Fever: Protection lasts 10 years. Vaccination is contra-indicated during pregnancy but if you must travel to a high-risk area it is probably advisable. Check with your doctor.
•         Meningitis: This vaccination is recommended for visitors to Nepal and for visitors to some areas of Africa and Brazil. It is given as a single injection and gives immunity for up to three years duration.
•         Tuberculosis: TB is widespread throughout the developing world. Most Westerners will have been vaccinated at some time during their school years. For children vaccination is not deemed necessary unless they will be spending prolonged periods (say up to a year) in an area of risk.