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Travel Medicine
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Travel Vaccine RecommendationsMore Travel Medicine Information & Consultation Traveling outside the US? What vaccine should you have up-to-date? The following vaccines should be reviewed with a health care provider as far in advance of travel as possible to ensure the proper scheduling of recommended vaccines. Consultation? Primary Vaccine SeriesFor travelers over 2 years of age the following immunizations normally given during childhood should be up to date:
Children over 2 should be "on schedule" with each vaccine's primary-series schedule, while adults should have completed the primary series. The number of doses needed depends on the child's age. If you are unsure about your vaccine history, consult with your physician. In addition, adult travelers may want to consider
Booster or Additional DosesTetanus and DiphtheriaA booster dose of adult tetanus-diphtheria (Td) is recommended every 10 years. PolioFor persons who have received a complete series of polio vaccine (either IPV or OPV), an additional single dose of vaccine should be received by persons 18 years of age and older traveling to the developing countries of Africa (Southern, Central, East, West, and North), Asia (East and Southeast), the Middle East, and the Indian subcontinent, and the majority of the New Independent States of the former Soviet Union. This additional dose of polio vaccine is necessary for travelers to risk areas only once in adulthood. Inactivated polio vaccine (IPV) is recommended for this dose. MeaslesPersons born in or after 1957 should consider a second dose of measles vaccine before traveling abroad. OthersYellow fever vaccine is recommended if traveling to certain parts of Africa and South America. Hepatitis B vaccine should be considered for those who will live 6 months or more in areas where there are high rates of hepatitis B (Southeast Asia, Africa (Southern, Central, East, West, and North), the Middle East, the islands of the South and Western Pacific, and the Amazon region of South America), and who will have frequent close contact with the local population. Children who have not previously received hepatitis B vaccine should be vaccinated. In general, hepatitis A vaccine and/or immune globulin (IG) is recommended for travelers to all areas EXCEPT Japan, Australia, New Zealand, Northern and Western Europe and North America (excluding Mexico). Typhoid vaccine is recommended for travelers spending time in areas where food and water precautions are recommended (including many parts of the world, especially developing countries). Meningococcal vaccine is recommended for travelers to sub-Saharan Africa during the dry season, which is from December through June, and especially if close contact with locals is anticipated. Japanese encephalitis or tick-borne encephalitis vaccines should be considered for long-term travelers to areas of risk. The risk of cholera to U.S. travelers is so low that it is questionable whether cholera vaccine is of benefit. All vaccines (except cholera and yellow fever vaccines) may be safely administered simultaneously without any decrease in effectiveness. Immune globulin (IG) may be simultaneously administered at different body locations with an inactivated vaccine such as DTaP, IPV, Hib, and hepatitis A and B vaccines. However, IG diminishes the effectiveness of live-virus MMR and varicella vaccines if IG is given simultaneously. IG does not interfere with either OPV or yellow fever vaccine when given simultaneously. For more information on simultaneous administration of vaccines, see Spacing of Immunobiologics. Pregnancy and ImmunizationsWomen who are pregnant or who are likely to become pregnant within 3 months should not receive MMR or varicella vaccines. Yellow fever or polio (OPV) vaccines should be given to pregnant women only if there is a substantial risk of exposure. If given during pregnancy, waiting until the second or third trimester minimizes theoretical concerns over possible birth defects. Women in the second and third trimesters of pregnancy have been found to be at increased risk of complications from influenza. Because currently available influenza vaccine is an inactivated vaccine, many experts consider influenza vaccination safe during any stage of pregnancy. A study of influenza vaccination of more than 2,000 pregnant women demonstrated no adverse fetal affects associated with influenza vaccine. However, more data are needed. Some experts prefer to administer influenza vaccine during the second trimester to avoid a coincidental association with spontaneous abortion (miscarriage), which is common in the first trimester, and because exposures to vaccines have traditionally been avoided during this time. No convincing evidence for risk to the unborn baby from inactivated viral or bacterial vaccines or toxoids administered to pregnant women has been documented. These vaccines include: hepatitis A, hepatitis B, rabies, injectable typhoid, meningococcal, pneumococcal, tetanus-diphtheria toxoid (adult formulation), and IPV. Immune globulin can be given to pregnant women. Specific information is not available on the safety of cholera vaccine during pregnancy; therefore, it is prudent on theoretical grounds to avoid vaccinating pregnant women. All vaccines may be administered safely to children of pregnant women and to breast-feeding mothers. What Precautions Can I Take?Visit to the PhysicianPhysical Examination and Medical Preparation. Travelers who plan to visit underdeveloped or tropical countries and those embarking on prolonged vacations or arduous treks should have a thorough check-up. In order to complete all necessary immunizations and medical preparations prior to departure, travelers to developing countries should ideally begin the process ten weeks in advance. Travelers should obtain a brief summary of their medical histories to take with them, including the results of abnormal tests or EKGs and a list of drug allergies. They should also prepare a list of medications they normally use, noting all trade and generic names as well as dosages. Contact lens wearers should consider taking ocular antibiotics if traveling to remote countries. In addition, the doctor should provide a letter authorizing any necessary medications; this precaution will facilitate customs and security checks. Since doctors may have trouble keeping abreast of medical trends in foreign countries, travelers should investigate medical problems specific to the countries on their itinerary. Immunizations: General Guidelines as outlined above. First Aid Kits and Other SuppliesFirst aid supplies should include sunblock, topical disinfectants, bandage materials, insect repellent, a thermometer, any prescription drugs regularly taken, antifungal foot powder, hydrocortisone cream for rashes, loperamide (Imodium) and Pepto-Bismol for diarrhea, and a nonprescription pain reliever. (The traveler should note that acetaminophen, the generic name for Tylenol, is known as paracetamol outside America.) Travelers should also bring along iodine tablets, such as Globaline or Potable-Aqua, to purify water. Small portable water filters are also available, which remove parasites and clear murky water without leaving the chemical taste. These are particularly beneficial for pregnant women and people who cannot take iodine. When purchasing such a filter, the phrase EPA Registration should be printed on the label, indicating that the Environmental Protection Agency has guaranteed its effectiveness. As an alternative to iodine, travelers might also consider buying an electric heating coil (with appropriate plug adapters and voltage converters) to boil and purify tap water. InsuranceTravelers should remember to check what coverage their health insurance company offers for policy holders abroad. Medicare does not provide coverage outside the United States. Individual supplementary health insurance policies should cost no more than a few dollars a day for international travelers. Reference
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