.varicella-susceptible pregnant females;
.individuals at high risk of severe varicella, including those
with immunodeficiency or those receiving
immunosuppressive therapy.
Varicella-zoster immunoglobulin p. 775 is used to protect
susceptible children at increased risk of severe varicella
infection (seeImmunoglobulins p. 770 ).
Yellow fever vaccine
Live yellow fever vaccine, live p. 802 is indicated for those
travelling to or living in areas where infection is endemic.
Infants under 6 months of age should not be vaccinated
because there is a small risk of encephalitis; infants aged
6 – 9 months should be vaccinated only if the risk of yellow
fever is high and unavoidable (seek expert advice). The
immunity which probably lasts for life is officially accepted
for 10 years starting from 10 days after primary
immunisation and for a further 10 years immediately after
revaccination.
Very rarely vaccine-associated adverse effects have been
reported, such as viscerotropic disease (yellow fever vaccine,
live-associated viscerotropic disease, YEL–AVD), a
syndrome which may include metabolic acidosis, muscle and
liver cytolysis, and multi-organ failure. Neurological
disorders (yellow fever vaccine, live-associated neurotropic
disease, YEL-AND) such as encephalitis have also been
reported. Thesevery rareadverse effects have usually
occurred after thefirst dose of yellow fever vaccine, live in
those with no previous immunity.
Vaccines for travel
Immunisation for travel
See advice on Malaria, treatment p. 386.
No special immunisation is required for travellers to the
United States, Europe, Australia, or New Zealand, although
all travellers should have immunity to tetanus and
poliomyelitis (and childhood immunisations should be up to
date); Tick-borne encephalitis vaccine is recommended for
immunisation of those working in, or visiting, high-risk
areas. Certain special precautions are required in non-
European areas surrounding the Mediterranean, in Africa,
the Middle East, Asia, and South America.
Travellers to areas that have a high incidence of
poliomyelitisortuberculosisshould be immunised with
the appropriate vaccine; in the case of poliomyelitis
previously immunised travellers may be given a booster dose
of a preparation containing inactivated poliomyelitis
vaccine. BCG immunisation is recommended for travellers
aged under 16 years proposing to stay for longer than
3 months (or in close contact with the local population) in
countries with an incidence of tuberculosis greater than 40
per100 000(list of countries where the incidence of
tuberculosis is greater than 40 cases per100 000is available
fromwww.gov.uk/phe); it should preferably be given^3 months
or more before departure.
Yellow feverimmunisation is recommended for travel to
the endemic zones of Africa and South America. Many
countries require an International Certificate of Vaccination
from individuals arriving from, or who have been travelling
through, endemic areas; other countries require a certificate
from all entering travellers (consult the Department of
Health handbook,Health Information for Overseas Travel,
http://www.dh.gov.uk)..)
Immunisation againstmeningococcal meningitisis
recommended for a number of areas of the world.
Protection againsthepatitis Ais recommended for
travellers to high-risk areas outside Northern and Western
Europe, North America, Japan, Australia and New Zealand.
Hepatitis A vaccine is recommended and it is likely to be
effective even if given shortly before departure; Public
Health England recommends travellers can be vaccinated
with hepatitis A vaccine up to the day of travel, and no
longer recommends the use of normal immunoglobulin for
travel prophylaxis. Special care must also be taken with food
hygiene.
Hepatitis Bvaccine is recommended for those travelling
to areas of high or intermediate prevalence who intend to
seek employment as healthcare workers or who plan to
remain there for lengthy periods and who may therefore be
at increased risk of acquiring infection as the result of
medical or dental procedures carried out in those countries.
Short-term tourists or business travellers are not generally at
increased risk of infection but may put themselves at risk by
their sexual behaviour when abroad.
Prophylactic immunisation againstrabiesis
recommended for travellers to enzootic areas on long
journeys or to areas out of reach of immediate medical
attention.
Travellers who have not had atetanusbooster in the last
10 years and are visiting areas where medical attention may
not be accessible should receive a booster dose of adsorbed
diphtheria [low dose], tetanus and poliomyelitis (inactivated)
vaccine, even if they have received 5 doses of a tetanus-
containing vaccine previously.
Typhoid vaccineis indicated for travellers to countries
where typhoid is endemic, but the vaccine is no substitute
for personal precautions.
There is no requirement for cholera vaccination as a
condition for entry into any country, butoral cholera
vaccineshould be considered for backpackers and those
travelling to situations where the risk is greatest (e.g. refugee
camps). Regardless of vaccination, travellers to areas where
cholera is endemic should take special care with food
hygiene.
Advice ondiphtheria,onJapanese encephalitis, and on
tick-borne encephalitisis included inHealth Information for
Overseas Travel.Food hygiene
In areas where sanitation is poor, good food hygiene is
important to help prevent hepatitis A, typhoid, cholera, and
other diarrhoeal diseases (including travellers’diarrhoea).
Food should be freshly prepared and hot, and uncooked
vegetables (including green salads) should be avoided; only
fruits which can be peeled should be eaten. Only suitable
bottled water, or tap water that has been boiled or treated
with sterilising tablets, should be used for drinking.Information on health advice for travellers
Health professionals and travellers canfind the latest
information on immunisation requirements and precautions
for avoiding disease while travelling from:www.nathnac.org.
The handbook,Health Information for Overseas Travel
( 2010 ), which draws together essential informationfor
healthcare professionalsregarding health advice for
travellers, can also be obtained from this website.
Immunisation requirements change from time to time, and
information on the current requirements for any particular
country may be obtained from the embassy or legation of the
appropriate country or from:
National Travel Health Network and Centre
UCLH NHS Foundation Trust
3 rd Floor Central,
250 Euston Road,
London, NW 12 PG
Tel:0845 602 6712
(Monday and Friday: 9 – 11 a.m. and 1 – 2 p.m, Tuesday to
Thursday: 9 – 11 a.m. and 1 – 3 : 30 p.m. For healthcare
professionals only)www.travelhealthpro.org.uk/
Travel Medicine Team
Health Protection ScotlandBNFC 2018 – 2019 Vaccination 787
Vaccines14