VACCINE - PREVENTABLE DISEASES!!

Preferably start 6 weeks before departure

Keep a photocopy of your official "yellow vaccination booklet" at home !!

THE PRICES OF THE VACCINES CAN BE SUBJECT TO UNEXPECTED FLUCTUATIONS!

1. YELLOW FEVER (www.who.int/ith) - disease distribution maps

This deadly viral infection – transmitted by mosquitoes that bite during day time - occurs only in some countries of South-America and Africa. There is no medication against yellow fever, but there is a very effective vaccine that is well tolerated. One injection in the arm – (price € 20.00) offers a 100 % protection for ten years. This protection only begins 10 days after vaccination if this is the first vaccination. In 10 to 30 p.c. of the cases a slight influenza-like reaction may occur after a few days or up to a week after vaccination (take paracetamol if this happens). Allergic reactions are very rare. However, during the last years life-threatening side effects have been reported very exceptionnally and only at the first vaccination and in persons over 60 years old. The doctor will weigh the advantages against the (extremely) rare disadvantages of the vaccination in persons of 60 years or older taking into account the destination and circumstances of their trip. ("The risk for a non-vaccinated person travelling to a country where yellow fever occurs, is much higher than the risk of having side effects of the injection. It is important to vaccinate all travellers who could run risk."WHO 2010) It is the only disease for which a certificate (“yellow booklet”) is required of the traveller going to or coming from areas in which yellow fever occurs (see map on www.itg.be). A vaccination can only be obtained in vaccination centres that are recognised by the National Administration of Public Health. Children are vaccinated from the age of one, in exceptional cases from the age of 6 months. The vaccine is usually not administered to pregnant women nor to immunosuppressive people (HIV, corticosteroids, other immunosuppressive medications, etc.): for them it is not recommended to travel to countries endemic to yellow fever (without being vaccinated). People who have undergone a thymectomie or have other thymus problems should not be vaccinated. In case Yellow Fever vaccination is contra-indicated, it may be wise to recommend a change in destination. If necessary a declaration of "temporarily medical exemption of vaccination" can be given in the specialized vaccination centre (in which case it is very important to apply the measures against mosquito bites during daytime).

2. TETANUS, DIPHTERIA, PERTUSSIS

Travel preparations are an ideal time to update your tetanus and diphtheria vaccinations. For most people and certainly for young people, a booster every ten years is sufficient (Tedivax pro Adulto^â € 8,03). If the last injection dates back to over 20 years, two injections with an interval of 6 months are recommended. If there are any doubts as to the completeness of the earlier vaccination, the schedule consists of two injections with a 1-month interval, followed by a third injection after 6-12 months. It is advisable for adults, in close contact with infants, to get one injection with the combined vaccine against tetanus, diphtheria and pertussis (Boostrix^®).

3. POLIO http://www.polioeradication.org/content/general/casemap.gif or www.who.int/ith - disease distribution maps

Since 1965 every Belgian citizen has been vaccinated against polio (using an oral vaccine (Sabin^®), since 2001 an injection). In most cases the vaccination ensures lifelong protection. As the virus is still prevalent in certain parts of Africa and Asia, a booster vaccination against polio is advisable, even for a short trip to the tropics. One subsequent booster injection from the age of 16 years alone is sufficient to protect for life if a complete vaccination cycle had been given before. If one has never been vaccinated before: 2 injections with a 2 month interval, and a third injection after 12 months.

There are two types of vaccine: (in Belgium the oral vaccine Sabin® is not used anymore).

Imovax^® Polio injection € 7.34	Revaxis^â injection € 17.20
- Vaccine against polio	- combination vaccine against tetanus, diphtheria and polio - not for children under 7 years

4. MEASLES

Vaccination is recommended for non-vaccinated persons born after 1970 who did not have a measles infection yet, 2 injections with the measles-mumps-rubella vaccine, with a minimum interval of 1 month.

4. HEPATITIS A (JAUNDICE) www.who.int/ith - disease distribution maps

Hepatitis A is a contagious liver disease that is transmitted through food, drinks, or objects that have been contaminated either directly or indirectly with faeces. Although hepatitis A is usually quite a mild disease, its evolution can sometimes be very slow. The risk of infection in industrialised countries remains very low because of the high level of hygiene. In developing countries the risk of infection is high. Hepatitis A vaccination is recommended by the WHO for travellers to Africa, Latin America and Asia. Individuals who have had the disease acquire a lifelong immunity and thus do not need vaccination. (This should be confirmed by a laboratory test). Antibody screening after vaccination is only indicated in case of reduced immunity.

Epaxal^®, Havrix^® :

- 14 days after one injection there is nearly 100% protection for at least one year

- a 2° injection after 6 to 12 months will give a lifelong protection.

- When there is a long delay (even of several years) the course does not have to start again from zero. The next injections can be carried on according to the plan i.e. at the point where they left off.

- the price per dose : Epaxal^® 39,58 € (from the age of 1 year); Havrix^® € 45.66 (adults) and Havrix Junior^® € 30.04 (1-15 years) (2x), these vaccines can be used together in one vaccination scheme

If vaccination against Hepatitis B is recommended (see below), a combination vaccine is used (Twinrix^® : 3 injections : adults € 54.60 per dose, children up to 15 years € 41.05 per dose); as Twinrix^® only has 1/2 of the hepatitis A vaccine dose, protection against hepatitis A for at least 1 year occurs only after 2 doses of Twinrix^®.

6. TYPHOID FEVER

Typhoid fever is a serious infection accompanied by high fever; in the early stages rarely accompanied by diarrhoea. Its transmission occurs through the intake of contaminated food or water. Again, strict precautionary measures in order to prevent diarrhoea are important. The risk of infection is fairly low (and much lower than the risk of a hepatitis A infection), the risk is highest in Northern and Northwestern Africa, India and Peru. Vaccination protects about 60-70% for three years and is recommended for journeys to the tropics longer than 3 weeks or for adventure journeys, even if less than 3 weeks.Two types of vaccines exist :

Vivotif^®	Typherix^®/Typhim Vi^®
- 3 capsules, each to be taken at intervals of exactly 48 hours for three doses. The capsules have to be taken on an empty stomach. - to be taken two weeks before departure - Not to be taken together with antibiotics or some kinds of antimalaria drugs; not suitable for pregnant women. - € 17.85; keep in a cool place! Do not open or dissolve capsules.	- a single injection that is tolerated very well. - vaccination two weeks before departure - price: € 22.36

7. CHOLERA

Cholera is characterised by frequent watery stools which may cause rapid dehydration. Cholera is a disease which affects deprived people living in poor hygienic conditions and who are usually suffering from malnutrition. The old, injectable vaccine against cholera was of little efficacy and a frequent source of side effects; the more recent, drinkable vaccine is much better tolerated and of greater efficiency. However, for the healthy traveller who applies the preventive measures for diarrhoea mentioned above, the risk is as good as almost completely non-existent, even when travelling in an area where a cholera epidemic is occurring.

Some African countries still require a vaccination certificate. In order to avoid problems at frontier borders, an extra stamp ("cholera vaccination not indicated; unlimited time) may be useful here. It can be provided by your doctor when necessary. www.who.int/ith - disease distribution maps

8. HEPATITIS B www.who.int/ith - disease distribution maps

(Engerix^®B, HBVAXPRO^® : € 26,55/dose, children up to 15 years € 16,81/dose, 3 injections, on day 1-30-120 to 180, or 4 injections on day 1-7-21-360) (Twinrix^®: 3 injections : adults € 54.60 per dose, children up to 15 years - € 41.05 per dose). When there is a long delay (even of several years) the course does not have to start again from zero. The next injections can be carried on according to the plan i.e. at the point where they left off. In principle a lifelong protection after a full vaccination is possible, though a check-up of antibody titre after 10 years is recommended. Vaccination is recommended: (1) For people who frequently travel to Asia, Latin America and Africa, or stay there longer than 3-6 months, also for children who will be staying there, migrants and their children visiting their country of origin ("VFR travellers": visiting friends and relatives) N.B. there is also a risk for contamination when taking care of adopted children, orphans or street children, even when the hygienic standard of living is high during the whole stay (infection through direct or indirect contact with mucous membrane, eye membrane and skin lesions); (2) For travellers ^(a) who may have sexual contacts or ^(b) may have to undergo medical or dental operations abroad, ^(c) also the adventurous traveller or the traveller who will practise dangerous sports activities, who are at risk of trauma and medical care in a hospital in poor hygienic conditions; (3) In Belgium Hepatitis B vaccination is ^(a) strongly recommended (if not mandatory) to people that are at risk through their profession; and recently ^(b) it has also become part of the basic vaccination schedule for infants, children and adolescents. Antibody screening 1-3 months after the complete vaccination series is advisable for adults; the presence of (at least 10 IE/ml) antibodies implicates a life long protection for persons with a normal immunity; this will be obtained in 90-95% with 1 vaccination series. Every injection counts, even if there were several months or years between the different injections, one does never has to restart the entire vaccination series.

9. MENINGITIS CAUSED BY MENINGOCOCCI A,C,W,Y (Mencevax^® A-C-Y-W135, € 32,99; 1 injection, booster every 3 years - Menveo^® , € 50,00; 1 injection, it is not yet clear when a booster vaccination is required (for the moment the US advises after 3-5 years, but probably the protection lasts longer)). Vaccination is indicated for travellers going to countries in the African sub-Saharan belt during the epidemic meningitis period, who will be living in close contact with the local population (i.e. travelling by public transport, sleeping in local guesthouses, migrants who are travelling to their country of origin and who will be staying there with family members), or who will be staying there for more than 4 weeks. Vacination is mandatory for pilgrims to Mecca (should be administered ten days before departure). For more information, see www.itg.be - www.travelhealth.be.

10. RABIES (3 injections: on day 1-7-21/28 (3 x 30-40 €), one booster 1 year after the start of the basic vaccination scheme; a supplementary vaccination is needed when being bitten (2 injections: day 1 & 3). For more information: see www.itg.be - www.travelhealth.be.

11. Japanese Encephalitis (Far East) (vaccine "Ixiaro^®": € 83,28 x 2, on day 1 & 28; booster after 12-24 months, later boosters not yet determined). The same protective measures against mosquito bites for malaria are an effective alternative! For more information: see www.itg.be - www.travelhealth.be.

12. European tick-borne Encephalitis (FSME, TBE) (€ 34.5; 3x), FSME-junior

(€ 29,64 x 3). For more information concerning this vaccination and to avoid tick bites; see www.itg.be - www.travelhealth.be.

13. If necessary: (booster) Influenza; Pneumococcal; in exceptional cases: TB (BCG)