Vaccination

The following information is taken from the Travel Doctor TMVC‘s Bhutan Advisory. Please consider this general advice and contact your medical professional for specific questions.

Routine background Immunisation | Hep A | Hep B | Typhoid | Rabies | Japanese Encephalitis | Cholera | Malaria Medium Risk | Dengue Fever | Medical Kits & Products | Travel Medicine

Routine background immunisation

All travellers should be up-to-date with their routine, “background” , vaccinations.

These are usually commenced as babies, and some boosters are due into adult life. The range of diseases includes those that are very common and severe in places where vaccinations are inadequate or absent. This includes:
-Tetanus and Diphtheria, and travellers should have had a tetanus booster in the last 10 years.
-Pertussis, (whooping cough) is now often combined with tetanus and diphtheria.
-Polio, which only requires a single booster in adult life.
-Measles, Mumps and Rubella ( German Measles) are common childhood infections, and protection is provided after two combination vaccinations through life.
-Chicken pox, (varicella), is preventable by vaccination.

-Influenza is now considered a routine vaccination, and travellers should have an annual influenza vaccination. It is safe for children from 6 months of age and upward.

The vaccine for tuberculosis is not very efficient, and so is not routinely recommended any more. It may be considered for small children (under 5 years) if travelling long-term or living in developing countries where the rate of tuberculosis in the community is high.

Other paediatric vaccines for consideration in travellers will include rotavirus, haemophilus influenzae type b, and pneumococcal vaccine, and where indicated, rapid schedules for baby travellers can be done. See Travel Doctor-TMVC.

Hepatitis A

Hepatitis A is recommended for this trip. This viral disease is transmitted through eating contaminated food or drinking contaminated water. Most adults in less developed countries have already acquired the disease in childhood and are immune for life.
Vaccines (there are several available) are all very effective and safe and will provide very longlasting protection.

Hepatitis B

Consider hepatitis B for this trip if you are a frequent traveller or intending on a long stay overseas. This viral disease is transmitted via blood, blood products or bodily fluids – similar to HIV. The vaccine provides good protection but in high risk situations confirmation should be made by blood testing.

Typhoid

Vaccination against typhoid fever should be considered for travellers to the above country/ ies. It is particularly recommended for all travellers to areas where environmental sanitation and personal hygiene may be poor.

Immunisation provides approximately 70% protection and can be achieved using different vaccines:
– a single injection, typhim Vi vaccine lasting for three years. This provides good early protection. It also has few side effects. It also comes combined with hep-A vaccine.
– oral typhoid vaccine (Vivotif capsules). These capsules are taken on alternative days for 3 doses (providing 1 years protection) or 4 doses (providing 5 years)

Rabies

Pre exposure vaccination against rabies should be considered for all travellers spending extended periods of time in the above country/ies. It is strongly suggested for individuals working with animals eg veterinarians, animal handlers, zoo workers etc.

Rabies is a fatal viral disease of the central nervous system transmitted by the saliva of an infected animal (usually dog, cat etc).
The incubation period ranges from days to months and no treatment is available once the disease is symptomatic.
Pre exposure vaccination involves 3 IMI injections at 0,1,4 weeks of one of the modern cell-culture derived vaccines. Rabies vaccine can be given to anyone over 12 months age and boosters after 2 – 3yrs years only if at high-risk. If using vaccine by the intradermal route antibody levels must be tested prior to departure. .

Japanese Encephalitis

Recommended for travellers spending at least 4 weeks in rural areas of the transmission zones. Expatriates and long term travellers should be vaccinated. This viral disease is transmitted by mosquitoes and is more prevalent in rice growing areas where pig farming is common.

Vaccination should be considered in the following situations.
A. Long term residents staying in endemic areas.
B. Travellers spending more than 4 weeks continually in rural rice growing areas endemic for JE.
C. Individuals visiting areas where an epidemic is current.

Cholera

Cholera is reported in the above country/ies but Travel Doctor-TMVC does not generally recommend vaccination for most travellers, as the actual risk of acquiring the disease is low. Care with food and beverage selection is far more important than vaccination.
Where an individual has a particularly high risk, eg travellng in an epidemic situation, hospital worker etc, a very effective oral vaccine is available that can provide good protection for about 2 years. It is two doses taken as a drink about 1 week apart.

Cholera vaccination is not subject to International Health Regulations for any country however there are a few border crossings in Africa where customs officials may seek a certificate of vaccination.

Malaria Medium Risk

Malaria in this country is considered medium-risk. This may be because of the amount of disease burden, the intensity of biting of infected mosquitoes, the local type of malaria, and the health resources available for diagnosis and treatment. For most countries in this category it is because malaria only occurs in certain areas (usually rural).

The principles of protection include avoidance of bites from mosqitoes, early diagnosis and treatment for illness, and preventive medications (chemoprophylaxis).

The choice of medication depends on many factors, both related to the prevailing malaria situation, and to the personal requirements of the traveller. In general, Travel Doctor-TMVC will determine the level or location of risk and if medications are considered warranted will choose from doxcycline, malarone or mefloquine for this country.

Dengue Fever

Dengue Fever occurs in this country. It is a viral illness that occurs widely through the tropical countries, and is transmited by day-biting mosquitoes. It is caused by 4 subtpes of Dengue virus, and all produce an identical illness charecterised by fever, headache, body aches and pains and rash. It lasts for about 2 weeks. A rarer form of the illness, Dengue Haemorrhagic Fever, is thought to be caused by a second infection with a different subtype.

Currently no vaccine is available, but a trial vaccine against all 4 strains is undergoing late trials and is expected to be available in Travel Doctor clinics in the near-future. Protection is by avoiding mosquito bites, and avoiding aspirin if sick.

Medical Kits and Products

A medical kit should be prescribed for this trip. Medical kits contain prescription and non-prescription medications for the self management of common travellers problems while away, and are vital for healthy travel. Travel Doctor-TMVC has a range of medical kits to suit different types of itineraries and destinations.
Insect repellent is an important additional item to be carried, and is a main item for protection agains at a wide range of insect-borne diseases.
Other considerations include sun-block, water purifiers, mosquito nets and travellers’ support stockings. Travel Doctor clinics are your one-stop-shop.

TRAVEL MEDICINE and your trip

The following information must be viewed as a guide only. It is not intended nor implied to be a substitute for professional medical advice. Specific travel health advice is recommended on an individual basis, taking into account the personal health of the traveller including past medical and vaccination history, intended activities, itinerary, style of travel, type of accommodation, time of year, altitude and length of stay. Some vaccines eg rabies, tuberculosis are very much influenced by local risk and length of stay. Specific advice is particularly important when recommending antimalarial medications and vaccines for the more exotic trip.

We strongly recommend travellers seek an appointment with your closest Travel Doctor-TMVC clinic, or in countries where no Travel Doctor-TMVC clinic is available, with a doctor trained in travel health.

Medical and nursing staff at The Travel Doctor (TMVC) are trained in international public health issues with a focus on immunisations and preventive medicine. Many have travelled extensively and a number have worked in less developed areas of the world for extended periods. Travellers undergo individual risk assessments whether they are short term holiday makers, business people or the long term expatriate worker. In Australia the local centre may be contacted on 1300 658 844

Similar travel medicine centres and medical practitioners with an interest in travel medicine may be found in many countries internationally.

Your medical advisor may cover the following vaccinations and healthy travel information.