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Vaksin untuk Traveller

I. Introduction
Over the last 60 years international tourist arrivals increased from 25.3
million in 1950 to 1.2 billion in 2015.Changes in travel patterns include a
continuing trend for visiting remote destinations and for longer stays.
Many people are unaware that exotic destinations include potential exposure
to infections that are rare in their home environment and other infections
such as malaria that they have never previously encountered. The resurgence
of malaria in many parts of the world, with an increasing pattern of drug
resistance, has led to an increase in the number of cases presenting in non-
endemic areas. The emergence of new infections such as SARS, MERS, Ebola
and Zika virus disease and the spread of dengue fever, chikungunya and
West Nile Virus place an increasing responsibility on doctors to remain up-to-
date with current advice.
Responsibilities that travellers need to accept before travel include:
• Seeking advice in good time
• Complying with recommended vaccines and other medications
• Carrying a medical kit
• Obtaining adequate health insurance cover.
Vaccine for Global Traveller
Vaccines for global travellers :

• Cholera
• Diphtheria
• Hepatitis A
• Hepatitis B
• Influenza
• Japanese B encephalitis
• Meningococcal Infection
• Poliomyelitis
• Rabies
• Tick-borne encephalitis
• Tuberculosis
• Typhoid
• Yellow fever
Cholera
Cholera is an acute diarrhoeal disease caused by an enterotoxin of Vibrio
cholera which has infected the small bowel. Two main serogroups occur (01 and
0139). Humans are the only known natural host for V. cholerae, and the disease is
spread mainly by faecal contamination of water and food. Transmission from person to
person is uncommon.

Vaccine
Cholera vaccine (inactivated, oral) (Dukoral) is provided as a suspension (3 mls) of
inactivated bacteria and effervescent granules for dissolution in 150 mls water. For
details of preparation, see the SmPC. It contains inactivated antigens of serogroup O1
but is not effective against 0139 strains. Protection is achieved in 85-90% of recipients,
with antibodies persisting up to 3 years after the primary course.
Diphteria
Diphtheria
Diphtheria continues to pose a threat to public health and travellers to any
part of the world should be fully vaccinated. Those aged 10 years and over should not
be given the higher strength childhood vaccine due to the possibility of a significant
local reaction.
Influenza
Influenza (notifiable)
All travellers are at some risk of acquiring seasonal influenza during an
outbreak. Tourists are at increased risk because they often travel in crowded
conditions and visit very crowded locations.

Vaccine
There may be, in any given year, a significant difference between strains
circulating during the influenza seasons of the northern and southern
hemisphere which occur at different times of the year (November to April
in the North and April to September in the South). Therefore influenza
vaccine administered in one hemisphere may only offer partial protection
to travellers to a different hemisphere. At-risk travellers who are going to
another hemisphere during the influenza season should arrange to have
influenza vaccine as soon as possible after arriving at their destination.
Japanese B encephalitis
Japanese B encephalitis
Japanese encephalitis (JE) virus is a mosquito-borne flavivrus, closely related
to dengue, yellow fever, tick-borne encephalitis and West Nile viruses, and
endemic in South East Asia. It is predominantly a rural disease causing a
potentially fatal encephalitis. It is spread by bites from mosquitoes (Culex genus) that
bite mainly from dusk to dawn. Rice fields are important breeding sites. Mosquitoes
become infected by feeding on infected domestic pigs and wild birds.

Vaccine
Japanese encephalitis vaccine (inactivated, adsorbed) (IXIARO) is the only
licenced JEV vaccine available in Ireland (see Table 5.2).
A second JE vaccine (Green Cross) is available in some countries.
The vaccine should be stored between +2◦C to +8◦C.
Meningococcal infection
Meningococcal infection
Different meningococcal serogroups predominate in different regions of the world.
Serogroup A predominates in Africa (see Figure 5.1).

Vaccine
Table 5.3 outlines the meningococcal vaccines required for travel. Both are conjugate
MenACWY vaccines.
Indications for Travellers
1. Travel to high-risk areas, including the meningitis belt of Africa and Saudi
Arabia during the Hajj. Vaccination with MenACWY is mandatory for
pilgrims entering Mecca for pilgrimages.
2. Travel to areas where epidemics of meningococcal disease are occurring
(see WHO website for up-to date information)
Poliomyelitis
Poliomyelitis
Transmission of poliomyelitis has been significantly lessened during the
past 20 years. However, in 2016, cases of wild polio were reported from
Afghanistan, Nigeria and Pakistan. Polio continues to pose a public health
threat and travellers to any part of the world (including Europe) should be
fully vaccinated. For an up-to-date list of countries for which polio boosters
are recommended for travellers,
Tick-borne encephalitis (TBE)
Tick-borne encephalitis (TBE)
Although TBE is most commonly recognised when it presents as a meningo-
encephalitis, mild febrile illnesses can also occur. There are three forms of
the disease related to the virus subtypes, namely European, Far Eastern and
Siberian. The disease is caused by a flavivirus belonging to the same family
as Japanese encephalitis, dengue, yellow fever and West Nile viruses.

Vaccine
This is an inactivated TBE Virus produced in chick embryo fibroblast cells and
adsorbed on aluminium. It is presented as TicoVac 0. 5 ml for those aged
16 upwards, and TicoVac Junior 0.25 ml children from 1 to 15 years. Both are
supplied in a prefilled syringe.
TBE vaccine should be stored between +2◦C to +8◦C.
Typhoid
Typhoid fever is a systemic infection caused by
Salmonella typhi or paratyphi. Humans are the only hosts.
Typhoid is predominantly a disease of countries with poor sanitation and
poor standards of personal and food hygiene. It is particularly prevalent
in the Indian sub- continent. All travellers to endemic areas are at risk of
infection. The risk is lowest in tourist and business centres and rises as
travellers enter more rural areas where standards of accommodation and
food hygiene are poor.
Vaccine
Three typhoid vaccines are available.
1. Oral typhoid vaccine (Ty 21a, Vivotif enteric coated capsule). This contains
a live, attenuated strain of S. typhi (Ty 21a). A three dose course gives a
cumulative three year efficacy of 50 to 60%. The vaccine is indicated for
persons from six years of age.

2. Monovalent typhoid vaccine (Typhim Vi). This contains Vi capsular


polysaccharide from S. typhi Ty 2 strain. In non-endemic countries
seroconversion occurs in >90% two to three weeks after single injection.
Efficacy wanes, such that <50% are seropositive after 3 years. Children under
2 years may show a sub optimal response. Use of the vaccine in this age group
should therefore be governed by the likely risk of exposure to infection.

3. Hepatitis A and Typhoid polysaccharide vaccine (Viatim). A dual-chamber


syringe contains 0.5 mls of inactivated Hepatitis A vaccine and 0.5 mls of
Typhoid polysaccharide Ty 2 strain vaccine which are mixed prior to injection.
Yellow fever
Yellow fever
Yellow fever is an acute haemorrhagic fever spread by mosquitoes
that occurs in tropical South America and in many countries in sub-
Saharan Africa. It generally presents as an acute fever with jaundice and
haemorrhage, with a mortality rate of up to 50% in outbreaks. The risk of
acquiring disease increases in patients who travel to rural areas but also
in urban centres reporting outbreaks. Areas where yellow fever occurs far
exceed those officially reported.

Vaccine
Yellow fever vaccine is a live viral vaccine. Duration of protection is lifelong,
with some exceptions. Among over 540 million doses of YF vaccine
administered up to 2015, only 18 vaccine failures were identified.
A certificate of vaccination is required for travel to endemic areas.
The vaccine should be stored between +2◦C to +8◦C.

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