Yellow Fever Vaccinations

Yellow Fever Vaccination & Outbreaks

Yellow fever infection is present in regions of South and Central America as well as Africa.

Increase in disease activity was observed with outbreaks in seven countries across South America, including Colombia, Ecuador, Peru, Bolivia and Brazil between January 2016 and December 2017.

Brazil continues to suffer with new cases being reported. The risk areas for infection has now extended across the country and includes the states of Rio de Janeiro and Sao Paolo. The map below taken from the European Centre for Disease Control and Prevention shows the current situation in Brazil.

Confirmed cases of yellow fever

About Yellow Fever

Yellow fever is a viral infection that is spread by the Aedes spp of mosquito. The mosquito bites during the daytime.

The symptoms present after 3-6 days of contracting the infection with high temperature, muscle aches and loss of appetite. Patients can recover after this stage or go on to develop the severe (Toxic) form of the disease which consists of internal bleeding, organ failure and death. There is no treatment for the infection. Therefore, prevention is key.

There is a highly effective vaccine against yellow fever infection, which takes effect in 10 days and provides protection for a lifetime. The vaccine can be given from 9 months of age.

The vaccine is available at CityDoc Travel Clinics registered as Yellow Fever Centres through the National Health and Travel Network (NaTHNaC).

You can book a free travel consultation at your local CityDoc Travel clinic for assessment of your risk of contracting this potentially fatal, but easily preventable illness and your suitability for vaccination.

Please note that although there no requirement to show proof of vaccination to enter Brazil if you are travelling from the UK, the current outbreak and risk of the disease in Brazil, means that vaccination should be considered for all travelers to risk areas to prevent acquiring this deadly infection.

 

Dr Shalini Mahtha
Medical Director
25/01/2018

Cholera – Vaccination & Outbreaks

Across the African continent, there is an ongoing outbreak of Cholera infection. Nine countries have reported cases as well as deaths to the World Health Organisation. These include the popular destinations of Kenya, Nigeria, Tanzania and Zambia.

In Kenya, outbreaks have occurred in the main Cities of Nairobi and Mombasa and in Zambia, the majority of cases are in Lusaka. The Zambian Authorities have now started a vaccination programme for the residents of Lusaka to prevent the spread.

About Cholera

Cholera is an acute diarrhoeal illness that is spread through contaminated food and water. Disease transmission is linked to poor access to clean water and sanitation facilities. As it is highly infectious, the disease can spread rapidly leading to outbreaks.

The infection can take 12 hours to 5 days to manifest following exposure and can present with profuse watery diarrhoea. The majority of people infected have mild symptoms that are easily treated with oral rehydration salts. In those who develop severe symptoms, the disease can lead to dehydration and death in a few hours of onset if treatment is not sought urgently. Over 50 percent of the most severely affected patients die within a few hours. Severe disease is more likely to occur in those with lowered immunity, pre-existing liver disease or if a high number of infecting bacteria is ingested.

Prevention

Maintaining food and water hygiene is key to prevention of cholera and other infections transmitted this way, such as hepatitis A and Typhoid.

All travelers should:

  • Only drink boiled or bottled water-it may be necessary to use bottled water to brush teeth also.
  • Avoid any ice
  • Only eat food that has been thoroughly cooked-avoid salads, uncooked fruit and vegetables.
  • Avoid raw or under-cooked meat, fish and shellfish.

Vaccination is another method to reduce the risk of infection. The cholera vaccine is available as a drink and can be given to individuals from 2 years and over. It is available at all CityDoc Travel Clinics.

The vaccine consists of 2 doses in individuals above 6 years of age and 3 doses in children between 2-6 years of age.

As the vaccine is inactivated, it cannot cause the disease and nor is the vaccinated person infectious afterwards.

The vaccine should be considered if you are:

  • Travelling to a country with an active outbreak of Cholera
  • If you have an underlying condition, such as liver disease, or immune disorders that will predispose to severe infection.
  • If you are going to undertaking activities that may increase the risk of contracting the infection, such as Humanitarian Aid Work, voluntary work or travel o remote locations where access to clean water may be inadequate.
World Rabies Day - 28th September

World Rabies Day – 28th September 2017

Increasing awareness of an under-reported and deadly disease

About Rabies Infection

rabies-vaccinationRabies is a viral infection that is transmitted by the saliva of infected animals. The virus enters the body through a bite or lick onto broken skin. From the wound, the virus spreads to the brain and nervous system. The incubation period from infection to symptoms can range from 7 days to 1 year, but on average takes 2-3 months.

If treatment is not sought, the disease is invariably fatal. To date, the only survivors of the disease have received rabies vaccine before the onset of illness.

The disease presents as either:

  • Furious Rabies – the most common presentation with symptoms of agitation, hydrophobia (fear of water), which then progresses to coma and death within a few days.
  • Paralytic Rabies – this presents with gradual paralysis of the muscles leading to death from respiratory failure.

Children are much more vulnerable as they are more likely to approach animals and are less likely to report bites and obtain urgent lifesaving treatment. Additionally, the virus does not have far to travel from any wound to the brain so symptoms are more likely to develop leading to invariable fatality.

rabies-batThe Statistics (WHO data)

  • Rabies causes 1 death every 15 minutes worldwide
  • 1 in 4 bites and deaths occur in children under 15 years of age
  • Rabies is found in over 150 countries and in every continent except Antarctica. However, 99% of the deaths occur in Asia and Africa and the majority of cases are due to dog bites
  • In the Americas, Western Europe and Australia, transmission is mainly through bats.
  • Around 29 million people seek lifesaving treatment worldwide each year to prevent rabies.

Prevention

Vaccination before exposure consists of a 3 dose course given at day 0, 7 and 21 or 28 days. After completion of the three dose course, travellers have protection for 10 years, following which, single booster doses only are required.

The vaccine was first used by Louis Pasteur over 100 years ago and is safe and well tolerated. It is an inactivated vaccine and can be used for all ages from birth.

Full three dose vaccination prior to exposure or bite simplifies the post exposure treatment to a further 2 doses of the vaccine. Without pre-exposure vaccination, a 5 dose vaccination course is required as well as possible administration of Rabies immunoglobulin – a life-saving blood product which is in short supply and can be difficult to obtain in many areas.

It is very important that urgent medical attention is sought if a potential rabies bite occurs. The wound should be washed immediately with soap and water for 10-15 minutes and a disinfectant such as Iodine or alcohol should be applied.
Rabies infection is 99.9% fatal without treatment, but is 100% preventable with vaccination.

Meningitis ACWY

Meningitis Certificate Requirements For Pilgrims To Saudi Arabia

Pilgrims attending Saudi Arabia for Hajj or Umrah are required to provide a certificate showing proof of vaccination against Meningitis Strains A, C, W and Y to obtain a Visa.

About Meningitis ACWY

Meningitis is caused by the bacteria, Neisseria Meningitides, of which there are several strains. The combined vaccine provides protection against 4 strains; A, C, W, and Y, which are encountered worldwide.

The infection is spread by coughing, sneezing, kissing and sharing cutlery and utensils.

Meningitis ACWY Vaccine

There are two types of vaccines-conjugated and polysaccharide. Conjugated vaccines have a better immune response and are now the main vaccines used for prevention of Meningitis ACWY.

The conjugated vaccines can be given from 1 year of age (Nimenrix) or 2 years of age (Menveo).

Additionally, Menveo can be used “off license” for those from 2 months to 1 year of age as per Department of Health Guidance, as there is sufficient clinical data on safety and effectiveness.

Since 2015, the conjugated vaccines are given to UK school children aged 14-16 years as part of the national childhood immunisation schedule.

A single dose of the vaccine provides protection for at least 5 years in clinical studies.

Current Guidance for Pilgrims to Saudi Arabia

Meningitis ACWY certificate requirements apply to Adults and children over 2 years of age travelling to Saudi Arabia for Hajj or Umrah.

For the certificate to be valid, the Meningitis ACWY vaccination must be administered as below:

  • Conjugated vaccine (Menveo and Nimenrix)-single dose given within the last 5 years and not less than 10 days prior to arrival.
  • Polysaccharide vaccine-single dose to be given within last 3 years and not less than 10 days prior to arrival.

Visas will only be issued if there is a valid certificate of vaccination at least 10 days prior to entry into Saudi Arabia

Please note that the Saudi Arabian Ministry of Health are advising that the following groups should defer pilgrimage due to potential safety concerns:

  • The elderly (above 65 years of age).
  • Those with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes).
  • Immune deficiency (congenital and acquired).
  • Those with malignant disease.
  • Those who are terminally ill.
  • Pregnant women.
  • Children (under 12 years).
Japanese Encephalitis Vaccine

Japanese Encephalitis Vaccine Scheduling Options

About Japanese Encephalitis

Japanese encephalitis is a viral infection that is found throughout South and South-East Asia, where transmission can be seasonal (usually May-October coinciding with the rains) or all year long.

The virus is spread by the Culex mosquito (vector) and the hosts for the virus are water fowl and pigs. Humans are the end host. Consequently, the disease is mainly found in rural areas, around rice paddies, farmlands (especially pig farms). However, it is important to note that outbreaks can and do occur in urban locations.

Disease Prevention

There is no treatment for the disease and it can cause fatality or permanent disability.

Therefore, all travellers at risk of this of exposure to this illness should carry out Mosquito bite prevention, which includes insect repellent, mosquito nets, insecticide infused clothing (if necessary) and strongly consider Vaccination.

Japanese Encephalitis Vaccine

Ixiaro is the licensed vaccine against Japanese Encephalitis and it is safe to administer from 2 months of age.

Previously there was one schedule, the STANDARD Schedule, which required two doses of the vaccine given 1 month apart (day 0 and 2nd dose day 28). Full protection against the disease is only achieved 7 days after the second dose. Therefore, if you were travelling to an “at risk” destination in less than 1 month and thus, unable to get two doses, you would not be covered against the illness.

There is now an ACCELERATED schedule, which can be used for travellers who do not have enough time to complete the standard course. This is licensed for use in adults aged 18-65 years and consists of two doses given 1 week apart (day 0 and 2nd dose day 7). This schedule provides the equivalent protection 7 days after the second dose as the standard schedule.

Additionally, the Department of Health guidance advises that clinicians can use this ACCELERATED schedule “off license” in children aged 12-17 years also, if there is genuinely insufficient time before travel.

Booster doses should be given at 2 years if there will be further exposure to the illness. After this, in those between 18-65 years of age, a second booster should be given at 10 years.

Travel Health News March 13th 2016

Yellow Fever Outbreaks

News from National Health and Family Planning Commission in China.

Case Report of a man who was found to have confirmed yellow fever in Beijing, China.

The man in question had returned from Luanda, Angola with symptoms of a high fever. There is currently a large outbreak of yellow fever in Angola.

Travel Advice

It is important to remember China has yellow fever vaccination certificate requirements for all those over the age of 9 months. Although there is no actual yellow fever in China, the risk of a potential outbreak is there, because of the presence of the mosquito vector – Aedes Aegypt. An outbreak would require first an infected individual to enter the area and then subsequently to be bitten by the vector mosquito.

Make sure you attend your local Travel Clinic for yellow fever at least ten days before departure. The vaccination lasts for life and the certificate for a minimum of 10 years.

Yellow fever is a live vaccine and there are a number of contraindications so its important you attend a registered yellow fever travel clinic for expert advice. Yellow fever vaccination is contraindicated in those with a true egg allergy.

 

Travel Clinic Alert March 15th 2016

Guidance CDC Providing Care Women following Zika Virus Exposure

New Travel Health guidance from the CDC regarding the provision of care for women of child bearing age after Zika virus exposure. The latest recommendation is for health care professionals to provide serology screening to those pregnant women without symptoms and have travelled to geographical regions with Zika virus cases.

Zika Virus Facts

  • Zika virus transmission is continuing to spread
  • Mainly transmitted by Aedes aegyptimosquitoes,
  • Associated with congenital microcephaly and other central nervous abnormalities
  • There is currently no preventable Travel vaccination or treatment
  • World Health Organization declared Public Health Emergency on Feb 1 st 2016.

Mosquito Bite Prevention

Travellers to areas with Zika virus prescence, are reminded of the importance of bite prevention.

Main methods include-

  • Wear long sleeved clothing and trousers.
  • Use permethrin soaked clothing.
  • Use adequeate strength DEET repellent. 50 % or greater.
  • DEET should be applied after the Sunscreen and may reduce in effectiveness because of the sunscreen, so may need to be re-applied.

Mosquitos spread also

  1. Yellow Fever
  2. Dengue
  3. Japanese Ecephalitis
  4. Chikungunya
  5. Rift Valley Fever
  6. West Nile Fever

Protection yourself before travelling by attending your local Travel Clinic at least 6 weeks before travel.  Ensure you are up to date on all essential vaccinations and obtain the necessary general pre travel advice for your specific itinerary.

Travel Alert South America March 15th 2016

Chikungunya in South America

Chikungunya cases had been initially noted in French Guiana at the end of 2013. The condition has spread throughout the South Americas including

Argentina, Brazil, Columbia, Peru , Venezuela

Prevention Methods

The CDC has recommended that all visitors to South America take extra precautions in terms of bite prevention.

High risk groups for Chikungunya include

  • Travelers over age 65
  • Those who have pre-existing arthritis
  •  Serious chronic disease e.g. Ischaemic heart disease/Diabetes Mellitus
  • Long term visitors and those staying mainly in rural areas

Medical Facts

  • Virus transmitted via mosquitos
  • No travel vaccination available to prevent
  • Spread via same mosquito as Dengue-Aedes specie
  • Most usual symptoms –joint aches particularly hands/feet
  • Other general symptoms include headache, myalgia and rashes
  • Majority recover within 7 days
  • Can cause long term joint pain
  • Death from the condition is very rare

Travel Health News March 10th 2016

Lassa Fever Outbreak Nigeria March 10th

Lassa Fever has been reported in numerous areas of Nigeria. As of March 10th over 250 cases and over 100 fatalities have occurred from Lassa Fever.

Lassa Fever –The Facts

  • Viral Illness transmitted via rats.
  • Humans become infected by direct contact rat faeces or urine
  • Additionally infection through inhalation droppings/or contaminated food

What are the symptoms of Lassa Fever ?

There a number of symptoms associated with Lassa fever and the majority have mild symptoms including-

  • Mild pyrexia
  • Lethargy
  • Weakness
  • Headaches

Severe symptoms include bleeding from the the mouth and nasal passages, Dyspnoea (shortness of breath), generalized pain and shock from blood loss.

Incubation is usually 1-3 weeks post infection. Main region affected are Nigeria, Guinea, Sierra Leon.

Prevention of Lassa Fever

  • Avoid contact with rats
  • Maintaining high standard of food hygiene
  • Do not eat rats
  • Wash hands effectively and regularly

For the latest up to minute pre travel advice ensure you book an appointment at your local travel vaccination centre.

Chikungunya in South America

Chikungunya cases had been initially noted in French Guiana at the end of 2013. The condition has spread throughout the South Americas including

Argentina, Brazil, Columbia, Peru , Venezuela

Prevention Methods

The CDC has recommended that all visitors to South America take extra precautions in terms of bite prevention.

High risk groups for Chikungunya include

  • Travelers over age 65
  • Those who have pre-existing arthritis
  •  Serious chronic disease e.g. Ischaemic heart disease/Diabetes Mellitus
  • Long term visitors and those staying mainly in rural areas

Medical Facts

  • Virus transmitted via mosquitos
  • No travel vaccination available to prevent
  • Spread via same mosquito as Dengue-Aedes specie
  • Most usual symptoms –joint aches particularly hands/feet
  • Other general symptoms include headache, myalgia and rashes
  • Majority recover within 7 days
  • Can cause long term joint pain
  • Death from the condition is very rare

 

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