Vaccines for Travelers

When counselling travellers about the need, benefits and risks of travel vaccines, the following factors must be considered: o Environmental factors, e.g., destination, duration of exposure (including expected cumulative life-time exposure), epidemiological situation, travel style (low budget associated with higher risk), travel purpose (visiting friends or relatives [VFR] - often results in higher risk) o Host factors include e.g. age, origin (potential exposure at home vs. at destination, is there an incremental risk?), pre-existing illness, particularly immune suppression (e.g. HIV, medication), pregnancy, nursing A structured discussion about required, routine and recommended vaccinations is beneficial o Required by destination country: yellow fever (special rules based on the International Health Regulations), meningococcal disease (Hajj), COVID-19 o Routine: usual childhood / adolescence / adult / senior citizen vaccinations. Programs differ between countries. Some proof of vaccination may be required for schools mainly in North America. o Recommended: depending on exposure to risk (incidence rate, also incremental risk compared to home country), impact of infection, cost of vaccines, etc. Essentials when protecting travellers against vaccine preventable diseases: o Set correct priorities; base decisions on epidemiological evidence; consider contraindications o Always state that  No vaccine is 100% effective;  All vaccines may have adverse reactions, rarely serious ones.

Vaccines for Travelers

When counselling travelers about the need, benefits and risks of travel vaccines, the following factors must be considered: Environmental factors, e.g., destination, duration of exposure (including expected cumulative life-time exposure), epidemiological situation, travel style (low budget associated with higher risk), travel purpose (visiting friends or relatives [VFR] - often results in higher risk) Host factors include e.g. age, origin (potential exposure at home vs. at destination, is there an incremental risk?), pre-existing illness, particularly immune suppression (e.g. HIV, medication), pregnancy, nursing A structured discussion about required, routine and recommended vaccinations is beneficial Required by destination country: yellow fever (special rules based on the International Health Regulations), meningococcal disease (Hajj), COVID-19 Routine: usual childhood / adolescence / adult / senior citizen vaccinations. Programs differ between countries. Some proof of vaccination may be required for schools mainly in North America. Recommended: depending on exposure to risk (incidence rate, also incremental risk compared to home country), impact of infection, cost of vaccines, etc. Essentials when protecting travelers against vaccine preventable diseases: Set correct priorities; base decisions on epidemiological evidence; consider contraindications Always state that No vaccine is 100% effective; All vaccines may have adverse reactions, rarely serious ones.

Identifying UK travellers at increased risk of developing pneumococcal infection: a novel algorithm

Background In 2016, the travel subcommittee of the UK Joint Committee on Vaccination and Immunisation (JCVI) recommended that 13-valent PCV (PCV13) could be offered to travellers aged over 65 years, visiting countries without infant PCV immunization programmes. This study aimed to identify, collate and review the available evidence to identify specific countries where UK travellers might be at an increased risk of developing pneumococcal infection. The data were then used to develop an algorithm, which could be used to facilitate implementation of the JCVI recommendation. Methods We conducted a systematic search of the published data available for pneumococcal disease, PCV vaccine implementation, coverage data and programme duration by country. The primary data sources used were World Health Organization databases and the International Vaccine Access Centre Vaccine Information and Epidemiology Window-hub database. Based on the algorithm, the countries were classified into ‘high overall risk’, ‘intermediate overall risk’ and ‘low overall risk’ from an adult traveller perspective. This could determine whether PCV13 should be recommended for UK adult travellers. Results A data search for a total of 228 countries was performed, with risk scores calculated for 188 countries. Overall, 45 countries were classified as ‘high overall risk’, 86 countries as ‘intermediate overall risk’, 57 countries as ‘low overall risk’ and 40 countries as ‘unknown’. Conclusion To our knowledge this is the first attempt to categorize the risk to UK adult travellers of contracting pneumococcal infection in each country, globally. These findings could be used by national travel advisory bodies and providers of travel vaccines to identify travellers at increased risk of pneumococcal infection, who could be offered PCV immunization.

Better Late Than Never - An Analysis of Last-Minute Travelers Attending a Specialist Travel Medicine Clinic in Ireland

Introduction: Last-minute travelers (LMTs) are a vulnerable group, because it may not be possible to adequately vaccinate them against exposure to infectious diseases. The purpose of this retrospective cross-sectional study was to describe the characteristics of LMTs attending a travel health clinic. Methods: The following data was extracted from records of travelers attending the Tropical Medical Bureau (Galway, Ireland) over a 6-year period with less than 2 weeks remaining before their departure: gender, age, occupation, destination(s), purpose of travel, departure date, travel duration, travel group size, accommodation, past medical history, medications, and vaccination history. Results: Of 7555 traveler records, 1296 (17.2%) were of LMTs, of whom 45 (3.5%) were recurrent LMTs. LMTs were equally likely to be male or female. The mean age of this cohort was 32.2 years. The most common travel destination was Asia, and holiday was the most frequent purpose of travel. The mean interval before departure was 7.54 ± 3.65 days, and the mean travel duration was 7.36 ± 2.3 weeks. The majority (n=454, 35.1%) of LMTs traveled in pairs. Approximately 2 in 5 (n=497, 38.4%) travelers reported a past medical history; over half (n=674, 52.0%) had previously received travel vaccinations. The majority (n=1202, 92.8%) of LMTs were unable to complete a scheduled course of pre-travel vaccines. Conclusion: This study provides insight into the characteristics and travel patterns of LMTs. A large proportion of LMTs have pre-existing medical conditions. Further research should focus on the travel health risk-taking behavior of these individuals.