Vacation Vaccinations: Who Needs What and for Where?

Are you planning an out-of-the-country vacation this summer?  You may not be, but some of your patients and their families will be traveling to all sorts of exotic-and not-so-exotic-destinations. Most of them will have given no thought to vaccines they might need beyond what they have already received. Are you prepared to offer them the latest recommendations? Try our summer travel quiz to see how up-to-date you are.

Question #1.

A family of 4, ages 36, 34, and 13 years, and a 10-month-old baby will be spending a week in various parts of Israel, but not the West Bank or Gaza. They are all currently up to date on the CDC recommended vaccines for the United States.  You tell them that the parents need:

A. Typhoid vaccine

B. An extra dose of hepatitis A vaccine (both received the recommended 2-dose schedule before age 18).

C. An extra MMR vaccine (both received 2 doses before age 6).

D. An extra polio dose (both received 4 doses before age 6).

E. 2 of the above recommendations are correct

F. 3 of the above recommendations are correct

Please choose an option and leave a comment?

For answer, discussion, and the next question,CLICK HERE.

Answer: D. The parents need an extra polio dose.

In May 2014, the World Health Organization listed 10 countries with ongoing poliovirus transmission. Three countries (Cameroon, Pakistan, and Syria) are designated as “exporting wild poliovirus” and 7 countries as “infected with wild polio virus” (Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Somalia, and Nigeria). The CDC recommends a single lifetime extra dose of polio vaccine beyond the basic series for persons traveling to any of these countries. 

Had the family planned to visit the West Bank, then typhoid vaccine would be recommended. The CDC provides a special link for travel health notices. Type in the country of interest and quickly see what vaccines and precautions are recommended for that country as a whole, and sometimes for regions of the country as well.

Question #2.

If this same family had planned to spend some time in the West Bank, typhoid vaccine would have been recommended for:

A. Everyone

B. The children only

C. Everyone except the 10-month-old

D. Only the 10-month-old

Please choose an option and leave a comment?

For answer, discussion, and the next question, CLICK HERE.

Answer: C. Everyone except the 10-month-old

Two typhoid vaccine options are available: an oral and an injectable vaccine. The oral, live attenuated vaccine is approved for those 6 years and older; the injectable formulation is approved for those over 2 years of age.

Question #3.

The family asks you some questions about the two typhoid vaccines to help them choose between them. You tell them:

A. The oral vaccine has been shown to be a little more effective than the inactivated injection.

B. The oral vaccine will provide protection for 5 years

C. The inactivated vaccine will provide protection for 5 years.  

D. The inactivated shot is not given to persons younger than 2 years because there is an increased risk of adverse effects.

Please choose an option and leave a comment?

For answer, discussion, and the next question,           CLICK HERE.          

Answer: B. The oral vaccine will provide protection for 5 years

Booster doses are recommended every 2 years if needed for the shot and every 5 years for the oral vaccine. Which of these is more effective is not known. There are no head-to-head trials to determine non-inferiority, which is true with most of our “competing” vaccines (eg, Rotateq vs Rotarix, Merck’s Hep A vs GSK’s Hep A vaccine, etc). The inactivated shot is a polysaccharide vaccine to which children yournger than 2 tend to mount a very poor antibody response. Pneumovax, for example, is another polysaccharide vaccine that is not given to children under the age of 2 for this reason.

Question #4

This intrepid family then plans to visit Paris, France, for 4 days on their way back to the US. You tell them that one or more of them will need:

A. Typhoid vaccine

B. An extra dose of hepatitis A

C.  An extra dose of MMR

D. None of the above

Please choose an option and leave a comment?

For answer, discussion, and the next question, CLICK HERE.

Answer: D. None of the above. 

At this time, no extra vaccines would be needed for travel to western Europe. Had the family chosen this route in 2011, however, the answer would be have been option C.

France had a huge outbreak of measles from 2008 to 2011. More than 20,000 cases, 80% in unvaccinated persons, were reported. Hospitalization rates were high in infected persons: 28% of infected infants and about 35% of infected adults. Pneumonia was the leading reason for admission in both groups. There were 26 cases of encephalitis, 1 of myelitis, and 10 deaths. Because of the widespread nature of this outbreak, in 2011 the CDC was recommending a dose of MMR in 6- to 11-month-old children who would be traveling to France. This dose would not count toward the required/recommended 2 doses for school entry. The rationale for this is that some babies may at that age still have adequate maternal antibodies from birth to interfere with the necessary replication of the live virus in the vaccine; the result is a poor immune response. At the same time, some babies in that age range will not have an adequate amount of antibody to prevent infection.

How many did you answer correctly?

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