Polio, Diphtheria & Tetanus
| Typhoid |
Measles, Mumps & Rubella
| Meningococcus Meningitis
| Hepatitis A
| Hepatitis B
| Tuberculosis |
Yellow Fever |
Rabies | Cholera
| Japanese B Encephalitis
Tetanus, Diphtheria and Polio or Pertussis
These immunizations should
be boosted if it is more than 10 years since your last booster. Polio
has already been eradicated in the Western hemisphere and adults who have had at least one shot are immune for overseas travel. Adults should have at least one Tetanus booster that also contains Pertussis.
Price: no charge to patient
Typhoid
There are 2 injectable vaccines,
called Typhim Vi and Typherix. A single injection of either of these
vaccines gives immunity for 2 to 3 years for those 2 years and older.
Price: $40 per injection
There is also a live, oral
typhoid vaccine (Vivotif). It comes in either liquid or capsule form
and is taken once every other day for a total of 3 doses. The immunity lasts 7 years
and the booster dose is exactly the same as the initial series. It
is very important that the doses be taken exactly as directed. Antimalarials
should be started no sooner than 2 weeks after the final dose of this
vaccine. One must wait until at least 48 hours after
antibiotics to start these capsules. This vaccine is not safe in pregnancy.
It often causes nausea and/or abdominal cramping.
Price: on prescription
Measles, Mumps & Rubella (MMR)
Anyone born after 1956 who
has not received this injection, does not have physician-documented
history of infection with these illnesses or who has laboratory evidence
of lack of immunity to any of these illnesses should receive this
injection.
Two injections give life-long
immunity. If in doubt, get the injection since it is safe to give
it to someone who is already immune, but it is not safe in pregnancy.
Price: no charge to patients
Meningococcus Meningitis
This disease is endemic in sub-Saharan Africa, especially
in the savanna areas extending from Mali eastward to Ethiopia, especially from Dec to June and is spread by droplets in the air so is difficult to avoid There are sporadic outbreaks in the countries south of this as well. Anyone
anticipating travel to these areas should get this vaccine before
leaving Canada.
One shot of the quadrivalent
vaccine gives protection for 3 years and possibly longer. The shot
is not given to children under age 2 but there is a monovalent vaccine
for children that can be used.
Price: $140 per injection
Hepatitis A
Hepatitis A is a viral illness
that is spread by the fecal-oral route and is a threat to anyone travelling to developing countries. Those who have already had
a case of Hepatitis A have lifelong immunity to the disease and those who spent their childhood in a developing country are very likely immune.
There are now 4 Hepatitis
A vaccines available in Canada, Havrix, Avaxim, Vaqta and Epaxal.
They are all interchangeable and are given as a series of two shots
6 months or more apart. The first shot gives immunity in a few days
for several years. The second confers very longterm immunity, probably for life.
Price: $70 Children $40 per injection
Hepatitis B
This disease is spread by
body fluids, the same as HIV, and this vaccine is therefore recommended primarily for
health workers, workers in institutions such as prisons or group homes
and for men who have sex with men. People who are to live in an area
where Hepatitis B is endemic such as east and central Asia, the Pacific
islands, sub-Saharan Africa (extending south to the borders of South
Africa), the interior Amazon basin, Haiti or the Dominican Republic
should make every effort to have the protection of this vaccine. The more one travels overseas the greater the chance of accidental exposure to body fluids so this vaccine should be considered then.
The usual series consists
of 3 shots at 0, 1 and 6 months. An alternative series is
4 shots at 0, 1, 2, and 12 months. Engerix-B, one of the brands of
Hepatitis B vaccine, is stable outside a refrigerator for up to 2
weeks making its transport easy for those who do not have time to
complete the whole series before leaving Canada.
The immunity of this vaccine
is thought to last for many years but it is suggested that blood levels
of the antibody be taken if it has been more than 5 years since the
last shot.
Price: $35 per injection
There is a combined Hep A/Hep
B vaccine called Twinrix. It is given at 0, 1 and 6 months. The immunity
from this vaccine is the same as for the 2 components given separately.
This is useful for those needing both Hep A and Hep B immunization
but 2 shots must be given before travel to get protection against
Hep A which is the biggest danger to travelers.
Price: $70 Children $40 per injection
Tuberculosis
There is no need to receive
BCG, the active vaccine against TB. It is necessary, though, to know
the status of your TB skin test prior to leaving Canada.
If your test is already positive,
have a chest xray before leaving and again upon return. This will
be the case for those who have had, for some reason, BCG and for those
who have been exposed to TB. Do not have a skin test if you have had
BCG.
If the skin test is negative,
have a repeat test done 3 months or more after your return to Canada.
Price: no charge to patient.
Yellow Fever
This shot is recommended only
if travel through tropical Africa (north of Namibia, Zambia and Mozambique)
or tropical South America is anticipated. One shot gives protection
for 10 years. The shot is available only through designated immunization
centres such as travel clinics across
Canada. It is a live vaccine and should not be given to pregnant women
or to those allergic to eggs (but if eggs in baked items are tolerated the vaccine is safe).
Price: $140 per injection
Rabies
This is a series of 3 shots
that takes a month to complete. It is generally recommended only for
people such as veterinarians, foresters, taxidermists or others who
work with, or could come in contact with, animals, dead or alive.
For others, the only advantage of having the shots before being bitten
by a rabid animal is that fewer shots are then required after the
attack.
If an immunized person is
bitten by a rabid animal 3 shots of the same vaccine are then needed
over a period of a week. If an unimmunized person is bitten 3 shots
of the vaccine must be administered over a period of 28 days with
the first shot accompanied by Rabies Immune Globulin. RIG is often
difficult to find, however.. These shots should be begun as soon as
possible after the attack but could be delayed for as long as 2 weeks
afterwards.
Price: $210 per injection
Cholera
The World Health Organization no longer recommends this shot for routine
use. Cholera is a treatable illness and will not be contracted by
someone taking the recommended precautions with food and water. This
is an oral vaccine and is valid for only 6 months and so is of value
only if there is a cholera epidemic where unavoidable exposure to
contaminated water or food may occur, such as for those working in
refugee situations. There is also an oral vaccine, Dukoral, that gives
some protection against both cholera and a strain of E coli but it
is expensive and confers only partial and short-lived immunity.
Japanese B Encephalitis
This is a mosquito-borne viral
illness that may occur in late summer and autumn in Bangladesh, Myanmar
(Burma), China, India, Japan, Cambodia, Korea, Laos, Nepal, Thailand,
Viet Nam and eastern areas of the USSR. Occasional outbreaks also
occur in Indonesia, Malaysia, Philippines, Singapore, Sri Lanka and
Taiwan, usually in the rainy season and early dry season. Children
are most commonly affected.
The risk to short term travellers
and to those who confine their time mostly to urban centres is low.
Risk is highest for those who live or travel in rural areas where
rice culture and pig farming are common. In such areas the same anti-mosquito
measures mentioned in the following section on malaria should be taken.
Ixiaro is given as 2 injections 28 days apart.
Price: $210 per injection
R.J.
Birnbaum, MD, CCFP, FCFP
November 2011