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TRAVELLERS

Category

Vaccine

Comments

These vaccines are legal requirements for I

travel. Failure to obtain vaccines could result in non-entry/quarantine in destination as well as

home country j

Routine vaccination

Diphtheria/tetanus/pertussis Hepatitis B Measles-Rubella-Mumps Poliomyelitis

References

1. WHO. Intemational travel and health. (Website. www.who.intlith

2. Centers for Disease Control (Website: www.cdc.qov.travel)

Recommendations for these vaccines depend I on the countries of destination, the current ~ outbreak situation at the time of travel. the

~~d~~e. ~~~~.r.~ .. ~.e.ta.I.'.tu.t .. ~eoirt~.~~~~~~;~th of s. tay

As recommendations will change from time to

time, it is prudent to access the latest advisones from the following sites maintamed by the CDC and WHO

1. WWW.cd_c.goY.travel

2. www.whO.inVith

Mandatory vaccination

Yellow fever fur aunavelers traveling to or from yellow-fever endemic countries

Meningococcal vaccine (tetravalent) for all Haj and Umrah iI rims

Selective use for travelers

Cholera Influenza Hepatitis A

Japanese encephalitis Lyme disease Meningococcal Pneumococcal Rabies

Tick-bome encephalitis BGG

Typhoid

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5 Barra A, Cordonnier C, Preziosi MP et at. Immunogenecity of Hemophilus Influenzae type b conjugate vaccine in allogeneic bone marrow recipients. J Infect Ois 1992; 166: 1021-1028

6. Parxkell T, Kaythy H, Ruutu T et al. A comparison of early and late vaccination with Hemophilus Influenzae type b oonjugate and pneumococcal polysaccharide vaccines after allogeneic BMT. Bone Marrow Transplant 1996; 18:961-967

VACCINATION SCHEDULE FOR ADULTS AWAITING SOLID ORGAN TRANSPLANTATION AND SOLID ORGAN TRANSPLANT RECIPIENTS '( Level 9)

~~~~~~~~~~

i Vaccine . Fully Immunised

i Defined hll~na=~~iv~a~te·d~-~-~~~~~~~~~~~~~~~---_L---------- ~-----------------, i Vaccine

I Routine Schedule Once ; Comments

i Fully Immunised

. Diptheria,tetanus 3 doses, last within 10 Td-l Td-2 Td 3 ! Td every 10 years -l

years I I

'H~a~e~m~op~h~iiu~s~~~~~~~---~i-~~~~~~--~~~~~r-~~~--~~~-ti7C~o~nS~id~e~rf~or~lu~n~g"tr~an=s~PI~an~t~

Infleunzae : Not rout_inTel~y~re_co",m."m_e_n,de7Cd~= __ ~~-.",--,=-~==~ .i, recipients

i TypeBcon~ugate I -,-~~~~~~~c=c _ .. _

I Hepati~i~ 6 : 3 doses HepB-f Hep B-2 i Hep B-3 Booster if titer <10mlUtml '

._: "/e,-,v",el-,,8L_}-,-,,.--+"'~====-~--i-==,.----i -~~-+~~~~--c==""co---,...,-,-=c;-~~~~~-. -,.----_J

: Pneumococcal I 2 doses of PPV23 PPV23-1 i Complete 2 doses, second

h~epatitis A J 2 doses, at risk patients Hep A-1Hep--;;A-'-2'-~-f1 ~~~:S"'c~=~~~:"::~~e~ft:rf~~~i~~~e at

(JeveI9) only i (isk, complete 2 doses

I

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,-; ~",ae"'~=;~"';O"'OO"'C::-ca:OI--i-'.;i~; ~~!i:;~~~~k Mening-1

~'v~a~~~i~ne~ __ ~~pa~.~-.~nt~s~onIL __ ~~_L~~~~

Use if Indicated

I ~tr~i:~;n~!~~~~a~t~:~ :~ing

! chronic liver disease and

i those with risk of exposure to I hepatitis A

Recommended for patients at i risk '

- i· ~ecommended for patien~ts~a~t-1!'A"I-'-ris:OkCCin"'c'-/u7deC::S"lhC::oC:-se::--wCCi"'th~--'

~~~-'-~~~~Lr",lS",k" _9Omplete 1.2 doses,2nd !~enia.trayel exposure and

IPV-3

IPV-1 IPV-2

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4 Palmovic D, Prevention of hepatitis B infection in health care workers after accidental exposure. Journal of Infection. 1987, 15(3):221-4

5. CDC. Varicella zoster immune globulin for the prevention of chickenpox. MMWR 1984;33:84-90,95-100.

6. Human Rabies Prevention - United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP), MMWR 1999; 48 (RR-1).

VACCINATION SCHEDULE FOR BLOOD AND MARROW TRANSPLANTATION (ALLOGENEIC AND AUTOLOGOUS),,2,3.4(LeveI9)

Time after Transplantation

Vaccine or toxoid

I 14 months I 24 months

12 months

Inactivated vaccine or toxoid

Diphteria,tetanus, Pertussis

Children aged < 7 yrs

DT should be used if there is any contraindication for pertussis vaccination

Diphteria toxoid-tetanus toxoid- I DTP or DT I DTP or DT

pertussis vaccine(DTP) or

diphteria toxoid-tetanus

lo,oid(DT) ~C"h"'ild~r~en~a~ed~>7~yr~~~T~e~la~nu~~~d2i~h~le~ria~l~O'~O~id~T~DO---~TD~--~------~~e~s----+nBoo~~~e~re~v~~e~1~~e~a=rs------~

Adults ~~b conjugate ~~ conjugate I ~~ conjugate yes Boo~t~~~~~___!Q_ye~s

t~:em~~~il~~~~f15utnzae I: yes -1

Pneumococcus (level PPV23 I PPV23 I' yes Recommended that adjunc1lv~

5) I antibiotics proptrylaxls for patients

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1--1

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- 'Varicella zoster --- -.

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(VZIG) (maximum: 625 Units) 10 a person with varicella

I administered as soon as possible Household contact, close

, ~~~~~"; 72 hours after known pro,ongE~I~~~~E:c~ 4

contact e.g occurs with nurses or

-----.-- ,Hepatltls,B ... doctorswhocar~!orpatient

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(HBIG) after exposure.' {Level 3)

LI Susceptible. severely immunocompromised persons after significant exposure to needlestick, sexual exposure to person positive for hepatitis B surface antigen

If the Hepatitis B vaccine series has not been started.

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I administered 1 month later (for percutaneous I mucous

; membrane exposure) or 3

l__ __l _.l...-"m",o",nt""hs"l",at,,,er.l~exual exposure)

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i should be repeated at 1 month

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Note 3: Vaccination for haemodialysis and chronic renal failure patients (Level 9)

The above persons are at high risk of infection with HBV and routine serologic screening is advised. Susceptible patients should receive three doses of HB vaccine of double strength. Postvaccination antibody screening is recommended. Revaccination is considered for non-responders and if anti-HBs levels remain < 10m1U/mL. As these patients are at increased risk of lower respiratory infections, pneumococcal and influenza vaccination are also recommended.

References'

1 Recommendations of the Advisory Committee on Immunization Practices: Use of vaccines and immune globulins in persons with altered immunocompetence. MMWR 1993; 42{RR-04)

3. Anonymous. Australian Immunization Handbook 2001

2 CDC. Update on adult immunization: Recommendations of the Advisory Ccmmdee on Immunization Practices(ACIP). MMWR 1991; 40(No.RR-12)

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IMMUNOCOMPROMISED PATIENTS

VACCINATION FOR INDIVIDUALS WITH SPLENECTOMY OR FUNCTIONAL/ANATOMICAL ASPLENIA

, Recommended P01Y\fa~~~~~:~mocOreus, i To be give~ea~~~a~~~-~~i,~csCCb'"'e-;:foC::reC-;"'B;COO=SI=-er:-:d;::O=-se:::s-:Crec:-:C"'o~=mm=:::~:::;~I=:d.-ce::Cv=ery=5CCye:::aC:rs:--

~.e~~ngococcus, Hib _]1 splenectomy or soon after surgery , _ ~~~i~~~~~~~~~us and 3 years for

Use if indicated: BeG, Hepatitis A. Influenza, MMR,

Inactivated polio vaccine, Rabies. Td, Typhoid. Varicella

and Vaccinia _J_ _

VACCINATION FOR INDIVIDUALS WITH SUPPRESSED IMMUNITY DUE TO DISEASE OR TREATMENT

Vaccine HIV Immunosuppression T- Renal failure Diabetes -Ai~_~oliSn:!_ __
BCG C C UI UI UI
~··~'(BOUbJe UI UI UI UI U,---------
UI UI !R UI UI
dose)
Hib UI R i UI UI UI
Influenza ,R R iR R R , ... _---
, MMR R- C UI UI UI
Meninaococcus UI UI UI UI lUI
i IPV oolio UI UI UI UI • UI
OPV oclo, live C C UI UI ' UI
Pneumococcus R R R UI UI
Rabies UI UI UI or UI
Td UI UI UI UI UI
Typhoid, UI UI UI or UI
inactivated & Vi
-Varicella C C UI UI UI
Vaccinia C C UI I LiT \/'-,------
c ccntratndtcated R recommended UI - use if indicated 75

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The following vaccines are recommended as for the general adult population:

Tetanus

• Diptheria

• Pneumococcal polysaccharide vaccine

References.

1. Hadler SC, Margolis HS. Hepatitis B immunization; Vaccine types, efficacy & indications for Immunization, Current topics in Infectious Diseases.

Boston Blackwell Scientific, 1992: 282-308

2. Peces R, Laures AS. Persistence of immunologic memory in long-term hemodialysis

patients and healthcare workers given hepatitis B vaccine: role of a booster dose on antibody response. Nephron 2001 Oct;89(2):172-6

3. European Consensus Group on Hepatitis B Immunity.Are booster immunisations needed for lifelong hepatitis B immunity? Lancet 2000 Feb 12;355(9203):561-5

4. Williams JL, Christensen CJ, McMahon BJ, et at. Evaluation of the response to a booster dose of hepatitis B vaccine in previously immunized health care workers.Vaccine 2001 JuI16;19(28-29):40B1-5

5. Davis RM, Orenstein WA, Frank Jr. JA et al. Transmission of measles in medical settings. 1980-84. JAMA 1986; 255:1295-1298.

6. Sienko DG, Friedman C, McGee HB et at. A measles outbreak at university medical settings involving healthcareworkers. Am J Public Health 1987; 77:1222-4.

7. Wharton M, Cochi SL, Hutchison RH, Schaffer W. Mumps transmission in hospitals.

Arch Intern Med 1990' 150:47-49.

8 CDC. Mumps prevention. Recommendations of Immunization Pra~tjces Advisory Committee.

MMWR 1989; 38:388-392, 397-402

9 Greaves WL, Orenstein WA, Stetler He et at. Prevention of rubella transmission in medical facilities.

JAMA 1982; 248:861-864.

10. CDC, Increase in rubella and congenital rubella syndrome - USA 1988-90 ..

MMWR 1991; 40:93-99.

73

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* The category of neettncsre workers (HeWs) include persons who provide healthcare to patients or work in institutions that provide patient care ego doctors. nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, hospital volunteers and support staff providing patient care in health care institutions

On the basis of documented nosocomial transmission, HeWs are considered to be at significant risk for acquiring and transmitting the following vaccine-preventable infections.

The following vaccinations (listed in the table) are strongly recommended among HeWs:

rCategoryofHCW r :": rec~:~~~~ed

l All health care wor"'k=ercc, --+---"H=ep=a""tit=i'''Scc,CCj) --h1" ,C:a=cc:::Cin=a"'tio:::n","'h=o,"'ld"b=e,--hP;::re:Cv=ac=c"'in:::a'=io:Cn ='e"'ro"'lo=9::::iC,----1

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Indicated for Hews who do not have documented vaccination. physician-diagnosed infection or serologic evidence of immunity Not indicated in pregnant women (8,9;

Timing

Comments

(Level 1)

Post vaccination serologic testing for antibodies recommended. (1)

Measles, mumps i 10 vaccination (2 doses)

and rubella before onset of career

(5-10) MMR vaccine preferred.

Heahhcare workers who have contact with patients at high-risk of influenza or its complications;

HeWs who work in chronic care facilities.

(Level 4)

Booster doses not necessary (8,9)

Influenza (12-14)

__ _L__ ~

Annual vaccination (1M)

(Leve/4)

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Vaccines and toxoids recommended for adults, by age groups. Summary:

Age group

(years) Td + Measles Mumps Rubella Influenza

Pneumococcal Polysaccharide

25-64

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