What do measles and yellow fever have in common? Depending on the country your patients are travelling to they may need booster vaccinations for both.
Professor Nicholas Zwar, a GP with around 30 years’ worth of research and teaching experience in travel medicine says Australian’s are on the move again post COVID-19, but the travel landscape has changed.
Alongside advising patients to take hard copies of their vaccination record, he warns that travel has become less reliable with delays and luggage losses. This means travellers should also take their medications and copies of their prescriptions in their hand luggage just in case their suitcases go missing.
For GPs, this new landscape presents a lot more to consider when it comes to boosters or vaccinations than it did in the past.
Declining vaccination rates for routine diseases in many countries now means diseases like measles, polio and whooping cough are on the list of boosters to think about, Professor Zwar says.
“We do see that measles has become a disease of travel. It gets introduced into countries through unvaccinated or partially vaccinated travellers. And then if there’s sub optimal vaccination in the local community, it can spread,” he says.
He says the MMR booster is probably most relevant for the 30-40-year-old age group who may have missed out on their second doses.
When it comes to polio, Professor Zwar says circulating wild polio is confined to Pakistan and Afghanistan, but sporadic cases have been popping up elsewhere such as along the border of Israel and Syria and in some countries in Africa.
“It is an indication that diseases that we think are things of the past are not necessarily things in the past. And if vaccination programmes drop away, then things will re-emerge,” he warns.
“If you have sub optimal vaccination rates in the population, you can get the occasional instance where the attenuated virus becomes virulent again and could cause actual polio and that can be transmitted. That is happening in a number of countries around the world and it’s something that WHO and others are quite concerned about.”
His recommendation: if your patient hasn’t had a booster in the past ten years and they’re going to an area where they may be affected, this is one to add to the list.
He adds it’s wise to ensure routine jabs like tetanus, hepatitis B, influenza and pneumococcal are up-to-date, as well as considering vaccinations for vaccine preventable disease such as typhoid and hepatitis A, depending on where the traveller is going and what they’re doing.
When it comes to more exotic diseases, Professor Zwar says it all comes down to a risk assessment of ‘the time, the trip and the traveller’.
“The way I think about it is ‘this traveller’ is all about the person, their history, any long-term conditions, allergies, what previous immunisations they had, potential past exposures, etcetera,” he says.
Next is ‘this trip’.
If the person is going to developing countries, consider:
• food and waterborne disease
• insect bites
• animal bites with possible rabies risk
• malaria risks
• yellow fever if travelling to sub–Saharan Africa or parts of South America.
“If they’re going to the developing world, you really need to think about hepatitis A and typhoid. You need to think about mosquito borne diseases such as dengue and malaria. If you’re going to malarious area, then they should have malaria advice and if needed, drug prophylaxis,” Professor Zwar says.
“As people are travelling more post pandemic the number of cases of malaria seen in returned travellers has increased,” he adds.
That brings us to ‘the time’.
Are they travelling to the developing world or the tropics in the wet season where malaria and other insects are more active? Is there a known outbreak?
He says providing information on avoiding mosquito bites is a must, but he warns there’s a long list of other mosquito-borne infections to consider like dengue, chikungunya and Japanese encephalitis depending on where they’re going to and the time of the year.
Professor Zwar says it’s important to consider what else the traveller could be exposed to. For example, is there political unrest? Are they doing potentially risky activities such as mountain climbing or scuba diving?
“Is there a risk of injury or accidents, is the person travelling alone, might they be at risk of a new sexual contact and STIs? So, think broadly, not just about the vaccine preventable disease,” he urges.
Another thing to consider is the person’s medical history. Depending on a person’s risk profile GPs may have to prioritise which vaccines a person receives. For example, if they are immunosuppressed live vaccines may not be safe and he recommends seeking expert advice if in doubt.
“Yellow fever is a live vaccine and has risks in older people who may have more serious side effects. So, there’s a lot to think about. You have to work through those issues and prioritise the severity of the risk, the likelihood of the risk, and that helps you prioritise which vaccines you’re going to give.”
Professor Zwar says good hygiene measures, such as regular hand washing, never go out of style when abroad and he reminds all travellers to check the COVID requirements for the countries they are travelling to. He also recommends ensuring patients have adequate travel insurance, in case they need care overseas or if seriously unwell need to be medevaced back to Australia.
Related articles:
Malaria cases on the rise – Healthed
Traveller’s diarrhoea: not your bog-standard advice – Healthed
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