Traveller vaccination diphtheria, tetanus, and pertussis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Traveller vaccination cholera}}
{{Traveller vaccination}}
{{CMG}};{{AE}}{{MehdiP}}
{{CMG}};{{AE}}{{USAMA}}
==Disease cause==
==Diphtheria==
[[Vibrio cholerae]] bacteria of serogroups O1 and O139.
Protection against diphtheria is not specific to the needs of travellers. In most countries diphtheria vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.
==Transmission==
===Disease cause===
*Directly or indirectly contaminated food or water with faeces or vomitus.
Toxigenic [[Corynebacterium diphtheriae]] and in tropical climates occasionally toxigenic C. ulcerans.
*[[Cholera]] affects only human beings; there is no insect vector or animal reservoir host.
===Transmission===
==Nature of the disease==
[[Corynebacterium diphtheriae|C. diphtheriae]] residing in the respiratory tract is transmitted through droplets and close physical contact; C. ulcerans by close contact.
Mostly asymptomatic. Mild cases present with watery [[diarrhea]]. In severe cases, there is sudden onset of profuse watery diarrhea with [[nausea and vomiting]] and rapid development of [[dehydration]]. In severe untreated cases, death may occur within a few hours due to dehydration leading to circulatory collapse.
===Nature of the disease===
==Geographical distribution==
Clinical manifestations are usually mild but, occasionally, potent bacterial [[toxins]] cause obstructive membranes in the upper respiratory tract ([[croup]]) or damage to the [[myocardium]] and other tissues. Systemic manifestations are less likely to be caused by C. ulcerans.
*Mainly in low-income countries with poor access to sanitary and clean water.
===Geographical distribution===
*Many developing countries are affected, particularly in Africa and Asia and, to a lesser extent, in Central and South America.
Very rare in countries with high coverage with diphtheria/tetanus/pertussis (DTP) vaccine. Incidence increases in crowded regions where vaccination programmes are insufficient and standards of hygiene are poor. <br clear="left" />
[[image:Cholera-1.jpg]]
<br clear="left"/>  
==Risk for travellers==
Risk for travellers is low even in epidemic regions. However, humanitarian relief workers in disaster areas and refugee camps may be at risk.
==General precautions==
*Cholera vaccination is not required as a condition of entry to any country.
*Avoid drinking or eating unsafe water or foods.
==Vaccine==
*Oral vaccine consisting of killed whole-cell V. cholerae O1 in combination with a recombinant B-subunit of cholera toxin (WC/rBS).
*Primary immunization consists of two oral doses  ≥7 days (but <6 weeks) apart for adults and children aged 6 years and over.
*For children aged 2–5 years, three doses are recommended.
*Following primary immunization, protection against cholera may be expected after about 1 week.
*The vaccine is not licensed for children under 2 years of age.


== Summary of vaccine data ==
===Risk for travellers===
{| class="wikitable"
Risk of exposure increases in populations with low DTP vaccination coverage.
!
===General precautions===
!Considerations
Cholera vaccination is not required as a condition of entry to any country.
|-
Avoid drinking or eating unsafe water or foods.
| rowspan="2" |Type of vaccine
|Killed oral O1 whole-cell with Bsubunit.
|-
|Killed oral O1 and O139.
|-
| rowspan="2" |Number of doses
|
* Two doses (minimum 1 week and maximum 6 weeks apart).  


* Three doses for children aged 2–5 years (minimum 1 week and maximum 6 weeks apart)
===Vaccine===
|-
For primary or booster vaccination appropriately formulated combined DTP vaccines should be used according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content (diphtheria toxoid or tetanus-diphtheria-acellular pertussis vaccine).
|
 
* Two doses 14 days apart for individuals aged ≥2 years. One booster dose is recommended after 2 years.
==TETANUS==
|-
Protection against tetanus is not specific to the needs of travellers.
|Contraindications
In most countries tetanus vaccine is routinely administered in
|Hypersensitivity to previous dose.
childhood. Missing vaccinations in travellers should be offered
|-
according to national recommendations.
|Adverse reactions
 
|Mild gastrointestinal disturbances.
=== Disease cause ===
|-
The bacterium ''[[Clostridium tetani]].''
|Before departure
 
|2 weeks.
=== Transmission ===
|-
Spores of C. tetani may contaminate necrotic, [[anaerobic]] tissue and transform into vegetative, toxin-producing bacteria. [[Tetanus]] is not communicable.
|Indication
 
|Travellers at high risk (e.g. emergency/relief workers).
=== Nature of the disease ===
|}
Potent bacterial neurotoxins originating from vegetative C. tetani may cause local muscular spasms or generalized tetanus. Untreated generalized tetanus is often fatal.
 
=== Geographical distribution ===
Spores of C. tetani are widespread globally, particularly in the soil.
 
=== Risk for travellers ===
The risk is linked to acquisition of contaminated injuries. This risk is not necessarily increased when travelling.
 
=== Vaccine ===
Travellers should be vaccinated with combined diphtheria/tetanus or DTP vaccines according to national recommendations. Individuals ≥7 years of age should receive tetanus containing combinations with reduced content of diphtheria toxoid.
 
== Pertusis ==
Protection against [[pertussis]] is not specific to the needs of travellers. In most countries pertussis vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.
 
=== Disease cause ===
The bacterium [[Bordetella pertussis]].
 
=== Transmission ===
[[Bordetella pertussis]] is transmitted from infected respiratory mucosa through droplets.
 
=== Nature of the disease ===
The [[Bordetella]] bacteria colonize only [[ciliated]] cells of the respiratory mucosa causing [[whooping cough]] (pertussis), an acute respiratory infection marked by severe, spasmodic coughing episodes during the paroxysmal phase. In early infancy, pertussis may be atypical and sometimes life-threatening. Disease manifestations are less dramatic with increasing age, including in adults.
 
=== Geographical distribution ===
Pertussis incidence depends on DTP vaccination coverage; the disease is common where coverage is low and rarely seen in countries with high DTP vaccination coverage.
 
=== Risk for travellers ===
The highest risk is for unvaccinated infants visiting countries with low coverage of DTP vaccination.
 
=== Vaccine ===
For primary as well as booster vaccination one should use acellular (aP) or whole-cell (wP) pertussis vaccines in fixed combination with vaccines against diphtheria (D) and tetanus (T). The schedule should be according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content
 
== References ==
{{Reflist|2}}

Latest revision as of 18:40, 20 April 2017

Vaccination Main Page

Traveler Vaccination

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Overview

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Diphtheria, tetanus, and pertussis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Diphtheria

Protection against diphtheria is not specific to the needs of travellers. In most countries diphtheria vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.

Disease cause

Toxigenic Corynebacterium diphtheriae and in tropical climates occasionally toxigenic C. ulcerans.

Transmission

C. diphtheriae residing in the respiratory tract is transmitted through droplets and close physical contact; C. ulcerans by close contact.

Nature of the disease

Clinical manifestations are usually mild but, occasionally, potent bacterial toxins cause obstructive membranes in the upper respiratory tract (croup) or damage to the myocardium and other tissues. Systemic manifestations are less likely to be caused by C. ulcerans.

Geographical distribution

Very rare in countries with high coverage with diphtheria/tetanus/pertussis (DTP) vaccine. Incidence increases in crowded regions where vaccination programmes are insufficient and standards of hygiene are poor.

Risk for travellers

Risk of exposure increases in populations with low DTP vaccination coverage.

General precautions

Cholera vaccination is not required as a condition of entry to any country. Avoid drinking or eating unsafe water or foods.

Vaccine

For primary or booster vaccination appropriately formulated combined DTP vaccines should be used according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content (diphtheria toxoid or tetanus-diphtheria-acellular pertussis vaccine).

TETANUS

Protection against tetanus is not specific to the needs of travellers. In most countries tetanus vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.

Disease cause

The bacterium Clostridium tetani.

Transmission

Spores of C. tetani may contaminate necrotic, anaerobic tissue and transform into vegetative, toxin-producing bacteria. Tetanus is not communicable.

Nature of the disease

Potent bacterial neurotoxins originating from vegetative C. tetani may cause local muscular spasms or generalized tetanus. Untreated generalized tetanus is often fatal.

Geographical distribution

Spores of C. tetani are widespread globally, particularly in the soil.

Risk for travellers

The risk is linked to acquisition of contaminated injuries. This risk is not necessarily increased when travelling.

Vaccine

Travellers should be vaccinated with combined diphtheria/tetanus or DTP vaccines according to national recommendations. Individuals ≥7 years of age should receive tetanus containing combinations with reduced content of diphtheria toxoid.

Pertusis

Protection against pertussis is not specific to the needs of travellers. In most countries pertussis vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.

Disease cause

The bacterium Bordetella pertussis.

Transmission

Bordetella pertussis is transmitted from infected respiratory mucosa through droplets.

Nature of the disease

The Bordetella bacteria colonize only ciliated cells of the respiratory mucosa causing whooping cough (pertussis), an acute respiratory infection marked by severe, spasmodic coughing episodes during the paroxysmal phase. In early infancy, pertussis may be atypical and sometimes life-threatening. Disease manifestations are less dramatic with increasing age, including in adults.

Geographical distribution

Pertussis incidence depends on DTP vaccination coverage; the disease is common where coverage is low and rarely seen in countries with high DTP vaccination coverage.

Risk for travellers

The highest risk is for unvaccinated infants visiting countries with low coverage of DTP vaccination.

Vaccine

For primary as well as booster vaccination one should use acellular (aP) or whole-cell (wP) pertussis vaccines in fixed combination with vaccines against diphtheria (D) and tetanus (T). The schedule should be according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content

References

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