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

Revision as of 15:07, 20 April 2017

Template:Traveller vaccination cholera Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

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).

@@ Line 3: / Line 3: @@
 {{CMG}};{{AE}}{{MehdiP}}
 ==Disease cause==
-[[Vibrio cholerae]] bacteria of serogroups O1 and O139.
+Toxigenic Corynebacterium diphtheriae and in tropical climates occasionally toxigenic C. ulcerans.
 ==Transmission==
-*Directly or indirectly contaminated food or water with faeces or vomitus.
+C. diphtheriae residing in the respiratory tract is transmitted through droplets and close physical contact; C. ulcerans by close contact.
-*[[Cholera]] affects only human beings; there is no insect vector or animal reservoir host.
 ==Nature of the disease==
-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.
+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==
-*Mainly in low-income countries with poor access to sanitary and clean water.
+*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" />
-*Many developing countries are affected, particularly in Africa and Asia and, to a lesser extent, in Central and South America.
-[[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.
+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==
-*Oral vaccine consisting of killed whole-cell V. cholerae O1 in combination with a recombinant B-subunit of cholera toxin (WC/rBS).
+*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).
-*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 ==
-{| class="wikitable"
-!
-!Considerations
-|-
-| 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)
-|-
-|
-* Two doses 14 days apart for individuals aged ≥2 years. One booster dose is recommended after 2 years.
-|-
-|Contraindications
-|Hypersensitivity to previous dose.
-|-
-|Adverse reactions
-|Mild gastrointestinal disturbances.
-|-
-|Before departure
-|2 weeks.
-|-
-|Indication
-|Travellers at high risk (e.g. emergency/relief workers).
-|}