Five Things You Need to Know About Common Resort Travel Vaccines

1.      Most Young People are Not Going to Require Hepatitis B Vaccine

  • Hepatitis B vaccine is recommended for almost every traveller
  • Hepatitis B immunization has been part of the routine immunization for many years
  • Most people under 35 years will not require hepatitis B immunization prior to travel, if they received their full does as a child or teen

For more information on Hepatitis B, check out the Canadian Immunization Guide section on Hepatitis B Vaccine

2.      Hepatitis A Vaccine can be Given up to the Day of Travel

  • Hepatitis A virus has a long incubation period
  • You can inject one dose of hepatitis A vaccine on the day of travel and the patient will be protected for the trip
  • It is important to remember to give them a booster dose at 6 to 12 months to allow for long-term protection

For more information on Hepatitis A, check out the Canadian Immunization Guide section on Hepatitis A Vaccine

3.      The Timing of Travel Can Impact the Hepatitis Vaccine Choices

  • Ideally, hepatitis B vaccination should begin ≥6 months before travel so the full vaccine series can be completed before departure
  • You can determine the option to use by asking two questions:
    • Is the traveller under 35 years of age?
      • If yes, they may have been immunized by the routine or school-based program of your province of practice for Hepatitis B. If they have, they would only require hepatitis A vaccination.  However, be sure to check records.
    • When is the patient leaving for travel?
      • ≥ 30 days before travel – Regular schedule for adults (day 0, 30, 180 days)
      • 21-28 days before travel – Rapid schedule for adults (day 0, 7, 21, 360 days)
      • < 21 days before travel – do not give combination vaccine, dose hepatitis A monovalent and hepatitis B monovalent separately to ensure full hepatitis A protection for the trip

For more information on Hepatitis B, check out the Canadian Immunization Guide section on Hepatitis B Vaccine

4.      Boosters are NOT normally required for Hepatitis A and B Vaccines after the Original Series is Completed

  • I regularly get asked about boosters for a patient who had a completed Hepatitis A/B series (3 doses) 5 to 10 years ago
  • Currently, boosters are not recommended for most travellers
  • Titre levels in the blood can be assessed for people at high risk, but this is not necessary for most travellers
  • That being said, there is really no additional risk for giving another dose, we just don’t know if this will offer the traveller any additional protection

For more information on Hepatitis B, check out the Canadian Immunization Guide section on Hepatitis B Vaccine

5.      Typhoid can Occur in some Resort Travel Destinations

  • Although the risk of typhoid fever is highest in South East Asia, it can occur in travel destinations such as the Caribbean
  • This condition can be potentially fatal and is responsible for 215,000 deaths worldwide
  • Immunocompromised patients and those on acid suppression therapy (e.g. PPIs) are at higher risk of developing typhoid
  • Although the condition can be treated with antibiotics, its early symptoms can be confused with other relatively minor conditions. There is also increasing levels antibiotic resistance.
  • Some travel health professionals will recommend typhoid immunization for some resort destinations.
  • There are three typhoid vaccine options:
    • A live attenuated oral vaccine that is taken as 1 capsule every other day (e.g. Day 1, 3, 5, and 7) starting 14 days before travel. It offers protection for 7 years
    • A polysaccharide vaccine that is given IM 14 days prior to travel. It offers protection for 3 years
    • A combination of Hepatitis A and typhoid polysaccharide vaccine. It is given 1 dose 14 days prior to travel.  A booster of a plain hepatitis A vaccine is required in 6-12 months to ensure long-term hepatitis A protection

If you want to read more, check out the CATMAT statement on typhoid and the Yellow Book’s Typhoid and Parathyroid Fever chapter.

 

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