Travel Reference
In-Depth Information
SCHEDULING IMMUNIZATIONS
Months of planning and preparation usually precede foreign travel. Immunizations are a
critical part of such preparations and must not be put off until the last minute. Starting im-
munizations six months in advance is not only entirely appropriate but is necessary for im-
munizations such as hepatitis A that require two injections six months apart.
Vaccinations for diptheria, tetanus, pertussis (whooping cough), measles, mumps, ru-
bella (German measles), varicella (chicken pox), poliomyelitis, hepatitis B,
Haemophilus
influenzae
typeb,andpneumococaldiseaseareroutinelyadministeredintheUnitedStates,
mostly in childhood. If travelers do not have a history of adequate protection against these
diseases, immunizations appropriate to their age and previous immunization status should
be obtained, whether or not international travel is planned.
The CDC advises that “All commonly used vaccines can safely and effectively be
given simultaneously … without impairing antibody responses or increasing rates of ad-
verse reactions” (
www.cdc.gov/travel/yellowBookCh1-GenRecVaccination.aspx
)
. In gen-
eral, inactivated (killed-virus) vaccines may be administered simultaneously at separate
sites. However, when vaccines commonly associated with local or systemic reactions are
given simultaneously, reactions can be accentuated.
Simultaneous administration of acellular pertussis (DTaP—diphtheria, tetanus, and
whoopingcough);inactivatedpoliovirus;
Haemophilus influenzae
typeb;measles,mumps,
andrubella(MMR);varicella;pneumococcalconjugate;andhepatitisBvaccinesisencour-
aged for persons who are the recommended age to receive these vaccines and for whom no
contraindications exist.
Yellowfevervaccinemaybeadministeredsimultaneouslywithallothercurrentlyavail-
able vaccines. Limited data suggest that the immunogenicity and safety of Japanese en-
cephalitis (JE) vaccine are not compromised by simultaneous administration with pertussis
vaccine. No data are available on the effect of concurrent administration of other vaccines,
drugs such as chloroquine or mefloquine, or biologicals on the safety and immunogenicity
of JE vaccine.
Inactivated vaccines generally do not interfere with the immune response to other inac-
tivated or attenuated live-virus vaccines. An inactivated vaccine may be given either sim-
ultaneouslyoratanytimebeforeorafteradifferentinactivated vaccineoralive-virusvac-
cine.
However, the immune response to a live-virus vaccine such as MMR, varicella, or yel-
low fever might be impaired if administered within twentyeight days of another live-vir-
us vaccine. Whenever possible, injected live-virus vaccines administered on different days
should be given at least twentyeight days apart. If two injected live-virus vaccines are not
administered on the same day but less than twenty-eight days apart, the second vaccine
should be readministered at least four weeks later.
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