IMMUNIZATIONS - Medicine for Mountaineering and Other Wilderness Activities - page 49

Viralvaccines,includinghepatitisAandB,andtoxoidfortetanusanddiphtheriacanbe
given six months or more before departure because such immunizations persist for years.
Bacterial immunizations such as typhoid fever are not as enduring and should be given
closer to the date of departure.
Immune globulin is not routinely administered because effective vaccines for hepatitis
A are now available.
TRAVELING WITH CHILDREN
Fortraveltodevelopingcountries,childrenshouldbeup-to-datewithallroutinechildhood
vaccinations, particularly when they can be expected to have contact with local children
andlocalcaretakers.Travel-relatedtimeconstraintsmayrequireinfantsandyoungchildren
to have vaccinations at earlier than optimum ages. The intervals between doses may have
to be shortened, and receiving only one or two doses of a three-part immunization sched-
ule may be possible before departure. Such modifications usually decrease the immune re-
sponse and additional vaccinations must be given later, usually six to twelve months later
(whichcausesnoknownuntowardeffects).Generally,immunizationsgivenatanageearli-
er than recommended should not be counted toward long-term immunity.
Childrenprobablyshouldreceivepreexposurerabiesvaccineiftheyaretovisitdevelop-
ing countries where rabies is endemic. One-half of all rabies deaths are in children fifteen
years old or younger. Children are attracted to animals, are more likely to suffer bites, and
may not report minor bites and scratches. (Preexposure rabies vaccination does not elimin-
ate the need for proper wound care and additional vaccination after an animal bite. It does
eliminatetheneedforadministrationofimmuneglobulin,whichisinseverelyshortsupply
worldwide.)
Hepatitis A is not routinely given to children less than one year old (two years old in
the United States). Younger infants who will be exposed to hepatitis A should be protected
with immune globulin.
Meningococcal meningitisvaccineforserogroupAisnoteffectiveforchildrenyounger
than three months. Vaccine for serogroup C is not effective for children younger than two
years. Serogroup B is present in some countries, but no effective vaccine exists for those
organisms.
Vaccines for typhoid fever have not been well studied in children younger than five to
six years. Younger children may not be able to swallow the capsules by which the live, at-
tenuated vaccine is administered.
Yellow fever vaccinations in children less than nine months old have been associated
with encephalitis and usually should not be administered. Infants from six to nine months
may be vaccinated, but only when traveling to an area in which ongoing yellow fever is
epidemic and they cannot be protected from mosquitoes.