Travel Reference
In-Depth Information
Although no vaccine for malaria is currently available, it is appropriate to point out that
most of the three million malaria deaths worldwide each year occur in children five years
old and younger. Parents of such young children must be vigilant in their administration of
antimalarial medications and protection from mosquitoes.
SPECIFIC VACCINES
Recommended immunizations for healthy adult travelers are listed in the following sec-
tions. Immunizations for children may be different and are constantly being changed. Par-
ents should consult their physician or a travel medicine specialist about immunizations for
children. Individuals who are immunocompromised as the result of infection such as HIV,
therapyforawidevarietyofdiseasesincludingmalignancies,orfromotherconditionsthat
require immunosuppressive therapy also need unique measures and should consult an ex-
perienced travel medicine physician.
Cholera
Cholera immunization is not recommended for travelers by the CDC or the World
Health Organization and is not available in the United States. Cholera immunization is no
longer required for entry into any country.
Older cholera vaccines had limited effectiveness. Vaccines produced from organisms
genetically modified to eliminate virulence and administered orally to stimulate
gastrointestinal mucosal immunity are being investigated. Dukoral®, a vaccine produced
by the Swedish drug company Crucell SBL Vaccines, is not licensed in the United States.
Information is available at
www.sblvaccines.se
.
Hepatitis A
AsimpleRNAvirusthatismostcommonlytransmittedbyfecalcontaminationofwater
produces hepatitis A, the most common vaccinepreventable infection encountered by trav-
elers.Diligentwaterdisinfectioneffectivelypreventsthisinfection.Althoughthemortality
rate averages only 0.3 percent, it is 1.8 percent in individuals older than fifty years of age.
Hepatitis A causes about a hundred deaths a year in the United States. It is far more com-
mon in developing countries, and vaccination for travelers is highly recommended.
The safety of hepatitis A vaccination during pregnancy has not been determined. Be-
cause hepatitis A vaccine is produced from inactivated virus, the theoretical risk to the de-
veloping fetus is low. The risk associated with vaccination in pregnant women should be
weighed against the risk for hepatitis A, which may be high.
Two inactivated vaccines, Havrix®, manufactured by GlaxoSmithKline, and Vaqta®,
manufactured by Merck, are available. Both vaccines are made with inactivated hepatitis
A virus and were licensed in the United States in 1995. Two injections six months apart
provideexcellent protection.Thefirstinjection providesahighlevelofprotectionfortrav-
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