Travel Advice
Travel Abroad
People who are travelling outside the UK may need to be vaccinated against some of the serious diseases that are found in other parts of the world.
As foreign travel increases to more far-flung places, more UK travellers than ever need vaccinations. For example:
Travel to tropical and sub-tropical destinations is becoming more popular. Dangerous diseases are more likely to be in these areas. Longer holidays abroad, such as gap year trips, are becoming more com- mon. This leads to greater exposure to the diseases that are found in the country, or countries, that are visited. Holidays involving overseas travel to rural areas, where standards of hy- giene and sanitation may be lower, are now more common. Medical treat- ment may also be more difficult to find in rural areas.
Some countries require anyone wishing to enter to have an International Certifi- cate of Vaccination or Prophylaxis (ICVP). For example, Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages (religious journeys).
Many tropical countries in Africa and South America will not accept travellers from an area where there is yellow fever, unless they can prove that they have been vaccinated against it.
Travel vaccinations
If you are planning to travel abroad, you should check which vaccinations are recommended for the areas you will be visiting. You can find this information on these two websites:
NHS Fit for Travel National Travel Health Network and Centre (NaTHNaC)
2 Cholera vaccination – is a disease that causes diarrhoea and vomiting and is usually caught through infected water.
Diphtheria vaccination – diphtheria is a bacterial infection that mainly affects the nose and throat.
Hepatitis A vaccination – is an infection that causes inflammation of the liver.
Hepatitis B vaccination – similar to hepatitis A but it is caused by a different virus.
Japanese encephalitis vaccination – is a disease that is spread by mosqui- toes. It is usually mild but can develop into encephalitis (inflammation of the brain).
Meningococcal meningitis vaccination – is an infection of the meninges (the protective membranes that surround the brain and spinal cord).
Poliomyelitis (polio) vaccination – is a highly infectious virus that can cause flu-like symptoms and is potentially fatal.
Rabies vaccination – is an infection of the central nervous system that is passed to humans through the bite of an infected animal.
Tetanus vaccination – severe but short-lived infection that is caused by bacte- ria.
Tick-borne encephalitis vaccination – similar to Japanese encephalitis but it is caught through the bite of an infected tick.
Tuberculosis vaccination – is a bacterial infection that affects the lungs.
Typhoid fever vaccination – is a potentially fatal bacterial infection that is caught through contaminated food or water.
Yellow fever vaccination – is a serious viral disease that is spread by mosqui- toes.
3 When you need to be vaccinated will depend on where you are going and what diseases are present in the country, or countries, that you are visiting.
As well as any new vaccinations that you need, also make sure that your exist- ing vaccinations are up to date and have booster jabs if necessary.
In the UK, the childhood vaccination programme protects against a number of diseases, such as tetanus, but it does not cover most of the infectious diseases that are found overseas.
Other vaccines are recommended for those at risk, so for example, the seasonal flu jab is usually recommended for people over the age of 65.
Exactly which vaccinations you need will depend on a number of factors. Cer- tain activities may place you at higher risk of getting some diseases. In particu- lar, consider the following:
The country, or countries, you are visiting. In some cases, the region of a country you are visiting will also be important. When you are travelling. Some diseases are more common at certain times of the year, for example during the rainy season. Where you are staying. In general, you will be more at risk of getting dis- eases in rural areas than in urban areas. If you are backpacking and staying in hostels, or camping, you may be more at risk than those on a package holiday who are staying in a hotel. How long you will be staying. The longer your stay, the greater your risk of being exposed to diseases. Your age and health. Some people may be more vulnerable to infection than others, while some vaccinations cannot be given to those with a par- ticular medical condition. What you will be doing during your stay. For example, whether you will be spending a lot of time outdoors, such as trekking or working in rural ar- eas. If you are working as an aid worker you may come into contact with more diseases if you are working in a refugee camp, or helping after a natural disaster. If you are working in a medical setting. For example, a doctor or nurse may require additional vaccinations. If you are in contact with animals, you may be more at risk of getting dis- eases that are spread by animals, such as rabies.
4 If you are only travelling to countries in northern and central Europe, North America or Australia, it is unlikely that you will need to have any vaccinations. If you are travelling outside these countries, it is likely that some vaccinations will be required.
If possible, see your GP at least eight weeks before you are due to travel, be- cause some vaccinations need to be given well in advance. Make sure that you tell your GP if you are doing any of the activities mentioned above that may place you at greater risk.
Pregnancy and breastfeeding
Speak to your GP before having any vaccinations if:
you are pregnant you think you might be pregnant you are breastfeeding
In many cases, it is unlikely that a vaccine given while pregnant or breastfeeding will cause problems for the baby.
People with immune deficiencies
For some people travelling overseas, vaccination against certain diseases may not be advised. For example, if you:
have a condition that affects your body's immune system, such as HIV or AIDS. are receiving treatment that affects your immune system, such as chemotherapy (a treatment for cancer) have received a recent bone marrow, or organ, transplant.
5 Not all travel vaccinations are free, and not all will be available from your GP. If you know which vaccinations you need, it is a good idea call your GP surgery to find out whether they are available there and how much they will cost.
If your GP cannot provide the vaccinations that you need, they should be able to refer you to a specialist travel clinic.
Yellow fever vaccines are only available from designated centres. The National Travel Health Network and Centre (NaTHNaC) can help you find where you can get a yellow fever vaccination.
Cost
Some vaccinations may be available free of charge on the NHS for overseas travel. This will depend on your risk of developing the medical condition - for ex- ample, due to where you are travelling to, and what you are planning to do on your trip. The following vaccines may be free of charge:
cholera, diphtheria, poliomyelitis, and tetanus booster, hepatitis A, meningitis C, and typhoid.
The following vaccines are not usually available free of charge on the NHS for overseas travel:
hepatitis B, Japanese encephalitis, other meningococcal vaccines, rabies, tick-borne encephalitis, tuberculosis, and yellow fever.
Your GP may charge for these vaccines (including an administration fee),
6 Some people may experience side effects after having some travel vacci- nations.
Cholera vaccine
After having the cholera vaccine, up to 1% of people may experience symptoms that are similar to a mild stomach upset, such as abdominal pain, diarrhoea, and nausea (feeling sick). However, severe reactions are rare.
Diphtheria vaccine
After having the diphtheria vaccine, it is common for there to be tempo- rary soreness, redness, or swelling at the injection site. A small, painless lump may also form at the injection site. This usually disappears within a few weeks and is not a cause for concern. Severe reactions are very rare.
Hepatitis A vaccine
After having the hepatitis A vaccine, some people develop temporary soreness, redness, and hardening of the skin at the injection site. A small, painless lump may also form at the injection site. This usually dis- appears quickly and is not a cause for concern.
Much less common side effects include:
tiredness, headache, loss of appetite, nausea, or a slightly raised temperature (mild fever) - a normal temperature is between 36-36.8C (96.8-98.24F).
Hepatitis B vaccine
After having the hepatitis B vaccine, some people develop temporary soreness and redness at the injection site. Severe reactions are rare.
7 SJapanese encephalitis vaccine
After having the Japanese encephalitis vaccine, around 20% of people develop temporary soreness, redness, and swelling at the injection site. About 10% of people who have the vaccine experience other side effects such as:
a high temperature (fever) of 38C (100.4F), headache, tiredness, chills, dizziness, nausea or vomiting, and abdominal pain.
In a small number of cases (about 0.6%), an allergic reaction to the vaccination can occur. The reaction can cause a rash, swelling of the face and, in rare cases, breathing problems.
Any allergic reaction usually occurs within minutes of having the injection, al- though in some cases, it can be delayed for up to two weeks. This is why the course of injections to provide protection against Japanese encephalitis should be completed at least 10-14 days before you travel.
Meningococcal meningitis vaccine
After having the ACWY vaccine to protect against groups A, C, W135 and Y meningitis, about 10% of people experience soreness and redness at the injec- tion site. This usually lasts around 24-48 hours. Mild fever can also occur; it is usually more frequent in young children than in adults. Severe reactions are very rare.
Poliomyelitis vaccine
After having the poliomyelitis vaccine, it is common for there to be temporary soreness, redness, or swelling at the injection site. A small, painless lump may also form at the injection site, which usually disappears within a few weeks and is not a cause for concern. Severe reactions are very rare.
After having the rabies vaccine, some people experience temporary soreness, redness, and swelling at the injection site for 24-48 hours after the vaccination. In rare cases, some people may also experience:
a mild fever, headache, muscle aches, vomiting, and/or a rash. Severe reactions are very rare.
Tetanus vaccine
After having the tetanus vaccine, it is common for there to be temporary sore- ness, redness, or swelling at the injection site. A small, painless lump may also form at the injection site, which usually disappears within a few weeks and is no cause for concern. Severe reactions are very rare.
Tick-borne encephalitis vaccine
After having the tick-borne encephalitis vaccine, some people experience tem- porary soreness, redness, and swelling at the injection site. Some people may also experience a mild fever within 12 hours of having the vaccination. This usu- ally disappears within 24-48 hours. Severe reactions are rare.
Tuberculosis vaccine
After having the tuberculosis vaccine, children may feel dizzy and they may de- velop a rash.
In all cases, a small, raised, red spot usually develops at the site of the injection within 2-6 weeks. This can grow into a circle up to 7mm in diameter, which may be crusty where fluid has dried on the surface, and it may also be bruised. A small scar is usually left at the site of the vaccination.
9 Typhoid fever vaccine
After having the typhoid fever vaccine, some people experience temporary sore- ness, redness, swelling, or hardness at the injection site. About 1% of people experience a high temperature (fever) of 38C (100.4F), while less common side effects include:
abdominal pain, headache, nausea, and diarrhoea.
Severe reactions are rare.
Yellow fever vaccine
After having the yellow fever vaccine, between 10-30% of people will experience mild side effects including:
headache, muscle pain, soreness at the injection site, and/or mild fever.
Reactions at the injection site usually occur within 1-5 days after being vacci- nated, although other side effects may last for up to two weeks.
An allergic reaction to the vaccine occurs in one case out of every 130,000 doses of the vaccine that are given.
Yellow fever vaccine-associated neurological disease (YEL-AND)
Very rarely, the yellow fever vaccine is associated with a neurological disease, known as yellow fever vaccine-associated neurological disease (YEL-AND).
Neurological means it affects the nerves and the nervous system, including the brain and spinal cord. YEL-AND occurs in around four cases for every one mil- lion doses of the vaccine that are given.
10 The symptoms of YEL-AND include:
a high temperature (fever) of 38C (100.4F) or above, headache, confusion, focal neurological deficit - problems with a nerve function in a specific place - for example, a problem with the nerves in your tongue that affects your ability to speak, coma - a sleep-like state when your are unconscious for a long period of time, or Guillain-Barré syndrome - when your immune system attacks the nerves that control movement, causing them to become inflamed (swollen).
Yellow fever vaccine-associated viscerotropic disease (YEL-AVD)
The yellow fever vaccine is also associated with a viscerotropic disease that is known as yellow fever vaccine-associated viscerotropic disease (YEL-AVD).
Viscerotropic means that it affects the viscera (your internal body organs, such as the heart or lungs). YEL-AVD occurs in around three cases for every one mil- lion vaccines that are given.
Symptoms of YEL-AVD include:
a high temperature (fever) of 38C (100.4F) or above, headache, muscle pain, hepatitis (inflammation of the liver), hypotension (low blood pressure), and multiple organ failure.
People who are 60 years of age, or over, are at slightly higher risk of developing YEL-AND and YEL-AVD. For example:
YEL-AND occurs in 18 cases for every one million doses of the vaccine that are given to people who are 60 years of age or over, and YEL-AVD occurs in 22 cases for every one million doses of the vaccine that are given to people who are 60 years of age or over.
11 Dr I Bhojani BSc (Hons), MBChB, DFFP, DRCOG, DCCH, MRCFP, PhD.
Dr. T Ahmed MBBS, DCCH, MRCGP.
Bangor Street Health Centre Bangor Street, Blackburn, BB1 6DY
Tel: 01254 674277 Fax: 01254 681091
www.shifasurgery.co.uk
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