• Next steps for shots...
• Vaccinations and Immunizations

From: Conor
To: Davie
Subject: Next steps for shots...

Contact Details:

Travelers' Advice and Immunization Center Infectious Disease Associates
Massachusetts General Hospital
Tel: 617-724-1934
Hours: Mon 1.00-8.30; Tue/Wed 8.30-4.30; Thu/Fri 8:30-1:00

Travel Resource Center
Mount Auburn Hospital
Tel: 617-499-5757

Okay, next we must call the travel clinics and see what they say we need.

Plans:

Cook Islands:	Sept
Fiji:	Sept
Vanuatu:	Oct
New Zealand:	Oct/Nov
Australia:	Nov/Dec;
Singapore:	Dec
Malaysia:	Jan
Thailand:	Jan/Feb
India:	Feb/Mar; only Northern India
Nepal:	Mar/Apr; 2-3 weeks at high elevation
Tibet:	Apr; 2 weeks at high elevation
China:	Apr/May
Vietnam:	May
Hong Kong:	May
South Korea:	May/Jun
Japan:	May/Jun

From: Conor
To: Davie
Subject: Vaccinations and Immunizations

Malaria
Vanuatu, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, South Korea
Malaria chemoprophylaxis should begin 1 week before traveling to risk areas except for doxycycline, atovaquone/proguanil, and primaquine, which should begin 1 day before travel. A pre-travel dosage period allows the drug's concentration in the body's tissue to build up to an effective level and gives the physician time to evaluate any side effects. Antimalarials should be taken for as long as malaria risk occurs, in some cases months or even years. It is important to continue taking your antimalarial drugs for a period of time after you leave the risk area. If you have been taking chloroquine, chloroquine/proguanil, mefloquine, or doxycycline for malaria prevention, you must continue taking these drugs for 4 weeks after leaving the risk area. If you have been taking atovaquone/proguanil or primaquine, you must continue these drugs for 1 week after leaving the risk area.

Hepatitis A
Tahiti, Cook Islands, Vanuatu, Australia, Singapore, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, Hong Kong, South Korea
A combination Hepatitis A/Hepatitis B vaccine requires a series of 3 injections. The most common side effect of hepatitis A vaccination is soreness at the site where the shot is given. Sometimes headache and fatigue may occur. Serious side effects are rare. The combined hepatitis A/hepatitis B vaccine is given in a series of 3 shots; the second shot is given 1 month after the first and the third shot is given 6 months after the first. There are no known problems in administering hepatitis A vaccine at the same time as other vaccines, but the shots should be given at different injection sites.

Typhoid
Tahiti, Cook Islands, Vanuatu, Singapore, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, Hong Kong, South Korea
The most common side effects are redness, hardening, and tenderness at the injection site; these symptoms almost always resolve within 48 hours of vaccination. Occasionally, fever, headache, and flu-like episodes have been reported. The primary vaccination is given in a single intramuscular injection. You should get this shot at least 1 week before arrival at a high-risk area. The booster dose, recommended every 2 years under conditions of repeated or continuous exposure, is also a single injection.

Hepatitis B
Tahiti, Cook Islands, Vanuatu, Australia, Singapore, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, Hong Kong, South Korea, Japan
See Hepatitis A.

Japanese Encephalitis
Australia, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, Hong Kong, South Korea, Japan
The vaccine for Japanese encephalitis is an injected vaccine, and it is not recommended for all travelers to Asia. There is a risk of serious side effects from the vaccine and the risk of travelers being infected is small. However, because the illness has the potential to be very serious, vaccination is well worth consideration if you will be at high risk. About 1 in 5 people who receive the vaccine do experience some pain, redness, and swelling at the injection site. About 1 in 10 people also experience 1 or more of the following reactions: fever, headache, dizziness, chills, muscle pain, nausea, vomiting or abdominal pain. About 1 in 260 vaccinees experience a general rash, itching, or swelling, especially of the extremities, face, lips, and throat. In rare cases, vaccinees may suffer shock or respiratory distress. Travelers (both children and adults) should try to allow at least 40 days before departure for the 3-injection vaccination schedule. The full recommended primary series has a 1-week wait between the first and second doses and a 3-week wait between the second and third doses. Then it takes 10 more days for the vaccine to take full effect.

Rabies
Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam
The rabies vaccine is an inactivated-virus vaccine. It comes in injectable form, and it is given as a series of 3 injections. Vaccinees may experience redness, swelling and itching at the injection site, as well as headache, nausea, abdominal pain and muscle aches. Also, 1 to 6% of people receiving the series will develop an �immune complex-like� syndrome 2 to 21 days later with itching, fever, fatigue, joint pain, arthritis, nausea and vomiting. The preexposure vaccine is given in a 3-dose series, usually given on days 0, 7, and 21 or 28. Travelers who will remain at continuous threat of exposure due to high-risk activities or extended visits in high-risk areas should consult with their health care providers every 6 months regarding the need to have their antibody levels checked and/or receive a booster dose of rabies vaccine.

Influenza
Tahiti, Cook Islands, Vanuatu, New Zealand, Australia, Singapore, Malaysia, Thailand, India, Nepal, Tibet, China, Vietnam, Hong Kong, South Korea, Japan
Influenza viruses change often, and they might not always be covered by the vaccine. But people who do get influenza despite being vaccinated often have a milder case than those who did not get the shot. The best time to get the influenza vaccine is during October and November. A new shot is needed each year.

Polio booster
Thailand, India, Nepal
IPV can cause a little soreness and redness where the shot was given. Most travelers to countries where polio is a problem will already be up to date with their polio vaccination. Even those who are up to date, however, will need a one-time booster dose of IPV if traveling to risk areas. For travelers who are not up to date, it may be necessary to allow as long as 7 months for the full recommended vaccination schedule, depending upon other vaccines that may be necessary for the trip.