Travel provides an opportunity to review and update routine vaccinations in adults. Routine childhood vaccinations should be reviewed for all persons, and boosters should be administered as necessary.
Tetanus and Diphtheria
Outbreaks of diphtheria have occurred throughout Eastern Europe and the former Soviet Union during the past decade, and tetanus remains endemic throughout the world. Previously immunized adults and children older than 7 years of age should receive a tetanus-diphtheria (Td, Aventis Pasteur) toxoid booster every 10 years. Travelers to remote areas, where post-exposure tetanus immunization might be unavailable, should consider receiving a booster dose prior to departure if 5 or more years have elapsed since their last vaccination.
Measles, Mumps, and Rubella
The measles-mumps-rubella vaccine (MMR, Merck) is a combined vaccine that is usually administered at 12 to 15 months of age. Since up to 5% of vaccine recipients fail to respond to primary immunization, a second dose of MMR vaccine is given at the time of school entry. Measles, in particular, is endemic in many developing nations, so immunity to the disease should be confirmed if a traveler’s itinerary includes one or more of these countries. Rubella is primarily a concern for women of childbearing age without documented immunity. People can be considered immune to measles, mumps, or rubella if they were born before 1957 (exposure is assumed), have a documented history of these diseases, received two doses each of monovalent measles, mumps, and rubella vaccines or two doses of MMR vaccine, or have serum antibody titers against these diseases. A booster of MMR vaccine is warranted for any person born after 1956 who does not have immunity. The vaccine rarely causes transient arthralgias, especially in non-immune women of childbearing age. Vaccination with this live attenuated viral vaccine is (Ontraindicated in women who are pregnant or anticipate pregnancy within 2 to 3 months.
Polio
Cases of poliomyelitis are still identified within developing countries of Africa, Asia, and Eastern Europe. Wild-type poliomyelitis has been eliminated from the Western Hemisphere. However, there was a recent outbreak in the Dominican Republic and Haiti in 2000. Travelers to Haiti, the Dominican Republic, Africa, Asia, and eastern Europe are advised to receive a single booster of inactivated polio vaccine (IPOL, Aventis Pasteur) if the primary series have already been administered. For those with an incomplete primary immunization series, three doses of inactivated polio vaccine should be given prior to departure.
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