2017 HCHB_digital

CONTINUING OTC EDUCATION
Vaccinations to Consider for Travellers
Disease Transmission Illness effects
Protective
effect
Countries where prevalent
(not all inclusive)
Chickenpox (varicella) a Virus transmitted through airborne droplets Generally mild, with a rash. Serious complications rare 10–20+ years Common in countries with low vaccination rates
Cholera
Bacteria transmitted through contaminated Acute, profuse, watery diarrhoea and dehydration 6 months–2 years Endemic in much of the developing world
water and food
Dengue b Mosquito-borne virus Generally mild and flu-like but severe dengue can be fatal Unknown (2+ years) Common throughout tropical and subtropical countries
Influenza
Virus transmitted through infectious airborne
droplets
Flu symptoms which can be fatal in certain groups of people 1 year (since virus
changes)
Worldwide
Hepatitis A
Hepatitis B a
Japanese B
encephalitis
Measles, Mumps,
Rubella a
Exposure to sewerage-contaminated water,
ice, shellfish, or uncooked, unpeelable fruits,
vegetables or other foods
Contact with blood or blood-derived fluids,
contaminated needles, unprotected sex
Viral infection of the liver – fever, anorexia, abdominal discomfort,
jaundice. Not associated with chronic or long-term infection
Viral infection of the liver – fever, anorexia, abdominal discomfort,
jaundice. Can become chronic
Vaccine: 20+ years
Lifelong
Common throughout the developing world
South-East Asia, Africa, Carribean
Mosquito-borne virus Only 1:250 infected people develop encephalitis symptoms 2–3 years Most of Asia especially rural agricultural regions where
flooding irrigation is used
Direct contact with infectious droplets,
sometimes airborne
Measles: Rash, fever, cough, sometimes severe complications
Mumps: Swelling of salivary glands, sometimes severe
complications and infertility
Rubella: Can cause birth defects in pregnant women
15+ years Common in countries with low vaccination rates
Meningococcal disease Direct contact Fever, headache, nausea, vomiting. Can be fatal 2–3 years Sub-Saharan Africa, Haj pilgrims
Epidemic in New Zealand 1991–2004
Poliomyelitis a Virus transmitted by faecal–oral or oral route Most infections asymptomatic, but in some people acute paralysis,
respiratory failure, and rarely death can result
10+ years Low incidence worldwide due to vaccination
Rabies Animal bite that inoculates virus into wound Incubation period of 1–3 months after which no treatment is
effective. Delirium and convulsions followed by coma and death
Tetanus/Diphtheria/
Pertussis a
Tuberculosis (BCG)
Traveller’s diarrhoea
Tetanus: Bacteria transmitted usually through
contaminated wounds though has occurred
during clean surgical procedures
Diphtheria: Raw milk or dairy products
Pertussis: Contact with respiratory droplets
Usually airborne spread of bacilli through
coughing or prolonged sharing of same
air space. Can be transmitted through
unpasteurised milk from infected cattle
Can be due to changes in food or water or
microbes (eg, bacteria, virus, protozoa)
Tetanus: Muscle rigidity and painful spasms, sometimes fatal
Diphtheria: Bacteria causes membrane to form over mucous
membranes. Can be fatal
Pertussis: Severe cough, sometimes serious complications
Latent TB is asymptomatic. Active pulmonary TB causes cough,
fever and weight loss
Dehydration caused by excessive diarrhoea and vomiting can be
very debilitating and even fatal
1–10+ years Found in many parts of the world. Risk highest with
unprotected outdoor exposure
10–20+ years Common in countries with low vaccination rates
Long for miliary and
meningeal forms.
Variable for pulmonary
disease
Vaccination unreliable in adults. Not generally recommended
since treatment is usually effective
3+ months Although traveller’s diarrhoea is common, routine
vaccination is not considered necessary unless under the
advice of a health professional
Typhoid
Bacteria transmitted through unboiled water, or Persistent very high fever, sometimes rash, can be fatal 2–3 years South-Asia, Central America
uncooked or poorly reheated foods
Yellow fever c Virus transmitted through mosquito bites Can cause severe hepatitis and haemorrhagic fever 10 years Parts of Sub-Saharan Africa (eg, Guinea, Kenya) and South
America (eg, Columbia, Brazil). Some countries require
International Certificate of Vaccination for entry
Protective effect of vaccination varies according to information source. a. Included in NZ immunisation schedule; b. Limited availability internationally (not currently New Zealand); c. Must be given at an authorised yellow fever vaccination centre.
diarrhoea and vomiting; with antidiarrhoeal medicines (eg, loperamide); and if
necessary, antibiotics (but only under medical supervision). See Diarrhoea for
OTC product information.
Initial assessment
If you know or suspect a customer may be travelling overseas, offer to help them
put together a first-aid kit and recommend other OTC travel-related essentials
(such as flight pillows, sunscreen and insect repellent). Check they have had
a recent dental check-up and sought advice about which vaccines they may
need. Encourage travellers going to less developed parts of the world to use
self-purified or properly sealed bottled water for drinking and cleaning teeth, and
to avoid ice. Hands should also be washed thoroughly before eating and after
toileting or hand sanitiser used if washing facilities are unavailable or suspect.
Foods should be cooked thoroughly and served piping hot. Avoid vegetables or
fruits that cannot be peeled and raw seafood and shellfish.
Customers should also be directed to the New Zealand Government’s official
source of advice for New Zealanders travelling or living overseas (www.
safetravel.govt.nz) which contains information on everything from passports
and visas to weather warnings and recommendations about what countries NOT
to visit. Travellers can also register their travel plans on the site.
Information about the association between venous thromboembolism
(blood clots) and air travel can be found in the Varicose Veins and Support
Stockings chapter).
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