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Disease
Estimateddurationof
protectionfromvaccine
afterreceiptofall
recommendeddoses1,2
Comments
Pertussis
(whooping
cough)
46years
Immunityfromnaturalinfectionalsowanes.
Boosteratage11yearsisoffered.
Diphtheria
Around10years
Boostersarerecommendedinadultsat45&
65yearsofage.
Tetanus
96%protected1314years,
72%>25years
Boostersarerecommendedinadultsat45&
65yearsofage.
Polio
>99%protectedforatleast
18years
Boostersofferedtothosetravellingtoatrisk
countries.
Haemophilus
influenzaetype
B
>9yearstodate
Excellentimmunogenicityobservedforthis
vaccinesuggestinglongtermprotection.
HepatitisB
>20yearstodate
Likelylifelongforthosewhohave
seroconvertedbut>20yearshasbeen
observedtodate.
Measles
Lifelongin>96%vaccines
Communityprotectionisimportanttostop
transmissiontothosetooyoungtobe
immunised,orthosewhocannothavethe
MMRvaccine.
Mumps
>10yearsin90%,waning
slowlyovertime
Durationofimmunityvariesindifferent
populations.Itisnotaslonglivedasmeasles
orrubella.
Rubella
Mostvaccinees(>90%)
protected>1520years
Communityprotectionisimportanttostop
transmissiontothosetooyoungto
beimmunised,orthosewhocannothave
theMMRvaccine.
Pneumococcal
>45yearssofarfor
conjugatevaccines
Todateantibodyconcentrationshave
remainedhighinvaccinees.Community
protectionmeansvaccinatingchildren
reducesthediseaseinallagesinthe
community.
HumanPapillo
mavirus
>5yearstodate
Responsefollowingantigenchallenge
indicatesimmunityfromvaccinelikelytobe
verylongterm.
Plotkin,S.A.,W.A.Orenstein,andP.A.Offit,Vaccines.5thed.2008,Pennsylvania:ElsevierInc
AccordingtothecurrentNZImmunisationSchedule1Plotkin.Vaccines.FifthEdition.2
Vaccineimmunogenicityisameasureoftheimmuneresponsetoavaccine.Thisusuallyinvolves
measuringspecificantibodiesinthebloodaftervaccination.
Immunogenicitygivesanestimateofprotectionforsomevaccines.
Immunogenicitydoesnotdefinitivelytellusifapersonisprotectedagainstdisease,howeveritis
anindication.
Largerisesinantibodylevelsfollowingaboosterdoseindicatethatgoodimmunememoryis
presentandsuggeststhatgoodprotectionislikely.
Possiblevaccinesideeffects
Commonsideeffects
Uncommonsideeffects
Rare/veryraresideeffects
Soreness/pain,redness,
swellingand/orinduration
(areaofhardinflammation)
aroundtheinjectionsite.
Feverlessthan39C.
Irritability.
Drowsiness.
Feverabove39C.
Uncontrollableorunusual
crying.
Anaphylaxis.
Urticaria.
Pruritus.
Oedemainoneorbothlowerlimbs
withinthefirstfewhoursafterthe
firstHaemophilusinfluenzaetypeb
immunisation.Colourchangesof
theskin,transientbruisingand
severecryingmayalsooccur.All
eventsresolvespontaneously
withoutlongtermconsequences
within24hours.
Convulsion(withorwithoutfever).
AboutVaccines
HepatitisA
Thisviraldiseaseoftheliveristransmittedbyconsumingcontaminatedfoodandwater,usuallyby
thefecaloralroute(passedbypersonswhousethebathroomanddontwashtheirhands).Thevirus
cansurviveonadriedsurfacefortwelvedaysandcanliveonapersonshandsforuptofourhours.
Theillnesscanbesevereandrecoverycanbeprolonged.HighestratesoccurintheCaribbean,
Mexico,Asia,Africa,India,China,SouthAmerica,andSouthernandEasternEurope.Thevaccineis
recommendedforalltravelersolderthan1yearofagevisitingdevelopingcountries.
HepAisa2shotseries.Theinitialdoseprovidesadequateantibodiesin2weeksafterthe
injection,andaseconddosegiven6monthsafterthefirstdosewillconferalifelongprotection.
HepatitisB
Aviraldiseasethatcausessevereliverinfectionthatistransmittedbybloodandbodyfluids.It
causessevereliverinfectionwithfeverandjaundice,andcanprogresstochronicliverdiseaseand
cancer.Thevaccineseriesisrecommendedforhealthcareworkers,prolongedtravel,persons
participatinginadventuretraveling,personswhomayhaveunprotectedsex,thepossibilityof
acupunctureandtattooing,andfortravelerswithahighpotentialtoseekmedicalcareinlocal
facilities.
Threedosesaregivenat0,1,and6months.Adequateprotectionfortravelisobtainedafter2
doses,andthe3rddoseprovidesalifelongprotection.
Twinrix
ThisisavaccinethatcombinestheHepatitisAandHepatitisBvaccines.Thebenefitofthisvaccine
isthatyourreceiveprotectionagainstbothHepAandHepBwith3shots,ratherthan5separate
shots.
Threedosesaregivenat0,1,and6monthsandconferlifelongprotection.
TyphoidFever
Thisisabacterialinfectionthatisacquiredbyconsumingcontaminatedfoodandwater,resultingin
fever,abdominalpain,andeitherdiarrheaorconstipation.Itisespeciallyaconcernforpersons
travelinginsmallercities,villagesorruralareasofftheusualupscaletouristitineraries.
Onedoseofinjectabletyphoid(forages>2years)becomeseffectivein1weekafterinjection,
andprotectsfor2years.Fourdosesoftheoralvaccine(forages>6years)takeneveryother
dayprovidesprotectionin1weekandlasts5years.
YellowFever
Anoftenlifethreateningviraldisease,itisspreadbymosquitoesintheAmazonbasinofSouth
AmericaandsubSaharanAfrica.Proofofyellowfevervaccinationmayberequiredforentryinto
certaincountriesandforpersonswhohavetraveledthroughyellowfeverendemiccountries.
Onedoseisgivenandbecomeseffectiveinabout10daysandprotectsfor10years.
Meningitis
Thisisaseriousbacterialinfectionthataffectstheliningofthebrain,andistransmittedbyexposure
torespiratorysecretionssecretions(coughing,sneezing,kissing,usingutensilswhichmaynothave
beencleanedproperly).Thediseasecausesevereillnesswithfever,rashandoftenmayleadrapidly
todeath.Thevaccineisrecommendedforpersonswholiveinclosecontactwithothers(dorms,
militarybarracks),personstravelingtothemeningitisbeltinsubSaharanAfrica,andpersons
travelingtoSaudiArabiaforthepilgrimagetoMecca(Hajj).
Menactra,licensedin2005,isgiventopersons1154yearsofage.Itisestimatedtohavea10
yearprotection.Menomuneisgiventopersonsyoungerthan11and55yearsofolder.Both
protectagainst4serotypesofthemeningitisbacteriaA/C/Y/W135.
Rabies
Rabiesisadiseasetransmittedthroughbitesandscratchesofanimals,mostcommonlydogs,bats,
cats,raccoons,skunks,andfoxes.Ifnottreatedthisdiseaseisalwaysfatal.Thevaccineis
recommendedforpersonsworkingwithanimals,youngchildren,personswithextensiveoutdoor
activitiesinruralareas(trekkersandbikers),andpersonswithprolongedstaysinendemicareas.
Preexposurevaccinationconsistsof3dosesgivenondays0,7,or2128.
JapaneseEncephalitis
Thisdiseaseistransmittedbyamosquitoandcausesaviralinfectionofthebrain.Itisrelatively
uncommonintravelers.Thevaccineisrecommendedtopersonstravelingtoricefieldsandpigfarms
inruralareasofIndiaandSoutheastAsia.
IXIARObyNovartiswaslicensedinMarch2009forpersons17yearsofageorolder,andis
givenasa2doseseries,ondays0and28.
1 Forpersonsyoungerthan17years,thereisalimitedsupplyofJEVAXby
Biken,butsuppliesmostlikelywillbedepletedby2010.Threedosesofthe
vaccinegivenon0,7,and30daysprotectsforabout3years.
RoutineVaccinations
Polio
Thisisaviralillnessthatisspreadbycontaminatedfoodandwaterandcanproduceparalysis.All
personsshouldhaveanadequateprimaryseriesandaonetimeadultboosterisrecommendedif
travelingtoAfrica,India,andtheMiddleEast.
TheboosterdoseintheU.S.isaninjectableinactivatedvaccine.
Influenza
Thefluisaviralinfectionthatcausesfever,headache,muscleachesandlunginfectionandoccurs
yearroundinthetropics.Thefluvaccineisrecommendedforalltravelersoverage50,childrenages
623monthsandclosecontactsofchildren023months,pregnantwomenandallpersonsofanyage
withanychronicorimmunocompromisingconditions.Aflushotshouldbeconsideredforany
travelerwishingtodecreaseriskofinfluenzaornonspecificrespiratoryillness.
Yearlyfluvaccineprovidesprotectionfor6months.
Tetanus/diphtheria
Tetanus(lockjaw)iscausedbycontaminationofcutsorwounds.Diphtheriaisapotentiallyfatal
bacterialinfectionthatisspreadbyrespiratorysecretions.Pertussis(whoopingcough)isahighly
contagiousrespiratorydiseasecausedbybacteria.Allpersonsshouldhaveanadequateprimary
seriesand1doseoftetanus/diphtheriawithinthelast10years.Adultswhohavenotreceivedatleast
1previousdoseofanyacellularpertussisshouldreceiveTdapvaccineatleastonce,inplaceofaTd
booster.
Tetanusvaccineprovidesprotectionfor10years.
Pneumonia
Pneumoniaiscausedbybacteriatransmittedfrompersontopersonthroughrespiratorydropletsand
canleadtoseriousinfectionsofthelungs,(pneumonia),blood(bacteremia),andthecoveringofthe
brain(meningitis).Thepneumoniavaccineisrecommendedforallpersonsover65andthosewith
chronicdiseasesorcompromisingconditions,includingpersonswithasthmaorcigarettesmokers.
1doseformostadults,someadultsmayneedanotherdoseafter5years.
Varicella(chickenpox)
Aviralillnessspreadbyrespiratorydroplets,causinganitchyblisterlikerash.Nonimmuneadults
areatincreasedriskofsevereillness.Thevaccineisrecommendedforallpersonswhohavenothad
chickenpox.
2dosesaregiven48weeksapartforpersons13yearsandolder,whichconferslifetime
protection.Forpersonsyoungerthan13yearsofage,the2dosesshouldbegiven3months
apart.
Measles,MumpsandRubella
Measlesisapotentiallyseriousillnesswithfever,cough,andrash.Mumpsmaycausebraininfection
orinfertilityinmales.Rubella(Germanmeasles)causesamildfeverandrashbutcanbedevastating
toadevelopingfetus.Thesediseasesarecommonindevelopingcountries.TheMMRvaccineis
recommendedforthosebornin1957orlaterwithouthistoryofdiseaseor2adequatedosesoflive
vaccineatanytimeduringtheirlife.
TheMMRconferslifetimeprotectionafter12injections.
Shingles(HerpesZoster)
Shinglesisanoutbreakofblistersandrashthataffectsjustonesideofthebody,andusuallycauses
veryintensepain.Itiscausedbyareactivationofthedormantvirusinthenervesofpeoplewhohave
previouslyhadchickenpox.Anyonewhohashadchickenpoxisatriskforshingles,butrisk
increaseswithage,andchronicconditionsthatsuppresstheimmunesystem.Ashinglesvaccine
(ZostavaxbyMerck)waslicensedin2006forthepreventionofshinglesinpersonsover60yearsof
age.
Theshinglesvaccineisjustoneshot.Thedurationofimmunityisunknownatthistime.
HPVVaccine(Gardasil)(HumanPapillomavirusQuadrivalentVaccine,Recombinant)
Gardasilisaninactivatedvaccinetopreventcervicalcancerandgenitalwartscausedby4typesof
HPV.Itiscurrentlyrecommendedonlyforgirlsandwomen9to26yearsold.Cervicalcanceristhe
2ndleadingcauseofcancerdeathsamongwomenintheworld.50%ofsexuallyactivemenand
womenareinfectedwithHPVatsometimeintheirlives.Three doses are given at 0, 2,
and 6 months. The duration of protection is expected to be long
lasting.
Commonvaccinereactions(reactogenicity)
Thecommonreactionsarecausedbythebodysresponsetothevaccineantigen(s)andtheother
vaccineconstituents.Ingeneraltheyoccurwithin2448hoursofvaccinationandareselflimiting.
Howeverreactionsfollowinglivevaccines(e.g.MMR)maybedelayedandresembleamildversion
ofthedisease.
Symptomorsign
Maximumdifferenceinrate*
Peakfrequency(days
aftervaccination)
(%)
CI(95%)
Localerythema(>2cm)
0.8
0.11.4
Otherlocalreaction
0.4
01.4
Mildfever(<38.5Crectal)
2.7
06.1
10
Moderatefever(38.639.5C)
2.9
1.64.3
Highfever(>39.5C)
1.4
0.72.1
10
Irritability
4.1
2.16.1
10
Drowsiness
2.5
1.43.6
11
Willingnesstostayinbed
1.4
0.52.3
11
Generalisedrash
1.6
03.0
11
Conjunctivitis
2.1
0.93.2
10
Arthropathy
0.8
0.21.3
79
Peripheraltremor
0.4
00.9
Coughand/orcoryza
1.5
4.61.6
Nauseaand/orvomiting
0.8
1.60
78
Diarrhoea
0.7
01.7
11
Rarevaccinereactions
Whilethereissomesimilaritybetweenthecommonreactionscausedbyallvaccines,theraremore
seriousreactionstendtobemorespecifictoeachvaccine.
Mostoftherareandmoreseriousvaccinereactions(e.g.seizures,thrombocytopaenia,hypotonic
hyporesponsiveepisodes,persistentinconsolablescreaming)donotleadtolongtermproblems.
Anaphylaxis,whilepotentiallyfatal,istreatablewithoutleavinganylongtermeffects.Although
encephalopathyisincludedasapossiblerarereactiontomeaslesorDTPvaccine,itisnotcertainthat
thesevaccinesinfactcauseencephalopathy(braininflammation)asthereisnodifferencein
incidencebetweenvaccinatedandunvaccinatedpeople.
Clearexplanationsabouttheimmunisationandcalm,confidentdeliverywilldecreasethelevelof
anxietyabouttheinjectionsandthusreducethelikelihoodofaninjectionreaction.
Itisimportanttobeabletodistinguishthelossofconsciousnessresultingfromafainting(vasovagal)
injectionreactiontothatofanaphylaxis.
Faint
Anaphylaxis
Onset
Usuallyatthetimeorsoon
aftertheinjection
Usuallysomedelaybetween530
minutesafterinjection
System
Skin
Pale,sweaty,coldand
clammy
Red,raisedanditchyrash;swollen
eyes,face;generalisedrash
Respiratory
Normaltodeepbreaths
Noisybreathingfromairways
obstruction(wheezeorstridor)
Cardiovascular
Bradycardia
Transienthypotension
Tachycardia
Hypotension
Gastrointestinal
Nausea/vomiting
Abdominalcramps
Neurological
TransientLOC,good
responseonceprone
LOC,littleresponseonceprone
Distinguishinganaphylaxisfromafaint(vasovagalreaction)Source:ImmunisationSafety
Surveillance:guidelinesformanagersofimmunisationprogrammesonreportingandinvestigating
adverseeventsfollowingimmunisation.Manila:WorldHealthOrganization,1999.
Coincidentalevents
Becauselargenumbersofimmunisationsaregiveneveryday,itisinevitablethatinthedays
followingimmunisationmanypeoplewillsuffermajorhealthevents.
Examplesoffalseallegationscausedbycoincidentalevents
Ex1immunisationandSuddenInfantDeathSyndrome(SIDSorcotdeath).TheincidenceofSIDS
peaksaroundtheagewheninfantimmunisationsaredelivered.So,manySIDScaseswilloccurin
childrenwhohavebeenrecentlyimmunised.Inevitably,whenapreviouslyhealthychilddiesacause
issought.
Ex2AutismandMMR
DiseaseinCanadainternationaltraveling
Africantrypanosomiasis(sleepingsickness)
Africantrypanosomiasisisaparasiticdiseasespreadbyaninfectedtsetsefly.Thediseaseis
transmittedinsomeareasofsubSaharanAfrica.
Americantrypanosomiasis(Chagasdisease)
Americantrypanosomiasis,morecommonlyknownasChagasdisease,isatropicalparasiticdisease
spreadbyinfectedtriatomineinsects.
Avianinfluenza
Avianinfluenza,commonlyknownas"birdflu,"isaviralinfectionthatspreadseasilyandquickly
amongbirdsandcancauseillnessinhumansandmanyotheranimalspecies.
Bedbugs
Bedbugscaneasilyhideinluggage,clothing,andotherpersonalitems,sotakeafewprecautions
whiletravellingtokeepthemfromcominghomewithyou.
Chikungunya
Chikungunyaisaviraldiseasethattypicallycausesfeveralongwithanarthritislikepaininthe
joints.Itisspreadtohumansthroughthebiteofaninfectedmosquito.ChikungunyaoccursinAfrica,
AsiaandtheIndiansubcontinent.
Cholera
CholeraisanacuteintestinalinfectioncausedbythebacteriumVibriocholerae.Itisspreadby
drinkingoreatingcontaminatedwaterorfood.
Considergettingvaccinated
Mosttravellersareatverylowrisk.Travellersathigherrisk(thoseinareaswithlimited
accesstocleanwaterandfoodand/orwithpoorsanitation),shoulddiscusswithahealthcare
providerthebenefitsofgettingvaccinatedbeforetravelling.
Ciguatera
Ciguateraisafoodbornediseasecausedbyeatingtropicalorsubtropicalfishcontaminatedwith
ciguatoxin.
Denguefever
Denguefeveristhemostcommonviraldiseasespreadtohumansbymosquitoes.Itcancausesevere
flulikesymptoms.Insomecases,itleadstodenguehaemorrhagicfever,whichcanbefatal.
Ebolavirusdisease
Ebolavirusdiseaseisarare,severeandsometimesfatalviraldisease.Avoidallnonessentialtravel
toGuinea,LiberiaandSierreLeone,wherethereisanongoingoutbreakofthevirus.
Hand,footandmouthdisease
Hand,footandmouthdiseaseisacommonviralillnessthatmainlyaffectsinfantsandchildren.Itis
causedbyagroupofvirusescalledenteroviruses.
HepatitisA
ThehepatitisAvirusattackstheliverandcancausemildtosevereillness.HepatitisAiscommonin
developingcountriesandisgenerallyassociatedwithpoorsanitationandpoorhygiene.
HepatitisB
HepatitisBiscausedbyavirusthatinfectstheliver.Itishighlycontagiousandisoneofthemost
commonvaccinepreventablediseasesaffectingtravellers.
HIV/AIDS
HIV(HumanImmunodeficiencyVirus)attacksandimpairstheimmunesystem,resultingina
chronic,progressiveillnessthatleavesthoseinfectedwithitvulnerabletoseriousinfectionsandcancers.
Influenza(flu)
Influenza(orflu)isacommonrespiratoryillnessthataffectsthousandsofCanadianseachyear.Travellersareatriskin
anycountryduringthefluseason.
Japaneseencephalitis
Japaneseencephalitisisavirusthatcausesswellingofthebrainandpossiblelongtermnerveandbraindamage.Itis
spreadtohumansbythebiteofaninfectedmosquitoandcanbepreventedbyavaccine.
Leishmaniasis
Leishmaniasisisaparasiticdiseasethatistransmittedbythebiteoffemalephlebotominesandflies.Itoccursintropical
andsubtropicalareas.
Leptospirosis
Leptospirosisisabacterialdiseasespreadthroughcontactwithwater,soilorfoodcontaminatedbyurinefrominfected
animals,orbydirectcontactwithinfectedanimals.Itoccursworldwide,butmostcommonlyinfectspeopleinwet,
tropicalclimates.
Malaria
Malariaisaseriousandoccasionallyfataldiseasethatisspreadbythebiteofaninfectedmosquito.
Measles
Measlesisahighlycontagiousdiseaseandistheleadingcauseofvaccinepreventabledeathsinchildrenworldwide.
Meningococcaldisease
MeningococcaldiseaseisaninfectioncausedbythebacteriumNeisseriameningitidis.Thisbacteriumcancauseserious
andsometimesfataldiseasesincludingmeningitis(infectionofthebrainlining)andmeningococcalsepticemia(infection
oftheblood).Meningococcaldiseaseoccursworldwidewithseasonalvariations
Polio
Polio(poliomyelitis)isacontagiousdiseasethatcanbepreventedbyvaccination.Itisspreadthroughcontaminatedfood
andwater
Rabies
Rabiesisaviralinfectionthatistransmittedtohumansthroughclosecontactwiththesalivaofaninfectedanimal.
Worldwide,dogbitesareresponsibleformosthumancasesofrabies.
Sexuallytransmittedinfections
Therearemanydifferentsexuallytransmittedinfections.Somearespreadbyskintoskincontactandothersthrough
semen,vaginalfluid,bloodorotherbodyfluidsduringsexualactivity.
Tickborneencephalitis
Tickborneencephalitisisaviraldiseasethatcausesswellingofthebrain,swellingofthemembranearoundthebrainand
spinalcord,and/orswellingofthespinalcord.Itistransmittedthroughthebiteofaninfectedtick.
Travellers'diarrhea
Travellers'diarrheaisthemostcommonillnessthataffectstravellers.Itiseasilyspreadfrompersontopersonorby
eatingfoodordrinkingwatercontaminatedwithfeces.
Tuberculosis
Tuberculosis(TB)isacontagiousbacterialdisease.Afterbreathinginthebacteria,5%to10%ofpeoplewillbecome
sickanddevelopactiveTBovertime,usuallyinthelungs.
Typhoidfever
Typhoidfeverisaninfectioncausedbyabacteriafoundincontaminatedfoodorwater.Thediseaseiscommonly
associatedwitheatingfoodspreparedinunsanitaryconditions,andwitheatinguncookedfoodsordrinkinguntreated
waterinareaswheresewageisnotdisposedofsafely.
Valleyfever
ValleyfeverisaninfectioncausedbyinhalingthesporesofafungusthatisfoundinthesoilinthesouthwesternUnited
States,Mexico,CentralandSouthAmerica.
YellowfeverYellow fever is caused by a virus that is transmitted by the bite of an infected
mosquito. It is always present in many tropical areas in South America and Africa.