For a list of Travel Clinics
in the UK where you can obtain your travel vaccines:

When the body is exposed to foreign organisms, such as bacteria and viruses, the immune system produces antibodies against them. Antibodies help the body recognise and kill the foreign organisms. They then remain in the body to help protect the body against future infections with the same organism. This is known as active immunity.

The immune system produces different antibodies for each foreign organism it encounters. This establishes a pool of antibodies that helps protect the body from various different diseases.

Vaccines contain extracts or inactivated forms of bacteria or viruses that cause disease. These altered forms of the organisms stimulate the immune system to produce antibodies against them, but don't actually cause disease themselves.

The antibodies produced remain in the body so that if the organism is encountered naturally, the immune system can recognise it and attack it, thus preventing it from causing disease.

Each bacteria or virus stimulates the immune system to produce a specific type of antibody, and this means that different vaccines are needed to prevent different diseases.

Where possible, the recommended intervals between different vaccines or doses should be followed. This allows time for antibodies to be produced and any reaction to the vaccine to subside.

All commonly used vaccines can safely and effectively be given simultaneously (that is, on the same day) without impairing antibody responses or increasing rates of adverse reactions. This knowledge is particularly helpful for international travelers for whom exposure to several infectious diseases might be imminent.

In general, inactivated vaccines may be administered simultaneously at separate sites. However, when vaccines commonly associated with local or systemic reactions are given simultaneously, reactions can be accentuated.

Inactivated vaccines usually require one primary dose followed by one or more booster doses given at intervals of around four weeks. If time is short, a single dose will give some protection. Most inactivated vaccines can be given together safely; inactivated and live vaccines can also be administered simultaneously.

When two live vaccines are required, they should be given either simultaneously at different sites or with a gap of at least three weeks. Oral polio vaccine should not be given at the same time as oral typhoid vaccine.

Human Normal Immunoglobulin (HNIG) may interfere with the immune response to live vaccines and so should not be administered simultaneously. A live vaccine should ideally be given three weeks before or three months after an injection of HNIG. However, HNIG is unlikely to contain antibodies to the yellow fever virus and so they can be administered simultaneously. Oral polio vaccine when given as a booster can also be administered simultaneously with HNIG.

Diphtheria/Tetanus/Polio

Diphtheria is transmitted through respiratory droplets, personal contact and contaminated clothing, bed linen etc. Tetanus spores are present in the soil worldwide and the disease is caused from contaminated wounds. Polio is transmitted through the faecal/oral and oral routes.

The primary vaccination course for all three is given as part of the childhood immunity programme (in the UK). It is also recommended that booster vaccines be given to persons travelling to certain high risk areas.

Diphtheria: Prior to the 1940s, diphtheria was a common disease in the UK but with the introduction of an immunization programme in the 1940s there was a dramatic fall in the number of cases reported. By the late 1950s the disease had been all but eradicated.

Diphtheria cases continue to be reported from the Indian Subcontinent, South East Asia, Africa and South America. There was also a resurgence of diphtheria in the former Soviet Union as a result of epidemics in the 1980s and 1990s.

Booster vaccines are now recommended for travellers to these regions. The diphtheria vaccine is made from a toxin extracted from a strain of the organism responsible for the disease. It is now only administered as a part of combined products.

Tetanus: The Department of Health previously recommended administration of reinforcing (booster) doses of tetanus vaccine at ten year intervals, with the administration of further doses in the event of injuries that may give rise to tetanus.

Dirty wounds can become infected with tetanus spores anywhere in the world. Therefore, every traveller should be fully protected against tetanus. Any type of injury from a simple laceration to a more serious wound can expose the individual to the spores.

The Department of Health further advised in 2002 that tetanus vaccine is to be replaced by the combined tetanus/low dose diphtheria (pertussis & polio) vaccines for adults and adolescents for routine use and for travel vaccination. Stocks of single tetanus vaccine are now exhausted and companies are no longer supplying this product.

Polio: Until 2004 Oral Polio Vaccine was used for routine immunisation in the UK. Immunised individuals only required a single booster dose every ten years if they intended to travel.

Travellers who have not been properly immunised or whose immunity has waned are at risk if they are travelling to areas of the world where polio still occurs. ie. parts of Africa, Afghanistan and the Indian Subcontinent are particularly at risk.

Until the disease is certified as eradicated, the risk of acquiring it remains. The consequences of infection are life-threatening or crippling and infected travellers may also act as vectors for transmission and possible reintroduction. All travellers should therefore be up to date with vaccination against poliomyelitis.

The oral vaccine is no longer available for routine use and will only be available for outbreak control. The polio vaccine is now usually (but not always) given as a part of a combined product.

All individuals in the UK should have undergone a primary immunisation course for all three as part of the childhood vaccination shedules. They are usually administed in conjuction with other vaccines such as pertussis (whooping cough). Individuals who are resident in the UK but have not been previously immunised should should contact their GP for immunisation advice.

Tetanus immunization is generally required before starting school. Five doses of vaccine are recommended. When over ten years has elapsed since the primary immunisation course or the person is travelling to a country where tetanus is indicated, a tetanus booster should be given. This could either be in the form of a "Td vaccine" which is a 2-in-1 vaccine that protects against tetanus and diphtheria and is required every 10 years or in the form of the new "Tdap vaccine" one time. The Tdap vaccine is a 3-in-1 vaccine that comprises tetanus toxoid, reduced diphtheria toxoid and acellular pertussis.

Diphtheria vaccination is also one of the recommended childhood immunisations which should begin during infancy. A diphtheria booster should also be given if travel is for more than one month to a country or region where it is indicated.

Polio vaccination is another one of the recommended childhood immunizations and vaccination should begin during infancy. A polio booster may also be advised for travel to certain countries if ten years has elapsed since the primary course.

The appropriate combined diphtheria/tetanus or diphtheria/tetanus/polio etc. preparations are now normally used when any of these is required. Here are some (not all) of the vaccines available:

REVAXIS (diphtheria toxoid, tetanus toxoid and poliomyelitis inactivated vaccine) is a booster vaccination used following primary immunization against diphtheria, tetanus and polio. 0.5ml is given by intramuscular injection, Immunity is immediate and lasts for 10 years. It is particularly useful for travellers since it provides a booster dose for all three diseases.

DIFTAVAX (diphtheria toxoid and tetanus toxoid). A vaccine suitable for persons over 10 years of age. When used as a booster, 0.5ml is given by intramuscular injection. Immunity is immediate and lasts for 10 years.

INFANRIX (diphtheria toxoid, tetanus toxoid, pertussis toxoid & inactivated poliovirus). This vaccine is indicated for booster vaccination against diphtheria, tetanus, pertussis, and poliomyelitis diseases in individuals from 16 months to 13 years of age inclusive. A single dose of 0.5 ml should be administered by intramuscular injection, usually into the deltoid muscle. Immunity is immediate and lasts for 10 years.

BOOSTRIX (tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine - Tdap). A booster vaccine for adults and adolescents. 0.5ml is given by intramuscular injection, usually into the deltoid muscle. Immunity is immediate and is supposed to last for life. Currently available in the USA but not in the UK.

Rabies

The risk to travellers in endemic areas is proportional to their exposure to potentially rabid animals. Travellers in tourist resorts are at very low risk.

Prophylactic immunisation against rabies is therefore recommended for long term travellers to endemic areas especially those travelling to remote locations beyond the reach of immediate medical help.

Following suspect contact, especially from a bite or scratch, competent medical advice (where available) should be sought even in those who have received pre-exposure vaccines.

Vaccination against rabies is carried out in two distinct situations:

1. To protect those who are likely to be exposed - Pre-exposure.
2. To prevent establishment after exposure has taken place - Post-exposure.

The vaccines used for pre and post exposure are the same but the schedule of administration is different.

For pre-exposure; three 1.0ml doses are given by intramuscular (deltoid) injection on days 0, 7 and 21 to 28 (a few days variation in timing is not important).

A booster dose is required every two to three years depending upon risk of exposure.


Rabies Vaccine BP:

Hepatitis B

Hepatitis B is a bloodborne viral infection that is spread through infected blood, contaminated needles, etc. The hepatitis B virus (HBV) causes hepatitis (inflammation of the liver), jaundice, long term liver damage and occasionally liver cancer.

Hepatitis B is also a sexually transmitted disease and the virus is found in the blood and semen of infected men and is spread in the same manner as HIV. HBV is easier to catch than HIV because it is more than 100 times more concentrated in an infected person's blood and can exist on surfaces outside the body.

Hepatitis B can be prevented through vaccination. If the vaccine is administered before infection, it prevents the development of the disease and the carrier state in almost all individuals.

Short term travellers are not generally at risk but may place themselves at risk by their sexual behaviour. Travellers requiring surgery in certain countries will be at risk so a kit containing sterile needles, sutures, etc. would be very useful.

Those visiting high risk areas for long periods or at social or occupational risk should be immunised e.g. such as voluntary workers, who may also be at risk from medical or dental procedures carried out in those countries.

The prevalence of chronic hepatitis B virus (HBV) infection is high in certain areas of the world. These include all of sub-Saharan Africa, Southeast Asia, including China, Indonesia, Korea, and the Philippines; the Eastern Mediterranean except Israel; South and Western Pacific islands; the interior Amazon Basin; and certain parts of the Caribbean, i.e. the Dominican Republic and Haiti.

The disease is moderately prevalent in South, Central and Southwest Asia, Israel, Japan, Eastern and Southern Europe, the Russian Federation, and most of Central and South America.

The hepatitis B vaccine is a synthetically made yeast derived vaccine. The body is stimulated by the vaccine to form antibodies against the actual hepatitis B virus.

There are two different types of the vaccine. One is called Engerix-B and the other is called HB-II Vax. There is a new combined vaccine available which also protects against Hepatitis A (Twinrix).

The vaccination is given as a course of three 1.0ml intra-muscular injections, the second 28 days after the first and the third 6 months after the second. Immunity lasts for at least 15 years. The need for a booster is uncertain but some vaccination programmes recommend it.

Universal infant immunization is now recognized as the proper strategy for every country for the long-term control of chronic HBV infection.

Cholera

Cholera is no longer routinely recommended for international travel. The Department of Health has advised that in rare circumstances where an unofficial demand be anticipated, confirmation of non requirement of cholera vaccine may be given on official note paper, signed and stamped by a medical practitioner.

The old type cholera vaccine which was given by injection offers poor protection against the disease and is no longer recommended for use by the Department of Health or the World Health Organisation.

However, in May 2004 a new vaccine (Dukoral) was licensed in the UK for immunisation against cholera for people travelling to highly endemic or epidemic areas, particularly emergency relief and health workers in refugee situations.

The vaccine may be considered for the following: People working in areas where there are known cholera outbreaks (e.g. aid workers). Travellers staying for long periods in known high risk areas and/or where close contact with locals is likely, and who do not have access to medical care. Travellers to risk areas who have an underlying gastro-intestinal disease or immune suppression.