This year the summer vacation is going to be a long one. Travel plans are brewing in every home. Parents overlook immunizing their children without realizing the risk they are putting their children in. What should parents do? Precautions should be taken several months before the trip. Parents should consult a pediatrician to check and update the previous immunization status for any missed vaccines in addition to specifying which vaccines can be given according to the age of the child. Which vaccine should be given at short notice? A wide range of vaccines can be given prior to your trip, diphtheria, tetanus and whopping Cough vaccines can be given at a priority basis on four weeks to eight week intervals if not previously taken at ages two or four. A six months polio vaccine double dose is optimal before traveling to areas in which poliomyelitis is considered an endemic. Measles, mumps and rubella vaccine is usually given at 12 months of age; this schedule can be modified to be given at the age of 6 months and repeated at age of 12 months, as initial immunization at 6 months of age may not give long term protection. Travel vaccines Hepatitis A: This is a viral disease which is vaccine preventable. Risk of acquiring this disease is high; three to twenty percent of travelers end up with hepatitis A. Receiving the hepatitis A vaccine is highly recommended for those who plan on going to Asian countries. This disease is transmitted through food and water and can be very serious in some cases. The vaccine can be given to children of 12 months and above, two weeks before travel, but if no time is available, it can be given just before travel with almost 90% protection. The second dose should be given not later than 6 months, this in the form of injection. Yellow fever: this is a viral infection with a high risk of incidence for travelers to African and South American countries. Yellow fever vaccine should not be given to infants, pregnant women and people with true allergy to egg proteins. Vaccinations should be done ten days prior to travel as a single injection. Immunity is life long but t immunization certificate are valid for ten years only. Yellow fever and cholera vaccines shouldn't be given together or within three weeks, since they induce a poor immune response for both diseases when given simultaneously. The vaccine is usually available in Public Health Department Japanese encephalitis: Like yellow and dengue fever, it is a viral infection that affects ten percent of travelers, usually children. This disease is mostly present in Asian countries and its vaccine is recommended in case of prolonged stay of one month or more in rural areas, farming, and remote areas with out door activity. Three injections are needed within a month and completed two weeks before departure. It should not be given below 1 year of age for safety reasons. Rabies: A list of rabies free countries is available on WHO's website. The concept of immunization against rabies has changed drastically with more safety and efficacy. Protection against rabies is recommended for toddlers and children that come in contact with rabid animals (usually determined by type of animal involved and location of the incident). It is important to consult local health authorities before post exposure vaccination is taken. Anti malaria drugs can interfere with vaccination response. Meningitis: caused by bacteria, this disease is a worldwide pandemic. The Great Sahara region in Africa is known as the meningitis belt in the period between December and June. The vaccine ACWY 135 can be given after two years of age as a single injection. The other type is AC vaccine, component A gives immunity over three months of age and component C over two years. In epidemic situations children under 18 months of age are given two doses, three months apart. Cholera: Vaccination for cholera is no longer recommended by WHO for travel to and from Cholera infested area due to the poor efficacy of the vaccine, unless local authorities require it. It is given in the form of two injection doses, one week to one month apart. Enteric fever: this vaccine is given against typhoid and paratyphoid infections. Typhoid is common in Asian, Africa and Latin American countries, infecting 1: 3000 people per month of travelers to India, Bangladesh and Pakistan. Remember, vaccination is not a substitute for precautions against food and water poisoning. Periodic repeated injections are needed to maintain protection for future travels. For children above six years of age, oral vaccine in the form of capsule is required. One capsules every day for four days. Vaccinations should be completed one week before travel. Vaccines in the form of injection are recommended for children over two years of age. It should be given one month before travel. Patients with continuous exposure will need booster dose. Remember prevention is better than cure. Have a wonderful and safe holiday. * The writer is a pediatrician at My Care Medical Center, Jeddah, with and M.B.B.S, DCH (Dublin) __
