Q: What vaccines are the 'most important' when traveling to developing countries like India?
A: These are excerpts from our discussion in the ISTM list (International Society of Travel Medicine) for the tourist who is reluctant to take a lot of vaccines, or cannot afford them (vaccines are ridiculously expensive in USA & many other developed countries).
Of course there is a list of vaccines/ travel health recommendations from CDC that will provide a comprehensive overview to travelers, but for an individual, here are some guidelines that may be helpful.
Dr John D Wilson has summarized things quite well, and here is his view
>> The patient should take some responsibility in decision-making, since it
>> is his money, and his body which would be affected by disease or side
>> effects.
>>
>> Consider outlining for him each disease (what the disease is like, how it
>> feels, incidence, morbidity, etc), and each vaccine (efficacy, side effects
>> and cost), then make recommendations, let him decide, and intervene if he
>> is making a big mistake. Emphasize that if there is risk for a given
>> disease, getting the vaccine is much safer than getting the disease.
>>
>> Priority:
>> 1. Hep A (highest priority)
>> 2. MMR, 2 doses a month apart before departure, very important - explain
>> how common measles is in India, and how communicable it is, and what
>> happens to susceptibles if they are on a plane with someone with early
>> undiagnosed but communicable measles
>> 3. Influenza vaccine is probably more important than typhoid vaccine if
>> the trip is short
>> 4. Tdap (more for home risk) - show him the NEJM video of a pertussis
>> patient http://www.nejm.org/doi/full/
>> will be is the opportunity for 2 more Td to complete the series over the
>> next year after return - tell him I've seen tetanus twice; each patient was
>> on a respirator in the ICU for 6 weeks.
>>
>> For the short trip, incidence of typhoid fever is 0.1% per year, or 0.004%
>> (40 per million) for a 2 week trip.
>> Polio and hep B are even farther down the list. There are reasons to give
>> a compressed series of polio vaccine, but it is less essential than those
>> above.
>>
>> An antimalarial, insect repellent, azithro for diarrhea treatment. Talk to
>> him about jet lag.
>>
>> For a short trip, point out that his preference to minimize vaccines
>> make tight food/water precautions and aggressive mosquito precautions
>> (malaria, JE, dengue) even more important. And avoid stray dogs.
>>
>> If the trip is long (or he is returning again in the near future to India
>> or another place with typhoid), oral typhoid vaccine, rabies vaccine, polio
>> vaccine, hep B vaccine, mefloquine trial, purchase of a bednet, purchase of
>> clothing with permethrin and perhaps sunblock, are all
>> long-term investments.
>>
>>
>> John D. Wilson, M.D.
>> The Travel Clinic, USA
COMMENTS: Some of the other experts agreed with the list in general, but also commented about possible need of Malaria Pills (except in low risk places like Delhi, Bangalore).
I would like to consider Typhoid & Rabies Vaccine as well, given the significant morbidity and misdiagnosis with Typhoid, and high level of Antibiotic resistance. The high number of Dog bites occurring in India, are a reason that Rabies vaccine may be considered here as well.
A: These are excerpts from our discussion in the ISTM list (International Society of Travel Medicine) for the tourist who is reluctant to take a lot of vaccines, or cannot afford them (vaccines are ridiculously expensive in USA & many other developed countries).
Of course there is a list of vaccines/ travel health recommendations from CDC that will provide a comprehensive overview to travelers, but for an individual, here are some guidelines that may be helpful.
Dr John D Wilson has summarized things quite well, and here is his view
>> The patient should take some responsibility in decision-making, since it
>> is his money, and his body which would be affected by disease or side
>> effects.
>>
>> Consider outlining for him each disease (what the disease is like, how it
>> feels, incidence, morbidity, etc), and each vaccine (efficacy, side effects
>> and cost), then make recommendations, let him decide, and intervene if he
>> is making a big mistake. Emphasize that if there is risk for a given
>> disease, getting the vaccine is much safer than getting the disease.
>>
>> Priority:
>> 1. Hep A (highest priority)
>> 2. MMR, 2 doses a month apart before departure, very important - explain
>> how common measles is in India, and how communicable it is, and what
>> happens to susceptibles if they are on a plane with someone with early
>> undiagnosed but communicable measles
>> 3. Influenza vaccine is probably more important than typhoid vaccine if
>> the trip is short
>> 4. Tdap (more for home risk) - show him the NEJM video of a pertussis
>> patient http://www.nejm.org/doi/full/
>> will be is the opportunity for 2 more Td to complete the series over the
>> next year after return - tell him I've seen tetanus twice; each patient was
>> on a respirator in the ICU for 6 weeks.
>>
>> For the short trip, incidence of typhoid fever is 0.1% per year, or 0.004%
>> (40 per million) for a 2 week trip.
>> Polio and hep B are even farther down the list. There are reasons to give
>> a compressed series of polio vaccine, but it is less essential than those
>> above.
>>
>> An antimalarial, insect repellent, azithro for diarrhea treatment. Talk to
>> him about jet lag.
>>
>> For a short trip, point out that his preference to minimize vaccines
>> make tight food/water precautions and aggressive mosquito precautions
>> (malaria, JE, dengue) even more important. And avoid stray dogs.
>>
>> If the trip is long (or he is returning again in the near future to India
>> or another place with typhoid), oral typhoid vaccine, rabies vaccine, polio
>> vaccine, hep B vaccine, mefloquine trial, purchase of a bednet, purchase of
>> clothing with permethrin and perhaps sunblock, are all
>> long-term investments.
>>
>>
>> John D. Wilson, M.D.
>> The Travel Clinic, USA
COMMENTS: Some of the other experts agreed with the list in general, but also commented about possible need of Malaria Pills (except in low risk places like Delhi, Bangalore).
I would like to consider Typhoid & Rabies Vaccine as well, given the significant morbidity and misdiagnosis with Typhoid, and high level of Antibiotic resistance. The high number of Dog bites occurring in India, are a reason that Rabies vaccine may be considered here as well.
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