Traveller vaccination diphtheria, tetanus, and pertussis
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Traveler Vaccination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Diphtheria
Protection against diphtheria is not specific to the needs of travellers. In most countries diphtheria vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.
Disease cause
Toxigenic Corynebacterium diphtheriae and in tropical climates occasionally toxigenic C. ulcerans.
Transmission
C. diphtheriae residing in the respiratory tract is transmitted through droplets and close physical contact; C. ulcerans by close contact.
Nature of the disease
Clinical manifestations are usually mild but, occasionally, potent bacterial toxins cause obstructive membranes in the upper respiratory tract (croup) or damage to the myocardium and other tissues. Systemic manifestations are less likely to be caused by C. ulcerans.
Geographical distribution
Very rare in countries with high coverage with diphtheria/tetanus/pertussis (DTP) vaccine. Incidence increases in crowded regions where vaccination programmes are insufficient and standards of hygiene are poor.
Risk for travellers
Risk of exposure increases in populations with low DTP vaccination coverage.
General precautions
Cholera vaccination is not required as a condition of entry to any country. Avoid drinking or eating unsafe water or foods.
Vaccine
For primary or booster vaccination appropriately formulated combined DTP vaccines should be used according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content (diphtheria toxoid or tetanus-diphtheria-acellular pertussis vaccine).
TETANUS
Protection against tetanus is not specific to the needs of travellers. In most countries tetanus vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.
Disease cause
The bacterium Clostridium tetani.
Transmission
Spores of C. tetani may contaminate necrotic, anaerobic tissue and transform into vegetative, toxin-producing bacteria. Tetanus is not communicable.
Nature of the disease
Potent bacterial neurotoxins originating from vegetative C. tetani may cause local muscular spasms or generalized tetanus. Untreated generalized tetanus is often fatal.
Geographical distribution
Spores of C. tetani are widespread globally, particularly in the soil.
Risk for travellers
The risk is linked to acquisition of contaminated injuries. This risk is not necessarily increased when travelling.
Vaccine
Travellers should be vaccinated with combined diphtheria/tetanus or DTP vaccines according to national recommendations. Individuals ≥7 years of age should receive tetanus containing combinations with reduced content of diphtheria toxoid.
Pertusis
Protection against pertussis is not specific to the needs of travellers. In most countries pertussis vaccine is routinely administered in childhood. Missing vaccinations in travellers should be offered according to national recommendations.
Disease cause
The bacterium Bordetella pertussis.
Transmission
Bordetella pertussis is transmitted from infected respiratory mucosa through droplets.
Nature of the disease
The Bordetella bacteria colonize only ciliated cells of the respiratory mucosa causing whooping cough (pertussis), an acute respiratory infection marked by severe, spasmodic coughing episodes during the paroxysmal phase. In early infancy, pertussis may be atypical and sometimes life-threatening. Disease manifestations are less dramatic with increasing age, including in adults.
Geographical distribution
Pertussis incidence depends on DTP vaccination coverage; the disease is common where coverage is low and rarely seen in countries with high DTP vaccination coverage.
Risk for travellers
The highest risk is for unvaccinated infants visiting countries with low coverage of DTP vaccination.
Vaccine
For primary as well as booster vaccination one should use acellular (aP) or whole-cell (wP) pertussis vaccines in fixed combination with vaccines against diphtheria (D) and tetanus (T). The schedule should be according to national recommendations. Individuals ≥7 years of age should receive combinations with reduced diphtheria toxoid content