Traveller vaccination diphtheria, tetanus, and pertussis

Template:Traveller vaccination cholera Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [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).