Tetanus is a life-threatening disease caused by toxins produced by Clostridium tetani, often from an infected wound. This disease is entirely vaccine-preventable. A recent random survey of Americans revealed that only 70% six years of age and older had protective levels of tetanus antibodies. Unvaccinated adults should receive a primary series of three doses of tetanus toxoid vaccine in the form of diphtheria-tetanus (dT). A diphtheria-tetanus (dT) booster should be received if the last booster was more than 10 years prior in order to avoid an overseas tetanus vaccination in the event of a contaminated wound. An updated dT booster is particularly important for travelers to the Russian Federation and Eastern Europe where diphtheria epidemics have been circulating since 1990.
Measles, Mumps and Rubella (MMR)
Travelers should be immune to measles, mumps and rubella (MMR). Measles is an acute, systemic, febrile disease that is highly contagious. Of measles cases reported in the USA from 1991-1994, 5% to 20% were internationally imported. Vaccination with the live-virus vaccine is recommended for non-immune adult travelers and a booster to non-immunocompromised, non-pregnant adults born after 1956. Immunization of persons with AIDS is controversial. Mumps is a contagious, systemic disease that is endemic throughout most of the world and is commonly exhibited by swelling of the salivary glands. It primarily affects school-age children, but it can be very severe if contracted in adulthood. Persons without evidence of rubella immunity, especially susceptible women of childbearing age who travel abroad, should be vaccinated since rubella is endemic in many countries throughout the world.
Poliomyelitis is an enterically acquired disease that causes paralysis that is often irreversible. Travelers to countries where poliomyelitis is epidemic or endemic may be at increased risk and should be fully immunized. There have been many cases of imported polio in residents of Europe, U.S. and Canada who traveled to poliomyelitis endemic areas. Many of these persons traveled for less than one week. Since poliomyelitis was targeted for global eradication by the year 2000 by the World Health Organization (WHO), many countries are completely free of the disease. This includes the Americas, which have been declared polio-free since 1994. Most recently (2001) there has been an outbreak of poliomyelitis in The Dominican Republic and Haiti due to a mutated vaccine poliovirus acquired from contaminated water. Unvaccinated adult travelers should complete the primary three-part series with the inactivated polio vaccine (eIPV). The oral polio vaccine is no longer in common use in the US due to the the risk of vaccine-associated paralysis. Adults who have received a primary series who are at increased risk of exposure to polio can be given a single boost of eIPV.
Influenza (Flu) Vaccine
This killed trivalent vaccine is recommended yearly for those over the age of 65 years of age or with chronic heart, lung, renal disease or immunocompromised state. Remember that the flu season in the northern hemisphere is November to April, while in the Southern Hemisphere is May - August.
The 23-valent pneumococcal vaccine is recommended for those adult travelers over the age of 65 years or with chronic illness that involve the heart, lungs, kidneys, or an immunocompromised state. This may need to be repeated. There is a recently approved 6-valent pediatric pneumococcal vaccine that has recently been approved for children.