Getting Vaccinated!

Who is the travel doctor at Manly Village Medical?

Dr Bruce Maybloom has a passion for travel. Immediately after completing high school, he headed out for a year of travelling the Middle-East and Europe and hitched, trained, bussed and hiked his way throughout continental Europe. That’s when his decades of self-directed travel began. Europe was immediately followed by years of backpacking and working in Central and South America.  North America, Asia and the Pacific region have also been frequented. Before relocating to Brisbane to raise kids, he and his wife lived in London for almost a decade, providing a convenient hub for travel adventures. And the travel adventures continue…

One of his children has recently been to Tanzania with a very-well known company that has been organising school trips for decades. Having been involved in getting his daughter prepared and sitting in on presentations, he is up to speed with the needs of student groups on organised trips.

Why is this important. Because you need to know the doctor behind travel medicine at Manly Village Medical just doesn’t merely state to “have an interest” in travel medicine, he knows what you may encounter from first hand experience; including getting sick when travelling and resolving issues in remote locations when far from help.

Bruce’s travel adventures are backed up with a Masters in Public Health with sub speciality interest in International Disease Control. He has spent years both working and travelling in the developing and ‘developed’ world.

When deciding upon the type of immunisations you require it is essential to consider factors such as:

• Your destination(s) and the known endemic diseases.
• The time of year (season) you will be travelling can influences risk to some diseases such as those transmitted by mosquitoes.
• What you will be doing. Will you be staying in a resort, living in a rural village, hiking through jungle, etc?
• How long you will be there?  Days, months or years?
• If you be working with animals or living in close proximity to them.

In planning on getting your vaccinations, there are some important points to consider:

• It is recommended to get your vaccinations completed 14 days prior to travel. This gives your body sufficient time to develop defences to the disease (antibodies) for which you have been immunised.
• Before immunisation, we need to know if you are pregnant or trying to get pregnant. We also need to know about any allergies you may have, if you have had problems with your spleen, if you have lowered immunity,  if have any long-term illnesses and if you feel unwell including any fevers in the last 48 hours.
• Multiple live vaccines can be given on the same day, but 4 weeks between the next live vaccine is required.
• The live vaccines are: Yellow Fever, Japanese Encephalitis, Chicken Pox, Measles, Mumps, Rubella, Rota Virus.
• Most vaccinations are not live vaccines and they may be given at any time.
• We use 4 common injection sites (arms and upper buttocks) enabling us to give as many as 4 injections on one day.
• It is preferable to complete a multi-shot vaccination course before beginning your travels. Specific Information below will indicate the duration of a course if more than one shot is required.

Typhoid vaccinations can be given in a number of ways:

• Typhim Vi. (from 2 years). Re-vaccinate every 3 years especially if travelling or living in an endemic area.  Typhim Vi is the most popular option.
• Vivaxim (from 16 year). A combined Hepatitis A and Typhoid vaccination. The Hepatitis A requires a booster in 6 months and the Typhoid will require a booster in 3 years from the Vivaxim injection.
• Vivotif Oral is an oral vaccine recommended in people 6 years or older. It comes as 3 capsules taken on days 1, 3 and 5 about 1 hour before food. Studies show that a 4^th tablet on day 7 gives even better protection from Typhoid.  The tablets must be swallowed whole and not chewed or it will be destroyed by acidic stomach juices. A repeat course in 3 years is recommended.

Vivaxim has been found by some to be more costly from the manufacturer than a separate Typhoid and Hepatitis A injection.  Also, it may be more beneficial to get a separate Typhoid injection (Typhim Vi)  and a combined Hepatitis A&B (i.e. Twinrix).

Information on this page is sourced from The Australian Immunisation Handbook (10^th Ed).

Hepatitis A immunisation is a priority for travellers.  The key issue for travellers is that it can be food borne through poor hygiene during preparation and therefore difficult to prevent.

Hepatitis B on the other hand is through bodily fluid and can be transmitted through poorly screened blood transfusions, poorly sterilised tattoo needles or sharing syringes.  An example of how it may be transmitted is if you were in an accident and required a transfusion of blood products that were not screened as being negative for the Hepatitis B virus.

Hepatitis A&B can be given together in a single injection called:

• Twinrix 720/20 (from 16 years). A 2^nd dose is required 1 month after the 1^st dose.
• Twinrix Junior 360/10 (1year – <16 years). A 2^nd dose 1 month after 1^st dose and a 3^rd dose 6 months after 1^st 

Hepatitis A can be given as a single injection called:

• Havrix 1440 (from 16 years).
• Havrix Junior (from 2 to less than 16 years). First dose at day 0, then 2nd dose 6-12 months from first dose.

Hepatitis A and Typhoid vaccination can be given as a single injection called:

• Vivaxim (from 16 year). The Hepatitis A requires a booster in 6 months and the Typhoid will require a booster in 3 years from the Vivaxim injection.

Coverage for Hepatitis A&B can be lifelong for some people. If previously vaccinated, a blood test is available to test the status of your immunity.

Information on this page is sourced from The Australian Immunisation Handbook (10^th Ed).

Malaria

Childhood immunisations are those which are included in the Australian Immunisation Schedule.  We recommend, that if you are travelling the developing world then you should give consideration to booster shots if it has been over 10 years since you were last immunised.

This excludes immunisation for Human Papiloma Virus and Menningitis ACWY which have been added to the schedule in recent times:

We reccoment the following Boosters:

Boostrix IPV (from 7 years) covering: Tetanus, Diptheria, Whooping Cough, Polio.

MMRV  () convering

Japanese Encephalitis vaccination can be given as a single injection called:

• Imojev (from 12 months).  One injection. Lifelong immunity.

Information on this page is sourced from The Australian Immunisation Handbook (10^th Ed).

The Bexsero injection is the vaccination desighned to protect you from catching Meningitis B.

The Menactra menningitis ACWY vaccination covers four major classes of meningitis.

A single dose of Menactra is 0.5 mL.

• Menactra:  (9 to 23 months) of age, 2 doses 3 months apart.  If at high risk of exposure, then a booster every 5 years is recommended.
• Menactra: (2 to 55 years) as a single dose. If at high risk of exposure, then a booster every 5 years is recommended.

It important to note that Menactra is now part of the Australian Immunisation schedule for those 15-19 years old. It is often administered during Year 10. It is important to note that there is a catch-up for those 15-19 years old who may not have been immunised at school.  The ‘catch-up’ program funds a free vaccination with only a GP consultation fee to pay.

Information on this page is sourced from The Australian Immunisation Handbook (10^th Ed).

Getting immunised for rabies is one of those series of injections that leaves people wondering “will I or won’t I get immunised?”  For those at very high risk, such as vets, animal researchers or those that will come in direct contact with species that are known carriers, this question is easy to answer. For others not.

If not at high risk, then it is worthwhile weighing risk against benefit. My own experience of this was sending my daughter to Tanzania on a school trip for a month which including volunteer work in a local village. Whilst there was a definite risk, it was low. But, the treatment of rabies is time critical and the logistics of accessing ‘very rapid’ treatment in many locations  extremely challenging. In that rabies can be fatal

We are a World Health Organisation (WHO) Accredited Yellow Fever Vaccine clinic.  When you are immunised you will be issued with a complementary International Certificates of Vaccination yellow booklet which you will need to carry with you when travelling to prove to government officials that you have been vaccinated against Yellow Fever.

Yellow Fever vaccination can be given as a single injection called:

• Stamaril. (from 9 months).  One injection. Lifelong immunity.

Information on this page is sourced from The Australian Immunisation Handbook (10^th Ed).