Travel Immunisations

Hepatitis B

The disease hepatitis B can be contracted from being bitten or scratched at school ( this is why hepatitis B immunisation is given to all children in America at birth and has been for more than 10 years ).It can also be acquired at birth from and infected mother or from breast feeding. There is a 10-20% mortality from acute liver damage and then it can cause liver cancer and progressive liver damage for life .For this reason it is an important cause of death in developing countries.

The immunisation which is very safe and effective is given at time zero, 1 month and at 6 months (it is recommended to children from 1 years old only). A fourth dose is generally given in 5 years.

It can be safely combined with hepatitis A (both are killed, mercury free vaccines) and given using the same time schedule.

Hepatitis A is usually a less serious disease than B rarely causing death but is much more easily caught usually from contaminated water or food.

I have been giving hepatitis B immunisation at my clinic to children now for  over 7 years and I now give both as combined hepatitis A and B immunisation particularly if foreign travel is considered.

Hepatitis A

Hepatitis A is spread though contaminated food and water and can cause inflammation of the liver and jaundice. It occurs throughout the world and vaccination is advised when good standards of hygiene cannot be guaranteed. One dose may give protection for one year. To increase the length of protection to at least 10 years, a second dose will be required. It is recommended to children from 1 years old only.

Typhoid Fever

Typhoid fever is also spread through contaminated food and water and can result in severe illness in some individuals. It can occur worldwide and vaccination is recommended for travellers to areas where sanitation and hygiene is very poor. The vaccine can be given from 18 months of age and lasts for 3 years.

(There is now a combined Hepatitis A and Typhoid vaccine from GSK called Hyper-tyrix) 

Yellow Fever

Yellow fever is spread by mosquitoes. It is a serious, sometimes fatal, illness. It occurs in parts of tropical South America and sub-Saharan Africa. The vaccine can be given from 9 month of age, lasts for 10 years and should be given at least 10 days before travel. Yellow fever vaccination is mandatory for travel to some countries.

You will not be allowed to enter these countries without a valid international certificate of  vaccination.(The yellow fever vaccine can only be administered at a registered yellow fever clinic)

Meningococcal meningitis

Meningococcal meningitis is a bacterial infection that is spread by droplets form an infected person’s nose and throat. It occurs most frequently in sub-Saharan Africa and vaccination is particularly recommended for those who are going to live and work for more than 4 weeks. Vaccination against the meningococcal strains A,C,W and Y is mandatory for entry to Saudi Arabia in order to attend the hajj or for the Umrah.  One dose of vaccine should provide protection for 3-5 years.

Rabies

Rabies is fatal disease spread by the saliva of infected animals. It is present in many countries but is as higher risk in some developing countries. If you are travelling in rural areas of high-risk countries away from medical care, then you should consider vaccination before you go and avoid touching any local animals, even if they appear healthy. If you are bitten abroad you should seek medical attention immediately -even if you have been vaccinated. The course consists of 3 injections over 3-4 weeks.

Japanese Encephalitis

Japanese Encephalitis is a life- threatening viral disease which affects the brain. The virus is spread by mosquitoes in South East Asia and the Far East. The risk of infection is greatest during , or just after, the wet season. The vaccine is recommended for travellers who will be staying for a month or longer, especially if travel will include rural areas. Vaccination can be given from one year of age and 2 or 3 doses are given over 2-4 weeks.

Diphtheria/tetanus/Polio

Everyone should have completed a course of the these vaccinations . Ensure that boosters are up-to-date before travelling to certain destinations.

• Polio: for travel to areas where polio still occurs such as Africa and India.
• Diphtheria: for travel to developing countries or Eastern European destinations.
• Tetanus: for travellers to remote locations or locations without access to good medical care

 

 

 

Tick –Borne Encephalitis

Tick –Borne encephalitis is a viral infection spread by ticks and occurs in the summer months in forested areas of central of eastern Europe and Scandinavia. Vaccination is recommended for those who will spend prolonged periods in infected areas or those who will be camping or working in forest during the summer months.

Malaria Prevention

Malaria is a serious disease that is transmitted by mosquito bites. It can occur in many tropical destinations. There is no vaccination available, so prevention consists of a combination of preventive medication and avoidance of mosquito bites.

Avoid being bitten by insects wherever possible; use insect repellents, wear light, loose clothing and sleep under a mosquito net if your accommodation is not air-conditioned. Seek advice on the most appropriate anti-malarial medication to suit your needs from your doctor.

Remember that anyone who has visited a Malarious country should mention this to their doctor if they develop a high fever up to two years after travelling.

How to take Malarone paediatric tablets:

In order to prevent malaria, it is important that the child starts taking Malarone paediatric tablets 1 or 2 days before travelling to a country or countries where there is a risk of catching malaria through being bitten by infected mosquitoes. Malarone Paediatric tablets should be taken each day while in these countries and for 7 days after returning home. If the trip will include visits to some areas or countries where malaria is a problem and also to some where it is not a problem, it is important to continue to take malarone paediatric until 7 days after leaving the last area or country where malaria can be caught.

Usually, malarone paediatric tablets should not be taken for more than 28 days.

Weight (kg)	Number of Malarone Paediatric tablets
11-20 21-30 31-40	1 Malarone Paediatric tablet daily 2 Malarone paediatric tablets as a single dose dialy 3 Malarone paediatric tablets as a single dose daily

Bed-wetting

Bedwetting (Nocturnal Enuereis)

Bedwetting, also called nocturnal enuresis, occurs when a child accidentally passes urine at night during sleep, after the age that he would be expected to be dry. It is not something that the child does on purpose.  Doctors often separate bedwetting into two types, primary enuresis and secondary enuresis.  In primary enuresis, the child has never been dry at night.  In secondary enuresis, the child was dry at night for one year but has suddenly and unexpectedly started to wet the bed again.  In general, boys are about three times more likely to have problems with bedwetting than girls and the problem tends to run in families.

Primary enuresis (never being dry) is probably caused by some delay in a child’s development, since the percentage of children with this type of bedwetting decreases with age.  At age 5, the % for males is 7% and for females 3%; at age 10 the % for males is 3% and 2% for females.  One % of males at 18 is still enuretic.  Persistent bedwetting may be the result of inadequate and inappropriate toilet training.  Psychological factors may play a part, especially if the child spent his toddler years living through times of unusual stress.  Children of immigrants, children who live in overcrowded conditions and those who come from families with psychiatric illness are all at risk from primary enuresis.  Some experts believe that primary enuresis is related to a slower development of nerves and brain centre that allow a child to control urination.  Others believe that the child’s bladder may be smaller than normal for size.  Still others blame a reversed pattern of urine production, so the child’s body makes more urine at night than during the day.

In secondary enuresis (bedwetting after being dry), stress is often to blame, although it is important to exclude a urinary tract infection.  Usually the child begins bedwetting when a sudden change occurs in their world. Almost any change in the environment, good or bad, can be a trigger.  This includes a new baby, a death in the family, parental or marriage problems, a new home or school.  It may be related to sexual abuse.

What to look for

In most children with bedwetting, soaked sheets and wet pyjamas are things that parents will see.  Still, it is wise to look for signs of a urinary tract infection.  He may urinate more often than normal during the day or complain of an uncomfortable or “burning” feeling when urinating, and the urine may look cloudy or have a very strong smell.  Other symptoms include fever, chills and pain in the back or lower abdomen.

 

 

 

 

What to do

If your child is younger than 6 years old, just give him time.  Let him know that about 1 in 5 of his classmates have the same problem and that almost all children outgrow bedwetting before the age of 10.  To help your child achieve his first dry night, try these suggestions :-

·      Encourage and praise him for dry nights.  Never punish, scold or blame.

·      Remind your child to urinate before going to bed.  If he doesn’t feel the need to urinate, tell him to “try” anyway.

·      Limit liquids in the last two hours before bedtime.

·      Use real cloth underwear rather than nappies or plastic pants.  “Grown-up” or “trainer” pants help remind your child to stay dry.

·      To make clean up easier, use plastic sheets or place a large plastic bag under cloth sheets.

If your 6 year old is still bedwetting, you may want to ask your doctor for suggestions.  By this age, most children can use an incentive with gold stars or small rewards for each dry night.  During the day your child can practice holding his urine for a few extra minutes rather than running to the bathroom right away.  He can also try starting and stopping his stream as he urinates, to help strengthen and control muscles around the urethra.  By this age, your child can help with a morning clean up after a wet night.  This is important as it empowers him.

After age 7, your doctor may recommend a personal enuresis alarm.  An alarm uses sounds or vibrations to wake your child if he wets his underwear.  It is important that he wakes up completely and quickly as soon as the alarm rings so that a conditioned response develops between having a sensation of urine in the urethra and waking.  This will require you to wake him as soon as you hear the alarm.  Some doctors prescribe a nasal spray or oral Desmopressin at night, a drug that is similar to the body hormone that switches off urine production.

Call your doctor if

Your child is wetting the bed at night and is age 6 or older, and never had a dry night, or started bedwetting after having many dry nights.  Also call your doctor if your child has pain, discomfort or a “burning” feeling when urinating, has urine that is cloudy or smelly, has a fever, chills, pain in the back or abdomen or often runs to the bathroom during the daytime and always seems to be thirsty.

MMR Vaccination

Measles, Mumps and Rubella Immunisation

I believe that MMR (triple dose: PRIORIX GSK) immunisation has a reasonable safety profile from the available evidence at the moment.  Two of my three children have been given the MMR immunisation.  The Department of Health recommends MMR immunisation.  Information can be obtained on their web site at http://www.doh.gov.uk/cmo/cmoh.htm

Some of the concerns about MMR immunisation stem from the research of a group at The Royal Free Hospital led by Dr Andrew Wakefield, who have suggested that both the measles infection and measles vaccination can be associated with an increased risk of Crohn’s disease (an inflammatory disease of the bowel), and that MMR vaccine may be associated with the development of autism (a disorder frequently diagnosed in the 2^nd year of life). 

MMR was introduced into the UK immunisation programme in 1988, since when around 10 million immunisations have been given to children at the age of 13-15 months as well as at 4 years of age and no obvious statistical relationship between MMR and autism or Crohn’s has been established.  This said, I understand as a parent your concerns given the present media attention to MMR and the fact that it may be considered unnatural to get infected with three live, albeit attenuated viruses, all at once.

I believe that giving the measles, mumps and rubella immunisation separately provides an acceptable way of immunising against these three conditions.  There is, however, little evidence in the literature that they are safer when given singly.  It has been suggested that they are marginally less effective when given singly because the immune response obtained is not so great.  However, it is just the sheer volume of the immune response when all are given at the same time which has given cause for concern.  The single measles, rubella and mumps immunisations do not have a UK product licence but do in France, France and USA respectively.   They are the same attenuated viruses as in the MMR. That is for measles the Schwartz strain, for rubella the Wistar RA27/3M and the mumps the Jeryl Lynn Strain. As with any vaccines there may be problems with availability. 

(Currently the Mumps Vaccine is unavailable. It has been off the market for about 2 years now.)

The other disadvantage of giving the immunisations separately is the time it takes for the full immunisation programme to be completed.  I recommend a period of six months between immunisations as by this time the acute antibodies to an infection have fallen back to normal levels.  (Dr Andrew Wakefield at The Royal Free Hospital recommends one year.  There is some evidence that having the wild measles and mumps within a year of each other in childhood predisposes to Crohn’s disease).  These are both empirical times.

My experience with giving the immunisations singly over the past 4 years is that they are at least as effective at inducing protective antibodies as the MMR. Also if I had given as many MMRs as I have given completed single immunisations I would have expected between 6 and 10 children to be admitted to hospital with fever induced fits .So far none have needed admission or had fits, neither have any children had measles, mumps or rubella after or whilst waiting immunisation.

                                                                                                                                                           

                                                                                                                                   

POSSIBLE REACTIONS TO MEASLES, MUMPS AND RUBELLA IMMUNISATIONS

Allergic reactions to the individual components of the measles, mumps and rubella immunisations

After any immunisation one can have an acute allergic reaction to it and so following immunisation I ask you to wait for about 10 minutes (or one hour if there is a suspicion that your child is egg allergic).  It is also possible to have an allergic type reaction 24 – 48 hours after the immunisation with swelling at the site, fever and irritability.  This should be treated with regular a Calpol

The infective elements of the reaction tend to occur later than this:

Measles 

With the measles vaccine there is a 1:10 chance of a modified measles like illness at 5–12 days after immunisation with fever, rash, irritability and diarrhoea.  You should treat this with regular Calpol and Nurofen as it is said that 1 in 1000 children will develop a febrile convulsion or fit following the measles (or MMR) immunisation.

With both the measles and rubella components the child may very rarely develop a rash of small bruise-like spots in the six weeks after immunisation.

Mumps

A modified mumps infection following the mumps immunisation is less common than with measles and occurs later, 2–3 weeks after the immunisation, with pain and swelling in the parotid glands (the glands just beneath the ear), fever and irritability.  There is generally no rash.  Again Calpol or Nurofen should be given regularly.

Rubella

Following the rubella immunisation there is not usually very much in the way of an infective reaction but more often there is a post viral “reactive arthritis” with pain and swelling in the joints which occurs 2–3 weeks after the immunisation.

The strains of the viruses given singly are exactly the same ones as in the MMR so your doctor will have come across the various components to the reactions if your child develops these.  However please let me know if you think your child has had any reaction to any of the given vaccines on 02072244668 in hours or on 07765162004 out of hours.

After the MMR there is a 1 in 1000 chance that your child will be admitted to hospital with a febrile convulsion .To date with 4 years experience we have had no serious reactions to the single vaccines we have given.                                 

Flu Vaccination

     Flu Vaccination                                                    

Influenza is an illness capable of affecting the entire respiratory tract from the nose and throat down to the bronchial tubes and lungs.  It is caused by a group of 3 viruses (influenza A, B or C).  Unfortunately these viruses keep changing from year to year, forming new outer coats which our immune system can’t recognize. This means that even if you or your child had influenza in the past, this year’s virus may be different enough to infect either of you again.

Influenza spreads very rapidly by direct contact with nasal mucus from an infected person or by inhaling droplets coughed or sneezed into the air.  The virus is fragile and does not survive for long in the air or on surfaces of furniture, kitchen or bathroom facilities.  Illness usually begins 1 to 3 days after exposure.

I recommend flu immunization for all children between the ages of six months and sixteen.

I have been offering annual flu immunization to all children that I see in my clinic now for over 5 years.

The reason for this is that the individuals that are particularly at risk from the complications of influenza are the very young and old. In the UK it is offered to the old but not young .In most other developed countries it is offered to both old and young for instance the USA.

Children over the age of six months may receive flu vaccine (though from ages 6 to 35 months it is given at a reduced dose).

For children under the age of 13 years, who have not been vaccinated previously, or who have never before been ill with flu, a second dose four weeks later is advised for full protection.

An annual immunization needs to be administered because the types of influenza most likely to cause an out break each year changes and so the vaccine has to be specially prepared every year to combat the most likely influenza types to cause an outbreak. The manufacturers have got better at doing this year on year.

 

If you would like to make an appointment for your family to be immunized this year then please contact us 0207 224 4668.