hot topics fromcistm16 june5-9th, 2019 · je vaccine pros and cons •toleranceand safety...
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HOT TOPICS from CISTM16
June 5-9th, 2019
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ourworldindata.org
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Climate change
• Voluntary migrations
• Forced displacements
• Tourism & Travel
• Migrants more at risk of communicable
and non communicable diseases
• Migra�on ≠ driver of communicable
disease outbreaks
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Air pollution
Incorporate consideration of air quality,
especially if underlying comorbidity
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C. Sanford ‘Every breath you take’
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Health effects of air pollution
•Stroke
•Sudden death
•Heart disease
•COPD
•Asthma
•Lung cancers and other cancers
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Prevention?
Masks? No recommendation
Awareness
Apps exist to ajust activities
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D. LaBeaud ‘Climate change and the ecology of
vector-borne diseases’
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Vector Borne Zoonotic Dis. 2015 Climate change will shift burden of malaria
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Japanese Encephalitis (JE): to vaccinate
or not?
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Usual rule in Travel Medicine
General traveler risk = 1/1-10 000 000
Propose vaccine only if travel >30 days in
rural areas in at risk-season
Lancet Neurology 2015
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Expansion of JE areas
< climate change
< economic development
< agricultural change
< urbanisation of rural areas
< increased migration to cities
leading to …
� Blurring of boundaries of rural areas where
natural enzootic cycle exists
� Expanding of urban areas
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Yellow Book 2020
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JE in travelers 1992-2013 (N=14)
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JE vaccine
Pros and Cons
•Tolerance and safety
•Convenience
•Efficacy, effectiveness
•No accurate data about
risk for travelers
•Risk for death/sequelae
•Most effective way of
prevention
•No accurate data about
risk for travelers
•Lots of asymptomatic
forms
•Price
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Why not immunize?
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At least inform the traveler
and propose vaccination!
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Examination of the evidence
Use of compression socks to prevent DVT : NO
Doxy wkly for prevention of leptospirosis : YES
Hygiene to reduce TD occurrence: NO
Use of insect repellents to reduce the risk of
malaria: YES
Screening for latent TB in traveler: NO
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Older travelers
•5-30% travelers >60 years old
•Different profiles of vaccine response and
vaccine AE
•Risk of health pb during travel:
↓if higher educa�on, travelling with
partner
↑if longer dura�on, travel experience
•Documented increased risk for Influenza,
pneumonia, Zoster
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Reduced antibody responses to all antigens
Young cells die and memory cells survive �
difficulty to respond to a new vaccine
< decreased response to Ag
< decreased neutros function
< increased damage
< increased time to recover
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Lack of studies especially for travel vaccines in the
elderly
•Hep A vaccine : response vaccine delayed and decreased in older adults (65%-97%) � 2 doses before travel•YFever, Imojev® and rabies : excellent immunogenicity•Ixiaro ® : >65 y � 65% efficacy•Hepatitis B 65% > 65y after 3 doses (98% à 20 ans)•Measles: benefit of age but lose Ab quicker if immunized later•Typhoid: CRF 36%- no data >55 y
•Think S. pneumoniae vaccine if RF, mass gathering•Think Pertussis if>10 years
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M Walberg ‘To vaccinate or not elderly’
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Thank you for your attention!