Short consensus25/1/2018

Short consensus 25-1-2018

Dr Ula Maniewski-ITG

Yellow Fever

Yellow fever map South America

2018

2014

Outbreak YF in Brazilseveral cases in Sao Paulo-city

Yellow fever: for how long is vaccination valid ?

Amendment to International Health Regulations (2005), Annex 7 (yellow fever):

“as of 11 July 2016, for both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travellers as a condition of entry into a State Party, regardless of the date their international certificate of vaccination was initially issued.”

• No new certificate is needed

• “Countries and health care providers continue to be free to make requirements on vaccination, revaccination or boosters for their own populations, or patients, respectively.”

�No WHO guidelines about

• suboptimal protection in certain subpopulations

• boosterinjections

� each country issues its own guidelines

• Stratification endemic/ non endemic

• Endemic 97,6% remains seropos

• Non endemic: 83,6%

• -� almost 1/5 or 1/6 loose measurable antibodies in non endemic setting

• Protection?

• Role of memory T cells unclear and certainly not proven: it is not sure if memory T cellscan protect against YF in case of neg NT

• cutoff for PRNT: breaktrough infections in PRNT of 10 and 20

• In children seroconversion only 84,8%-88%-and lower if combined with MMR

• Underreporting of breakthrough YF cases

Belgian guidelines 2017

Most travelers

Children, pregnant

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HIV, immunosuppressed

In daily practice

• The certificate is lifelong valid

BUT in general: a single booster is recommended for most travellers

• Certificate: remains the same

• Explain to traveller difference between “administrative lifelong” andrecommandation (in general: single booster once in a lifetime)

• ????? What will WHO do?

Example of a tool which can help your traveler-to attach in the back of the yellow book

If you wish a PDF/excel version, you can send

a mail to us or to lhuyskens@itg.be

Cholera

HistoryHistoryHistoryHistory of cholera of cholera of cholera of cholera vaccinationvaccinationvaccinationvaccination/stamp/stamp/stamp/stamp

• 1961: 7th cholera pandemy, started in Indonesia-> Asia-/Far East

• 1970: cholera epidemic spreads to Africa

• 1973: WHO decides that cholera vaccination is not mandatory any more

• But vaccination against cholera was routinely given to travelers to Africa/ Asia in ’80-because proof of vaccination was still checked when entering certaincountries

• 1991: cholera in South America (Peru)-� ITM decides not to vaccinate for South America-nor to give a “cholera stamp”

• 1995: national scientific studygroup of travel medecine is born; they decide not tovaccination anymore against cholera for the ordinary traveler, but to give a stamp that vaccination is not indicated for Africa, where some coutries still require proofof vaccination

Cholera: stamp still needed?

WhoWhoWhoWho elseelseelseelse usesusesusesuses a “cholera stamp”? a “cholera stamp”? a “cholera stamp”? a “cholera stamp”?

• CDC: no mention in yellow book

• Autriche: no

• Suisse: non

• Allemagne: non

• UK: non

• France: non

• Pays-Bas: oui

2018

Cholera: stamp still needed?

TyphoidTyphoidTyphoidTyphoid feverfeverfeverfever

• Typherix®: not available any more

• Typhim Vi®: available

• Vivotif®: availabe

• WHO-SAGE recommended the use of typhoid conjugate vaccines for use in infants between 6 and 23 months of age and catch up vaccinations for children between 2 and 15 years of age.

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CDC-Yellow book 2016

MeningococcalMeningococcalMeningococcalMeningococcal ACWACWACWACW135135135135Y vaccineY vaccineY vaccineY vaccine

• Menveo®

• can be administered from the age of 2 years (off label).

• Since 2010 in the UK: Menveo® is administered from the age of 2 months: m0-m1 –m12 (if the risk persists) (off label).

• >1y: 1 dose.

Nimenrix®

• Registered from the age of 6 weeks

• For babies between 6 and 12 weeks : M0-m2 and the 3rd dose at m12

• For babies between 12 weeks and 12 months: no recommendations of the producer� follow the same vaccination scheme as with the younger group of age: m0-m2 (and the 3rd dose at 12m)

• From the age of 12 months: 1 injection

2 conjugated vaccines: Nimenrix ® Menveo ®

• 5y valid (all indications-also pilgrimage)

Mencevax® : Quadrivalent, not conjugated on the Belgian market again (valid 2-3y)

JAPANESE ENCEPHALITIS

Ixiaro: notice

• Conventional vaccination schedule: • d0

• d28

• first booster between 12 and 24 months

• next boosters: no clear guidelines yet, not sooner than after 10 years.

• Rapid vaccination schedule: (in adults) • d0

• d7

• first booster between 12 and 24 months

• next boosters: no clear guidelines yet, not sooner than after 10 years.

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FSME immune

• No need to restart vaccinationschedule after interruption “everyinjection counts”

• First booster at 3y, next booster 5-10y if < 60y

Reminder travelers diarrea

• Prescription for antibiotics

• when ?

• Traveling to Asia/ Africa; longer than 16d

• Or vulnerable (elderly, child, pregnant, underlying disease,…)

• What? Azithromycine

• When to use?: in case of severe diarrhea:

• High fever > 38, 5°C

• Heavy cramps

• Blood/ slimes

Thank you for your attention on behalve of the

Scientific Studygroup of Travel Medecine

• Chairman: Patrick Soentjens (ITG / Defensie)

• Ula Maniewski (ITG)

• Charlotte Martin – Yves Van Laethem – Anna Vanderfaeillie (St.-Pierre)

• Frédérique Jacobs – Maya Hîtes (ULB)

• Willy Peetermans – Paul De Munter (KUL)

• Bernard Vandercam – Julien De Greef –Dimitri Vanderlinden (St-Luc)

• Steven Callens – Diana Huis in’t Veld (UZGent)

• Patrick Lacor – Rembert Mertens (VUB)

• Jeroen Van der Hilst (Jessa)

• Philippe Léonard (ULg)

• Sophie Quolin (WIV/ISP)

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