Consensus October 2019New Belgian recommendations in travel medicine

Dr Ula Maniewski

umaniewski@itg.be

Consensus October 2019

Vaccines:

Yellow fever vaccination

Interval between yellow fever vaccination and measles vaccination

Polio

Rabies

Zika: recommendations+ testing policy

Malaria map

Yellow fever

But…

Immunorespons is less in some subgroups

In several publications, neutralizing antibodies decline over time

Quid non responders?

Few cases of “breakthrough infections” have been documented

None of them in vaccinated travellers

Most of the life attenuated vaccines are administered 2x

Most neighboring countries leave a door open/ recommend a second dose:

Yes: French; UK, Swiss, CDC

No: Netherlands

WHO: “Questions and answers”

Q: Does this amendment to the IHR (2005) affect what measures States

Parties can implement for the protection of their own populations or

what doctors may advise their patients concerning vaccination against yellow fever, including potential boosters?

A: No. The amendment only affects what countries may require of

international travellers as a condition of entry in terms of vaccination

against yellow fever and related IHR international certificates of

vaccination. Countries and health care providers continue to be free

to make requirements on vaccination, revaccination or boosters for

their own populations, or patients, respectively.

WHO: “Questions and answers”

Q: On new certificates, what term should be entered in the space on

the certificate(see above) indicating the period of validity?

A:“While the IHR do not specify the exact words to include on the

certificate to indicate lifetime validity of the certificate, WHO

encourages countries to use words which clearly and

unambiguously indicate that the validity of the certificate is for life of the person vaccinated…”

https://www.who.int/ith/annex7-ihr.pdf?ua=1

Consensus

A second dose will be offered to travellers to endemic regions

This dose can be offered at any time (min 1 month after the first dose)

Refer to leaflet at the last page of the certificate (available at

www.travelhealth.be ---> info for professionals)

° The reinforcing vaccination can be administered at any time after the first dose (months or years, one does not have to wait 10 years anymore), but at least 1 month after the first dose.

Example: first dose, no special condition

• Validity: “lifelong”, but

advise to get second dose

at the occasion of a future

travel.

• Refer to leaflet in the back

• One can add “first dose”

Example: second dose

• Validity: “lifelong”,

• one can add “second

dose”

Example: first YF vaccine

-and pregnant

-OR together or < 28d interval with measles

-OR child between 1 and 2 years

• Validity: 1y

• Boost before next

exposure

Example: child <1y- child born on 1/12/2018

Validity until

2nd birthday

Example: HIV patient

Validity : 10y

What changes can we expect in the

near future?

Advice about boostervaccination in young children

Country requirements South Africa

What changes?

Travellers to South Africa:

Yellow fever vaccination NOT

recommended anymore for

visitors of Victoria Falls.

It remains recommended for

travellers with transit in Ethiopia

NB: More an more travellers to

Namibia stop in Luanda → offer YF

vaccine

Type name department in window

Extra poliovaccine OBLIGED

in case of >4 weeks

Measles

• Interval yellow fever/ measles

vaccination

• Early measles vaccination

Interval: Review data-THX Dr. Charlotte Martin Type

study

Country of

study

n/ children

or adults

Vaccines

coadministrated

Results GMT

Nascimento RCT Brazil 1769 child. YFV/MMR

together vs ≥30d

YFV 70% vs 87% 3xhigher

Goujon Retro cc France 131 child. YFV/M(MR) together vs 1-27d

vs >27d

96% immunog, non

inf/4 together

no

Michel Prosp obs Senegal

(Fguyana)

284 child. M/YFV together vs 7-28d 93% vs 90.7% Same

GMT

Lancet Global

Health-Clarke

Prosp Gambia 1500 child. IPV/MR/YFV apart or 2/2 Same immunog for

YFV

Lower

GMT

Huang Random

open

Taiwan 550 child. JEV/MMR together vs 6wks 97-100% d42/d365 no

Nasveld Prosp RCT Australia 108 adu YFV/JEV together vs 30d 100% Same

GMT

Conclusions

Mainly data in children: consistent trends in several

studies

Administrer Yellow fever and measles vaccine

>28days apart

If not possible: same day, different limp

If not possible: any time

Early measles vaccination

Early vaccination in children 6< 12 months when travelling to a

region with an outbreak, mainly Africa, Asia and East-Europe

Vaccine needs to be repeated at 12m

List on www.travelhealth.be

Flanders: this vaccine can be given for free with vaccine from

Vaccinnet

Early second dose?

Breakthrough infections after 1st vaccine

“late” second vaccine in Belgian vaccination schedule

but this is not “for free” (needs to be prescribed)

Rabies vaccine Oct 2019

After many stock ruptures, Rabipur

is available again in officina

Prep: D0-D7 or D0-DX

ID and IM interchangeable

When ID use, write 4 lines in

certificate of vaccination

When can we offer testing for zika?

Symptomatic patients

after traveling to endemic region

or having sex with someone coming from endemic region

In case of fever: PCR on blood/ urine can be tested

No fever anymore: serology

Asymptomatic people with possible exposure (travel to endemic region)

In case of pregnancy or male partner of pregnant women: Screening by

serology 3 weeks after return

Preconception

screening: not recommended anymore

© Pirre Pluymers

THX for your attention!