Travel health update

This month Jane Chiodini addresses one of the most frequently asked questions on a social media forum, highlights the need for advice to men travelling to World Pride, and reveals an unanticipated consequence of the forthcoming election

CLARIFICATION ON MMR VACCINE FOR TRAVEL PURPOSES

Measles has been in the news again with the outbreak in Europe continuing, particularly in Romania. The question regarding who should be vaccinated with MMR for travel crops up frequently on social media forums, with many left unsure as to what they should do. The basic principle is to ensure people are vaccinated for life in the UK, which means everyone should have had two doses of MMR vaccine irrespective of age. This is part of our national immunisation programme, and stock obtained from ImmForm should be used to administer the vaccine. A travel consultation is an ideal opportunity to ensure the patient is up to date on all immunisations for life in the UK – and don’t forget the helpful chart ‘Vaccination of individuals with uncertain or incomplete immunisation status’ available at https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status. For MMR this states:

• Doses of MMR/measles vaccine given prior to 12 months of age should not be counted
• For individuals <18 months of age, a minimum interval of three months should be left between first and second doses
• For individuals >18 months of age a minimum of one month should be left between first and second doses
• Two doses of MMR should be given irrespective of history of measles, mumps or rubella infection and/or age

The Green Book chapter on measles indicates that, for travel, infants can receive vaccine from six months if the destination is higher risk, but because residual maternal antibodies may reduce the response rate to the vaccine, the normal routine schedule still needs to be administered. It also states that children who are travelling who have received one dose of MMR at the routine age should have the second dose brought forward to at least one month after the first. If the child is under 18 months of age and the second dose is given within three months of the first dose, then the routine pre-school dose (a third dose) should be given in order to ensure full protection.

Dealing with people born before 1970 has historically caused a greater quandary, but while the Green Book acknowledges this cohort are more likely to have had all three natural infections and are less likely to be susceptible, it states MMR vaccine should be offered to those who request it or if they are considered to be at risk of high exposure. See https://www.gov.uk/government/publications/measles-the-green-book-chapter-21

NaTHNaC has published a ‘Diseases in Brief’ article on measles which is also very helpful – see http://travelhealthpro.org.uk/disease/116/measles

HEPATITIS A OUTBREAK AND LEAFLETS

NaTHNaC recently reported a European cluster of cases of hepatitis A, mostly affecting men who have sex with men (MSM). Since February 2016, a total of 287 confirmed hepatitis A cases related to these outbreaks have been reported by 13 European countries, including the UK. Most of these cases were reported in unvaccinated MSM, and transmission by person-to person sexual contact is considered to be the most likely. World Pride is taking place in Madrid, Spain from 23 June until 2 July 2017, and NaTHNaC is reminding MSM travelling to this event to seek early advice about travel related risks, including hepatitis A. The April edition of vaccine update flags up two new publications, in the form of a leaflet and a poster, to help provide advice – see https://www.gov.uk/government/publications/hepatitis-a-preventing-infection-in-men-who-have-sex-with-men.

GENERAL ELECTION IMPACTS MALARIA GUIDANCE

The latest statistics for travellers returning to the UK with malaria are usually published on World Malaria Day – always held on 25 April. This year it was also hoped that the updated Guidelines for malaria prevention in travellers from the UK 2017 would be published then as well. These were much awaited as the Advisory Committee for Malaria Prevention has undertaken a comprehensive review of its country recommendations and significant changes are likely. However, as a general election has been called, no announcements are allowed to be made in the lead up, so we’ll have to wait until after 8 June to learn more!