Travel health update
This month we have timely reminders and new resources to help you with ongoing issues of measles, Zika, yellow fever and rabies
MEASLES
International concern about the current increase in outbreaks of measles is growing, and news items concerning anti-vaxxers and the impact of social media on vaccine uptake are rife. Stories about governments in different country discussing potential measures to enforce MMR vaccination of children before starting school continue. Provisional new measles surveillance data from the World Health Organization reported that reported cases rose by 300% in the first three months of 2019, compared with the same period in 2018.1 Although the data is not yet complete, many countries are in the midst of sizeable measles outbreaks, including the Democratic Republic of Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children. Worryingly, many cases have occurred in countries with overall high vaccination coverage, including the USA. We need to continue to be vigilant about checking the MMR status of our travellers and remember that they need a record of two doses of MMR vaccine irrespective of their age and if required then ImmForm stock may be used. I’ve refreshed a blog about this at http://janechiodini.blogspot.com/2019/05/mmr-and-travel.html. The latest MMR leaflets published by Public Health England are available in English, Polish, Romanian and Somali at https://www.gov.uk/government/publications/mmr-for-all-general-leaflet and a simple poster I created for waiting rooms to alert travellers going to Europe to seek vaccination if not up to date can be downloaded from item no. 24 at https://www.janechiodini.co.uk/tools/.
ZIKA
Thailand is a popular destination for UK travellers but following recent reports of cases of Zika in Thailand, and a review of the available evidence, NaTHNaC has upgraded its advice. It states that pregnant women are advised to avoid travelling to Thailand until after the pregnancy.2 More detail can be read at https://ecdc.europa.eu/en/publications-data/zika-virus-transmission-worldwide. On a similar theme, remember that PHE published a new leaflet in February entitled Zika virus: advice for women returning from areas with active transmission, which is an invaluable resource to have available for travellers in this cohort.3 I’ve recently moved the Zika resources page on my website to https://www.janechiodini.co.uk/help/zika/
YELLOW FEVER
In mid April the Medicines and Healthcare products Regulatory Agency (MHRA) published an alert following two fatal adverse reactions to yellow fever vaccine. The drug safety update highlighted the importance of a detailed individual risk assessment before administering yellow fever vaccine especially for those who may be immunocompromised or aged 60 years and older. See https://www.gov.uk/drug-safety-update/yellow-fever-vaccine-stamaril-and-fatal-adverse-reactions-extreme-caution-needed-in-people-who-may-be-immunosuppressed-and-those-60-years-and-older#background. The alert places great emphasis on the risk assessment process, and says: ‘Sufficient time should be set aside to ensure that the person is immune competent and has no contraindications to the vaccine, including a review of full medical history and any available medical records. Any potential history of thymus disease or thymus removal should be specifically queried. Any decision to administer the vaccine to a person aged 60 years and older must be based on a significant and unavoidable risk of acquiring yellow fever infection.’ It suggests using the manufacturer’s Patient Information Leaflet as a useful basis for discussion found at https://www.medicines.org.uk/emc/product/1683 and it reminds practitioners to be aware of their YFVC code of practice found at https://nathnacyfzone.org.uk/managing-your-yfvc.
RABIES
PHE has updated its database for rabies risks in terrestrial animals by country, which is a useful resource for use in post-exposure risk assessments.4 Remember, if you need to seek specialist advice regarding a returning traveller with contact with a potential rabies risk, you can find full details on page 10 of the rabies chapter in the Green Book, at https://www.gov.uk/government/publications/ rabies-the-green-book-chapter-27.
REFERENCES
1. World Health Organization. Measles surveillance data for 2019. Press release, 15 April 2019. https://www.who.int/immunization/newsroom/measles-data-2019/en/
2. NaTHNac. Zika advice for Thailand updated for pregnant women, 3 May 2019. https://travelhealthpro.org.uk/news/406/zika-advice-for-thailand-updated-for-pregnant-women
3. Public Health England. Zika virus: advice for women returning from areas with active transmission. February 2019. https://www.gov.uk/government/publications/zika-virus-advice-for-women-returning-from-areas-with-active-zika-virus-transmission.
4. Public Health England. Rabies risks by country, 1 May 2019. https://www.gov.uk/government/publications/rabies-risks-by-country