News from Around the World
Australia – Meningococcal vaccine
Meningococcal C conjugate vaccine has been added to the Australian National Immunization Program as of January 1st 2003. The age groups approved for free vaccination initially are the 1 - 5 and 15 - 19 year old groups, with varying catch-up schedules in different States. The decision reflects the increasing incidence of morbidity and mortality from the disease in these age groups over the last few years. Whilst the risk of meningitis for short term travelers to Australia is very low, longer term travelers should consider vaccination, especially under the age of 25 years as the incidence is markedly higher in this age group. Three brands of vaccine effective against type C meningitis are available (Baxter, Wyeth and Chiron). Travelers vaccinated with meningitis C vaccine, who require vaccination against other serotypes should allow 6 months between vaccinations.
Dr Jonathan Cohen, Medical Director, Travel Clinics Australia, Melbourne.
United Kingdom – More travel advice and fewer vaccinations are needed.
The health risks associated with international travel range from minor symptoms to severe morbidity and death. In 2000, residents of the United Kingdom made 56.8 million visits abroad, 3.3 times the number made in 1980. Of all visits abroad, 72% were to countries in the European Union and 9% were to North America.
Hand in hand with an increase in travel we can expect a similar increase in travel related morbidity, and therefore a need for effective, accessible, and appropriate pre-travel health advice. We were encouraged by the recognition of travel medicine as an important role of the United Kingdom’s public health service. We were, however, disappointed at the review’s emphasis on vaccine preventable disease, including hepatitis A (81 cases in 2000), which from surveillance data provided by the Public Health Laboratory Service shows a fall in cases over the 20 year period. Likewise, the number of cases of imported malaria has remained static over this time, despite the threefold increase in travel.
The Foreign and Commonwealth Office consular report highlights 1843 deaths in United Kingdom residents abroad during 2001; road traffic accidents, drowning, and suicide were the commonest causes of death after medical causes. Diarrhea, although not usually a cause of serious morbidity, affects up to 70% of tourists on package holidays in tropical counties.
Risk assessment is important to rationalize pre-travel preparation, but the advice needs to reflect the health risk and not the interventions available. The emphasis on vaccination for low risk travel may give a false sense of security and encourage unsafe eating and drinking. Failing to advise on the management of diarrhea, a much more common event, may lead to dehydration and admission to hospital.
Morbidity associated with behavior –for example, sexually transmitted disease and solar and skin associated problems, alcohol related traumas, and injuries from recreational activities – up the main proportion of illness associated with travel. Prevention of these and the other diseases mentioned above requires effective advice and good communication between travelers and their advisers.
The emphasis on vaccinating travelers rather than advising them is a widely held misconception and needs to be corrected. Health promotion and health education need to be the focus of pre-travel consultations. Risk assessment should be based on a broader view than administering drugs and vaccines.
BMJ 2003;326:52 ( 4 January)
N Hoveyda and Ron Behrens, London School of Hygiene and Tropical Medicine, Department of Infectious and Tropical Diseases, Clinical Research Unit, London
