Preparing patients to travel abroad safely - Part 2: Updating vaccinations

OBJECTIVE To provide, for family physicians without access to a travel clin ic, evidence-based recommendations on vaccinating infants and children, adu lts, pregnant women, and immunocompromised patients traveling to non-Wester n countries. QUALITY OF EVIDENCE Searches were undertaken of MEDLINE from 1990 to Novemb er 1998 (372 articles); the Cochrane Collaboration Library; publications of the National Action Committee on Immunization and the Committee to Advise on Tropical Medicine and Travel in Canada Communicable Disease Reports; the Canadian Immunization Guide; and Laboratory Centre for Disease Control, Un ited States Centres for Disease Control, and World Health Organization webs ites. Evidence-based statements, randomized controlled trials, systematic r eviews, and meta-analyses were selected. Vaccination recommendations are ba sed on this evidence. MAIN MESSAGE Physicians should complete vaccination schedules for children whose primary series is incomplete and vaccinate unvaccinated adults. Hepat itis A is widespread, and travelers to areas where it is endemic should be vaccinated. The elderly should be vaccinated against influenza and pneumoco ccal disease. Pregnant women should receive vaccines appropriate to their t rimester. Immunocompromised patients should be vaccinated, but BCG and live vaccines are contraindicated. Travelers to areas where meningitis, typhoid , cholera, Japanese encephalitis, and rabies are endemic should be vaccinat ed if they are likely to be exposed. Those traveling to areas where tubercu losis is endemic should take precautions and should have skin tests before traveling and 2 to 4 months after return. CONCLUSIONS Family physicians can administer all necessary vaccinations. Th ey can advise pregnant women and immunocompromised people about the balance of risk of disease and benefits of vaccination.