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In the October Bulletin, we discuss the changes to Yellow Fever vaccination guidance

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Welcome to the October 2016 Travel Health Bulletin. This  month we look at the changes to the Yellow Fever vaccine that we need to be clear on and some complex scenarios.

New Changes

 
 

As of the 11th July 2016 WHO announced that the Yellow Fever vaccine is valid for life in well individuals for all certificates issued, whether for first doses or replacement certificates they should always be dated 10 days from the vaccine given till ‘Life of person vaccinated’.

Travellers who have been vaccinated more than 10 years ago and still hold their original certificate can travel with this. Their certificate cannot be rejected on the grounds it is dated up till 10 years after vaccination. Boosters and re vaccination cannot be asked for by receiving countries. Existing certificates must never be amended.

 

Complex traveller



 
When a client presents with a yellow fever certificate that has expired it is important to just check a few things with the client before advising them that they have life cover. These are:

    •    Was the client less than 2 yrs of age when you had the vaccine?
    •    Was the client  pregnant at the time of vaccination?
    •    Was the client HIV positive at the time of vaccination?
    •    Did they have the vaccine before undergoing a bone marrow transplant?
    •    Did they have the vaccine when immune suppressed?

Travellers in these groups may have elicited a poor immune response to the vaccine. If there are no current contraindications and the client is travelling to a risk area for Yellow Fever than the traveller should be re vaccinated and a new certificate completed as per the new guidelines.
Additionally if vaccinating travellers in this group for the first time they should be advised to consider re vaccination before travelling to a yellow fever risk area in the future.
 

The traveller over 60




Remember that being over 60 years of age is not a contraindication for Yellow fever vaccination. It is a caution because the risk of YF vaccine-associated viscerotropic disease is slightly increased In those over 60 having the vaccine for the first time.  Many people are travelling later on in life and throughout their retirement years. They are often over 60 and visiting countries with Yellow Fever risk where vaccination is recommended. A thorough and individualised risk assessment taking into account health status is important to advise and educate these clients of the risk of Yellow Fever but also to enable them to make an informed choice on having the vaccine. If they choose not to have the vaccine we should advise them not to travel into a risk area. Information on the risks can be found at travelheathpro.org.uk
 

Question


 

A 65 year old man with Parkinson’s (Controlled with medication) well enough to travel to the Gambia on a two week holiday.  High risk for Yellow Fever. Can you vaccinate this client?

Think carefully. What is the caution Parkinson’s or his age? Is Parkinson’s a Contraindication? Is this client immunosuppressed? Can he be exempt from vaccination?
 

Answer

 

Parkinson’s is not a contraindication and medication for Parkinson’s do not supress the immune system. Of course how well this is controlled is important In the client’s safety when travelling abroad and should be discussed. The caution is age, so the risk of vaccination needs to be discussed with the client. There are no certificate requirements for travellers arriving from the UK. An exemption certificate cannot be issued on the grounds that this client has Parkinson’s and is over 60. Vaccination can be given if the client is well and chooses to travel to this country.
 
References:
http://travelhealthpro.org.uk/news/9/changes-to-yellow-fever-certificates-11-july-2016
https://www.gov.uk/government/publications/yellow-fever-the-green-book-chapter-35 (page 447)
 
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