Vaccination of the traveller

The establishment of a vaccine calendar for the traveller is complex. Indeed, this one is a function of the traveller, the voyage and epidemiology, often changing according to countries of destination's. It is however possible to give some general rules.

Medical recommendations for the travellers are worked out by the Committee of the diseases of importation and the diseases related to the voyage, Standing Committee (Decree of September 25, 2002) of the higher Council of public health of France. The recommendations as regards vaccination were published in the weekly epidemiologic Bulletin n° 26-27 of 2003 with the other medical recommendations necessary for the traveller.

Some recent investigations make it possible to appreciate the vaccine statute of the travellers. An investigation of vaccine cover carried out by the Group of epidemiologic and prophylactic studies at 5 355 tropical travellers at the beginning of Paris for three destinations, Cameroun, Senegal and French Guiana, shows that only 6,9 % of the travellers were correctly vaccinated for the voyage.

A multicentric serologic investigation was carried out by the Company of medicine of the voyages carrying into the immunization of 790 travellers arising in seven centers of antiamaril vaccination before the vaccinations carried out for the voyage. This study revealed a rate of protection rather low against tetanus (87 %) justifying an antitetanus recall, especially at the women after 40 years. The various rates of immunization observed in this investigation are 94 % with respect to polioviruses 1-2-3, 68 % with respect to the diphteria, 99 % with respect to measles and are lower than 12 % for hepatitis B In addition, it appears judicious to carry out a control serologic for hepatitis A before vaccination after the 40 years age or if there is the concept of former stays.

Before describing the decision criteria, it should be noted that the only exigible vaccines for the entry in the countries are the yellow fever vaccine, and the vaccine against méningocoques A, C, Y and W135 for the pilgrims going to Mecque.

The programme of vaccination of the traveller

Two criteria intervene in the establishment of a program of vaccinations intended for a traveller.

The first of these criteria is the administrative obligation, which corresponds more to protection of the country against an infectious risk coming from outside than to the real risks incurred by the traveller; the real risks incurred by the traveller constitute the second criterion and vary according to several parameters:
- the medical situation of the visited country;
- conditions and duration of the stay;
- particular characteristics of the traveller, in particular the age and also the former vaccine statute.

These elements make it possible to establish an adapted vaccine program, starting from the range of vaccines available.

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