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Wilderness Medical Society - snowmass 2005 (Page 136)

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Wilderness Medical Society - snowmass 2005
7
vaccine be recorded. Yellow fever immunizations should also list the destination country
for which this vaccine has been recommended. For those vaccines listed as "R" (for
required) in the VIS column above must also indicate that the VIS was provided the
patient and the date of its publication.

Report major reactions (anaphylactic shock, encephalopathy, seizure,) or other serious
reactions using the Vaccine Adverse Event Reporting System (VAERS). The official
website is:
http://www.vaers.org

The Available Travel Related Immunizations
(adopted from IAMAT International
Immunization Guidelines, 2005)

Hepatitis A (Infectious Hepatitis)

All travelers going anywhere but Northern Europe, Canada, United States, Australia,
and New Zealand should obtain this vaccine.

Two vaccines are currently available in the United States: VAQTA by Merck &
Company and Havrix by GalaxoSmithKline Pharmaceuticals. The primary series for
either must be completed 2 weeks prior to potential exposure. Neither is to be used in
children less than 2 years of age. The adult dosing for both follows a similar schedule.
One intramuscular injection of 1 ml of VAQTA 50 units or of 1 ml of Havrix 1440 EL.U.
constitutes the basic immunization. VAQTA should be boosted in 6 months and Havrix
in 6 to 12 months. For youngsters age 2 to 18 years the dose of Havrix is 720 El.U./0.5
mL followed by the same dose as a booster in 6 to 12 months. The VAQTA schedule for
youngsters age 2 to 17 years is 25 U/0.5 mL, followed by the same dose as a booster in 6
to 19 months later. Re-immunization should be done in three-year intervals for adults and
children using the above doses of the respective vaccines.

A single dose of pooled immune globulin (10% solution) provides immediate protection
against hepatitis A, although both VAQTA or Havrix form an adequate antibody
response rapidly enough to protect the traveler from simultaneous accidental exposure to
this infection. The VAQTA or Havrix may be given simultaneously at a different site.
Immune globulin must not be given at the same time as the Measles, Mumps, Rubella
(MMR) vaccine. It must be given at least 14 days after MMR or 6 weeks to 3 months
(preferably 6 months) before MMR. There are no apparent problems in the
administration of Yellow Fever vaccine with or near immune globulin administration.
Dosage depends upon body weight and length of time of required protection. At
maximal doses it still must be repeated every 6 months for continued protection, but if
VAQTA or Havrix has been obtained, the 3 month dose as shown on the following table
is sufficient. Side effects are minimal other than rather mild possible pain at the injection
site. Immune globulin must be given in the gluteal muscle, while VAQTA and Havrix are
given in the deltoid muscle.

Hepatitis B (Serum Hepatitis)

Recommended as part of a standard immunization program regardless of travel.

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