Wilderness Medical Society snowmass 2005 Page 137
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This disease is most commonly spread by hypodermic usage, sexual contact, and blood
transfusions. In travelers the majority of hepatits B is contracted through unexpected
surgical and dental emergencies. It has a very high prevalence in many areas of the
world. Immunization is from a series of 1.0 ml IM injections of Hepatitis B Vaccine,
called "Recombivax HB" by the manufacturer Merck & Company or Engerix-B by its
manufacturer GalaxoSmithKline. Either vaccine is usually given on day 0, 1 month, and
6 months. Special preparations of these vaccines and alternate schedules are used for
children of various ages and for persons at very high risk, such as dialysis patients.
Duration of protection and need for revaccination has not been defined. A blood test to
determine adequate antibody response can be performed. If the antibody level falls
below 10 SRUs, revaccination with 1.0 ml of vaccine should be considered. The
injection must be given in the deltoid muscle. Side effects include: pain, inflammation at
injection site; fatigue/weakness and low-grade temp; nausea and diarrhea; sore throat and
upper respiratory symptoms in 1% or slightly greater of recipients.
Twinrix® Combined hepatitis A and B is manufactured by GalaxoSmithKline. It contains
the same antigenic components used in their HAVRIX (hepatitis A) and ENERGIX-B
(hepatitis B). Indicated for the simultaneous immunization against hepatitis A and B for
persons 18 years and older. The immunization schedule follows the hepatitis B scheme,
namely 1 ml intramuscularly at 0-, 1-, and 6-months.
Influenza
Recommended for jet travelers during September through February, persons over the age
of 65, and persons with chronic medical problems.
Vaccines are prepared that give 1 to 2 years of immunity for prevalent strains of
influenza A or B. New strains are constantly arising that require formulation of new
vaccines to compensate for this "antigenic drift." Dosage is 0.5 ml IM in the deltoid
muscle, given in the fall of the year. This vaccine is not required for routine travel, but
may be suggested for the traveler heading into an epidemic area. Being confined on
airplanes for long flights places you at high risk as the air breathed by everyone on the
plane is re-circulated. A booster of 0.5 ml must be given yearly. Fewer than 1/3 of
recipients have local soreness around the injection for less than 2 days; fever, muscle
ache, malaise can begin 6 - 12 hours after injection and last 1 or 2 days; persons with
very severe egg allergy have increased risk of allergic reaction.
Japanese Encephalitis
To be given travelers exposed for greater than 3 weeks to rice farming or pig raising
areas of Southeast Asia, Philippines, south-eastern Russian Federation, the Indian
subcontinent, islands in the Torres straight off the Australian mainland and China or
Korea during warm months.
