Passport. Toothbrush. Health.
Highland Travel Medicine is a full-service clinic specializing in preparing you to stay healthy no matter where in the world you go. Our practitioners are certified by the International Society of Travel Medicine and carry a Certificate in Travel Health®.
We’ll create a personalized travel medicine plan for you, based on your destination and the latest guidelines from the Center for Disease Control (CDC). Your plan may include vaccinations for infectious diseases and/or medications, as well as information on how to handle medical issues that arise on your trip.
We’re also here to help if you need medical care upon your return.
Group and Corporate Rates are available. For Groups of 10 or more, we will come to you.
Scheduling your Travel Medicine Consultation
We recommend making an appointment (to decrease your wait time). But we also accept walk-ins and can frequently accommodate same-day appointments.
We stock many vaccines and can write prescriptions for other medications. However, we have to order some vaccinations and they can take 24-48 hours to arrive, so please call ahead to make sure we have what you need.
*Yellow Fever Vaccine is available and in stock.
To expedite your consultation:
- When you make your appointment, please tell us the medications you are on and your travel itinerary.
- When you come in, please bring your immunization records and previous vaccination cards if you have them.
Hepatitis A is a viral infection that affects the liver. It is caused by the Hepatitis A Virus (HAV). This virus is shed in the waste of people infected with the virus. HAV can spread from person to person but is usually transmitted as a result of consuming contaminated food or water. Sources of infection include polluted water, ice or shellfish harvested from sewage-contaminated water; or from produce or other foods that are raw that have been infected during harvesting. The result of an infection from the HAV may either be asymptomatic, or range in a mild symptomatic illness that lasts for 2weeks up to a severe illness that is persistent for months. Symptoms include: fever, malaise, poor appetite, nausea, abdominal pain followed within days by jaundice (yellowing of the skin). There is a high prevalence of hepatitis A in Mexico, South America, Africa and Asia. It is not prevalent in developed regions of Europe, North America (except Mexico), Japan, Australia and Europe.
Hepatitis A is easily preventable with vaccination. When traveling to North America (with the exception of travel to Mexico), Japan, Australia, New Zealand, and developed countries in Europe, there is no greater risk of infection from HAV than in the United States. For travelers going elsewhere, the risk increases with duration of the visit, those traveling to rural areas, and partaking in foods in the settings of poor sanitation. Also, since 2005, the CDC recommends all children over 12months of age in the United States be vaccinated against Hepatitis A.
Vaccination is recommended for persons traveling to most areas, including Central and South America, Africa, Asia, Eastern Europe and Russia. The vaccination is a series of two injections. The first should be administered prior to travel. After one month from the first dose, 94% of adults will have immunity. The second injection is given anytime 6-12months from the initial shot, to give lifelong immunity against the HAV. For this reason it is highly recommended that travelers visit their travel medicine clinic at last 1month prior to departure. Reported adverse reactions to the immunization include pain at the injection site and headache. The risk of Hepatitis A vaccination has not been established in pregnancy, though the vaccine is not a live vaccine, and in theory the risk should be low for mother and baby. Other ways to avoid contracting HAV is by cooking or boiling foods for at least one minute to inactivate the virus. Avoid potentially contaminated water and uncooked shellfish or produce that has not been handled by the traveler personally. Remember, if you can’t cook it or peel it, don’t eat it! MORE INFO.
Hepatitis B is a viral infection that affects the liver. A person infected with the Hepatitis B Virus (HBV) can show a range in severity of symptoms from mild fever, decreased appetite, abdominal pain, and nausea followed by yellowing of the skin, called jaundice, to death. The virus is transmitted through activities that involve contact with blood or body fluids (i.e. sharing needles for injections, having unprotected sex, working in a healthcare setting that exposes one to body fluids, receiving blood transfusions with infected blood and direct contact with open sores of a person infected with HBV). The prevalence of chronic HBV infection in general is low in Northern and Western Europe, North America, Australia, New Zealand, Mexico and the Southern parts of South America. There is an intermediate prevalence in South Central and Southwest Asia, Israel, Japan, Eastern and Southern Europe, Russia, and the surrounding areas of the Amazon basin. The highest incidence is noted in the middle and southern parts of Africa, Southeast Asia (including China and Korea), countries of the Middle East and parts of the Caribbean. The overall risk for international travelers is considered low except in those countries deemed intermediate or high risk.
Hepatitis B is preventable with vaccination and/ or avoiding risky behaviors (i.e. sharing needles, using contaminated health care equipment or having unprotected sex). In the United States, the CDC recommends all healthcare workers, all children and adolescents younger than 19years, and anyone how participates in risky behaviors have the vaccination. Furthermore, if one is traveling to a country considered an intermediate or high risk, a Hepatitis B vaccination is highly encouraged.
The Hepatitis B vaccination is a three-shot series. It is usually administered on the first day, one month later, and then 6 months after the initial injection. There is also a Twinrix vaccination available for people 18years of older that combines the Hepatitis A and B vaccinations so that travelers can get vaccinated against both viruses at the same time. This, too, is a series of 3 injections, given at day 1, one month later and then 6months after the first injection. If the series is not completed by the time of travel, there is some degree of immunization after the first two doses; however, one is not considered fully immunized until the series is finished. If time is an issue, there is an accelerated schedule for the Hepatitis B vaccination. This series consists of 4 shots, including day 1, day 7 and day 21, followed by a fourth injection 12 months later. The Hepatitis B vaccination is considered safe in pregnancy and in breastfeeding mothers. The most common side effect is pain at the injection site and a slightly elevated temperature. The traveler should remember that behavioral preventative measures should be practiced while traveling abroad. These measures include avoiding unsterile tattooing and piercing, unsterile hospital equipment, sharing needles and having unprotected sex. MORE INFO
The Twinrix is a combination immunization that vaccinates against both Hepatitis A and B. It is a three-part vaccination where you will be administered the first vaccine on the day of your visit. The second vaccine will be administered 1-2 months later and the third/final vaccine will be given 6 months later.
Yellow Fever is a viral disease transmitted to humans through the bite of an infected mosquito. Illness ranges in severity from an influenza-like illness (high fever, muscle aches, and headache) to severe hepatitis and hemorrhagic fever often resulting in death. The disease occurs in equatorial regions of Sub-Saharan Africa and South America. Travelers’ risk to these areas is dependent upon several factors including; immunization status, season, duration of exposure, occupational and recreational activities, and status of local outbreaks. Risk of infection is much higher in Africa than South America. Greatest risk in Africa is during and just after the rainy season July-October. Greatest risk in South America is January-March.
Prevention of Yellow Fever is best achieved with vaccination and the avoidance of mosquito bites. Wherever possible stay in climate controlled air-conditioned quarters and wear long-sleeved shirts and long pants. Mosquito netting is very important if sleeping in quarters which are not climate controlled. Insect repellents containing DEET or picaridin should be applied on exposed skin and re-applied as directed.
Vaccination with Yellow Fever vaccine is the best means of protection. Yellow Fever Vaccine is a live attenuated vaccine and should not be given to certain people. Children under six months, and persons older than sixty (seek advice from a travel professional) should generally avoid this vaccine. Immunocompromised persons; leukemia, lymphoma, or generalized malignancy will need professional medical guidance before administration. HIV positive persons with T-cells higher than 200 cells/mm3 can be vaccinated but will require close follow-up and surveillance for adverse reactions. Persons taking high dose corticosteroids or immunosuppressive drugs will require pre-vaccination evaluation. A history of Thymus disease or Thymus surgery should not be vaccinated. Any person with a history of allergy to egg or egg products should not be vaccinated. If you fall into a group which precludes vaccination, a letter from a travel physician in the form of a waiver should be carried with you for travel.
International Certificate of Vaccination (ICV) for Yellow Fever.
International health regulations allow countries to require proof of vaccination for travelers arriving from certain countries where Yellow fever is endemic. Travelers arriving without this certificate may be refused entry, quarantined, or forcibly administered vaccination. MORE INFO
Typhoid fever is an acute illness that causes high fever and can be life threatening. It is caused by the bacterium, Salmonella enterica serotype Typhi. Please note that most of the common “salmonella” infections in the United States are not of the variety that causes Typhoid fever; the strands of salmonella that cause this illness are typhoid specific. People who have traveled to an endemic area are subject to contracting this illness by eating foods that have not been cooked or cleaned properly and drinking the local water.
Symptoms of Typhoid range from a mild to life threatening. The key symptom to Typhoid is a high fever that lasts persistently, for days. The temperature normally ranges from 103 to 104degrees Fahrenheit. People may also experience headache, malaise, decreased appetite, or a rash.
Areas that are endemic include South Asia, Asia, Africa, the Caribbean, and Central and South America. Moreover, travelers that visit local relatives or rural cities that are not in the tourist populated areas, travelers who eat foods that have not been cooked and served hot, or those who drink local water that has not been boiled, are at a greater risk of contracting Typhoid as well.
Vaccination is available for Typhoid, either as an injection or pill form. Please note, neither vaccine guarantees 100% immunity to Typhoid, but by taking the vaccination, you are at a much lower risk of contracting this life threatening illness. Furthermore, you can lower your risk by eating only cooked foods that are served hot and by only drinking carbonated beverages and water that has been boiled. In order to assure the greatest levels of immunity, the traveler should be vaccinated 2 weeks prior to leaving the States. For the oral Typhoid pills, the traveler will take one pill every other day, for a total of 8 days prior to departure. For the injection, the traveler should receive the injection two weeks prior to departure. The oral pill will provide immunity for 5 years and the injection provides immunity for 2years. Neither form of the vaccine is given to pregnant women.
Remember, if you can’t cook it or peel it, then don’t eat it! MORE INFO
JAPANESE ENCEPHALITIS VIRUS
Japanese Encephalitis (JEV) is a mosquito borne Flavavirus which is closely related to the West Nile and Saint Louis Encephalitis viruses. JEV is the most common form of viral encephalitis in Asia. There have been no reported cases of JEV originating in Africa, Europe or the Americas.
JEV infects mosquitoes that typically feed on pigs or wading birds which harbor this virus. When an infected mosquito bites a non-immune human infection can be spread to that individual. Every year there are 35,000 to 50,000 cases of Japanese Encephalitis reported to the World Health Organization. Of these reported cases there are 10,000 to 15,000 deaths annually. Of those that live, greater than fifty percent will have permanent neurologic damage. In areas where the infection is endemic most adult residents will have natural immunity but non immune travelers to those areas are at risk.
In areas where flooding irrigation is practiced (rice paddies) there are increased numbers of the vector mosquitoes and higher rates of disease. The peak incidence of infection is from June through September (China, Korea, Japan, and Eastern Russia) and the mosquitoes carrying infection typically feed from dusk to dawn.
Travelers to urban areas for brief periods of time are at lower risk. Those who are in rural areas, spend considerable time outside from dusk to dawn, or are in endemic areas for extended periods of time are at higher risk. Mosquito netting while sleeping and the use of DEET containing mosquito repellants will decrease the frequency of bites.
Vaccination for Japanese Encephalitis is recommended by the CDC for travel to endemic areas only if you are staying for extended periods or traveling to rural farming areas. Because of limited vaccine supply, and relatively high rates of adverse vaccination events, vaccination is usually not recommended for short term trips to urban areas. Vaccination consists of a two-dose series at days 0, and 28, with the intent to give the last dose at least 10 days prior to departure. This vaccine, IXARO, is approved in people 17 years and older. MORE INFO
Measles is a viral infection that causes a range of symptoms as benign as rash, fever and eye irritation or more severe, such as pneumonia, seizures, brain damage and death. Mumps is also a viral infection that causes fever, headache, swollen glands, and can cause deafness, meningitis, painful swelling of the testes or ovaries and, rarely, death. Finally, Rubella, also known as German measles, can cause the same viral illnesses, but may result in joint pain as well. If a woman contracts rubella while pregnant, her unborn child may be born with serious birth defects. All three viruses are caused by inhaling infected droplets from a neighboring ill person.
Since 1956, MMR has been required for entry into the US school system; therefore, most people born after 1956 should be immunized. Prior to 1956, the assumption is most people were infected with measles, mumps and rubella, and are considered immune. However, if you were born after 1956 and are unsure of your immunity or if you only received one dose prior to entering school, then the series would need to be restarted to ensure immunity prior to travel to endemic countries. Also, in recent history, there have been more measles cases because of the decrease in the number of people vaccinated. There have been outbreaks of measles in many countries. A booster is recommended for people traveling to these areas with recent outbreaks.
Generally, the vaccine is given as two doses: the first at 12-15 months old and then at 4-6 years old. If you are an adult receiving the series for the first time, or as a booster, the 2 doses can be given 28 days apart. If you are traveling to an endemic country with a child <12 months old, the MMR vaccine can be given ahead of schedule to give the child some protection prior to travel, though the child would eventually need two more doses for lifetime protection.
The MMR vaccine is a live vaccine; therefore, pregnant women, acutely ill patients, and those with a compromised immune system should not receive the vaccine. Also, people with a neomycin allergy should not receive this vaccine. Reactions to this vaccine are generally mild, including fever, gland swelling and rash; severe reactions include allergic reactions and, incredibly rarely in children, deafness or brain injury. MORE INFO
TETANUS, DIPTHERIA, PERTUSSIS
Tetanus is a bacterial disease, caused by Clostridium tetani, which affects the nervous system. The bacteria enter the body through a break in the skin. If left untreated, it causes death in 1 out of 5 people. Early symptoms include lockjaw, stiffness in the neck and abdomen, and trouble swallowing. Late symptoms include severe muscle spasms, seizure like activity and abnormal heart rhythms.
DIPTHERIA is a bacterial infection that causes a thick covering in the back of the throat, resulting in severe respiratory compromise. It is spread by respiratory droplets of an infected person carrying the bacteria and is not symptomatic at the time.
PERTUSSIS, known as “Whooping Cough,” is spread by respiratory droplets from an infected individual who is not symptomatic at the time of transmission. It causes severe coughing spells, vomiting, rib fractures and even pneumonia. Whooping cough is not considered life threatening in an adult, but if an unimmunized child is infected, death can occur. Since 2005, the incidence of adolescent and young adult infection with pertussis has been on the rise, causing an effort to revaccinate adults whose immunity has waned.
Anyone age 19-64 years, who has not had a TDAP in the last 10 years should receive one as part of their routine vaccinations, and especially before travel to a foreign country. As an adult, if you have not received a full series of tetanus-diphtheria toxoid vaccination (Td) as a child, then you should receive a full three dose series, at day 0, 1 month later, then 6 months later; with one of those shots being TDAP. If a woman is pregnant and her last Td was ≥10 years ago, she can receive the Td vaccine in the second and third trimesters.
This vaccine should not be given to someone who has had an allergic reaction to previous tetanus vaccines. As with most vaccines, a mild reaction is not uncommon; including pain at the site, mild fever, fatigue, and GI upset. A small amount of adults may suffer more severe pain at the injection site, but it subsides after a few days. A severe reaction found in clinical trials resulted in nervous system problems, which resolved on their own and could not be completely attributed to the vaccination. MORE INFO
Polio is a viral infection that causes acute infections within the gastrointestinal tract and occasionally the central nervous system. It is spread via fecal-oral and oral transmission. Prior to the discovery of the Polio vaccine in 1955, the incidence for acute infection was worldwide, especially in the summer and fall. Since the introduction of the polio vaccine, the incidence of disease in the United States has fallen dramatically. There has not been any wild type polio reported in the US in the last 20 years. However, in some parts of the world, including Afghanistan, Nigeria, and Pakistan, the incidence is still prevalent and immunization should be considered when traveling to these and surrounding countries.
Polio vaccine is usually given in childhood, as a four-part series of inactivated vaccine. Children receive the vaccine at 2, 4, and 6-18months, and then again at 4-6years. Adults fall into three groups regarding immunization. If an adult has never been vaccinated, then he should receive 3 doses at Day 0, 1-2 months later and then 6-12months after the second dose. If an adult has had 1 or 2 doses previously, then he will receive the remaining doses. Finally, if an adult has received all childhood doses but is traveling to an endemic area, then he should receive a one-time booster.
People with allergic reactions to Neomycin, Streptomycin or Polymyxin B should not take this vaccine. Side effects of the vaccine include soreness at the site. MORE INFO
Meningococcal disease is caused by the bacterial infection, Neisseria meningitis. Meningitis is an inflammation of the linings of the brain and spinal cord caused by Neisseria. Symptoms can include sudden headache, stiff neck, fever, and neurological changes. Even if treated aggressively, the illness is still fatal for 10-15% of people who have the disease. It is spread by close contact and respiratory secretions amongst people who carry the infection. Anyone can get meningococcal disease, but people who are in close contact with each other have a much higher incidence of occurrence. Moreover, there are endemic areas of meningitis outbreaks, including the “Meningitis Belt” which spans sub-Saharan Africa. Countries within this belt are Guinea, Guinea-Bissau, The Gambia, Mali, Burkina Faso, Ghana, Togo, Benin, Nigeria, Cameroon, Chad, Central African Republic, Sudan and Ethiopia. Small portions of the northern borders of Uganda and Kenya are also included in this belt.
Meningococcal infection has been extremely problematic in the past for visitors of the Hajj and Umrah pilgrimage to Saudi Arabia; therefore, vaccination is required for admittance to that country for those traveling to Mecca.
The CDC recommends vaccination against meningococcal disease to persons traveling to countries where meningitis is endemic, particularly, sub-Saharan Africa during the dry season, December to June. The most common serogroup of meningococcal disease that reigns in Africa is Serogroup A. The vaccination available in the United States is a quadrivalent polysaccharide-protein conjugate vaccine, named MCV-4, which covers Serogroups A, C, Y and W-135. This vaccine is available for persons aged 2-55years. The MCV-4 vaccine provides immunity for up to five years after receiving the injection. For those people traveling to Mecca during the annual Hajj and Umrah pilgrimage, Saudi Arabian government requires proof of this vaccination. MORE INFO
Gardasil 9 is the vaccine that protects against nine strands of the Human Papilloma Virus (HPV). HPV is the cause of 70% of cervical cancers and 90% genital warts. Recent research implicates HPV as the primary cause of oral, throat, and rectal cancers. Gardasil does not guarantee full protection against all diseases caused by HPV, nor does it protect against disease not caused by HPV. However, it is now understood that some cancers are vaccine preventable and Gardasil is the most effective agent in preventing these cancers.
Most causes of HPV infection are caused by close skin to skin contact, oral, and sexual contact. There are several strands of HPV that may cause warts and cancers, but the four most common strands are covered within this vaccine.
The Gardasil vaccine is not a live vaccine; therefore, you will not get HPV from the vaccine. Side effects include swelling, redness and discomfort at the site. Both females and males may receive Gardasil. Anyone ages 9-26years old may receive the vaccine. The vaccine is a three dose series, starting at day 0, then 2 months, and 6 months later. Because the vaccine can help protect you from HPV infection, it is ideal that you receive the vaccine prior to exposure. If you have already been sexually active, you may still receive the vaccine. A discussion with your provider is warranted regarding the benefits of the vaccine for those with potential previous exposure. The Gardasil vaccine is not a substitution for the PAP smear test. The Pap smear test is still our most effective means of discovering cervical cancer early in its course. Gardasil is a highly effective means of preventing cervical cancer but does not replace yearly PAP smears. MORE INFO
Rabies is a deadly disease, caused by a virus that is transmitted by the bite of a rabid animal to an unimmunized animal. The infected animal bites another animal and the virus is shed into the bite wound, which can acutely get into the nerve ends at the wound and cross into the brain of the victim. After infection, symptoms of rabies may not manifest for 1-3months, maybe longer. Symptoms progress from non-specific findings to paralysis, coma and death. There is no definitive treatment for rabies.
Any mammal can become infected with rabies, but bats and carnivores seem to be the most common animals infected. Dogs tend to be the reservoir in developing countries and bat bites are to most always be presumed infected.
Rabies is found in every part of the world, except Antarctica. There are endemic areas, such as Central and South America, Africa and Asia, but areas of alarming cases change. The World Health Organization is a good resource for sporadic outbreak. The risk for a traveler increases with journeys to rabies-endemic areas. The exact rate of occurrence is unknown but suspected to range from 16-200 incidences per 100,000 travelers. Therefore, people should avoid street dogs and monkeys near tourist attractions. Children are at a substantially higher risk of being bitten by a rabid animal. Parents of traveling children should reinforce the importance of avoiding strange animals and avoid feeding the animals.
The best way to prevent rabies is to avoid being bitten by any animal. Do not pet or feed wild or strange animals. If there is a significant risk of exposure, there is a vaccine available. If a wild animal bites you, immediately wash the area with clean water, then wipe with antiseptic cleaner (such as alcohol or iodine). Seek immediate medical attention.
Prior to travel, one may choose to vaccinate himself against rabies. This is a three-part series: Day 0, Day 7 and Day 28. This allows the body to make enough antibodies to rabies, that if a traveler were bitten by a rabid animal while abroad, the traveler would have enough immunity to only require two more rabies vaccine post exposure. This allows the traveler to forgo the need for Rabies Immunoglobulin (RIG), which is a shot of antibodies gathered from a pool of hyper-immunized volunteers. RIG is difficult to locate, expensive and may not be available in foreign countries. However, RIG is absolutely necessary if no pre-exposure vaccines were given. If someone who is unimmunized is bitten by a rabid animal, he must receive the RIG dose as soon as possible and a series of rabies vaccines on Day 0, 3, 7, and 14. He will possibly need a 5th vaccine on day 28, if immunocompromised. The vaccine is approved for all ages and is not contraindicated in pregnant women. MORE INFO
Pneumonia is a serious respiratory illness that is most often caused by the bacteria, Streptococcus pneumonia. This bacterium can also cause blood infections and meningitis. It is spread through close contact with infected people usually through respiratory droplets. The bacterial infection occurs throughout the world, but rates are higher in developing countries. In the United States, mostly children and older adults are at higher risk of this disease. Since 2000, there has been a vaccine available that has greatly decreased the incidence of pneumococcal infections in the United States. The risk for acquiring this infection in the traveler increases if there is an underlying medical condition (such as asthma, smoking, or diabetes) and if the traveler is very young or elderly. Symptoms include high fevers, lethargy, cough, bloody sputum, shortness of breath, stiff neck, and seizures. Diagnosis can be made with blood work or x-rays. Bacterial pneumonia is treatable with antibiotics.
There are two vaccines available. There is the PCV-13, the 13 valent pneumococcal conjugate vaccine that is used for children under 2 years old, people 2 years or older with certain medical conditions and most adults older than 65 years. It is part of the routine childhood vaccines in the United States. Typically the vaccine is given at 2, 4, and 6 months old and a booster at 12-15months. There is also a PPV23 vaccine which is generally recommended for all adults ≥65years old and for those aged 2-64 years old with underlying medical conditions. This vaccine is also recommended for adults ages 19 – 64 years old who smoke cigarettes. A one-time dose is recommended for those patients older than 65 years. However, if the patient does not have a spleen, has sickle cell anemia, kidney disease, blood disorders, cancers or other immunocompromising conditions, then a second dose is recommended five years after the first dose. If an adult received the first PPV23 prior to turning 65 years old, a second vaccine is recommended 5 years after the first. Common side effects are redness and soreness at the site of injection. Rarer side effects include fever and body aches.
VARICELLA ZOSTER (SHINGLES)
Zoster is a virus that causes infection of the nervous system in humans. Initial infection leads to Chicken Pox (Varicella). A generalized itchy rash often seen in children. This virus survives in nerve tissue for the remainder of the child’s life. Reactivation of the virus termed Shingles (Zoster) occurs when the immune system is stressed, either from recent illness, chronic illness or even immunosuppressant medications (i.e. steroids). A well defined often linear rash will develop usually only on the left or right side of the body. Shingles is a painful, blistering rash.People with shingles may also experience fever and headaches. If left untreated, there is a rare occurrence of pneumonia, encephalitis, or death. For 20% of people who suffer from shingles chronic pain can ensue. This is called Post Herpetic Neuralgia, which can leave permanent and debilitating pain over the site of the rash. People over the age of 50years are more likely to get shingles. The rash of Shingles can spread the Varicella Zoster virus to people who have never been initially infected with Chicken Pox. Pregnant women and their fetuses are at particular risk and should avoid contact.
ROUTINE VACCINATION OF PEOPLE 50 YEARS OLD AND OLDER
CDC recommends Shingrix® (recombinant zoster vaccine) as preferred over Zostavax® (zoster vaccine live) for the prevention of herpes zoster (shingles) and related complications. CDC recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults aged 50 years and older: Zostavax® may still be used to prevent shingles in certain cases for healthy adults 60 years and older. For example, you could use Zostavax if a person is allergic to Shingrix, prefers Zostavax, or requests immediate vaccination and Shingrix is unavailable.
TIMING CONSIDERATIONS FOR GIVING SHINGRIX FOR PATIENTS WHO PREVIOUSLY HAD HERPES ZOSTER
There is no specific amount of time you need to wait before administering Shingrix to patients who have had herpes zoster. However, you should not give Shingrix to patients who are experiencing an acute episode of herpes zoster.
FOR PATIENTS WHO PREVIOUSLY RECEIVED ZOSTAVAX
Consider the patient’s age and when he or she received Zostavax to determine when to vaccinate with Shingrix. Studies examined the safety of Shingrix vaccination five or more years after Zostavax vaccination. Shorter intervals were not studied, but there are no theoretical or data concerns to indicate that Shingrix would be less safe or effective if administered less than five years after a patient received Zostavax.
You may consider a shorter interval between Zostavax and Shingrix based on the age at which the patient received Zostavax. Differences in efficacy between Shingrix and Zostavax are most pronounced among older patients. Studies have shown that the effectiveness of Zostavax wanes substantially over time, leaving recipients with reduced protection against herpes zoster. For example, the vaccine efficacy among adults age 70 to 79 years and adults age 80 years and older is 41% and 18%, respectively, on average during the first three years following Zostavax vaccination.
Shingrix should not be administered less than two months after a patient received Zostavax.
FOR PATIENTS WHO DO NOT REPORT A PRIOR EPISODE OF VARICELLA
When vaccinating adults age 50 years and older, there is no need to screen for a history of varicella (chickenpox) infection or to conduct laboratory testing for serologic evidence of prior varicella infection. More than 99% of adults age 50 years and older worldwide have been exposed to varicella zoster virus, and the Advisory Committee on Immunization Practices (ACIP) considers people born in the United States prior to 1980 immune to varicella. Therefore, even if a person does not recall having chickenpox, serologic testing for varicella immunity is not recommended. It is often a barrier to herpes zoster vaccination, and false negatives are common. However, if serologic evidence of varicella susceptibility becomes available to the healthcare provider, providers should follow ACIP guidelines for varicella vaccination. Shingrix has not been evaluated in persons who are seronegative to varicella, and it is not indicated for the prevention of varicella.
CONTRAINDICATIONS AND PRECAUTIONS FOR HERPES ZOSTER VACCINATION SHINGRIX SHOULD NOT BE ADMINISTERED TO:
A person with a history of severe allergic reaction, such as anaphylaxis, to any component of a vaccine or after a previous dose of Shingrix
A person who is known to be seronegative for varicella. It is not necessary to screen (either verbally or via laboratory serology) for a history of varicella. However, if a person is known to be varicella-negative via serologic testing, providers should follow ACIP guidelines for varicella vaccination.
A person experiencing an acute episode of herpes zoster. Shingrix is not a treatment for herpes zoster or postherpetic neuralgia (PHN). The general guidance for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.
Shingrix has not been studied in pregnant women or women who are breastfeeding. Providers should consider delaying Shingrix vaccination for these women.
Adults with a minor acute illness, such as a cold, can receive Shingrix. Adults with a moderate or severe acute illness should usually wait until they recover before getting the vaccine. This includes anyone with a temperature of 101.3°F or higher.
To learn more, see Contraindications and Precautions, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP).
For more information on herpes zoster and immunization, see the Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines, 2018.
Varicella is the virus that causes chicken pox. This virus is transmitted through the air and from droplets of an infected person and is considered highly contagious. Once a person has been infected, the virus lives within him forever, in the nerve ganglia of the spine. If ever the immune system falters, the virus can be reactivated in the form of shingles. The rash of shingles sheds the virus and can cause chicken pox in people who have never been immunized nor had the infection previously. Varicella is usually a mild disease for children, lasting about a week causing a characteristic itching rash in different stages of healing. The symptoms can be more severe in adults, stemming from secondary bacterial infections. The virus is present throughout the entire world.
In 1995, the U.S. approved a varicella vaccination for children 1-12years. The vaccine is considered 90% effective, and the chicken pox illness is not nearly as common as it was previously. The vaccination is highly recommended for people traveling to foreign countries who have never had the illness and never been vaccinated in the past. This is a two series vaccination, given 4-8weeks apart.
This vaccination is a live virus, so certain people are not eligible to take this immunization. Persons who are pregnant, have certain cancers, HIV/AIDS, or are allergic to gelatin or neomycin should NOT receive this vaccination. Adverse reactions include pain at the injection site, fever and/or rash. This vaccination causes a latent infection in the body, similar to how chicken pox illness does; therefore, people receiving this vaccine have shingles later in life. MORE INFO
Helpful resources and numbers
CDC’s Traveler’s Health – additional information regarding foreign travel and vaccine requirements
CDC Travel Health Kits – advice on medications and preparing for travel health
U.S. Department of State Travel Website — up-to-date travel information including travel insurance, finding doctors and hospitals abroad, med-evac coverage, etc.
Frommer’s – travel insurance information
A Briggs Passport & Visa – information on expedited passports
U.S. Embassy, Consulate
1-888-407-4747, if calling from US or Canada
00 1 202-501-4444, if calling from overseas.