Travel Clinic and Advice

Travelling abroad always brings some risks to your health, but by ensuring you have the correct vaccinations and you take certain precautions you can minimise your exposure to most of the major health hazards.

For advice on any travel vaccinations the doctor will be well informed with up-to-date charts for vaccinations in each country and the different regions of each country, which may change frm time to time.

Travel vaccinations and certificate service are available to those who do not have HIV, and should safeguard their health while away. The majority of vaccinations will take 2 - 6 weeks to provide adequate protection and some countries also require a certificate to show you are covered for yellow fever and meningitis. Protection against Hepatitis B and Hepatitis A requires a course of injections over a period.

If you travel extensively in or make multiple visits to third-world countries you should ensure you are protected. If you are travelling to a country where the safety of medical care cannot be assured it is advisable to take an emergency medical kit. You should also take out medical insurance before travelling and take an EHC card if travelling to EU countries. At the Capio clinic Dr Sood will advise on all appropriate vaccination needed to each country being visited, he will also explain the administration process, and any side effects that may occur, and follow-up care.

Travel Clinic for HIV Positive Travellers

Compared with HIV-negative individuals, HIV-positive persons may have an increased risk of infection or experience more severe disease following exposure to vaccine-preventable diseases.

The doctor will highlight special restrictions for HIV positive travellers. This involves the use of inactivated vaccinations rather than vaccines that include a live virus

The doctor will also assess if you are well enough to travel, also important to find out in advance if the country you are travelling to puts any restrictions on entry for people with HIV, there are no restrictions within the EU countries. Take enough medication as it may be difficult or impossible to get supplies of your medication once you have left home. It is advisable to take additional doses in case you get delayed

Carrying medication

Its safest to carry your medication in your hand luggage, as this is less likely to get lost, if travelling across boarders, its recommended to take a copy of your prescription or a letter from your doctor saying you are taking the medication for a chronic condition.

Evidence-graded recommendations on the appropriate use of active and passive immunization in HIV-infected adults. There are several factors that make the of HIV-specific immunization

Guidelines are important at a time when highly active antiretroviral therapy (HAART) is modifying the natural history of HIV infection, vaccination practices are changing and new vaccines are becoming available . Compared with healthy individuals, HIV-infected adults may have an increased risk of infection or experience more severe disease following exposure to vaccine-preventable diseases. As a result, a lower threshold for recommending immunization may be indicated relative to the general population. Responses to vaccination are often below standard in HIV-infected persons, who may benefit from higher or more frequent vaccine doses. Furthermore, reduced rates and durability of responses may require more frequent use of serological testing than is generally recommended, in order to determine antibody levels after vaccination and guide boosting.

As a result of improved health and prognosis, HIV infected persons are increasingly likely to engage in exposure-prone activities related to occupation or travel, and may require vaccines that are traditionally contraindicated in immunocompromised persons but may be safe to use in HIV-infected persons with restored immunity.

Safety of vaccination remains an important consideration. Inactivated vaccines can be used safely in HIV-infected persons if indicated.

For some people travelling overseas, immunisation against some diseases may not be advised. For example, if you have a condition that affects your body's immune system, you are receiving treatment that affects your immune system, you have HIV, you are undergoing chemotherapy or radiotherapy, or you have received a recent bone marrow or organ transplant, you may be unable to have some travel vaccinations. You GP will be able to provide further advice.

As well as any new vaccinations, you should make sure your existing vaccinations, such as tetanus and poliomyelitis (commonly known as 'polio') are up to date, and have booster jabs if necessary. In the UK, tetanus and poliomyelitis are vaccinated against under the childhood immunisation programme.

		World Map

Select location to view general recommended precautions

Please discuss in detail your actual travel itinerary with your travel Doctor to ensure you are effectively covered for all vaccinations/immunisations you will require, the map is for very general guidance only.

Malaria Recommendations for HIV-Positive People Traveling to Malaria Risk Areas

HIV-positive people are at higher risk for malaria because of their weakened immune systems and should be sure to follow the standard mosquito precautions recommended for all travelers to malaria risk areas

Malaria chemoprophylaxis for HIV-positive travelers(Use of anti-malarial drugs to prevent the development of malaria) follows the same guidelines as those for HIV-negative travelers, although potential drug interactions between antimalarials and antiretroviral drugs should be considered.

If travelers, regardless of their HIV status, should experience symptoms of malaria, they should seek help right away and, if diagnosed with malaria, be treated with a highly effective antimalarial drug. The importance of precautions against mosquito bites should be emphasized.

Yellow fever

Proof of vaccination is required for all travellers coming from countries where yellow fever occurs, including transit through such countries. The international yellow fever vaccination certificate becomes valid 10 days after vaccination and remains valid for a period of 10 years.

The fact that a country has no mandatory requirement for vaccination does not imply that there is no risk of yellow fever infection

Live Vaccines

Poilio (oral)
Typhoid (oral)
Yellow Fever

Inactivated Vaccines (not Live)

Meningitis
Hepatitis A
Hepatitis B
Typhoid
Tetanus
Diphtheria
Rabies
Encephalitis

Vaccine [Indication] Common use

Anthrax [RS] Occupational
Cholera WC/rBS [RS] Travel
Hepatitis A [RS] Risk groups
Hepatitis B [R]
Haemophilus influenzae [RS] Risk groups
Influenza-parenteral [R] Indications are strengthened in the presence of additional risk factors
Japanese encephalitis [RS] Travel
Meningococcus (MenC) [RS] Risk groups
Meningococcus (ACWY) [RS] Travel
Pneumococcus (PPV23) [R] Indications are strengthened in the presence of additional risk factors
Rabies [RS] Travel
Tetanus-diphtheria-parenteral poliomyelitis (Td/IPV)
RS Uncertain vaccination status or travel Tick-borne encephalitis [RS] Travel
Typhoid (ViCPS) [RS]

R = recommended in all
RS = recommended in selected

Live vaccines for HIV travellers

Live vaccines that may be indicated in HIV-infected persons, but should not be used if the CD4 count is o200 cells/mL

Vaccine

Measles ,Mumps, Rubella (MMR)
Varicella
Yellow fever

Live vaccines contraindicated in all HIV-infected adults regardless of CD4 cell count

Vaccine

Cholera (CVD103-HgR)
Influenza (intranasal) Also contraindicated in close contacts
Oral poliomyelitis (OPV) Also contraindicated in close contacts
Typhoid (Ty21a)
Tuberculosis (BCG)
Smallpox (Vaccinia) Exceptions apply)

Vaccines recommended for HIV-infected adults found to be susceptible upon serological screening

(CD4 count) (cells/lL) Vaccine

Hepatitis B
Any Measles, mumps,rubella (MMR)
4200 All measles IgG seronegative persons; rubella IgG seronegative women of child-bearing age Varicella 4400 Also consider if 4200 All VZV IgG seronegative persons Table 5

Vaccines recommended for HIV-infected adults who have missed routine childhood vaccinations or have uncertain vaccination history

Vaccine Group CD4 count (cells/lL) Comments Tetanus-diphtheria/ parenteral poliomyelitis (Td/IPV) All Any Complete a five-dose course regardless of the interval since the last dose and the type of vaccine received previously Meningococcus-MenC Adults o25 years

Vaccines for travel-related indications

(CD4 count)(cells/lL)Vaccine Indication

Meningococcus (ACWY) [M] Recommended for travel to endemic or epidemic areas; mandatory for all Hajj and Umrah pilgrims; follow standard guidelines
(Any) Yellow fever [M] Consider if at true risk of infection
(4200) Hepatitis B [R] If prolonged travel
Any Measles, mumps, rubella (MMR) [R] If measles IgG seronegative
(4200) Tetanus-diphtheria/ parenteral poliomyelitis (Td/IPV) [R] Every 10 years
(Any) Cholera (WC/rBS) [S] Follow standard guidelines
(Any) Hepatitis A [S] Follow standard guidelines
(Any) Japanese encephalitis [S] Follow standard guidelines
(Any) Tick-borne encephalitis [S] Follow standard guidelines
(Any) Typhoid (ViCPS) S Low threshold for offering vaccination
(Any) Rabies S Low threshold for offering vaccination

It is recognized that the responsibility for providing the recommended immunizations and for meeting the associated costs remains an unresolved issue. It is currently envisaged that the HIV specialist should provide overall guidance on vaccine use and enlist the help of primary care physicians for vaccine administration where feasible. As is the case with HIV-negative travellers, HIV-infected persons should be advised that they will be expected to meet the cost of vaccines required for travel. Finally, while it is hoped that these guidelines will inform immunization practices widely, they are intended primarily for HIV infected adults in the UK

M, Mandatory for travel to selected countries. These vaccines are legal requirements for travel to some countries. Failure to obtain the vaccine could result in non-entry/quarantine in destination. Waiver documents may not be accepted by some countries.

R, Recommended

S, Selective use for travellers to risk areas. Recommendations for these vaccines depend on the countries of destination, the epidemic situation at the time of travel, the purpose of travel, the intended length of stay and the health status of the traveller. Because recommendations will change from time to time, it is prudent to access up-to-date health information for specific destinations.

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