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HEALTHY TRAVELLING? ASK YOUR PHARMACIST!
Vaccinations when travelling
Thursday 8thSeptember 2011 Claudine Leuthold, Pharm. D pharmaSuisse, Swiss Society of Pharmacists Department of Sciences, Education & Quality
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Vaccinations when travelling
Which vaccinations?
travel.nytimes.com/2011/07/31/travel/vaccinations-for-traveling-abroad.html July 27, 2011
Do you ever feel we’re having too many inoculations forced on us?
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Vaccinations when travelling
Last News !
WHOSince April 2011
- WHO recommends all travellers to be up to date with
routinevaccinations and
- for travellers to and from Europe, to be immunized against
Measles El Salvador
From July 1, 2011, El Salvador requires proof of vaccination against rubella and measles from travellers arriving from, or travelling to Europe
Other Central American countries may follow El Salvador’s lead after the Pan American Health Organization recently recommended all travelers heading to and from the region be vaccinated against the two highly contagious viruses.
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Travel Vaccinations
Agenda
1. Epidemiology and Travel vaccinations
• Some examples and proposed vaccinations for the practical case
2. Information Resources and Tools –examples 3. Vaccinations in Switzerland
A. Specific resources and tool
B. The Immunization scheduler and checker • program viavacfor the Swiss health
professionals
• website www.myvaccines.ch
C. Project of Vaccination Certificate for Pharmacists
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Travel Vaccinations
Introduction
Some facts• Since 2007: Urban population > Rural population • Urbanization is progressing more in developing
countries, especially in Asia and in Africa • Increase of urban population impacts on health
and diseases’ profile
• Travel begins usually with an urban stay Therefore
• It is essential for Pharmacists to give the right vaccination information to the public
• Community Pharmacy has a key role to play because of its easy access conditions
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Travel Vaccinations
Evolution within the 20 past years
• Number of available vaccines for travellers
grew considerably
• Most vaccines can be administered up to
departure date
• Common diseases (e.g. tetanus, measles)
still do occur in most countries
• Knowledge of vaccines needs to be
constantlyupdated
• Practical tools and websites are easily
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Travel Vaccinations
Pre-travel Evaluation (Interview)
Travel Plans ConclusionWhere? Destination, Itinerary, visited country(ies)
epidemiological evaluation personal risk assessment immunizationschedule When? Departure date, duration,
characteristics
Personal Data Conclusion
Who? Age Possible contraindications
Medical History Conclusion
Which? Vaccine history necessary vaccinations Which? History of hepatitis, measles unnecessary vaccinations Which? Chronic illness, medications,
allergies, pregnancy, nursing, thymus problems
Contraindications?
Evaluate earlyto minimize patient adverse events and allow time for immunity development
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Travel Vaccinations
Incidence Rates and Impact
Priorities = Incidence + Impact
R. Steffen, Vaccine preventable diseases, 15th Swiss International Short Course on Travellers‘Health, 02.09
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Pre-Travel Evaluation
Travel Vaccinations Categories
3 Rs1. Routine
2. Recommended
3. Required
Procedure :
• Verify immunization status (vaccination records) • Verify if routine vaccines are up to date • Consider any other vaccines according to
risk, illness incidence rate, individual’s health status, occupation or lifestyle
• Verify specific travel vaccines
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Travel Vaccinations
Vaccinations to be considered
1. Routine vaccines= Childhood or adult immunizations contained in the National Immunization Schedules
•In most countries : Diphtheria, Tetanus, Pertussis, Hepatitis B, Haemophilus influenzae type b (Hib), Poliomyelitis, Measles, Mumps, Rubella, Influenza, Pneumococcal, Varicella •In some countries: BCG, Hepatitis A,
Human Papillomavirus, Neisseria Meningitis, Rotavirus, Tick-Borne Encephalitis (TBE)
pharmaSuisse 2. Recommended - Travel-related vaccines
• Aim
• Protecttravellers from illnesses present in
other parts of the world
• Prevent import of infectious diseases across
international borders (e.g. Yellow fever) • Depend on destination, length, type of travel /
traveller, and previous immunizations
Main vaccines considered: Cholera, Hepatitis A, Hepatitis B, Japanese encephalitis,
Meningococcal Meningitis, Poliomyelitis, Rabies, Tick-Borne Encephalitis (TBE), Typhoid fever, Yellow fever
Travel Vaccinations
Vaccinations to be considered
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Is required for travels to certain countries in sub-Saharan Africa and tropical South America
• Meningococcal vaccine
Is required by the government of Saudi Arabia for pilgrims during the Hajj (Meningitis ACYW135 vaccine)
Travel Vaccinations
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Required Travel Vaccinations
Yellow Fever Distribution Map 2011
http://www.who.int/ith/en/
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Required Travel Vaccinations
Yellow Fever recommendations
required recommended not recommended
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Travel Vaccinations
Diseases with specific repartition and/or risks Meningococcal Meningitis
• Meningitis Belt in Africa
• Japanese Encephalitis
• Asia, Oceania
• Tick-borne Encephalitis
• Europe, Eastern countries, Russia
• Far Eastern, also known as Russian Spring-Summer Encephalitis (RSSE)
• European: also known as Central European Encephalitis (CEE)
• Influenza
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Travel Vaccinations
Influenza
Cause 3 types of Influenza virus A, B, C; A ad B: epidemic
Transmission Respiratory infection, person-to-person Risks for
Travelers
Important morbidity and mortality factor for risk groups and seniors > 65 years old
Acute exposition risk: Cruise, travel for 24 hours or more in a bus or a train, organized group travel, pilgrimage
Vaccination Several live inactivated vaccines, egg culture contra-indications!
Influenza viruses change vaccine composition changes every year revaccination
Efficacy: 6 months best vaccination period :
•North hemisphere: October to March
•South hemisphere: Mai to August
•Yearly for Tropical zone
pharmaSuisse Previous History
• Mrs AD is 45 years old • 5 years ago 2 weeks holiday
in Goa, India • Single dose of hepatitis A Itinerary
• Booked through a company specialized in an adventurous travel • 14-21 days in Tanzania,
travelling overland with a group of 10 people, visiting game parks and other places of interest, including mount Kilimanjaro 19’000 feet (5’791 m)
• cross into Rwandato see the mountain gorillas and other destinations away from the usual tourist routes. In total she will be away for 8 weeks.
Case Study
Recall
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Vaccination CH D UK USA
YF Rwanda: REQUIRED Tanzania, United Republic of :
generally NOT RECOMMENDED for travelers to Tanzania
REQUIRED if traveling from a country with risk of YFV transmi., from 1 year Diphtheria Tetanus Poliomyelitis (IPV) combination RECOMMENDED as a booster-vaccination combination RECOMMENDED as a booster-vaccination combination RECOMMENDED as a booster-vaccination combination RECOMMENDED as a booster-vaccination Measles born after 1963
check if vaccinated Born after 1970 check if vaccinated Born after 1970 check if vaccinated born after 1957 check if vaccinated Hepatitis A 2nddose RECOMMENDED
Hepatitis B if not yet immunized:
- RECOMMENDED for more than 1 mo exposure standard schedule: 0, 1 and 6 months
accelerated schedule: 0, 7, 21-28 days + 1 year
- combined vaccine Hepatitis A and Hepatitis B could be RECOMMENDED Typhoid Fever RECOMMENDED because outside usual tourist routes
Rabies Could be recommended because rural areas and animal parks but expensive, on a low budget , < 3 months Instructions: not to feed monkeys Meningococcal Men. Tick-Borne-Encephalitis Japanese Encephalitis Cholera NO Influenza RECOMMENDED
Case Study
pharmaSuisse International World Health Organization (WHO) • International Travel and Health: www.who.int/ith/ • Links to National travel and health websites:
www.who.int/ith/links/national_links/en/index.html# Americas CDC Yellow Book www.nc.cdc.gov/travel CND Public Health Agency of Canada Travel Medicine
www.phac-aspc.gc.ca/tmp-pmv
UK National Travel Health Network and Centre www.nathnac.org
D Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG) dtg.org/
Resources for Travel Vaccinations
International and National References
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Website of the Federal Office of Public Health • Information on infectious diseases and vaccinations • Website: www.myvaccines.ch
= Swiss Electronic Vaccination Record Tool
• viavac : Immunization scheduler
Specialized Travel medicine websites
• www.safetravel.ch (public, free of charge) • www.tropimed.com (under subscription)
Resources for Vaccinations
Websites and Tool
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Vaccinations in the Pharmacy
viavac– Help for Vaccinations’ Management ! Great tool to manage individuals vaccinations
• Gives the official recommendations for various types of vaccination, risks groups and situations
• Take into account individual factors: e.g. travel, pregnancy, risk factors, etc.
• List of vaccines availableon the Swiss market (including old ones)
• Allow the selection of vaccines by antigen
• Calculate an individual catch-up plan to print and to give to the patient
• Immunization Record done with viavac replace the multiple records accumulated during lifetime
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viavac for Physicians
viavac for Pharmacists
• Help to manage complex situations • Individualized catch-up plans
• Ease and speed (during the consultation) • Respect of the Vaccination State of the art • Help to Manage the patients schedule
(ex: delays)
• New service to the customers
• Fast and effective vaccination records control
• Allow individual recommendation: is there a need for a vaccination’s update?
• Extension of services and skills (image)
• Collaboration pharmacists / physicians
• Intensification of individual and public health Campaigns "Check your vaccines “
Program
viavac
Brings Vaccinations also in the Pharmacy
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Vaccinations in the Pharmacy
viavac - Patient’s Vaccination status
up-to-date optionnal to do not recommended
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Vaccinations in the Pharmacy
viavac – Vaccination and Catch-up plans
Vaccination’s date Vaccine’s antigen Missing vaccinations Catch-up Plan Future doses
Printed version of Immunization Record is considered as “official“ when validated by a health professional
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Vaccinations in the Pharmacy
www.myvaccines.ch
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Swiss Electronic Vaccination Record
www.myvaccines.ch
• Personal Vaccination Record with individual
vaccines
• Secured file with password
• Possible access for authorized health
professional to verify / complete the vaccines
• Link to the viavactool:
• To identify missing vaccinations (red code)
• To access to detailed information
• To exchange data (files export/import)
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Electronic Vaccination Record
www.myvaccines.ch – Patient’s view
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Electronic Vaccination Record
www.myvaccines.ch – Health professional view
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Vaccination in the Community Pharmacy
The Swiss project
• Create a Certificate of post-graduated
training "Vaccination and blood sampling“
• This Certificate should allow to
administer vaccines in pharmacies
Prerequisite
• Modify political legal bases to allow to
immunize and administer parenteral drugs
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• Easy access to pharmacy infrastructure
• No need to book an appointment
• Guaranteed cold chain: vaccines
management
• Reach customers without family doctors
Restrictions
• Population target : Healthy adults and
adolescents
• Begin with Influenza, possibly Measles
Vaccination in the Community Pharmacy
The Swiss project’s added Value
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Vaccination in the Community Pharmacy
Certificate «Vaccination and blood sampling»
Program split in 3 parts
1.Practical course including theory on
«Injection’s techniques and blood sampling»
2.Theoretical course on «Vaccinations »
3.CPR* or BLS** certification obtained
= Requirement to participate to the practical part and to obtain the Certificate Each module validated by an exam
Certificate granted if all exams passed
*CPR: Cardio Pulmonary Resuscitation
**BLS: Basic Life Support pharmaSuisse
Certificate «Vaccination and blood sampling» Next steps
• Recognition of the potential:
The pharmacists can contribute to improve the rate of vaccination
• Training of the pharmacists
• Creation of the necessary legal conditions
• Creation of a quality management system
(QMS) Module «Vaccination»
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• FIP Community Pharmacy Section
• ISTM Pharmacist Professional Group
• pharmaSuisse and its president:
Dominique Jordan
Thank you for your attention!
For more information, please contact:
claudine.leuthold@pharmasuisse.org
