# Monday, May 26, 2008
                 

With summer soon approaching, many Canadians are planning their summer vacation. For those who plan on leaving Canada, attention should be paid to not only what vaccinations are mandatory, but which ones are recommended. It is important to remember that not all countries face the same potential outbreaks; for every visit outside of Canada you should consult with your physician as well as reputable travel advisories in order to be informed of any potential health risks.

Certain diseases are far more common in developing countries than in Canada, however as Canadians are usually immunized early in childhood, there is very little risk of becoming infected. Check your childhood immunization chart to make sure you have been vaccinated for diseases such as rubella, tetanus, polio, and diphtheria. While outbreaks of these have not been prevalent in Canada for a long time, epidemics do occur in other countries. If you are traveling with young children, consult with their pediatrician about the status of their vaccinations, as well as any health risks concerning the area of travel.

The most common diseases that you can be vaccinated for and are at risk of acquiring are:

• Hepatitis A and B: Can be caught from "unclean" water, including fruits and vegetables that are washed in this water and ice cubes and is also transmitted by sexual contact. There is a combined vaccine that provides lifetime protection against both Hepatitis A and B consisting of three doses given over a 21 day period.
• Influenza: The flu vaccine in Canada is based on projections of what type of flu will be prevalent for the season. While this is usually consistent with flu outbreaks around the world, it does vary. Timing as well is a factor, as the flu season in the Northern Hemisphere occurs in wintertime; the Southern Hemisphere has their projected flu season during the summer, and flu season typically lasts all year round at the equator. As well, due to the recycled air on airplanes, the risk of catching infectious diseases is quite high.
• Typhoid: Be advised that the vaccination for typhoid only lasts for 3-4 years, and typically only provides 70% protection. Anyone traveling to a country with under-developed water treatment systems and/or sanitation systems should be vaccinated. New Canadians who are traveling back to their homeland are at the highest risk of becoming ill with typhoid.
• Yellow Fever: One of the only vaccinations that is required by health officials to cross international borders. 21 countries in Central Africa as well as South America require a yellow fever vaccination certificate for all entries; 102 countries demand this certificate from anyone who has been in the "yellow fever zones". There is a high mortality rate among people who become infected with yellow fever. The current vaccine only lasts for 10 years, so it is important to keep your immunization records, and be aware of when you need to be vaccinated again.
• Meningococcal (bacterial) meningitis: This is recommended for anyone traveling throughout sub-Saharan Africa, especially if you plan on living closely among the local population. This is a very dangerous disease and is highly contagious; it is passed between people through coughing and/or sneezing. This vaccination is now required for anyone going to Saudia Arabia to participate in the Hajj. As your risk of infection is lower when staying in a quality hotel, you may not need this vaccination. It is a wise idea to consult with a travel health professional in order to determine your individual risk.
• Japanese encephalitis: Is transmitted through mosquito bites, as is malaria and yellow fever. This is prevalent mostly in rural areas of South and Southeast Asia and can be fatal, as well as causing severe neurological damage. It is mostly contracted in the summer months by an evening-biting mosquito and the symptoms are similar to those of meningitis. The vaccine offers protection for 2-3 years; be aware that there have been allergic reactions associated to this vaccine. It is highly recommended for those who plan on spending more than a month in areas that are affected with this disease.
• European tick-borne encephalitis: Has similar symptoms to the Japanese version, but often has more severe consequences. It is a viral infection carried by ticks, and is found in Russia, the former Soviet Union, as well as other parts of Europe, and is most prevalent in the summer months. Anyone planning to stay in these areas for a long period of time should be vaccinated; this vaccine does need to be ordered, so you must plan ahead. It is also important to follow procedures that reduce the risk of being bitten by ticks.
• Rabies: A fatal disease of the brain and nervous system that is transmitted through animal bites, especially dog bites. Rabies is common throughout the world, including North America. Although this vaccine is expensive, it is very safe and effective. For those who have been vaccinated and are bitten by an animal, 2 additional doses are required. However, for those who have not been vaccinated, 5 doses of vaccine and one of rabies immune globulin are required for effective treatment. The rabies immune globulin is not widely available in the developing world, which poses a huge health concern if bitten. It is important to know whether or not this is easily accessible in the country you plan on traveling in, as well, consult with a travel medical professional. This is usually recommended for long-stay travelers, especially those traveling with children.
• Malaria: There is currently no malaria vaccine. There is however, three first-line antimalarial drugs that are recommended to help prevent becoming infected. These drugs should be taken for several weeks or even the day before potential exposure, as well as during the travel period, and for 1-4 weeks after returning. It is important to know that none of these drugs offer 100% protection, so it is important to take safety measures to prevent being bitten by virus-carrying mosquitoes. These include using insect repellants, as well as mosquito netting, screened accommodations, and wearing long pants and long sleeved shirts after dark.

You should consult with your physician as soon as possible when making your travel plans. This will allow you enough time for the slower vaccines to take effect. A 2 month time period is usually recommended to consult with your doctor. Your doctor will have the latest information on any outbreaks, as well as the latest vaccines that are available. As well, it is very important to tell your doctor that you have been abroad if you become ill within 2 months of returning to Canada, in case you have caught a foreign-based illness.

There are also websites that offer the latest information about these diseases globally. The Public Health Agency of Canada offers travelers advisories and/or warnings of any outbreaks throughout the world. This is an important tool when making your travel plans in order to decide if your destination is a safe one. Before booking your travel plans, make sure you have the latest information available about the country/region. Be aware that the health status of a country can and does change; make sure you read all travel advisories every time you plan on leaving Canada.

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