By: CHARLES N. CHUNGE
MB ChB MSc, CNM, PhD, MSc, DLSHTM, FRCPS(Glasg)
Consultant Microbiologist, & Specialist in Tropical & Travel Medicine.
Director of the Centre for Tropical
&Travel Medicine – Nairobi, Kenya.

MAIN OBJECTIVE TODAY
To make you medical people aware that excellent vaccines are available to prevent many serious/deadly diseases, so that you will take appropriate action to protect yourself & others.

• To sleep here (This is not
Parliament)
• To get to the TEA BREAK area very fast before others.
• To stare at other guests
• To ask political questions
• To sit next to her/him







GOES ON SAFARI
IS A TOURIST
EATS IN A RESTAURANT OR HOTEL
TRAVELS OVERSEAS
CATCHES A BUS, AEROPLANE,
TRAIN etc?
INGESTS FOOD PREPARED
OUTSIDE HIS HOME

Which are the common diseases that afflict travellers?
• Yellow Fever
• AIDS?
• Cholera
• Travellers Diarrhoea
• Hepatitis A
• Hepatitis B
• Influenza = Flu
• Japanese encephalitis
• Malaria?
• Measles/Mumps/Rubella*
• Meningitis
• Pneumonia
• Rabies
• Diphtheria
• Tetanus
• Polio
• Tuberculosis
• Typhoid fever
• Cancer of CERVIX
• Food-poisoning

• Many of these diseases can be prevented by vaccines.
• Many cannot be cured easily.
• With the increase in travel, serious diseases are literally only a plane-ride away.

• Infants, because their immune systems cannot easily fight off disease.
• Children & workers in crowded situations
• The Immuno-depressed/compromised
• Those pregnant
• Malnourished individuals
• Old people (? Over 65yrs)
• Professional groups (medical, military, students, nurseries, orphanages, prisoners)
• All Travellers

CHRONIC CONDITIONS WORSENED
BY FAILURE TO VACCINATE
• HEART DISEASES
• LUNG DISEASES
• LIVER DISEASES
• KIDNEY DISEASES
• MENTAL DISEASES - ? Where? Kisii?
• JOINT DISEASES
• DIABETES, HIV, etc

Available Vaccines for travellers
• Yellow Fever – Mandatory
• Meningitis – sometimes mandatory (during Hajj)
• Diphtheria-Tetanus (dT)
• Typhoid, Travellers diarrh, Cholera,
• Hepatitis A
• Hepatitis B
• Rabies
• Polio
• Measles-Mumps-Rubella
• Influenza
• Pneumococcal
• Japanese encephalitis
• Human Papilloma Virus (Cervical cancer)
• Tuberculosis*** Malaria****HIV****

TRAVEL VACCINES: Classification
Divided into 3 categories:
• Mandatory (M): International Certificate required
– Yellow fever vaccine
• Recommended (R) for all travellers to certain countries
– Meningo ACYW135 (Saudia Arabia) for Hajj travellers
– dTPolio to North and South America
• Recommended (r) for travellers to certain areas
– Influenza and Pneumococcal vaccines for at risk subjects: >65 yrs
– Varicella for travellers to USA who do not have antibodies
– Rabies in Latin America

Vaccines for healthcare workers
• Hepatitis B
• Influenza vaccine (annually for the flu)
• Measles-Mumps-Rubella (MMR) vaccine
• Varicella (chickenpox) vaccine
• Typhoid
• Meningitis

Vaccines for Students
Recommended or Mandatory ( depending on who?)
 dT-Polio (diphtheriaTetanusPolio)
Pneumococcal,








Flu,
Meningitis
Hepatitis A
Hepatitis B
Measles,mumps,Rubella(MMR)-Susceptible/without antibodies
Varicella (chicken pox)
Typhoid
ETEC travellers diarrhoea & Cholera


There are no vaccines for:








Malaria (current efficacy =35-45%)
HIV (current efficacy <31%)
Rift Valley Fever
Bird Flu = Avian influenza
Gonorrhoea or Syphilis
Swine Flu H1N1 – remarkable efforts
Anthrax
Most STIs

The Value of Vaccination
!
Produces two Types of Protection OR
Immunity among clients:
-Individual immunity
-Community Immunity
(Herd Immunity)

1. Immunisation saves 3Million lives/year
(WHO)
2. Immunisation is second to provision of clean water and third are antibiotics in saving lives
3. In addition to preventing disease, it reduces mortality, morbidity and medical/travel costs
4. It costs less than treatment
5. It is easily explained

• Smallpox was eradicated 1978

Vaccination costs less than treatment
(this is excellent for a traveller)
For example typhoid:
Vaccine Ksh 500-1000 every 3 years
Treatment of disease Ksh >12000 twice a year?
Man hrs lost on off duties
School HRS lost on absenteeism
Cost of death = is too large to calculate

• Choosing to avoid vaccines is simply a choice to take a different risk – usually much worse:
=>the disease & its complications .
e.g. meningitis, pneumonia, Yellow fever, paralysis, deafness caused by mumps, liver cancer (by hepatitis B virus), heart failure, kidney failure, peritonitis (typhoid) and of course DEATH.
Therefore: When you compare the side effects/benefits of vaccines and the risk of the actual diseases, vaccines are the safer choice."

WHICH DOCTORS ARE LIKELY TO
ADVISE PATIENTS ON PREVENTIVE
MEASURES?
• PAEDIATRICIANS&Travel Medicine
Specialists
• PUBLIC HEALTH SPECIALISTS
• GYNAECOLOGISTS
• PHYSICIANS & General Practitioners
• DERMATOLOGISTS
• SURGEONS
Why these differences?

Who consults prior to travel?
(In descending order)
» AMERICANS
» JAPANESE= very nice people
» GERMANS & FRENCH
» SCANDINAVIANS
» OTHER EUROPEANS
» THE BRITISH
» INDIANS,CHINESE
RUSSIANS, AFRICANS etc

• Kenyan people and medical insurance companies want to treat the illnesses once it occurs; they tend to react only when a crisis occurs.
• They always try to skip mandatory vaccines
(even doctors!)
• We need to teach them the truth:
“Prevention is better than cure”

Yellow and feverish

He is Yellow

• Why the name?
• The arbovirus is called Flavivirus
• The vector: Aedes, Haemagogus mosquitoes
• Prevalence = Variable (Africa &
Americas)
• India & Asia/Far East = Nil ( but very suitable
)
• A zoonosis = Primates reservoirs

• Endemic areas: Africa and C.&S.
America
• Urban YF seen in South America
• Sub clinical cases may occur = 15%
• Kills over 60-80% of its victims
• Why is it the only compulsory vaccine?
Because: The vectors, the primates & humans exist in Asia
But the disease does not.

VEGETATION
MAP OF AFRICA
Yellow fever belt

JUNGLE TYPE YELLOW
FEVER
• This enzootic cycle is essentially animal and keeps the virus alive in the tropical forest of
Africa and South America
• In Africa, Monkeys do not die once infected, they become and remain immune.
• Monkeys don’t act as virus hosts, as their viremia is short but rather as amplifiers & indicators of virus circulation
• Transovarial transmission in the mosquito keeps

EPIDEMIC YELLOW FEVER
• Transmission from man to man
=> epidemic
• Main vector : Aedes Aegypti

Aedes aegypti

Yellow Fever

Yellow Fever

DIAGNOSIS / TREATMENT
• Incubation period: lasts 3 to 6 days
• Evolution :
-Acute forms are fatal in 2-7 days,
Severe forms are fatal > 80% of cases.
-Milder forms similar to flu-like syndrome or viral hepatitis.
Mortality: Upto 80 % despite treatment
Diagnosis: Serology

Yellow Fever: TREATMENT
• There is no specific anti-viral Yellow fever therapy
• The mortality rate for acute forms of the disease is 80%, despite any treatment
• The only efficient prevention is the routine vaccination of all persons exposed to the disease risk
• Vaccination for international travellers is aimed at preventing travellers from getting infected abroad and taking the disease back home.

Side effects: Viscerotropic and
Neurotropic Disease
Age > 60 years
• Risk of Viscerotropic Disease:
≈ 20/10 6 or 1/50,000
• Risk of Neurotropic Disease:
≈ 15/10 6 or 1/65,000
VACCINE EXEMPTIONS allowed:
ESPECIALLY IN THOSE >65YRS







Vaccination Centres
Travel Health clinics
Hospitals
Medical Clinics
(with enlightened providers)
? Pharmacies
Airports/entry/exit points

LASTLY: Do not get involved with any of the following attractions




GOING TO MECCA TO WORSHIP
Allah using fake vaccine certificates
“MY BOOKLET IS LOST
SYNDROME” (ladies)
ACQUIRING/issuing of FAKE
BOOKS & STAMPS
COMING LATE FOR VACCINATION!
Then demanding a backdating.