Durationofprotectionbyvaccine

Disease

Estimateddurationof
protectionfromvaccine
afterreceiptofall
recommendeddoses1,2

Comments

Pertussis
(whooping
cough)

46years

Immunityfromnaturalinfectionalsowanes.
Boosteratage11yearsisoffered.

Diphtheria

Around10years

Boostersarerecommendedinadultsat45&
65yearsofage.

Tetanus

96%protected1314years,
72%>25years

Boostersarerecommendedinadultsat45&
65yearsofage.

Polio

>99%protectedforatleast
18years

Boostersofferedtothosetravellingtoatrisk
countries.

Haemophilus
influenzaetype
B

>9yearstodate

Excellentimmunogenicityobservedforthis
vaccinesuggestinglongtermprotection.

HepatitisB

>20yearstodate

Likelylifelongforthosewhohave
seroconvertedbut>20yearshasbeen
observedtodate.

Measles

Lifelongin>96%vaccines

Communityprotectionisimportanttostop
transmissiontothosetooyoungtobe
immunised,orthosewhocannothavethe
MMRvaccine.

Mumps

>10yearsin90%,waning
slowlyovertime

Durationofimmunityvariesindifferent
populations.Itisnotaslonglivedasmeasles
orrubella.

Rubella

Mostvaccinees(>90%)
protected>1520years

Communityprotectionisimportanttostop
transmissiontothosetooyoungto
beimmunised,orthosewhocannothave
theMMRvaccine.

Pneumococcal

>45yearssofarfor
conjugatevaccines

Todateantibodyconcentrationshave
remainedhighinvaccinees.Community
protectionmeansvaccinatingchildren
reducesthediseaseinallagesinthe

community.
HumanPapillo
mavirus

>5yearstodate

Responsefollowingantigenchallenge
indicatesimmunityfromvaccinelikelytobe
verylongterm.

Plotkin,S.A.,W.A.Orenstein,andP.A.Offit,Vaccines.5thed.2008,Pennsylvania:ElsevierInc
AccordingtothecurrentNZImmunisationSchedule1Plotkin.Vaccines.FifthEdition.2
Vaccineimmunogenicityisameasureoftheimmuneresponsetoavaccine.Thisusuallyinvolves
measuringspecificantibodiesinthebloodaftervaccination.
Immunogenicitygivesanestimateofprotectionforsomevaccines.
Immunogenicitydoesnotdefinitivelytellusifapersonisprotectedagainstdisease,howeveritis
anindication.
Largerisesinantibodylevelsfollowingaboosterdoseindicatethatgoodimmunememoryis
presentandsuggeststhatgoodprotectionislikely.
Possiblevaccinesideeffects
Commonsideeffects

Uncommonsideeffects

Rare/veryraresideeffects

Soreness/pain,redness,
swellingand/orinduration
(areaofhardinflammation)
aroundtheinjectionsite.
Feverlessthan39C.
Irritability.
Drowsiness.

Feverabove39C.
Uncontrollableorunusual
crying.

Anaphylaxis.
Urticaria.
Pruritus.
Oedemainoneorbothlowerlimbs
withinthefirstfewhoursafterthe
firstHaemophilusinfluenzaetypeb
immunisation.Colourchangesof
theskin,transientbruisingand
severecryingmayalsooccur.All
eventsresolvespontaneously
withoutlongtermconsequences
within24hours.
Convulsion(withorwithoutfever).

AboutVaccines
HepatitisA
Thisviraldiseaseoftheliveristransmittedbyconsumingcontaminatedfoodandwater,usuallyby
thefecaloralroute(passedbypersonswhousethebathroomanddontwashtheirhands).Thevirus

cansurviveonadriedsurfacefortwelvedaysandcanliveonapersonshandsforuptofourhours.
Theillnesscanbesevereandrecoverycanbeprolonged.HighestratesoccurintheCaribbean,
Mexico,Asia,Africa,India,China,SouthAmerica,andSouthernandEasternEurope.Thevaccineis
recommendedforalltravelersolderthan1yearofagevisitingdevelopingcountries.
HepAisa2shotseries.Theinitialdoseprovidesadequateantibodiesin2weeksafterthe
injection,andaseconddosegiven6monthsafterthefirstdosewillconferalifelongprotection.
HepatitisB
Aviraldiseasethatcausessevereliverinfectionthatistransmittedbybloodandbodyfluids.It
causessevereliverinfectionwithfeverandjaundice,andcanprogresstochronicliverdiseaseand
cancer.Thevaccineseriesisrecommendedforhealthcareworkers,prolongedtravel,persons
participatinginadventuretraveling,personswhomayhaveunprotectedsex,thepossibilityof
acupunctureandtattooing,andfortravelerswithahighpotentialtoseekmedicalcareinlocal
facilities.
Threedosesaregivenat0,1,and6months.Adequateprotectionfortravelisobtainedafter2
doses,andthe3rddoseprovidesalifelongprotection.
Twinrix
ThisisavaccinethatcombinestheHepatitisAandHepatitisBvaccines.Thebenefitofthisvaccine
isthatyourreceiveprotectionagainstbothHepAandHepBwith3shots,ratherthan5separate
shots.
Threedosesaregivenat0,1,and6monthsandconferlifelongprotection.
TyphoidFever
Thisisabacterialinfectionthatisacquiredbyconsumingcontaminatedfoodandwater,resultingin
fever,abdominalpain,andeitherdiarrheaorconstipation.Itisespeciallyaconcernforpersons
travelinginsmallercities,villagesorruralareasofftheusualupscaletouristitineraries.
Onedoseofinjectabletyphoid(forages>2years)becomeseffectivein1weekafterinjection,
andprotectsfor2years.Fourdosesoftheoralvaccine(forages>6years)takeneveryother
dayprovidesprotectionin1weekandlasts5years.
YellowFever
Anoftenlifethreateningviraldisease,itisspreadbymosquitoesintheAmazonbasinofSouth
AmericaandsubSaharanAfrica.Proofofyellowfevervaccinationmayberequiredforentryinto
certaincountriesandforpersonswhohavetraveledthroughyellowfeverendemiccountries.
Onedoseisgivenandbecomeseffectiveinabout10daysandprotectsfor10years.
Meningitis
Thisisaseriousbacterialinfectionthataffectstheliningofthebrain,andistransmittedbyexposure
torespiratorysecretionssecretions(coughing,sneezing,kissing,usingutensilswhichmaynothave
beencleanedproperly).Thediseasecausesevereillnesswithfever,rashandoftenmayleadrapidly
todeath.Thevaccineisrecommendedforpersonswholiveinclosecontactwithothers(dorms,
militarybarracks),personstravelingtothemeningitisbeltinsubSaharanAfrica,andpersons

travelingtoSaudiArabiaforthepilgrimagetoMecca(Hajj).
Menactra,licensedin2005,isgiventopersons1154yearsofage.Itisestimatedtohavea10
yearprotection.Menomuneisgiventopersonsyoungerthan11and55yearsofolder.Both
protectagainst4serotypesofthemeningitisbacteriaA/C/Y/W135.
Rabies
Rabiesisadiseasetransmittedthroughbitesandscratchesofanimals,mostcommonlydogs,bats,
cats,raccoons,skunks,andfoxes.Ifnottreatedthisdiseaseisalwaysfatal.Thevaccineis
recommendedforpersonsworkingwithanimals,youngchildren,personswithextensiveoutdoor
activitiesinruralareas(trekkersandbikers),andpersonswithprolongedstaysinendemicareas.
Preexposurevaccinationconsistsof3dosesgivenondays0,7,or2128.
JapaneseEncephalitis
Thisdiseaseistransmittedbyamosquitoandcausesaviralinfectionofthebrain.Itisrelatively
uncommonintravelers.Thevaccineisrecommendedtopersonstravelingtoricefieldsandpigfarms
inruralareasofIndiaandSoutheastAsia.
IXIARObyNovartiswaslicensedinMarch2009forpersons17yearsofageorolder,andis
givenasa2doseseries,ondays0and28.
1 Forpersonsyoungerthan17years,thereisalimitedsupplyofJEVAXby
Biken,butsuppliesmostlikelywillbedepletedby2010.Threedosesofthe
vaccinegivenon0,7,and30daysprotectsforabout3years.
RoutineVaccinations
Polio
Thisisaviralillnessthatisspreadbycontaminatedfoodandwaterandcanproduceparalysis.All
personsshouldhaveanadequateprimaryseriesandaonetimeadultboosterisrecommendedif
travelingtoAfrica,India,andtheMiddleEast.
TheboosterdoseintheU.S.isaninjectableinactivatedvaccine.
Influenza
Thefluisaviralinfectionthatcausesfever,headache,muscleachesandlunginfectionandoccurs
yearroundinthetropics.Thefluvaccineisrecommendedforalltravelersoverage50,childrenages
623monthsandclosecontactsofchildren023months,pregnantwomenandallpersonsofanyage
withanychronicorimmunocompromisingconditions.Aflushotshouldbeconsideredforany
travelerwishingtodecreaseriskofinfluenzaornonspecificrespiratoryillness.
Yearlyfluvaccineprovidesprotectionfor6months.
Tetanus/diphtheria
Tetanus(lockjaw)iscausedbycontaminationofcutsorwounds.Diphtheriaisapotentiallyfatal
bacterialinfectionthatisspreadbyrespiratorysecretions.Pertussis(whoopingcough)isahighly
contagiousrespiratorydiseasecausedbybacteria.Allpersonsshouldhaveanadequateprimary
seriesand1doseoftetanus/diphtheriawithinthelast10years.Adultswhohavenotreceivedatleast
1previousdoseofanyacellularpertussisshouldreceiveTdapvaccineatleastonce,inplaceofaTd

booster.
Tetanusvaccineprovidesprotectionfor10years.
Pneumonia
Pneumoniaiscausedbybacteriatransmittedfrompersontopersonthroughrespiratorydropletsand
canleadtoseriousinfectionsofthelungs,(pneumonia),blood(bacteremia),andthecoveringofthe
brain(meningitis).Thepneumoniavaccineisrecommendedforallpersonsover65andthosewith
chronicdiseasesorcompromisingconditions,includingpersonswithasthmaorcigarettesmokers.
1doseformostadults,someadultsmayneedanotherdoseafter5years.
Varicella(chickenpox)
Aviralillnessspreadbyrespiratorydroplets,causinganitchyblisterlikerash.Nonimmuneadults
areatincreasedriskofsevereillness.Thevaccineisrecommendedforallpersonswhohavenothad
chickenpox.
2dosesaregiven48weeksapartforpersons13yearsandolder,whichconferslifetime
protection.Forpersonsyoungerthan13yearsofage,the2dosesshouldbegiven3months
apart.
Measles,MumpsandRubella
Measlesisapotentiallyseriousillnesswithfever,cough,andrash.Mumpsmaycausebraininfection
orinfertilityinmales.Rubella(Germanmeasles)causesamildfeverandrashbutcanbedevastating
toadevelopingfetus.Thesediseasesarecommonindevelopingcountries.TheMMRvaccineis
recommendedforthosebornin1957orlaterwithouthistoryofdiseaseor2adequatedosesoflive
vaccineatanytimeduringtheirlife.
TheMMRconferslifetimeprotectionafter12injections.
Shingles(HerpesZoster)
Shinglesisanoutbreakofblistersandrashthataffectsjustonesideofthebody,andusuallycauses
veryintensepain.Itiscausedbyareactivationofthedormantvirusinthenervesofpeoplewhohave
previouslyhadchickenpox.Anyonewhohashadchickenpoxisatriskforshingles,butrisk
increaseswithage,andchronicconditionsthatsuppresstheimmunesystem.Ashinglesvaccine
(ZostavaxbyMerck)waslicensedin2006forthepreventionofshinglesinpersonsover60yearsof
age.
Theshinglesvaccineisjustoneshot.Thedurationofimmunityisunknownatthistime.
HPVVaccine(Gardasil)(HumanPapillomavirusQuadrivalentVaccine,Recombinant)
Gardasilisaninactivatedvaccinetopreventcervicalcancerandgenitalwartscausedby4typesof
HPV.Itiscurrentlyrecommendedonlyforgirlsandwomen9to26yearsold.Cervicalcanceristhe
2ndleadingcauseofcancerdeathsamongwomenintheworld.50%ofsexuallyactivemenand
womenareinfectedwithHPVatsometimeintheirlives.Three doses are given at 0, 2,
and 6 months. The duration of protection is expected to be long
lasting.
Commonvaccinereactions(reactogenicity)
Thecommonreactionsarecausedbythebodysresponsetothevaccineantigen(s)andtheother

vaccineconstituents.Ingeneraltheyoccurwithin2448hoursofvaccinationandareselflimiting.
Howeverreactionsfollowinglivevaccines(e.g.MMR)maybedelayedandresembleamildversion
ofthedisease.
Symptomorsign

Maximumdifferenceinrate*

Peakfrequency(days
aftervaccination)

(%)

CI(95%)

Localerythema(>2cm)

0.8

0.11.4

Otherlocalreaction

0.4

01.4

Mildfever(<38.5Crectal)

2.7

06.1

10

Moderatefever(38.639.5C)

2.9

1.64.3

Highfever(>39.5C)

1.4

0.72.1

10

Irritability

4.1

2.16.1

10

Drowsiness

2.5

1.43.6

11

Willingnesstostayinbed

1.4

0.52.3

11

Generalisedrash

1.6

03.0

11

Conjunctivitis

2.1

0.93.2

10

Arthropathy

0.8

0.21.3

79

Peripheraltremor

0.4

00.9

Coughand/orcoryza

1.5

4.61.6

Nauseaand/orvomiting

0.8

1.60

78

Diarrhoea

0.7

01.7

11

Rarevaccinereactions
Whilethereissomesimilaritybetweenthecommonreactionscausedbyallvaccines,theraremore
seriousreactionstendtobemorespecifictoeachvaccine.
Mostoftherareandmoreseriousvaccinereactions(e.g.seizures,thrombocytopaenia,hypotonic
hyporesponsiveepisodes,persistentinconsolablescreaming)donotleadtolongtermproblems.
Anaphylaxis,whilepotentiallyfatal,istreatablewithoutleavinganylongtermeffects.Although
encephalopathyisincludedasapossiblerarereactiontomeaslesorDTPvaccine,itisnotcertainthat
thesevaccinesinfactcauseencephalopathy(braininflammation)asthereisnodifferencein

incidencebetweenvaccinatedandunvaccinatedpeople.
Clearexplanationsabouttheimmunisationandcalm,confidentdeliverywilldecreasethelevelof
anxietyabouttheinjectionsandthusreducethelikelihoodofaninjectionreaction.
Itisimportanttobeabletodistinguishthelossofconsciousnessresultingfromafainting(vasovagal)
injectionreactiontothatofanaphylaxis.

Faint

Anaphylaxis

Onset

Usuallyatthetimeorsoon
aftertheinjection

Usuallysomedelaybetween530
minutesafterinjection

System

Skin

Pale,sweaty,coldand
clammy

Red,raisedanditchyrash;swollen
eyes,face;generalisedrash

Respiratory

Normaltodeepbreaths

Noisybreathingfromairways
obstruction(wheezeorstridor)

Cardiovascular

Bradycardia
Transienthypotension

Tachycardia
Hypotension

Gastrointestinal

Nausea/vomiting

Abdominalcramps

Neurological

TransientLOC,good
responseonceprone

LOC,littleresponseonceprone

Distinguishinganaphylaxisfromafaint(vasovagalreaction)Source:ImmunisationSafety
Surveillance:guidelinesformanagersofimmunisationprogrammesonreportingandinvestigating
adverseeventsfollowingimmunisation.Manila:WorldHealthOrganization,1999.
Coincidentalevents
Becauselargenumbersofimmunisationsaregiveneveryday,itisinevitablethatinthedays
followingimmunisationmanypeoplewillsuffermajorhealthevents.
Examplesoffalseallegationscausedbycoincidentalevents
Ex1immunisationandSuddenInfantDeathSyndrome(SIDSorcotdeath).TheincidenceofSIDS
peaksaroundtheagewheninfantimmunisationsaredelivered.So,manySIDScaseswilloccurin
childrenwhohavebeenrecentlyimmunised.Inevitably,whenapreviouslyhealthychilddiesacause
issought.
Ex2AutismandMMR
DiseaseinCanadainternationaltraveling

Africantrypanosomiasis(sleepingsickness)
Africantrypanosomiasisisaparasiticdiseasespreadbyaninfectedtsetsefly.Thediseaseis
transmittedinsomeareasofsubSaharanAfrica.
Americantrypanosomiasis(Chagasdisease)
Americantrypanosomiasis,morecommonlyknownasChagasdisease,isatropicalparasiticdisease
spreadbyinfectedtriatomineinsects.
Avianinfluenza
Avianinfluenza,commonlyknownas"birdflu,"isaviralinfectionthatspreadseasilyandquickly
amongbirdsandcancauseillnessinhumansandmanyotheranimalspecies.
Bedbugs
Bedbugscaneasilyhideinluggage,clothing,andotherpersonalitems,sotakeafewprecautions
whiletravellingtokeepthemfromcominghomewithyou.
Chikungunya
Chikungunyaisaviraldiseasethattypicallycausesfeveralongwithanarthritislikepaininthe
joints.Itisspreadtohumansthroughthebiteofaninfectedmosquito.ChikungunyaoccursinAfrica,
AsiaandtheIndiansubcontinent.
Cholera
CholeraisanacuteintestinalinfectioncausedbythebacteriumVibriocholerae.Itisspreadby
drinkingoreatingcontaminatedwaterorfood.
Considergettingvaccinated
Mosttravellersareatverylowrisk.Travellersathigherrisk(thoseinareaswithlimited
accesstocleanwaterandfoodand/orwithpoorsanitation),shoulddiscusswithahealthcare
providerthebenefitsofgettingvaccinatedbeforetravelling.

Ciguatera
Ciguateraisafoodbornediseasecausedbyeatingtropicalorsubtropicalfishcontaminatedwith
ciguatoxin.
Denguefever
Denguefeveristhemostcommonviraldiseasespreadtohumansbymosquitoes.Itcancausesevere
flulikesymptoms.Insomecases,itleadstodenguehaemorrhagicfever,whichcanbefatal.
Ebolavirusdisease
Ebolavirusdiseaseisarare,severeandsometimesfatalviraldisease.Avoidallnonessentialtravel
toGuinea,LiberiaandSierreLeone,wherethereisanongoingoutbreakofthevirus.
Hand,footandmouthdisease
Hand,footandmouthdiseaseisacommonviralillnessthatmainlyaffectsinfantsandchildren.Itis
causedbyagroupofvirusescalledenteroviruses.

HepatitisA
ThehepatitisAvirusattackstheliverandcancausemildtosevereillness.HepatitisAiscommonin
developingcountriesandisgenerallyassociatedwithpoorsanitationandpoorhygiene.
HepatitisB
HepatitisBiscausedbyavirusthatinfectstheliver.Itishighlycontagiousandisoneofthemost
commonvaccinepreventablediseasesaffectingtravellers.

HIV/AIDS
HIV(HumanImmunodeficiencyVirus)attacksandimpairstheimmunesystem,resultingina
chronic,progressiveillnessthatleavesthoseinfectedwithitvulnerabletoseriousinfectionsandcancers.
Influenza(flu)
Influenza(orflu)isacommonrespiratoryillnessthataffectsthousandsofCanadianseachyear.Travellersareatriskin
anycountryduringthefluseason.
Japaneseencephalitis
Japaneseencephalitisisavirusthatcausesswellingofthebrainandpossiblelongtermnerveandbraindamage.Itis
spreadtohumansbythebiteofaninfectedmosquitoandcanbepreventedbyavaccine.
Leishmaniasis
Leishmaniasisisaparasiticdiseasethatistransmittedbythebiteoffemalephlebotominesandflies.Itoccursintropical
andsubtropicalareas.
Leptospirosis
Leptospirosisisabacterialdiseasespreadthroughcontactwithwater,soilorfoodcontaminatedbyurinefrominfected
animals,orbydirectcontactwithinfectedanimals.Itoccursworldwide,butmostcommonlyinfectspeopleinwet,
tropicalclimates.
Malaria
Malariaisaseriousandoccasionallyfataldiseasethatisspreadbythebiteofaninfectedmosquito.
Measles
Measlesisahighlycontagiousdiseaseandistheleadingcauseofvaccinepreventabledeathsinchildrenworldwide.
Meningococcaldisease
MeningococcaldiseaseisaninfectioncausedbythebacteriumNeisseriameningitidis.Thisbacteriumcancauseserious
andsometimesfataldiseasesincludingmeningitis(infectionofthebrainlining)andmeningococcalsepticemia(infection
oftheblood).Meningococcaldiseaseoccursworldwidewithseasonalvariations
Polio
Polio(poliomyelitis)isacontagiousdiseasethatcanbepreventedbyvaccination.Itisspreadthroughcontaminatedfood
andwater
Rabies
Rabiesisaviralinfectionthatistransmittedtohumansthroughclosecontactwiththesalivaofaninfectedanimal.
Worldwide,dogbitesareresponsibleformosthumancasesofrabies.
Sexuallytransmittedinfections
Therearemanydifferentsexuallytransmittedinfections.Somearespreadbyskintoskincontactandothersthrough
semen,vaginalfluid,bloodorotherbodyfluidsduringsexualactivity.
Tickborneencephalitis
Tickborneencephalitisisaviraldiseasethatcausesswellingofthebrain,swellingofthemembranearoundthebrainand
spinalcord,and/orswellingofthespinalcord.Itistransmittedthroughthebiteofaninfectedtick.
Travellers'diarrhea
Travellers'diarrheaisthemostcommonillnessthataffectstravellers.Itiseasilyspreadfrompersontopersonorby
eatingfoodordrinkingwatercontaminatedwithfeces.
Tuberculosis
Tuberculosis(TB)isacontagiousbacterialdisease.Afterbreathinginthebacteria,5%to10%ofpeoplewillbecome
sickanddevelopactiveTBovertime,usuallyinthelungs.
Typhoidfever
Typhoidfeverisaninfectioncausedbyabacteriafoundincontaminatedfoodorwater.Thediseaseiscommonly
associatedwitheatingfoodspreparedinunsanitaryconditions,andwitheatinguncookedfoodsordrinkinguntreated
waterinareaswheresewageisnotdisposedofsafely.

Valleyfever
ValleyfeverisaninfectioncausedbyinhalingthesporesofafungusthatisfoundinthesoilinthesouthwesternUnited
States,Mexico,CentralandSouthAmerica.
YellowfeverYellow fever is caused by a virus that is transmitted by the bite of an infected
mosquito. It is always present in many tropical areas in South America and Africa.