Anda di halaman 1dari 70

TRAVEL

MEDICINE
BAGIAN 1

dr. Kr e sn awat i Wah yu Se t io no , MCTM


L e ct . D e pt . Tro pical Me di ci n e
N u sa C e n dan a Un i ve rsi t y

PENDAHULUAN
Mengenal daerah yang akan dikunjungi
secara epidemiologi dan geograf
Mengapa penting?
Karena bukan hanya untuk bisnis ataupun
bersenang-senang tapi ada yang sebagai
volunteer
Ada yang sakit karena travelnya ada yang
eksaserbasi akan sakit kroniknya
Pencegahan terhadapp penyakit infeksi
ataupun non infeksi yang berkaitan dengan
morbiditas dan mortalitas

MORBIDITAS DAN MORTALITAS


Bergantung dari durasi, musim, gaya
hidup, tujuan, dan karakteristik individu
Kecelakaan dan tenggelam dapat
dicegah
Malaria juga merupakan salah satu
penyebab
Travellers diarrhea masih merupakan
penyakit tersering
Sex trip

KONSULTASI PRA-TRAVELLING
3 saran yang harus disampaikan:
Berikan saran jelas dan berdasarkan
literatur
Fokus pada isu kesehatan
Diskusi dan berikan imunisasi
Berikan informasi pencegahan akibat
penyakit-penyakit tertentu
Apakah pasien FIT FOR TRAVEL

IMUNISASI
Live and killed vaccine
Oral, IM, ID
Adverse reaction dicatat
Dokumentasi imunisasi diperlukan

MALARIA
Sub-saharan Africa dan Oceania
Drug resistance perlu diperhatikan
Imunitas dari traveler diperhatikan
Pencegahan

TRAVELERS DIARRHEA
Paling sering
Enterotoxigenic E.coli
Host factors (usia, imunitas, faktor
genetik, dan penyakit penyerta)
Pencegahan terhadap makanan
tertentu tidak banyak bermanfaat

TRAVELERS WITH SPECIAL


NEEDS
Hamil dan menyusui
Anak dan remaja
Usia Lanjut
Disabilitas
Dengan penyakit penyerta
Immunocompromised
HIV
Pekerja
Adopsi
Berkunjung

TRAVELERS WITH SPECIAL


ITINERARIES
Expatriates
TKI/TKW
Misi medis
Cruise
Gathering massal

ENVIRONTMENTAL ASPECTS

High altitude
Diving
Extreme temperature
Jet lag
Motion sickness
Aircraft cabin

HEALTH PROBLEMS WHILE


TRAVELLING
Bites, sting, envenoming
Food borne
Psychiatric disorder
Travelers thrombosis
Personal security and crime avoidance

POST TRAVEL SCREENING


Anamnesa
Asimptomatis
Long term travelers harus di asses
mendetail
Laboratory test

PRE-TRAVEL
ASSESSMENT IN
HIGH-RISK
TRAVELERS

PRE-TRAVEL ASSESSMENT IN
HIGH-RISK TRAVELERS
1. Travelers with Cardiovascular
diseases
2. Travelers with Pulmonary diseases
3. Travelers with Diabetes
4. Travelers with Epilepsy
5. Pregnant Travelers
6. The Elderly Travelers

TRAVELERS WITH CARDIOVASCULAR


DISEASES
Pressure will be related
Oxygen saturation level 94%
Travelers with cardiac or pulmonary problem,
decreased oxygen concentration in the
cabintachycardia, patient with low cardiac
reserve, especially in the patients with ischemic
heart disease to myocardial ischemia or cardiac
decompensation.

TRAVELERS WITH CARDIOVASCULAR


DISEASES
Aerospace Medical Association
Contra Indication:
1. Uncomplicated myocardial infarction within 2-3 weeks
2. Complicated myocardial infarction within 6 weeks
3. Unstable angina
4. Congestive heart failure, severe, decompensated
5. Uncontrolled hy pertension
6. Coronary by pass graft surgery within 10-14 days
7. Cerebrovascular accident within 2 weeks
8. Uncontrolled ventricular or supraventricular tachycardia
9. Eisenmenger sy ndrome
10. Severe sy mptomatic valvular heart disease

M e d i c a l G u i d e l i n e s Ta s k F o r c e A e r o s p a c e M e d i c a l A s s o c i a t i o n : M e d i c a l g u i d e l i n e s f o r a i r l i n e t r a v e l ,
2 n d e d , Av i a t S p a c e E n v i r o n M e d 2 0 0 3 ; 7 4 : A 1 . Av a i l a b l e a t w w w. a s m a . o r g ( A c c e s s e d o n J u l y 1 8 , 2 0 0 6 )

TRAVELERS WITH PULMONARY


DISEASES
Anamnesis
Chest x-ray, pulmonary function test, blood
gas analysis (PaO2 >72 mmHg)

1.
2.
3.
4.

Contraindication
Pneumothorax
Contagious respiratory infection
Severe, uncontrolled COPD, Asthma
Thoracic surgery within 2 weeks
Gong, H, Jr. Advising pulmonary patients about commercial air travel. J
Respir Dis 1990; 11:484.

TRAVELERS WITH DIABETES


Problem: glycemic control
Time zone problem (<5 time zone mo meed
insulin adjusment)
Simple practical point for diabetic travelers

TRAVELERS WITH EPILEPSY


Well-controlled epilepsy
Epileptic patients should continue their
medications throughout the trips
mefl oquine and chloroquine are
contraindicated
carbamazepine, phenytoin or
phenobarbitone, it is recommended to
increase the dose of doxycycline to 200
mg/day.

PREGNANT TRAVELERS
Sangat penting
2 nd trimester : diperbolehkan
Perhatikan imunisasi yang
diperbolehkan dan yang tidak bagi ibu
hamil
Pemakaian obat-obatan prophylaxis,
seperti prophylaxis malaria

PREGNANT TRAVELERS
Potential contraindication for travel during
pregnancy
1.

Me di cal con di ti o ns s u ch as cardi ov ascul ar di se as e s, pul m onary


d i s e ase s
2. O bs te tr i c co ndi t i o ns
Pregnancy > 36 weeks
Multiple gestations in present pregnancy
Ectopic pregnancy
Premature labor
Incompetent cervix, threaten abortion
History of toxemia, hypertension, diabetes in pregnancy
3. Tr av e l to de s ti nati on that m ay be hazardous
High altitude >12,000 feet in normal pregnancy, >8,200 in late or
high risk pregnancy
Areas where live vaccines are required and recommended
Endemic area of malaria (esp chloroquine resistance P.falciparum)

THE ELDERLY TRAVELER


Most are su it able
Tambahkan imunisasi infl uenza dan pneum oc o cc a l

1.
2.
3.
4.
5.
6.
7.

The general advic es for the elderly tra velers


Plan t he tr ip early a nd co nsult t he t ravel doc t or 2-3 m ont hs
befo re depart ure
Early imm unizations are rec o m m ended
Kno w yo urs elf, your t ravel. Avoid ad vent ure t rip or tra vel t o the
ext reme climat e area
Carry adequ at e perso nal m edic at io n, im port ant m edic al rec ord
in the carry- o n baggage.
Check t he travel insur anc e before trip . Is there a ny lim ita tion in
the insurance. Is it c overing the repa triat io n?
Eat o nly clean, safe fo od. Avoid unco oked or underc ooked foo d.
Use co mmon sens e dur ing tra vel t o avoid ac c ident and injury.
Traffi c accident is t he c om m o n c a use of t ravel-relat ed m o rta lity

IMMUNIZATIONS IN
TRAVELERS

TO SOUTH AFRICA
DPT, Polio, Measles Mumps
Hep A, Hep B, Typhoid
Yellow fever, Flu vaccine
Other diseases prevalent in the
area : Rift
Valley fever, STD, Diarrhea

RISK ASSESSMENT
Risks assessments include knowledge base for
consideration and advice :
Destination
Duration and season of travel
Purpose of travel
Standard of accommodation and food hygiene
Behavior of traveler
Underlying health of traveler

RISK ASSESSMENT
Who will be traveling (age, gender,
health/medical and vaccination history)
Where (country(ies), urban/ rural)
When (departure date, duration and season of
travel) are they traveling ?
Why are they traveling ?
What will they be doing when they get there ?
How will they be traveling and living while
there ?

RISK ASSESSMENT
Why are they traveling ?
Purpose of travel:business vs tourism-backpack,
humanitarian worker
What will they be doing when they get there ?
Activities eg.safari, hiking (high altitude in sickle
cell
disease and trait-higher risk of crisis and splenic
infarction),golf ng
How will they be traveling and living while
there ?
eg. cruise ship,overland,

WHO? PATIENTS HISTORY


Allergy
Immunodef ciency
Pregnancy
Present medication (if receiving ATB, oral typhoid
vaccine should not be given)
Detailed immunization history
Travelers itinerary

WHO? PATIENTS HISTORY


Past history
coronary heart disease
ulcerative colitis
allergic reaction
neuropsychiatric symptoms (depression, seizures)
splenectomy etc.
COPD

RISK MANAGEMENT: VACCINE


RECOMMENDATIONS
Review standard and individualized recommendations
Based on risk assessment
Assist with decision making, base on facts while
consideration other concerns (cost, vaccine anxiety
etc.)
Review and discuss benef ts/ risks of all
recommended vaccines
Consult with travelers primary/ specialist
physician(s) as appropriate (e.g. pregnant traveler)
Finalize care plan with traveler

RISK MANAGEMENT:
ADMINISTRATION OF VACCINATIONS
Provide and review written information
(i.e., Vaccine Information Statements VIS) for all selected vaccines
Obtain verbal/ written consent for any
vaccines to be administered
Administer vaccination
Complete related documentation
including Yellow Card/ immunization
record

CONSIDERATION WITH LIVE


VACCINE
Live viral vaccines should be avoided in
pregnant women
If the female traveler is vaccinated with
live vaccines, should be advised to avoid
pregnancy for 3 months
Live viral vaccines should also be
avoided in immunosuppressed patients
(the exception is the MMR vaccine, which
is not contraindicated in HIV-infected
patients)

CONSIDERATION WITH LIVE


VACCINE
For travelers currently on antibiotics,
the oral typhoid vaccine is contraindicated
Live viral vaccine, including yellow
fever, MMR, infl uenza, and Varicella
vaccines, should not be given with
blood products, especially intravenous
immune globulin (IVIG)

EGG ALLERGIES AND VACCINES


Travelers with an allergy to eggs
will be concerned about specific
vaccines. Influenza, yellow fever,
and the purified
chick embryo cell (PCEC) rabies
vaccine viruses

CHOLERA
The risk is very low in travelers
simple precautions are taken to avoid
potentially contaminated food and water
The vaccine is recommended only for
individual at increased risk of exposure,
particularly emergency relief and health
workers in refugee situations
Cholera vaccination is not required as a
condition of entry to any country

CHOLERA VACCINE
Type of vaccine: Killed (Dukoral)
Number of doses: Two, one week apart (killed
vaccine)
Contraindications: Hypersensitivity to previous dose
Adverse reactions: Mild gastrointestinal disturbances
reported
Before to departure: 3 weeks (killed vaccine)
Consider for: Travelers at high risk (e.g. emergency or
relief workers)
Special precautions: None
The live vaccine is currently no longer available
commercially

HEPATITIS A
A viral (HAV) infection in Africa, Alaska, Asia,
Greenland, South America,and the western half of the
United States
The risk is 1:750 travelers per week
The attack rate for unimmunized long term traveler
as high as 28%during the f rst 2 years
When IG is given concurrently with the f rst dose of
hepatitis A vaccine, antibody concentrations are lower
The use of immunoglobulin is now obsolete for the
purpose of travel prophylaxis

www.who.int

HEPATITIS A
Special Considerations
Hepatitis A vaccine is not recommended for
postexposure prophylaxis
Because hepatitis A has a relatively long incubation
period, the vaccine may not prevent the disease in
individuals who have an unrecognized hepatitis A
infection at the time of vaccination

HEPATITIS A VACCINE
Type of vaccine: Inactivated, given i.m.
Number of doses: Two
Schedule: Second dose 6-24 months after the f rst
Booster: May not be necessary--manufacturers
propose at 10 years
Contraindications: Hypersensitivity to previous dose
Adverse reactions: Mild local reaction of short
duration, mild systemic reaction
Before departure: Protection 2-4 weeks after f rst
dose
Recommended for: All non-immune travelers to
endemic areas
Special precautions: None

HEPATITIS A VACCINE TYPE


Inactivated viral antigen
Harix (GSK) 70-80%(2 wk), 90%(4 wk)
VAQTA(Merck) 70-80% (2wk), 90%(4wk)

Inactivated virosome-formulated Ag
97%(2wk)
Epaxal(SSL,Berna) 99%(4wk)

Inactivated viral Ag-Avaxim (Sanof


Pasteur) >90%(2wk), 100%(4wk)

COMBINATION HEPATITIS A/
TYPHOID VACCINE

Hepatyrix
Active Ingredient : Inactivated hepatitis A and VI
polysaccharide typhoid vaccine
Manufacturer : GlaxoSmithKline
Administer : Intramuscular Injection
Before departure : It is recommended that the
vaccine is given one month prior to risk of
exposure to hepatitis A and at least two weeks
prior to risk of exposure to typhoid
Booster : None, Hepatyrix is generally given as a
single dose

COMBINATION HEPATITIS A/TYPHOID


VACCINE
ViATIM TM
Active Ingredient : Typhim Vi for typhoid fever and
Avaxim for hepatitis A
Manufacturer : Aventis Pasteur MSD
Administer : intramuscular injection
Before departure : 14 days post 1st vaccination
induce seroprotection for both hepatitis A and typhoid
fever
Booster : Provided protection against typhoid fever
for three years and hepatitis A for up to 10 years if a
booster is given six to 12 months after the initial
injection.

COMBINATION HEPATITIS A AND B


VACCINE
May be considered for travelers
who may be exposed to both
organism.
Primary immunization vaccine
consist of three doses, given on a
schedule of 0,1 and 6 months
According to manufacturers
instruction, this combination
vaccine may be administered on
day 0, 7 and 21 with a booster

COMBINATION HEPATITIS A AND B


VACCINE
Twinrix
Combination of Havrix (inactivated) for hepatitis A
and Engerix-B (recombinant) for hepatitis B, given
intramuscular injection
Manufactured by GlaxoSmithkline
Three doses ; 0, 1 and 6 to 12 months
Should be administered 4 weeks before departure
Local reaction : redness, swelling and pain at the site
of injection
Systemic reaction : fatigue, headache,
irritability/fussiness, loss of appetite, fever,
drowsiness, and gastro-intestinal symptoms
May be given d0,d7,d21 with booster at 12
month

INFLUENZA
In southern hemisphere, peak activity
occurs between April and September
In the northern hemisphere , between
November and March
Increase with air travel, cruise ship
and tour group
Elderly, respiratory or cardiac
disease, DM, and immunosuppressive
condition

INFLUENZA VACCINE
Two types of infl uenza vaccine are currently
available for use
Inactivated vaccine (viruses in inactivated
vaccines are killed), administered by
intramuscular injection
Live, attenuated infl uenza vaccine (LAIV),
administered by nasal spray :approved for
use only in healthy persons 5-49 years of age
The viruses used in both vaccines are
representative of viruses likely to circulate in
the upcoming season, and usually one or
more vaccine strains are updated annually.

INFLUENZA
Type of vaccine: Inactivated vaccine
Number of doses: One, given s.c. or i.m. for
inactivated vaccine
Booster: Annual; immunocompromised individuals
should receive a second dose 4 weeks after the
f rst
Contraindications: Hypersensitivity to previous
dose or severe hypersensitivity to egg
Adverse reactions: Inactivated vaccine : mild
soreness, fever, malaise
Before departure: 2 weeks
Recommended for: High-risk groups before the
infl uenza season, and optional for travelers to
countries currently in infl uenza season

INFLUENZA
Travellers with conditions placing them at high risk
for complications of infl uenza should be regularly
vaccinated every year.
In years in which the northern and southern
hemisphere infl uenza vaccine strains diff er, those
high risk individuals travelling from one hemisphere
to the other shortly before or during the other
hemispheres infl uenza season should obtain
vaccination
Receiving a vaccination at least 2 weeks before travel
is advisable

INFLUENZA
One dose of vaccine is given by intramuscular
injection for individuals aged over 9 years
Two doses are administered at least 4 weeks
apart for immunocompromised people and for
children aged 6 months 9 years
Mild local reactions such as pain or swelling
at the injection site are common
Systemic reactions such as fever are less
common
Vaccination is relatively contraindicated in
case of egg allergy

JAPANESE ENCEPHALITIS
Indications for Vaccination
JE vaccination is not recommended for
all travelers to Asia
This immunization should be considered
for travelers who will spend 1 month or
more in endemic areas during the
transmission season, especially if travel
will include rural areas, out door
exposure (camping, hiking,bicycle tour)

JAPANESE ENCEPHALITIS VACCINE


Inactivated mouse-brain-derived
vaccine (IMB)
Cell-culture-derived inactivated vaccine
Cell-culture-derived live attenuated SA
14-14-2 vaccine

JAPANESE ENCEPHALITIS
Ty pe o f v ac cin e : I n act iv e m o us e - br ain - de r iv e d (I M B ) or live
at te n uat e d
S ch e d ul e : Fo r t he in acti v ate d v ac cin e : 3 do s e s at d ay 0, 7 an d 28;
o r 2 do s e s g iv e n pre fe rab ly 4 w e e ks ap ar t (0. 5 o r 1.0 m l for
ad ul ts , 0 .2 5 o r 0 .5 m l fo r c hi ldre n d e pe nd in g o n th e v acc in e s) For
t he liv e at te n u at e d S A 1 4- 14 -2 v acc in e e qu ally g ood p rote c tion is
ac hi e v e d wit h a s in gle fo ll o we d , as re q u ire d , wi th a s in gle b oost e r
d o s e g iv e n at an in te r v al o f abo u t 1 y e ar
B o o s te r: Afte r 1 y e ar an d th e n 3 -y e ar ly (fo r I M B on ly )
Co ntr ain d icati o n s: H y pe rs e n s itiv ity t o p re v io u s dos e of v acc in e ,
p re g n anc y and i m m un o s up p re s sio n (liv e v ac cin e )
Adv e r s e re acti o ns : O cc asio nal m i ld lo c al o r sy s te m ic re act ion ;
o c cas io n al s e v e re re ac tio n w ith g e n e r aliz e d u r tic ar ia, hy po te n sion
an d co llap se
B e fo re de p ar tu re : In act iv at e d v acci ne ,at le as t t wo d os e s b e fore
d e p ar ture
L iv e at te n uat e d v a cci ne , o n e do s e i s e no ug h

SINGLE DOSE JAPANESE


ENCEPHALITIS VACCINE
ChimeriVax-JE
FDA identif ed August 31,2007 as the target date for the
FDAs license
ChimeriVax- JE is a live attenuated vaccine, injectable
vaccine
provide a convenient, aff ordable, single-dose vaccine to
travelers and those living in endemic regions.
A single-dose JE vaccine off ers signif cant benef ts in terms
of compliance and reduced healthcare infrastructure costs
while also being ideal for travelers by providing rapid,
durable immunity
Sanof Pasteur plans to introduce the new vaccine
throughout the Asia Pacif c region with particular focus on
the large endemic countries like Thailand and China

MENINGOCOCCAL
Vaccination should be considered for
travelers to countries where outbreaks
of meningococcal disease are known:
Travelers to industrialized countries are
exposed to the possibility of sporadic
cases
Travelers to Sub-Saharan
Tetravalent vaccine (A,C,Y,W135) is
required to go to Saudi Arabia for
pilgrims visiting Mecca for the Hajj

MENINGOCOCCAL DISEASE
Type of vaccine: Purif ed bacterial capsular polysaccharide
meningococcal vaccine (bivalent; A and C< or tetravalent; A,
C, Y, W-135)
Number of doses: One
Duration of protection: 3-5 years
Contraindications: Serious adverse reaction to previous dose
Adverse reactions: Occasional mild local reactions; rarely
fever
Before departure: 2 weeks
Consider for: All travelers to countries in the sub-Saharan
meningitis belt and to areas with current epidemics; college
students at risk from endemic disease; Haij pilgrims
(mandatory)
Special precautions : Children under 2 years of age are not
protected by the vaccine

TYPHOID FEVER
Risk for travelers
Occurs in 1:3,000 to 1:30,000 travelers per month

Risk is greatest for travelers to the Indian


Subcontinent and other developing countries in Asia,
Africa, the Caribbean, and Central and South America
length of travel longer than 3 weeks
rural locations
backpacking activities

Vaccination is particularly recommended for those


who will be traveling in smaller cities, villages, and
rural areas off the usual tourist itineraries, where
food and beverage choices may be more limited

TYPHOID FEVER
Type of vaccine: Oral Ty21a and injectable Vi CPS
Number of doses: One of Vi CPS, i.m. three or four of live
Ty21a, given orally at 2-day intervals as enteric coated
capsule
Booster: Every 2-3 year for Vi CPS, every 6 years for Ty21a
Contraindications: Proguanil, mefl oquine and antibiotics 3
days before or starting Ty21a
Adverse reactions: None signif cant
Before departure: 1 week
Recommended for: Travelers to high-risk area and travelers
staying longer than 1 month or likely to consume food or
beverages away from the usual tourist routes in developing
countries
Special precautions: Vi CPS-not under 2 years of age; avoid
proguanil,mefl oquine and antibiotics with Ty21a

YELLOW FEVER
The disease occurs only in sub-Saharan Africa and tropical
South America
Type of vaccine: Live, attenuated
Number of doses: One priming dose of 0.5 ml
Booster: 10-yearly (If re-certif cation is needed)
Contraindications: Egg allergy; immuno-def ciency from
medication, disease or symptomatic HIV infection;
hypersensitivity to a previous dose; pregnancy
Adverse reactions: Rarely, encephalitis or hepatic failure
Before departure: International certif cate of vaccination
becomes valid 10 days after vaccination
Recommended for: All travelers to endemic zones
Special precautions: Not for infants under 9 months of age;
restrictions in pregnancy

INTERNATIONAL CERTIFICATE OF
VACCINATION FOR
YELLOW FEVER
To prevent importation and transmission, a number of
countries require a certif cate from travelers arriving
from infected areas or from countries with infected
areas, even if only in transit
particularly for persons traveling from Africa or South
America to Asia
Some countries in Africa require evidence of
vaccination from all entering travelers; others may
waive the requirements for travelers coming from
non-endemic areas and staying in the country <2
weeks

INTERNATIONAL CERTIFICATE OF
VACCINATION OR REVACCINATION
AGAINST YELLOW FEVER
The valid certif cate
Signature of person
vaccinated
Date of vaccination
The certif cate must
be signed in his own
hand by a medical
practitioner or other
person authorized by
the National Health
Administration
Offi cial stamp

RABIES (ID AND IM)


Indications for Vaccination
There is a 1% to 2% risk of rabies per animal bite per
year in developing countries Persons
Per ACIP, pre-exposure immunization is recommended
for :planning to be more than 30 days in an area
where rabies is a constant threat
Travelers whose occupations or activities place them
at frequent risk of exposure

RABIES (ID AND IM)


Vaccine
This is an inactivated-virus vaccine, available in
several forms
Human Rabies Immune Globulin (HRIG) is a special
immune globulin formulation used in post-exposure
treatment of persons not previously immunized with
rabies vaccine

RABIES
Type of vaccine: Modern cell-culture or embryonated
egg vaccine
Number of doses: Three, one on each of days 0, 7 and
21 or 28, given i.m. (1 ml/dose) or i.d. (0.1 ml/per
inoculation site)
Booster: Not routinely needed for general travelers
Adverse reactions: Local pain, erythema, swelling and
pruritus, malaise, headache
Before departure: Pre-exposure prophylaxis for those
planning a visit to a rabies-endemic country, especially
if the visited area is far from major urban centres
where appropriate care, including the availability of
post-exposure rabies prophylaxis, is not assured

INFLUENZA VIRUS H5N1


FDA approved on 17 April 2007
First U.S Vaccine for Human against
Avian Infl uenza Virus H5N1
Manufacturer by Sanof Pasteur
Inactivated monovalent infl uenza virus
vaccine
Indicated for active immunization of
person 18 through 64 years of age at
increase risk of exposure to the H5N1
infl uenza virus subtype contained in the
vaccine

INFLUENZA VIRUS H5N1


DOSAGE AND ADMINISTRATION
Immunization consists of two 1 ml (90 g)
intramuscular injection
A 1 ml dose given on day 1 followed by 1 ml dose
given approximately 28 days later
The vaccine is available as a suspension in 5 ml
multidose vials containing 5 dose
Each 1 ml dose is formulated to contain 90 g
hemagglutinin of the infl uenza virus strain
A/Vietnam/1203/2004

INFLUENZA VIRUS H5N1


Can I get vaccinated now?
No, the manufacturer, Sanof Pasteur, will not sell the
vaccine commercially
The federal government has purchased the vaccine to
include within U.S. Strategic National Stockpile for
distribution by public health offi cials if needed.
How well does the vaccine work?
45% of 103 participants who received the vaccine
developed antibodies at a level that is expected to
reduce the risk of getting H5N1 infl uenza.
less than optimal antibody levels may still help
reduce the severity of the disease and related
hospitalizations and deaths.

VACCINE INTERACTIONS

VACCINE INTERACTIONS

VACCINE INTERACTIONS

VACCINE INTERACTIONS