CV

Name: Dr. Iris Rengganis, PhD,

FINASIM DOB: Jakarta, 29 June 1958
Education :
- GP: Faculty of Medicine, Universitas
Indonesia, 1983
- Internist: Faculty of Medicine,
Universitas Indonesia, 1994
- Consultant in Allergy-Immunology:
Faculty of Medicine, Universitas
Indonesia, 2000
- PhD: Bogor Agricultural Institute, 2009

Working Experiences :
- Community Health Center, South
Jakarta, 1984-1988
- Dr. Cipto Mangunkusumo Hospital,
Central Jakarta, as a fellow, 1989-1994
- Jakarta Hajj Hospital, East Jakarta,
1995-1997
- Dr. Cipto Mangunkusumo Hospital,
Central Jakarta, 1998-now
IMMUNIZATION FOR
TRAVELER
INTRODUCTION
• Estimation of risk in travelers
o 20 – 70 % overall risk of morbidity from illness or injury
o 5% of travelers require a doctor’s attention
o 1% require hospitalization while abroad
o Many travelers require medical care on returning home.
o Infectious disease accounts for only 1 – 2 % of deaths.
• Prevention:
Precautionary measures, appropriate, vaccinations, and chemoprophylactic
medications.

Steffen R, et al. J Travel Med 2008;15:145-6

Risk of Infection during travel
• Risk of infection varies according to:
1. The area to be visited (endemicity of diseases)
2. Timing 0f trip (season)
3. Nature of travel (holiday, business, backpacker, visit friends and
relatives)  role in spreading disease
4. Mode of travel
5. Type of accommodation
6. Anticipated activities
7. Duration of trip  long-term travelers are at greater risk
8. Health status of the traveler: their medical conditions, current
medications, allergies and immunization
history.

1. Herman J, et al. Medicine 2018;48:56-65

2. Sanford et al. Am Fam Physician 2016;94:620-7
 Vaccine-preventable diseases
The decision to vaccinate a traveler is
based on :
Epidemiology and risk of the
The effectiveness of the vaccine
disease
The risk of vaccine
The individual’s underlying health
associated
adverse events
The cost of vaccination
The ability to employ other disease
preventing measures
Herman J, et al. Medicine 2018;48:56-65

“Multiple Vaccination”

 Any combination of vaccines can be administered in 1 appointment.

 Live virus vaccines (yellow fever, varicella, zoster, measles-mumps-
rubella) should be administered on the same day or 4 weeks apart.

Leung et al. Ann Intern Med

TIME FOR PRE-TRAVEL CONSULTATION

• Ideally, pre-travel evaluation should be done at least 4–6

weeks before departure because certain vaccines require
multiple doses.
• If immunization records are not available and serologic
testing is not possible, the traveler should be considered
non-immune.
• When a traveler presents with insufficient time to complete a
vaccination series, consideration should be given to starting
the series with the understanding that complete immunity
may not be achieved before travel.

Leung et al. Ann Intern Med 2018;168:ITC1-16.

 Three main reasons for vaccinating

1. Routine 2. Required by the destination 3. Recommended because

healthcare country of travel-related risk
(Recommended as part of
routine healthcare)

ROUTINE VACCINATIONS
• In general, the diseases on the routine domestic immunization schedule are
more common in travelers than are the travel-specific illnesses  travelers
should be up to date on the routinely recommended vaccines.
• Traveler should be up to date with any additional vaccines that might be
recommended as a result of their work, lifestyle choice, or underlying health
problems.

1. Herman J, et al. Medicine 2018;48:56-65

2. Sanford et al. Am Fam Physician 2016;94:620-7
 REQUIRED
VACCINATION
S
 REQUIRED VACCINATIONS
• Two vaccinations the International Health
Regulations 2005 apply:
o Yellow fever
o Polio

• Specific vaccination requirements for entry into countries

o Saudi Arabia: quadrivalent (ACWY) Meningococcal
vaccine as a condition for granting a
Hajjor Umrah visa

Herman J, et al. Medicine 2018;48:56-65

YELLOW FEVER

• There is no specific treatment for yellow fever.

• Mortality can exceed 20–50%.
• The vaccine is a live attenuated virus.
• Travelers should be vaccinated at least 10 days before
arrival in a risk zone.
Leung et al. Ann Intern Med 2018;168:ITC1-16
YELLOW FEVER
YELLOW FEVER
POLIO
 POLIO
Travelling to areas with active poliovirus transmission
• Adult travellers who have previously received three or more doses of OPV
or IPV should also be given another one-time booster dose of polio
vaccine.
• Travellers to polio-infected areas who have not received any polio vaccine
previously should complete a primary schedule of polio vaccination before
departure.
Travellers from infected areas
• Before travelling abroad, individuals living in areas where polio cases are
still occurring should have completed a full course of vaccination against
polio, preferrably with OPV.
• Travellers from infected areas should receive an additional dose of OPV
4
weeks to 12 months before each international journey.
WHO. International Travel and Health. 2012
MENINGOCOCCAL
MENINGOCOCCAL
• The risk of meningococcal disease in travellers is
generally low.
• Outbreaks occur in schools, colleges, military
barracks  large numbers of adolescents and young
adults congregate.
• Outbreaks incidence rates in sub-Saharan meningitis
belt are very high during the dry season (December
to June).
• Pilgrims to Mecca are at particular risk.
• A protective antibody response occurs within 10
days of vaccination. WHO. International Travel and Health. 2012
IMMUNIZATIO
N FOR
TRAVEL-
RELATED RISK
IMMUNIZATION FOR TRAVEL-RELATED RISK
Vaccines that are medically advised based on the actual disease risks of the itinerary

Steffen et al. J Travel Med 2015;22:1-12

 INFLUENZA
• Influenza occurs all over the world, with an annual global attack rate
estimated at 5–10% in adults and 20–30% in children.
• In temperate regions, influenza is a seasonal disease
occurring
typically in winter months:
• northern hemisphere from November to April.
• In •tropical
southern hemisphere
areas there is from
no April
clear to September.
seasonal
and influenza circulation
pattern, is year-round, typically with several peaks
during rainy seasons.
• Travellers visiting opposite hemisphere during the influenza season
are at special risk, particular if they do not have some degree of
immunity
• High risk groups: elderly, people with chronic diseases, and
young
children
• “When the northern and southern hemisphere influenza vaccine WHO. International Travel and
strains differ, high-risk individuals should obtain vaccination for the Health. 2012
CHOLERA
CHOLERA
• A vaccine consisting of killed whole-cell V. cholerae O1 in
combination with a recombinant B-subunit of cholera toxin
(WC/rBS) has been marketed since the early 1990s
• WC/rBS induces approximately 50% short-term protection
against diarrhoea caused by enterotoxigenic Escherichia coli
(ETEC)
• Primary immunization consists of two oral doses 7–14 days
apart for adults
• Following primary immunization, protection against cholera
may be expected after about 1 week. Booster doses are
recommended after 2 years for adults
 HEPATITIS A
• Non-immune travellers to developing countries are
significant risk of infection.
at
• The risk is particularly high for travellers exposed to
poor
hygiene, sanitation and drinking-water control.
• oTheMonovalent
availableHepatitis
HepatitisA (2
A doses)
vaccines
o Combination Hepatitis A and B (3 doses)
o Combination Hepatitis A and Typhoid (single dose + repeating dose of
monovalent)
• In monovalent vaccine, protection is achieved 2-4 weeks after
first dose.

WHO. International Travel and

Health. 2012
PNEUMOCOCCAL
• Access to optimal health care may be limited during
travel  increasing the risk of a poor outcome should
disease occur.
• Vaccination against invasive pneumococcal disease is
advisable for children <2 years of age, children and
adults with underlying medical conditions predisposing
for pneumococcal infection, and elderly.

WHO. International Travel and Health. 2012

 SUMMARY
♥ Most travel-related illness is avoidable.
♥ Vaccination is one of prevention methods beside
precautionary measures and chemoprophylactic
medications.
♥ Perform a detailed riskassessment for each
individual traveler.
♥ Three types of vaccinations for traveler: routine, required,
recommended.
QUIZ
Indonesian female doctor, 33 years old, is planning to
attend a medical conference in US this December 2018.
She denies having any serious illness before, but she admits
to have allergic rhinitis.
She had completed routine immunization program during
childhood and had Tdap booster when there
diphtheria outbreak early this year.
was
What vaccinations will you recommend?