Discussing Immunizations

Discussing Immunizations : All required , routine , optional vaccines.

• Obtain informed consent
• Discuss possible adverse effects (usually minor) and cost – often a deterrent
• Minor illness is not a contraindication
• Reluctance to vaccinate: document refusals!
• Special precautions for persons allergic to egg, HIV +, or immunosuppressed

1. Routine/Basic  IMMUNIZATIONS

1- TDAP :

Why should you be vaccinated?

Tdap vaccine can prevent tetanus, diphtheria, and pertussis.

Diphtheria and pertussis spread from person to person. Tetanus enters the body through cuts or wounds.

• TETANUS (T)causes painful stiffening of the muscles. Tetanus can lead to serious health problems, including being unable to open the mouth, having trouble swallowing and breathing, or death.
• DIPHTHERIA (D)can lead to difficulty breathing, heart failure, paralysis, or death.
• PERTUSSIS (aP), also known as “whooping cough,” can cause uncontrollable, violent coughing that makes it hard to breathe, eat, or drink. Pertussis can be extremely serious especially in babies and young children, causing pneumonia, convulsions, brain damage, or death. In teens and adults, it can cause weight loss, loss of bladder control, passing out, and rib fractures from severe coughing.

 The Tdap vaccine protects against tetanus, diphtheria, and pertussis.

Diphtheria and pertussis are infectious diseases that spread from one person to another. Humans are infected with tetanus through cuts or wounds.

• TETANUS (T) is a contagious disease that causes painful muscle stiffness. Tetanus can cause serious health problems, including the inability to open one’s mouth, swallowing and breathing difficulties, and even death.
• DIPHTHERIA (D) can result in difficulty breathing, heart failure, paralysis, or even death.
• PERTUSSIS (aP), often known as “whooping cough,” is characterized by uncontrollable, violent coughing that makes it difficult to breathe, eat, or drink. Pertussis can cause pneumonia, convulsions, brain damage, and even death in newborns and young children. In teenagers, it can cause weight loss, loss of bladder control, passing out, and rib fractures.

Tdap vaccine

Tdap is only for children and adolescents aged 7 and up, as well as adults.

Tdap should be given to adolescents once, preferably when they are 11 or 12 years old.

Tdap should be given to pregnant women at least once during their pregnancy, especially in the early third trimester, to help prevent the newborn from pertussis. Pertussis has the highest risk of serious, life-threatening consequences in infants.

Tdap should be given to adults who have never had it before.

Adults should also have a booster shot of Tdap or Td (a separate vaccination that protects against tetanus, diphtheria, and pertussis but not pertussis) every 10 years, or every 5 years if they have a serious or unclean lesion or burn.

Tdap may be administered at any time.

Talk with your health care provider

Tell your vaccination provider if any of the below happens:

• If the individual receiving the vaccine has had an allergic reaction to a previous dose of any vaccine that protects against tetanus, diphtheria, or pertussis, or has any serious, life-threatening allergies, tell your vaccination provider.
• Has experienced a coma, loss of consciousness, or persistent seizures within 7 days of receiving any pertussis vaccine (DTP, DTaP, or Tdap)
• Suffers from epilepsy or similar nervous system disorder
• Has Guillain-Barré Syndrome (commonly known as “GBS”) ever affected you?
• Has experienced severe pain or swelling after receiving a previous dose of any tetanus or diphtheria vaccine

Your health care practitioner may decide to postpone Tdap immunization until a later appointment in some instances.

Vaccination may be given to those who have minor ailments, such as a cold. Tdap vaccination is normally not given to those who are moderately or severely unwell until they have recovered.

More information is available from your health-care provider.

Vaccine risks

• Following Tdap vaccination, pain, redness, or swelling where the shot was given, moderate fever, headache, fatigue, and nausea, vomiting, diarrhea, or stomachache may occur.

Medical procedures, such as immunization, can cause people to pass out. If you’re dizzy, have visual changes, or ringing in your ears, tell your doctor.

A vaccine, like any other treatment, has a small potential of producing a severe allergic reaction, other serious harm, or death.

2- POLIO

Who Should Get Vaccinated Against Polio?

Children and Infants

To prevent against poliomyelitis, or polio, children in the United States should receive the inactivated polio vaccine (IPV). They should receive four doses in total, one at each of the ages listed below:

• Age: 2 months
• 4 months of age
• Children aged 6 to 18 months
• Children aged 4 to 6 years old

Before leaving for their vacation, children who will be visiting a country where the danger of contracting polio is higherexternal icon should finish the series. An expedited schedule is recommended if a youngster cannot complete the normal series before leaving.

If the accelerated schedule cannot be completed prior to departure, the remaining doses should be administered in the afflicted nation or upon return home, at the intervals suggested in the protocol. Furthermore, children who have completed the accelerated schedule should still receive an IPV dose at the age of 4 or older, as long as it has been at least 6 months since the last treatment.

Adults

Most adults do not need polio vaccine because they were already vaccinated as children. But three groups of adults are at higher risk and should consider polio vaccination in the following situations:

• You are traveling to a country where the risk of getting polio is greater. Ask your healthcare provider for specific information on whether you need to be vaccinated.
• You are working in a laboratory and handling specimens that might contain polioviruses.
• You are a healthcare worker treating patients who could have polio or have close contact with a person who could be infected with poliovirus.

Adults in these three groups who have never been vaccinated against polio should get 3 doses of IPV:

• The first dose at any time,
• The second dose 1 to 2 months later,
• The third dose 6 to 12 months after the second.
• Adults who are at increased risk of exposure to poliovirus and who have previously completed a routine series of polio vaccine (IPV or OPV) can receive one lifetime booster dose of IPV.

What are the Types of Polio Vaccine?

Two types of vaccines protect against polio, or poliomyelitis.

• Inactivated poliovirus vaccine (IPV)
  • IPV is the only polio vaccine that has been used in the United States since 2000.
  • It is given by shot in the leg or arm, depending on the patient’s age.
  • Children should get four doses total, with one dose at each of the following ages:
    • 2 months old,
    • 4 months old,
    • 6 through 18 months old, and
    • 4 through 6 years old.

For more information about IPV, see Vaccine Composition, Dosage, and Administration.

What are the Different Polio Vaccine Types?

Poliomyelitis, or polio, is prevented by two types of immunizations.

• Inactivated poliovirus vaccine (IPV) o Since 2000,

• • IPV has been the sole polio vaccination used in the United States.
  • Depending on the patient’s age, it’s given as a shot in the leg or arm.
  • Children should have four doses in total, one at each of the following ages: two months, four months, six to eighteen months, and four to six years.

See Vaccine Composition, Dosage, and Administration for more information on IPV.

 Oral poliovirus vaccine (OPV)

• • o In the United States, this vaccine is no longer licensed or available.
  • In some places of the world, it is still used.
  • o Vaccine doses are given to children as drops in the mouth.

In the United States, only IPV has been used since 2000 to avoid the possibility of vaccine-derived poliovirus, which can occur with OPV.

3- HEPATITIS A, B, or Combined Hepatitis A and B (Twinrix: A and B)

HAV is transmitted through the fecal-oral route, most commonly through direct person-to-person contact or the ingestion of contaminated food or drink (33). Because the majority of children infected with HAV have asymptomatic or unrecognized infections and can shed the virus in their feces for months before HepA vaccination was available and recommended routinely for children, children were a key source of HAV transmission before HepA vaccination was available and recommended routinely for children (34,35). Currently, transmission occurs mostly among people who are vulnerable.

Hepatitis B can be prevented using the hepatitis B vaccine. Hepatitis B is a liver disease that can cause a little illness that lasts a few weeks or a serious, life-threatening illness for entire life.

• Fever, exhaustion, loss of appetite, nausea, vomiting, jaundice (yellow skin or eyes, dark urine, clay-colored bowel motions), and muscle, joint, and stomach pain are all symptoms of acute hepatitis B infection.
• Chronic hepatitis B infection is a long-term sickness caused by the presence of the hepatitis B virus in the body. Although most people with chronic hepatitis B have no symptoms, it is nevertheless a severe infection that can lead to liver damage (cirrhosis), liver cancer, and death. Even if they do not feel or appear unwell, chronically infected people can transfer the hepatitis B virus to others.

Hepatitis B is transmitted through contact with infected blood, sperm, or other bodily fluids infected with hepatitis B virus enters the body of healthy person.

• • • Childbirth (if a pregnant person has hepatitis B, their baby can become infected)
    • Sharing razors or toothbrushes with someone who is infected
    • Contact with an infected person’s blood or open sores
    • Sexual activity with an infected partner
    • Sharing needles, syringes, or other injectable supplies
    • Blood exposure from needles or other sharp instruments

The majority of people who are vaccinated against hepatitis B are immune for the rest of their lives.

4- MMR Vaccine is a vaccine that protects against measles, mumps (2 DOSES OF EACH OR TITER or reliable history)

The MMR vaccine, which protects against measles, mumps, and rubella, is recommended by the CDC.

Travelers from other countries

Measles vaccination is recommended for everyone aged 6 months and up who will be traveling internationally.

• MMR vaccine should be given to infants aged 6 to 11 months before to any international trip. Infants who have received one MMR vaccine dosage before their first birthday should receive two further doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days).
• Children aged 12 months and up should receive two MMR vaccine doses spaced by at least 28 days.

Teenagers and adults who do not have presumptive evidence of measles immunity should receive two MMR vaccine doses spaced by at least 28 days.

Women of Childbearing Age

Before becoming pregnant, women of childbearing age should check with their doctor to ensure that they are fully vaccinated. Women of childbearing age who are not pregnant and do not have presumptive evidence of immunity should receive at least one MMR vaccine dose.

MMR immunization is safe for women who are breastfeeding. Breastfeeding has no effect on the MMR vaccine response, and the vaccine has no effect on the baby through breast milk.

Those who are at a higher risk of contracting mumps as a result of a mumps outbreak

During a mumps outbreak, public health officials may suggest an additional dosage of MMR vaccine to persons who are at a higher risk of contracting the disease.

5- Varicela Vaccine

• VZV is spread from person to person through direct contact, inhalation of aerosols from vesicular fluid of acute varicella or zoster skin lesions, or infected respiratory tract secretions that are also aerosolized. The virus enters the body through the conjunctiva or the upper respiratory tract.

Routine 2-dose vaccination

• First dose between the ages of 12 and 15 months
• Second dose between the ages of 4 and 6 years

 Second dose catch-up vaccination

• If the second dose is given after the child’s seventh birthday, the minimum time between doses is 3 months for children aged 13 years and 4 weeks for children aged 14 years.

Adolescents (≥ age 13 years) without other evidence of immunity

• Give two doses 4 to 8 weeks apart to adolescents and adults (age ≥ 13 years) without additional evidence of immunity
• If it has been more than 8 weeks since the first dosage, the second dose may be given without restarting the schedule.

6- INFLUENZA

Why get vaccinated?

The influenza vaccine is effective in preventing influenza (flu).

Every year, between October and May, the flu spreads across the United States. The flu can affect anyone, but some people are more vulnerable than others. Flu complications are most common in infants and young children, persons 65 and older, pregnant women, and people with particular health disorders or a weaker immune system.

Flu-related problems include pneumonia, bronchitis, sinus infections, and ear infections. If you already have a medical problem like heart disease, cancer, or diabetes, the flu can exacerbate it.

Fever and chills, as well as a sore throat, muscle pains, exhaustion, cough, headache, and a runny or congested nose, are all symptoms of the flu. Some people may have nausea and diarrhea, though this is less common in adults than children

Thousands of people die each year in the United States from influenza, and many more are hospitalized. Every year, the flu vaccine prevents millions of illnesses and doctor visits due to the flu.

Influenza vaccines

Influenza vaccine may be given at the same time as other vaccines.

Every flu season, the CDC advises that everyone 6 months and older get vaccinated. During a single flu season, children aged 6 months to 8 years may require two shots. Everyone else simply requires one dose per flu season.

After immunization, protection takes around 2 weeks to develop.

There are numerous flu viruses, and they are constantly evolving. Every year, a new flu vaccination is developed to protect against influenza viruses that are expected to cause illness during the forthcoming flu season. Even if the vaccination does not match certain viruses perfectly, it may provide some protection.

The flu is not caused by the influenza vaccine

Talk with your health care provider

Tell your vaccination provider:

• If the person receiving the vaccine has had an allergic reaction to a previous dose of influenza vaccine or has any serious, life-threatening allergies
• Has Guillain-Barré Syndrome (commonly known as “GBS)

In some situations, your doctor may decide to defer influenza vaccine until a later appointment.

During pregnancy, the influenza vaccine can be given at any time. During influenza season, inactivated influenza vaccination should be given to women who are or will be pregnant.

Vaccination may be given to those who have minor ailments, such as a cold. Those who are moderately or seriously ill should normally wait until they have recovered before having the flu vaccine.

More information is available from your health-care provider.

Risks of a vaccine reaction

• Following influenza vaccination, you may experience soreness, redness, and swelling where the shot was given, as well as fever, muscular aches, and headache.
• Inactivated influenza vaccine may raise the risk of Guillain-Barré Syndrome (GBS) by a minor amount (the flu shot).
• Young children who receive the flu vaccine, as well as the pneumococcal vaccine (PCV13) and/or the DTaP vaccine, may be slightly more likely to experience a seizure induced by fever. If a child who is getting the flu vaccine has ever had a seizure, tell your doctor.

7-  PNEUMOVAX – ESPECIALLY FOR SENIORS

Young infants are susceptible to pneumococcal disease, but older persons are at the greatest risk of serious illness and death.

• Pneumococcal conjugate vaccines (PCV13 (Prevnar 13), PCV15 (Vaxneuvance), and PCV20) are two types of vaccines used to prevent pneumococcal illness in the United States (Prevnar 20)
• PPSV23 Pneumococcal Polysaccharide Vaccine (Pneumovax23)

Who Should Get Vaccinated Against Pneumococcal Disease?

Pneumococcal vaccine is recommended for all children under the age of two and adults aged 65 and up, according to the CDC. Adults and older children should also obtain pneumococcal immunizations in certain circumstances. More information on who should and should not have each type of pneumococcal vaccine can be found below.

Consult your or your child’s doctor to determine what is best for your case.

PCVs – CDC recommendations

The CDC recommends PCV13 for:

• All infants under the age of two;
• Children aged two to eighteen who have specific medical issues.

The United States Centers for Disease Control and Prevention Advisory Committee of Immunization Practices (ACIP) recommends administration of PCV20 alone or PCV15 in series with PPSV23 for all patients with an indication for pneumococcal vaccination

PPSV23 – CDC Recommendations

• • Adults aged 19 and up who get PCV15

VACCINES SOMETIMES REQUIRED

1- Yellow Illness Vaccine:  Yellow Fever is a life-threatening viral hemorrhagic fever spread by the Aedes aegypti mosquito. There is no treatment or cure for yellow fever. Many parts of Africa and South America are home to this species. Yellow fever vaccination is inexpensive, effective, and highly advised before traveling to a yellow fever-endemic area. For the vast majority of people, a single dose gives lifetime protection.

The virus that causes yellow fever is transmitted through the bite of an infected mosquito. It can be found throughout Africa and South America.

The majority of those infected with the yellow fever virus will either have no symptoms or have a moderate infection that will go away on its own. However, some people will get a serious illness.

Yellow fever symptoms and signs include:

• Fever and chills that come on suddenly.
• Nausea or vomiting
• Headache, back pain, or general body discomfort

Yellow fever symptoms that are more severe include:

• Yellowing of the skin (yellow skin or eyes)
• Bleeding from many locations on the body
• Shock (a life-threatening condition caused by a lack of blood flow to the body)
• Liver, kidney, or other organ failure

In 30 percent to 60% of those infected with severe yellow fever, death is a possibility.

Yellow fever vaccine

The yellow fever vaccine is a live vaccination that contains a weakened version of the yellow fever virus. It is administered as a single dose. For the most part, one dose is enough to protect you for the rest of your life.

• Yellow fever vaccination is advised for people aged 9 months and up who are traveling to or living in yellow fever-prone areas in Africa (https://www.cdc.gov/yellowfever/maps/africa.html) or South America (https://www.cdc.gov/yellowfever/maps/south america.html).
• Some nations may have specific vaccine requirements that demand yellow fever vaccination prior to entry.
• The CDC Travelers’ Health page at https://wwwnc.cdc.gov/travel/destinations/list/ has information on vaccination needs and recommendations for specific countries.

Yellow fever vaccine is administered only at certified immunization centers. You will be handed a “International Certificate of Vaccination or Prophylaxis” (ICVP, also known as the “yellow card”) after receiving the vaccine. To enter certain countries, you’ll need this card as proof of immunization. If you don’t have it, you may be obliged to get it before entering the country, or you may be made to wait up to 6 days to ensure you aren’t infected.

Don’t give blood for 14 days after getting vaccinated because there’s a chance you’ll transfer the vaccine virus on to others.

Even while vaccines are generally safe, there are a few unusual issues that can occur after they are administered, such as:

Yellow fever vaccine reactions are typically modest, with headaches, muscle aches, and low-grade fevers. The yellow fever vaccine can cause severe, potentially life-threatening reactions in certain people, including:

• Allergic response, such as breathing or swallowing difficulties (anaphylaxis)
• Swelling of the brain, spinal cord, or tissues around it (encephalitis or meningitis)
• Guillain-Barré syndrome is a rare nervous system illness in which a person’s immune system attacks nerve cells, producing muscle weakness and, in some cases, paralysis.
• Dysfunction or failure of internal organs

Consult your healthcare practitioner if you have a fever, headache, weariness, body pains, vomiting, or diarrhea after receiving the yellow fever vaccine.

Who should not be vaccinated against yellow fever?

The vaccine should not be given to infants under the age of six months. Furthermore, anyone who has a severe allergy to any component of the vaccine, including eggs, chicken proteins, or gelatin, should not receive it. Anyone who has had a severe reaction to a previous dose of yellow fever vaccine should avoid receiving another dose.

Your healthcare practitioner can help you decide if you can safely receive the vaccine if you have any of the following conditions:

• Disease that affects the immune system like HIV/AIDS etc.
• Weakened immune system due to cancer or other medical problems, transplant, or pharmacological treatment (such as steroids, chemotherapy, or other drugs that impact immunological function)
• Thymus disorder
• 60 years old or more adults
• 6 – 8 months of age infants
• nursing mothers and pregnant women

2- Meningococcal Meningitis (MENACTRA)

Meningococcal Meningitis (MENACTRA) is a serious bacterial illness that can cause meningitis, bacteremia, or both. In the United States, three quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate (MenACWY) vaccines and two serogroup B meningococcal (MenB) vaccines are licensed and available, and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) recommends them for the prevention of meningococcal disease caused by these serogroups

• Travelers to countries where meningococcal illness is hyperendemic or epidemic: Travelers to countries where meningococcal disease is hyperendemic or epidemic, such as the sub-Saharan African meningitis belt, are at a higher risk of exposure and disease.
• It is a mandatory vaccination for Haj pilgrims over the age of two.
• College students: With increased control of serogroups C, W, and Y disease following widespread use of the MenACWY vaccine among adolescents, serogroup B is the most common cause of meningococcal disease among college students.

Types of Meningococcal Vaccines

In the United States, three quadrivalent meningococcal conjugate (MenACWY) vaccinations are currently licensed and available:

1. Meningococcal groups A, C, W, and Y polysaccharide diphtheria toxoid conjugate vaccine (MenACWY-D) (Menactra)
2. Meningococcal groups A, C, W, and Y oligosaccharide diphtheria CRM197 conjugate vaccine (MenACWY-CRM) (Menveo)
3. Meningococcal groups A, C, W, and Y polysaccharide tetanus toxoid conjugate vaccine (MenACWY-TT) (MenQuadfi)

In addition, in the United States, two serogroup B meningococcal (MenB) vaccinations are licensed and available:

• MenB-4C (Trumenba)
• MenB-FHbp (Bexsero)

3- COVID Vaccine

COVID-19 primary series immunizations are recommended for everyone 6 months and older, while COVID-19 boosters are recommended for everyone 5 years and older, if eligible.

COVID-19 vaccinations, including boosters, are recommended for people who are moderately or severely immunocompromised.

In the United States, three COVID-19 vaccines are used to prevent COVID-19. COVID-19 mRNA vaccines from Pfizer-BioNTech or Moderna are preferred. In some cases, you may be given the Janssen (J&J/Janssen) COVID-19 vaccine by Johnson & Johnson.

How Effective Is the Vaccine?

• Vaccines minimize the risk of COVID-19 infection, including the risk of severe illness and mortality in completely vaccinated individuals.
• Although COVID-19 immunizations are beneficial, studies have indicated that vaccine protection diminishes over time, particularly with the Omicron form. Learn more about having a booster shot to boost or restore COVID-19 protection.
• All COVID-19 vaccinations licensed or authorized by the FDA provide significant protection against COVID-19 hospitalization and mortality
• the CDC will continue to provide updates as more information becomes available.

Pfizer-BioNTech (COMIRNATY)

Type of Vaccine: mRNA

How it’s Given?: A shot to the upper arm muscle.

Number of Shots: The primary series consists of two doses given three to eight weeks apart.

Moderately or severely immunocompromised children aged 6 months to 4 years should receive a third dosage at least 8 weeks following their second dose. The third dose should be given at least four weeks after the second dose to children and adults who are moderately or severely immunocompromised.

Booster Shots: Only those aged 5 and up should receive a booster shot at this time.

Do NOT contain: Eggs, preservatives, latex, and metals

People aged 6 months and up are strongly advised to use this product.

The Primary Series: 5 years and older: 2 Pfizer-BioNTech doses given 3–8 weeks apart in the initial series.

People who are immunocompromised (have a weakened immune system) should receive a third dose at least four weeks following the second dosage in the initial series.

From the age of six months to four years: In the primary series, there are three Pfizer-BioNTech dosages. The first and second doses are three to eight weeks apart, whereas the second and third doses are at least eight weeks apart.

Boosters: Children aged 5 and up: Pfizer-BioNTech primary series recipients should receive a booster.

From the age of six months to four years: A booster dose is not currently approved for children in this age group.

Moderna (Spikevax)

Manufacturer: ModernaTX, Inc.

Type of Vaccine: mRNA

How it’s Given: An upper-arm muscle is shot.

NOT INCLUDED: Metals, latex, eggs, preservatives

18 years and older: Primary Series: In the primary series, two doses of Moderna are given four to eight weeks apart. People who are immunocompromised (have a weakened immune system) should receive a third dosage at least 4 weeks following the second dose in the initial series.

From the age of six months to five years, the primary series consists of two doses of Moderna, spaced four to eight weeks apart.

Boosters:

18 and up: A booster should be given to everybody who obtained the Moderna primary series. A second booster dose is only available to a few people.

From the age of six months to five years old: For children in this age group, a booster dose is not currently recommended.

Safety Data Summary

Common Side Effects

On the arm where you got the shot:

• Swelling
• Redness
• Pain

Throughout the rest of your body:

• Fatigue
• Headache
• Muscle aches
• Shivers
• Fever
• Vomiting
• Although severe adverse responses to immunizations are uncommon, they can occur.
• Myocarditis and pericarditis have been linked to mRNA COVID-19 immunization in a small number of people; predominantly men aged 12 to 39. A longer gap between the first and second dose may lower the risk even more.

J and J vaccine

When Should You Get the J&J/Janssen COVID-19 Vaccine?

Due to the risk of major adverse events, Pfizer-BioNTech or Moderna COVID-19 vaccines are preferable over J&J/Janssen COVID-19 vaccines for initial and booster vaccination in most cases.In some cases, the J&J/Janssen COVID-19 vaccination may be recommended, such as for people who:

• Have had a severe reaction to an mRNA vaccination dosage or have a serious allergy to a Pfizer-BioNTech or Moderna ingredient (mRNA COVID-19 vaccines).
• Would otherwise go without a COVID-19 vaccine due to a lack of access to Pfizer-BioNTech or Moderna (mRNA COVID-19 vaccines).
• Despite safety worries, wants to acquire the J&J/Janssen COVID-19 vaccination.

The COVID-19 vaccination from J&J/Janssen contains a portion of a modified virus that is not the COVID-19 virus. The vector virus is the name given to this modified virus. COVID-19 cannot be caused by the vector virus since it cannot proliferate. This vector virus instructs the body’s cells to produce an immunological response. This reaction helps you avoid being ill with COVID-19 in the future. Following an immune reaction, the body discards all vaccination ingredients, just as it would any information that cells no longer require. This is a regular element of the body’s operation.

J&J/Janssen Primary Series: 1 dosage People who are immunocompromised (have a weaker immune system) should receive a second dose of Pfizer-BioNTech or Moderna at least 4 weeks following the first dosage in the primary series.

Boosters should be given to everybody who received a J&J/Janssen primary series. A second booster dose is only available to a select few people.

• Optional Vaccines :

1- Typhoid Vaccine

Typhoid fever can be prevented with vaccination. The CDC advises vaccination for:

• People traveling to areas where typhoid fever is widespread, such as South Asia, particularly India, Pakistan, or Bangladesh; and 2) people traveling to countries where typhoid fever is common.
• Those who like to try and eat new things
• Adventure sport lovers

Consult a doctor or a travel clinic to learn more about your alternatives.

In the United States, two typhoid fever vaccinations are available.

• Oral vaccine: Can be given to anyone over the age of six. It consists of four pills to be taken every other day for at least one week prior to departure.
• Injectable vaccine: Can be administered to anybody above the age of two, and should be given at least two weeks before to travel.

Vaccines against typhoid are not 100 percent effective. To help avoid infection, always eat and drink in a healthy manner. Vaccines against typhoid wane in effectiveness over time. A booster is required for the injectable vaccine every two years, and for the oral vaccine every five years. Ask your doctor if it’s time for a booster vaccination if you’ve already been immunized. Antibiotics do not prevent typhoid illness; they only aid in its treatment.

2- Rabies pre-exposure vaccination

• • Rabies can be prevented byrabies vaccine
  • Rabies is a severe illness that almost invariably results in death.
  • Rabies is caused by the rabies virus, which attacks the central nervous system. Delirium (confusion), odd behavior, hallucinations, hydrophobia (fear of water), and insomnia (difficulty sleeping) are among of the symptoms that might appear days to years after being exposed to the virus and occur before coma and death.
  • Rabies can be contracted if a person comes into touch with an infected animal’s saliva or neural tissue, such as through a bite or scratch, and does not receive prompt medical attention, including rabies vaccination.

Human Diploid Cell Vaccine (HDCV-Sanofi)

or Purified Chick Embryo Cell (PCEC-Novartis)

• 3 dose schedule : 1, 7, 21 or 28 days
• Intramuscular (NOT intra-abdominal!) in the deltoid area
• 0 ml dose all ages

After pre-exposure series: If exposed,

no need for rabies immune globulin

(HRIG) and only 2 boosters 2 doses,

one week apart

• On days zero and seven, you should have two doses of rabies vaccine.
• You may be advised to have one or more blood tests or receive a booster dosage within three years of the initial two doses, depending on your level of risk. More information is available from your health care provider.
• If given to a person after an exposure, the rabies vaccination can prevent rabies. The wound site should be carefully cleansed with soap and water after an exposure or probable exposure to rabies. Vaccination should be given as soon as possible after an exposure if your health care physician or local health department recommends it, although it may be helpful at any time before symptoms appear. The rabies vaccine is no longer effective once symptoms appear.
• If you’ve never been vaccinated against rabies, you’ll need four shots spread out over two weeks (given on days 0, 3, 7, and 14). You should also acquire rabies immunoglobulin on the same day or shortly after you get your first dose of rabies vaccine.
• If you’ve already had rabies vaccine, you’ll only need two doses after an exposure.

3- Japanese Encephalitis Vaccine

The Japanese encephalitis virus causes Japanese encephalitis (JE), which is a dangerous infection.

• It primarily affects Asia’s rural areas.
• It is transmitted by a mosquito that has been infected. It is not contagious.
• For the majority of travelers, the risk is minimal. People who live in disease-prone areas or who visit there for extended periods of time have a higher risk. The majority of people who have been infected with the JE virus show no signs or symptoms. Others may experience symptoms ranging from a moderate fever to encephalitis (brain infection).
• Fever, neck stiffness, convulsions, and coma are common symptoms of encephalitis. Encephalitis kills 1 out of every 4 people. Those that do not die make up to half of the population.
• A pregnant woman’s unborn child may be harmed by infection
• The JE vaccine can help prevent travelers against JE sickness.

Vaccines to Protect Against Japanese Encephalitis

• Ixiaro® is a trademark of Ixiaro Corporation (Inactivated cell culture derived)
• A two-dose regimen of the vaccination is given. People who are still at risk should receive a booster dosage after a year.
• One week apart, two doses
• It’s costly!
• Another option is to immunize in an endemic area outside of the country, particularly in Mahidol University in Bangkok.

(A Chinese vaccine that is both effective and cheap.)

Vaccine Recommendations:

Persons moving to a JE-endemic country to live, longer-term (e.g., 1 month or longer) travelers, and frequent travelers to JE-endemic countries should all get the JE vaccine. Short-term (less than 1 month) travelers with an elevated risk of JE due to planned travel duration, season, location, activities, and accommodations may also consider the JE vaccine. Travelers to endemic areas who are unsure of the length of their trip, their locations, or their activities may consider vaccination.

The JE vaccination is not suggested for travelers who will be traveling in low-risk areas, such as those who will be traveling for a short period of time in metropolitan areas or who will be traveling outside of a well-defined JE virus transmission season.