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see also p 53 - 56 part2. Australian Immunisation
Handbook, 8th Edition - 9/2003 )
Information mostly taken from: "International
Travel and Health" (WHO year book -
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf
Centre for Disease Control, USA - www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 &
March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine,
Melbourne, Oct 2004.
Updated 06/09/2006. Additional references & disclaimer.
(including persons with other impaired
At least 50 countries currently
restrict the entry of immigrants or travellers with HIV infection
or AIDS. For details of current restrictions, travellers should
contact the consulates or embassies of the countries to be visited
(anonymously). The American government travel website has information on entry
requirements on http://travel.state.gov/law/info_621.html
Many infections encountered by
travellers are associated with increased morbidity or mortality
in HIV-infected persons.
Persons with HIV infection are more
likely to have adverse reactions to drugs used to treat
infection, such as ampicillin, augmentin, ciprofloxacin,
They are at increased risk for
adverse effects from immunisation with live vaccines.
Their antibody response to vaccines
is reduced, generally in proportion to the degrees to which they
The clinical findings associated with
infection may be atypical, delaying correct diagnosis and
Several infections may be present
|ADT or DPT
influenza type b conjugate vaccine
- Annual influenza vaccine is
recommended for HIV-infected persons. Response rates to
the vaccine exceed 80% in persons with asymptomatic HIV
infection and are less than 50% in patients with AIDS.
- Immune globulin is safe.
- Oral polio vaccine (Sabin) is
contraindicated in HIV-infected persons. For primary
immunisation or booster immunisation against polio the
inactivated polio vaccine should be used. OPV has not
been proven to be harmful.
SPECIAL VACCINES WHICH MAY BE
Yellow fever vaccine, a live viral
vaccine, is not recommended for those with symptomatic HIV
infection or CD4 counts of less than 200/cmm, because of the
theoretical risk for vaccine strain encephalitis. Asymptomatic
HIV-infected persons with CD4 cell count > 200 who must travel
to areas where the risk of yellow fever is high should be
vaccinated. Data from the US. military indicate that
approximately 100 asymptomatic HIV-infected personnel received
yellow fever vaccine before routine HIV screening: no adverse
effects were detected. The vaccine should be given only for the
traveller's protection. If the vaccine is required only for legal
purposes, a letter of exemption from the doctor is generally
Measles is endemic in devloping
areas of the world. In HIV-infected persons, measles may be a
devastating disease and is occasionally fatal. Persons may be
considered to be immune to measles if they have a history of
physician-diagnosed measles or protective levels of measles
antibody. Measles outbreaks among previously vaccinated young
adults indicate the occasional failutre of vaccine-induced
Although there is a risk for
measles vaccine associated encephalopathy in immunosuppressed
subjects, no severe complications occurred in more than 300
HIV-infected children immunised with this vaccine. One should
weigh up the risks of contracting and developing severe measles
disease against that of vaccine associated encephalopathy. Short
term travellers not likely to have closed associated with the
local population will have a low risk of exposure to measles.
However if the contact is likely to be closed and prolonged the
risk may be substantial and immunisation with the live vaccine
would be justified.
Response rates of the vaccine
among HIV-infected persons ranges from 50 to 58% in those with
The risk of exposure to mumps and rubella may also be increased
during travel, the MMR (measles, mumps and rubella) vaccine
should be considered.
MMR is recommended by US authorities as routine
immunisation for asymptomatic HIV-infected children.
For symptomatic HIV-infected children the vaccine should
also be considered.
NHMRC (1994) states
"HIV-positive individuals may be given MMR vaccine in the
absence of other contraindications", and "MMR should be
routinely administered to HIV-infected children at 12 months of
CDC Recommendations for routine
immunisation of HIV-infected children
* should be considered
- Studies have shown little, if
any, increased morbidity from malaria in HIV-infected
persons from malaria-endemic areas. Whether the morbidity
of malaria is increased in HIV-infected travellers from
outside malaria-endemic areas is unknown.
- Anti-mosquito measures are
obviously important (see Malaria pamphlet).
Chemoprophylaxis (taking drugs to prevent malaria) is
- Chloroquine is acceptable.
Because its is immunosuppressive, theoretically it could
affect host response to infections or could contribute to
progression of HlV-related disease. There are no clinical
data on this issue.
- Proguanil is acceptable. Data
- Maloprim is no longer
recommended as a prophylactic drug for malaria.
- Doxycycline is acceptable.
- Mefloquine is acceptable, but
there is limited data.
TRAVELLER S DIARRHOEA
(See the pamphlet on
- The principal risk for the
HIV-infected traveller is enterically acquired
infections. Several of the pathogens causing traveller's
diarrhoea cause disease in HIV-infected person that is
severe, recurrent or persistent, and associated with extraintestinal spread.
- Gastric acid secretory
failure is common in patients with AIDS; thus a small
inoculum of ingested bacteria may produce disease.
Mucosal immune function may also be impaired in those
with a low CD4 count.
- Prolonged antibiotic use in
HlV-infected individuals, eg. for PCP prophylaxis, may
increase susceptibility to colonisation of bowel by
organisms such as Clostridium difficile.
- Shellfish should be steamed
for 4 6 minutes or avoided if such preparation cannot be
assured; although this is a general recommendation for
all individuals, an increased susceptibility to
septicaemia from Vibrio spp. makes compliance with this
guideline especially important for those who are immunosuppressed.
- Shigellosis in patients with
AIDS may be protracted, severe, bacteraemic, and followed
by chronic intestinal carriage.
- Non-typhoidal salmonellosis
is characterised by recurrent bacteraemia in patients
- Campylobacter infections are
also associated with bacteraemia and cholecystitis in
HIV-infected persons, and may follow a chronic, relapsing
- Cryptosporidiosis causes a
chronic infection in HIV-infected persons leading to
malnutrition, wasting, and susceptibility to other
- Isosporiosis in patients with
AIDS has been associated with malabsorption, weight loss,
and chronic watery diarrhoea.
- Microsporidiosis is another
cause of chronic diarrhoea in patients with AIDS.
- Advise the HIV-infected
traveller not to eat uncooked meat as it may cause
toxoplasmosis, and to avoid soft, ripened cheeses which
may carry the bacteria, Listeria.
- Individuals with chronic
diarrhoea may be more susceptible to complications of
superimposed traveller's diarrhoea (e.g. dehydration,
weight loss). Antibiotic prophylaxis is worth considering
for short trips.
- Drugs such as lomotil,
loperamide (Imodium), the quinolones, erythromycin,
ampicillin, tinidazole and metronidazole are safe. There
is an increased risk of drug rashes with ampicillin, augmentin, ciprofloxacin, co-trimoxazole.
- Tuberculosis is a major
threat to HIV-infected persons and has a high risk of
progression to active disease. The risk for becoming
infected during short-term travel is small l. The
probability of exposure increases with longer visits. All
HlV-infected persons should be tested with tuberculin
skin test regardless of travel plans, although anergy
limits the usefulness of the test, especially in those
with advanced HIV infection.
- Some experts offer
prophylaxis (isoniazid 300 mg daily) against tuberculosis
to severely immuno-compromised patients (with CD4 counts
less than 200) intending to travel to endemic areas for
periods longer than a few weeks (i.e. other than the
short trips to the usual tourist resorts).
- Leishmaniasis in HlV-infected
persons is often an extensive disease with high
- The first manifestation may
not appear for many months or years after exposure in
endemic areas. The clinical. illness may be atypical, the
serological tests are frequently negative, and the
disease may be refractory to treatment. Travellers should
be advised to avoid sandfly bites .
Examination after travel: It is advisable (if not essential) to visit your
local doctor promptly if you
suffer from a chronic disease, such as cardiovascular disease, diabetes
mellitus, chronic respiratory disease;
- experience illness in the weeks following their return home, particularly
if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin
disease or genital infection occurs;
- consider that you may have been exposed to a serious infectious disease while
have spent more than 3 months in a developing country.
Source: WHO - http://whqlibdoc.who.int/publications/2005/9241580364_chap1.pdf (page
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