Far-Off Adventures

By Sherri J. Tenpenny
Issue 120, September-October 2003

The time has finally arrived for the highly anticipated trip out of the country. The plans began long ago: airplane tickets, hotel reservations, rental car, sightseeing plans. The bags are being pulled from the attic to be packed, and the excitement mounts with each passing day. Everything is a go. But wait-what about vaccines? Is this one more preparation that needs to be added to the "To Do" list? Traveling out of the country can feel like a venture to another planet. Pictures of exotic destinations coupled with new, curious foods dance off the pages of the travel brochures. Anticipating the unexpected can be a challenge for even the most seasoned traveler. However, traveling with children adds an extra dimension to the anxiety-the thought of your child becoming ill in a foreign country is extremely frightening. Your doctor is recommending a variety of vaccines. Are they necessary? How do you evaluate the risks?

Vaccines in the U.S.
Currently, eight different vaccines are recommended for children in the US: Hepatitis B, polio, diphtheria-tetanus-pertussis (DTaP), measles-mumps-rubella (MMR), chickenpox, HiB, Prevnar, and, most recently, an annual influenza vaccine. (HiB and Prevnar are given to prevent bacterial infections caused by H. influenza and Strep. pneumonia, respectively. Some of these vaccines are also recommended for international travel. But are the risks of getting these diseases any greater when traveling than they are at home? Let's take a closer look at the more worrisome infections that might be encountered while traveling abroad.

Hepatitis B is a viral infection that is spread through contact with blood. In the US, Hepatitis B is primarily found in adults, and is spread through intimate contact or through sharing needles used with illicit drugs. Hepatitis B is more common in the general population in East and Southeast Asia and in Sub-Saharan Africa. Even in these areas, the risk for contracting the infection is very low, but if you do, Hepatitis B can make you very ill. Still, the risk of long-term complications is much less than we are generally led to believe. More than 95 percent of those who contract Hepatitis B fully recover, and an infection will result in lifetime immunity for that person. Unless you plan to spend extended periods in close contact with infected persons, the risk of contracting Hepatitis B while traveling is nearly the same as in the US.

Polio, or poliomyelitis, is an infectious disease caused by a virus that attacks the nervous system. The disease is seen primarily in children under five years of age; the initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. Paralysis results in approximately 1 to 2 percent of children who contract the viral infection, though the vast majority recovers completely from this paralysis. A few, however, go on to have permanent, lifetime disability.

While polio was once common throughout the undeveloped world, today only seven countries continue to have polio-endemic rural areas: Afghanistan, Egypt, India, Niger, Nigeria, Pakistan, and Somalia. The disease is no longer a threat and will soon be completely eradicated. Although the Western Hemisphere was certified "polio-free" by the World Health Organization in 1994 and there have been no cases of wild polio in this region since 1991, the US vaccination schedule still includes four doses of the polio vaccine.¹ The reason given for this is that, until polio is eradicated entirely, the risk of reintroducing polio into this country is "only a plane ride away." However, an examination of the data reveals only six cases of imported polio documented between 1980 and 1998, the last in New York City in 1993.² The risk for contracting polio is negligible, even at home.

Tetanus is an acute, spastic paralytic illness caused by a toxin released from the bacterium Clostridium tetani. The bacterium is found in soils and animal feces throughout the world.

There are several forms of tetanus: neonatal, cephalic, localized, and generalized. In infants, neonatal tetanus is the most common and most deadly. However, the vast majority of these cases occur following childbirth, as a result of using nonsterile equipment to cut the umbilical cord. Cephalic tetanus, the least common, causes muscle spasms in the face, leading to the classic case of "lockjaw." Localized tetanus is recurring muscle contraction near the original site of the infection; recovery can take many weeks.

Generalized tetanus, the most common, is the slowest to develop. The disease is characterized by a gradual increase in skeletal muscle rigidity and muscle spasm. Deep, dirty punctures are at greatest risk for developing the infection because the bacterium thrives only in areas that are deprived of oxygen.

The symptoms of any type of tetanus infection develop slowly. The incubation period-the time between when the injury occurred and the development of a full-blown infection-can range from five days to two months, but the initial symptoms most commonly begin to appear within 14 days. Early symptoms of infection include restlessness, headache, and localized itching or pain at the site of the injury. It is generally believed that tetanus is a highly fatal disease, but an examination of the data proves otherwise. In the most recent evaluation of tetanus data by the CDC, it was found that the death rate associated with tetanus was 11 percent, nowhere near the "nearly 100 percent fatal" so widely believed.³ It is also commonly accepted that a tetanus shot will prevent the onset of tetanus. Again, the data show that, even if a person has three or more tetanus shots, it is still possible to contract the disease.⁴ A recent issue of the British Medical Journal reported that tetanus can occur "despite adequate immunization and [adequate] levels of neutralizing antibodies."⁵