BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE … · 27/11/2015 2 REPORT BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 26, 2015 – PART 2 2015 • The consensus meeting was chaired

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BELGIANCONSENSUS MEETINGon TRAVEL MEDICINE

June 26, 2015

Belgian Scientific Study Group on Travel

Medicine

Pr. A. Van Gompel Dr U Maniewski (ITG)Pr. F. Jacobs (Hôp. Erasme, ULB)

Pr. P. Lacor & Dr L Seyler (UZ-Brussel) Dr. Ph. Leonard (CHU-ULg)

Pr. W. Peetermans (U.Z. - K.U.Leuven) Pr. S. Callens(UZ.- U.Gent) Dr. S.Quoilin (iph.fgov.be)

Dr.P. Soentjens (Belgian Defence)Pr. B. Vandercam (CHU. St. Luc, UCL)

Pr. Y. Van Laethem & Dr C Martin (CHU. St. Pierre, ULB)PART 2 version 25/11/15

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REPORTBELGIAN CONSENSUS MEETING on TRAVEL MEDICINE

June 26, 2015 – PART 2

2015

• The consensus meeting was chaired by A. Van Gompel and Y, Van Laethem

• Secretary of the meeting was P Lacor• A preliminary PowerPoint, prepared by A. Van Gompel,

was presented• The discussion and recommendations of the

meeting are included in this finale presentation.• The ESSENTIAL SLIDES (pdf-version) & the

CONSENSUS BROCHURE (in Dutch and French) highlighting the proposals for changes will been sent to all participants. May be used for teaching.

• These documents will serve as a proposal for approval by the governmental Belgian Health Council – section Vaccinations, on 17-09-2015

• Responsable final redaction : A. Van Gompel

PART 1• 1.a - Vaccination for Yellow Fever• 1.b - Malaria

PART 2• 2.A - Other vaccinations• 2.B - TD, other infections, …., • 2.C - VARIA

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Anaphylaxis • Anaphylaxis following administration of a

vaccine (after excluding severe allergy by medical history) is extremely rare.

• 15' of observation (in the waiting room or in the hall of the travel clinic) is a safety rule after vaccination

• Nr. 8802 Hoge Gezondheidsraad = Conseil Supérieur de la Santé 4/7/2012

– http://tinyurl.com/HGR-8802-anafylaxie– http://tinyurl.com/CSS-8802-anaphylaxie

2015

Basic Vaccinations - Tetanus-diphteria-pertussis- Poliomyelitis- Measles mumps rubella

2014

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Tetanus-Diphtheria-Pertussis

2014

2014

Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013

d’une dose unique de rapp

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2014


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2015

2015

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Primovaccinatie met dTp(a) ? In de bijsluiter wordt de primovaccinatiemet het dTp(a)-vaccin niet vermeld.Ook de aanbeveling van de HogeGezondheidsraad vermelden daaroverniets.Een studie uit 2007 onderzocht bijvolwassenen ouder dan 40 jaar die devoorbije 20 jaar geen tetanus of difterievaccinhadden gekregen of waarvan devaccinatiestatus onbekend was, de efficiëntievan dTp(a) en dTp(a)-IPV-vaccins.Eén maand na de toediening van 3 dosissen,bedroeg het niveau van beschermendeantistoffen 99%. Bij gebrek aan dT kan dTp(a) dus worden gebruikt voor primovaccinatie. Indien ook bescherming tegen polio nodig is, kan dTp(a)-IPV gebruikt worden

Primovaccination avec le dTp(a) ?

Ni la notice, ni les recommandations duConseil Supérieur de la Santé ne mentionnentla possibilité d’une primovaccinationavec le dTp(a).Cependant, une étude publiée en2007 a montré chez 99% des vaccinésl’obtention de taux séroprotecteurscontre le tétanos et la diphtérie après uneprimovaccination à l’aide du dTp(a) (3doses), chez des adultes de plus de 40ans (en absence de données vaccinalesou avec un dernier rappel datant de plusde 20 ans).En cas d’indisponibilté du dT, par exemple lors d’une rupture de stock, l’administration du dTp(a) pourrait donc être utilisé en primovaccination. En cas de nécessité d’une protection contre la poliomyélite, dTp(a)-IPV peut être utilisé,

Theeten H et al, Primary vaccination of adults with reduced antigen-content diphtheria-tetanusacellular pertussis or dTpa-inactivated poliovirus vaccines compared to diphtheria-tetanus-toxoid vaccines. Current medical research and opinion. Vol. 23, n° 11, 2007 : 2729-2739.

2014

POLIO

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POLIO

• SEARO/WHO South-East Asia: Press release 26 March 2014 :

WHO South-East Asia Region certified polio-free

2014

• WHO Polio Eradication Initiative http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

WHO 29-04-2014

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WHO 29-04-2014

2014

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July 2015(since 24/04/15)

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Sept 2015(since 04/08/15)

25-11- 2015(since 03/09/15)

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Imovax Polio ®

Revaxis ®

Boostrix IPV ®

=also Polio

Clearly mention that this is polio-vaccination

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Travel Vaccinations

1. Hepatitis A 2. Hepatitis B 3. Typhoid fever4. Rabies5. Meningococcal meningitis6. Japanese encephalitis7. TBE - FSME

2014

HEPATITIS A

Immunodepressed traveler should – if possible - receive the complete series

(2 / 3 doses) before leave(+ antibodytiter)

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2014

Results: • The final study population consisted of

53 patients treated with • TNFi (n 15),TNFi & MTX (n 21) or MTX (n 17)

months after the 1st dose % of the patients that had attained seroprotection

1 10%6 33%months after the 2nd dose1 83%6 72%

at month 24 86%

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Conclusions: • Two doses of hepatitis A vaccine at a 6-

month interval provided protection for most immunosuppressed RA patients.

• A single dose does not seem to afford sufficient protection to this group of patients.

2014

2014

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2015

2015

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HEPATITIS B

Immunodepressed …..

2015

2014


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2015

2015

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TYPHOID FEVER

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Vaccination against typhoid fever

• Stock of vaccine against typhoid fever depleted– Typhim ®– Typherix ® is available – but in limited

quantities– Vivotif ® is barely or not available

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CATMAT 2015

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CATMAT

2015

Extract from CatMat 2014 = Canadian guidelines

The strongest and most consistent predictor of typhoid risk in travellers is destination of travel. The estimated risk of developing travel associated typhoid is about:

– 1/3,000 travellers for travel to the South Asia (= high risk) • South Asia is defined as Afghanistan, Bangladesh, Bhutan, India,

Nepal, Maldives, Pakistan, and Sri Lanka. • Among these countries, the large majority (≥ 90%) of cases of typhoid

among travellers were reported from India, Pakistan and Bangladesh

– 1/50,000-100,000 for travel to Sub-Saharan Africa, North Africa and the Middle East, or South America (= intermediate risk)

– < 1/300,000 for travel to the Caribbean and Central America (= low risk).

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Extract Public Health England http://www.hpa.org.uk/webc/HPAwebFile/HPAweb

_C/1206575041711 (Accessed 2014 Feb 4)

Surveillance in the UK determined somewhatlower rates: • in travelers to South Asia,

the risk was 17 cases per 100,000

• in travelers outside the Indian subcontinent, the rate may be as low as 0.05 per 100,000

Typhoid

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New onelinerOLD : Vaccinatie wordt aangeraden• voor tropenreizen langer dan 3 weken OF • voor avontuurlijke reizen, zelfs indien korter dan 3 weken.

PROPOSAL FOR A NEW ONE:

•la vaccination contre la fièvre typhoïde est surtout conseillée pour les voyages de plus de trois semaines vers le sous-continent indien

• la vaccination contre la fièvre typhoïde est à considérer pour les voyages aventureux dans de mauvaises conditions sanitaires vers les pays tropicaux ou subtropicaux ou pour les immigrés et leurs enfants qui retournent dans leur pays tropical d’origine pour visiter la famille et les connaissances.

25-11-2015

• vaccination against typhoid fever is particularlyadvisable for trips longer than 3 weeks duration to the Indian subcontinent

•vaccination against typhoid fever can be considered in case of an adventurous trip in poor sanitary conditions to tropical or subtropical countries or for immigrants when they return to their homeland to visit friends and relatives.

• vaccinatie tegen buiktyfus is vooral aangeraden voor reizen langer dan 3 weken naar het Indisch subcontinent

• vaccinatie tegen buiktyfus kan overwogen worden voor avontuurlijke reizen in slechte hygiënische omstandigheden in tropische of subtropische landen of voor migranten en hun kinderen die terugkeren naar hun land van herkomst op bezoek bij familie of vrienden.

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MENINGOCOCCAL MENINGITIS

2015

oneliner 2015

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2014

2014

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RABIES

2015

2013

From 31- 05 - 2013 on:no booster after 1 year or later is advisedanymore for at least 20-30 yearsafter the basic series of 3 shots (1-7-21/28) in persons with normal immunity

2012

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www.health.belgium.be“RABIES vaccin”

2015

Accelerated schedule off label

• Accelerated schedules (D1, D4, D8) • Not licenced = off label• To be discussed with the client (traveling

at short notice)

2014 =2015

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NECTM 5 Bergen Norway 2014 Jelinek LECTURE & POSTER

accelerated pre-exposure purifiedChick-embryo cell-culture rabies

vaccine for travelers

2014

2014

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2015

Background: • For individuals traveling at short notice to rabies and Japanese encephalitis (JE) endemic countries, concomitant administration of travel

vaccines within a short period is often required.

Methods: • The aim of this study was to determine whether an accelerated (one-week: Days 1 + 8) pre-

exposure rabies (Rabipur, Novartis Vaccines) vaccination regimen administered concomitantlywith a Japanese encephalitis (JE) vaccination (Ixiaro, Valneva) regimen, is non-inferior to the standard (four-week: Days 1, 8, 29) rabies regimen administered alone or concomitantly with the JE vaccine.

• Healthy adults (18 to 65 years) were randomized into Rabies & JE-Standard, Rabies + JE-Accelerated, Rabies-Standard and JE-Standard groups.

• Relative immunogenicity for rabies in each regimen was assessed using the rapid fluorescent focus inhibition test.

• Safety was evaluated up to and including Day 57.

Results: • Non-inferior immunogenicity for rabies was established between the Rabies + JE accelerated

group compared to both the Rabies-Standard and Rabies & JE-Standard groups;• as well as between the Rabies + JE-Standard regimen and the Rabies-Standard regimen. • By Day 57, adequate neutralizing levels were achieved by 97- 100% of subjects across all groups.• Adverse events (AEs) were comparable for all groups.

Conclusions: • An accelerated pre-exposure rabies and JE vaccination regimen is non-inferior to the standard

four-week rabies regimen and may thus provide a more convenient regimen for individuals traveling to endemic countries at short notice.

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Travel medicine Seminar 19 /11/15 “Travel medicine Seminar 20 years later”

MILITAIR HOSPITAAL as in 1995 14.00-14.05 Introduction

14.05-14.35 Yellow fever vaccination issues CHARLOTTE MARTIN

14.35-15.05 The last-minute traveler: an update on accelerated vaccine schedulesPATRICK SOENTJENS

15.05-15.25 Epidemiologic flashes & edge cutting news / new vaccines STEVEN CALLENS

15.25-16.00 Coffee break

16.00-16.25 Travellers diarrheaLUCIE SEYLER

16.25- 16.50 Malaria: when prevention is not clear-cutULA MANIEWSKI

16.50-17.15 Traveller's ThrombosisPETER VERHAMME

17.15-17.45 What did change (drastically) in the last 20 years in travel medicine ? FONS & YVES

Have a look at http://www.sbimc.org for the pdf’s of the powerpoints of all the lectures since 2009

JAPANESE ENCEPHALITIS

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Oneliners• Les indications de vaccination

restent limitées: • voyageurs séjournant plus de

3-4 semaines dans les campagnes des zones endémiques, vivant proche des villages et des fermes dans les zones de rizières et d’élevages porcins.

• ….• Ce vaccin doit également être

proposé pour les expatriés vivant en pays d’endémie, même si leur domicile est en ville.

• De indicatie voor de vaccinatie blijft beperkt:

• reizigers die minstens 3-4 weken rondtrekken op het platteland in endemisch gebied, die in de dorpen en op boerderijen logeren, vooral in gebieden waar natte rijstvelden zich nabij varkenskwekerijen bevinden.

• …..• Deze vaccinatie moet

eveneens voorgesteld worden aan personen die gaan wonen in endemische gebieden, zelfs indien ze in de stad wonen.

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Oneliners

• Des mesures préventives contre les piqûres de moustiques dès la tombée de la nuit et la nuit, sont une alternative valable à la vaccination.

• Beschermende maatregelen tegen muggenbeten vanaf de beginnende avondschemering zijn een doeltreffend alternatief!

2015

Accelerated schedule

• NECTM5 Accelerated schedules (D1, D8) • 2014 : not licenced = off label• To be discussed with the client

• EMA approves accelerated schedule:

2014

2015

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NECTM 5 Bergen Norway 2014 Jelinek LECTURE & POSTER

accelerated JE vaccine for travelers

2014

JTM & EditorialVolume 22, Issue 4, July/August 2015

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JTM & EditorialVolume 22, Issue 4, July/August 2015

From: Membre-smv [mailto:[email protected]] On Behalf Of BOUCHAUD OlivierSent: donderdag 25 juni 2015 16:14To: [email protected]: [Membre-smv] schéma court vaccin encéphalite japonaise

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From: Mar Faraco via International Society of Travel Medicine [mailto:[email protected]] Sent: woensdag 26 augustus 2015 12:56Subject: RE: TravelMed : Japanese Encephalitis vaccine - last minute traveller

2015

“the rapid schedule for IXIARO was autorized by EMA (European Medicines Agency) this August, just in case you have at least 1 week to vaccinate this particular traveller http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000963/WC500037287.pdfIt is 2 dosis in days 0-7, but with the precaution to have both doses at least 7 days before departure (as normal schedule), to achieve immunity”

Last updated 13/08/2015

Duration immunity after full schedule Ixiaro ® ?

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Japanese encephalitis (Ixiaro®)

• CISTM 13 Maastricht : “Based on modeled data, we expect protection to last for at least 4 years in 95% of vaccinees”

2013

CISTMQuébec

2015

Protection after full schedule (month 0,1,12-24):- Till 6 years (96 % of the 67 participants)- Probably till 10 years, according to the modelling data

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PO03.10Long Term Immunity 6 Years after Booster Vaccination against Japanese EncephalitisM. Paulke-Korinek1, H. Kollaritsch1, M. Kundi2, I. Zwazl1, C. Seidl-Friedrich1, T. Jelinek3

1Medical University Vienna, Department of Specific Prophylaxis and Tropical Medicine, Vienna,Austria, 2Medical University Vienna, Institute of Environmental Health, Center for Public Health,

Vienna, Austria, 3Berlin Center for Travel and Tropical Medicine, Berlin, Germany

Background and Objective: Japanese Encephalitis is a mosquito-borne viral infection. In endemic• regions mainly in Southeast Asia, every year about 68,000 clinical cases of Japanese Encephalitis• occur. The only internationally available vaccine to prevent from the viral encephalitis is an inactivated• whole-cell vaccine containing the strain SA14-14-2. Basic immunization is recommended at day 1 and• day 29, followed by a booster vaccination 12 to 24 months later. To date, immunity after the booster• dose in adults has been investigated up to 12 months. This study was initiated to assess antibody• decline and to predict long-term duration of seroprotection.Method: A random sample of 70 volunteers from a preceding booster trial (booster given 15 months• after the primary series, 45% of originally vaccinated) was invited to the follow up study and 67 (96%)• participated approximately 6 years after their booster dose against Japanese Encephalitis. Sera were• analyzed using a 50% plaque reduction neutralization test (PRNT50-test). A positive opinion by• responsible ethics committees was present and all subjects provided informed consent.Result: Six years after the last booster dose, geometric mean titer was still 148 (95% CI:107 to 207),• and 96% of the tested subjects had antibody titers above PRNT50 values of 10, the surrogate level of• protection according to WHO. Antibody titers generally were lower in subjects aged 50 years and• older. Yellow fever vaccination and vaccination against TBE had no significant effects on antibody• titers against Japanese Encephalitis.Conclusion: Long-term protection against Japanese Encephalitis after basic immunization and one• booster dose against Japanese Encephalitis up to 6 years could be shown in the majority of subjects.• This implies that a second booster may not be necessary for at least 6 years after the first booster.Conflict of Interest: The study was supported by Valneva, Austria

2015 Final publication of these data available online since 30 May 2015

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Background: • Japanese Encephalitis (JE) virus occurs in wide regions of Asia with over 3 billion people living in areas at risk for JE. • An estimated 68,000 clinical cases of JE occur every year, and vaccination is the most effective prophylactic measure. • One internationally licensed vaccine containing the inactivated JEvirus strain SA14-14-2 is Ixiaro® (Valneva, Austria). • According to recommendations, basic immunizationconsists of vaccinations on day 0, day 28, and a booster dose 12–24 months later. • Protection in terms of neutralizing antibody titers has been assessed up to 12 months after the third dose of the vaccine.• The current investigation was designed to evaluate antibody decline over time and to predict long-termduration of seroprotection after a

booster dose

Method: • In a preceding trial, volunteers received basic immunization (day 0, day 28) and one

booster dose against JE 15 months later. A follow up blood draw 6 years following their booster dose was carried out in 67 subjects. For antibody testing, a 50% plaque reduction neutralization test (PRNT50-test) wasused. PRNT50values of 10 and above are surrogate levels of protection according to WHO standards

Result: • Seventy-six months following the booster dose, 96% of the tested subjects had

PRNT50 titers of 10 or higher. • Geometric mean titer (GMT) was 148 (95% CI confidence interval: 107–207). • Antibody titers were lower in volunteers 50 years of age and older. • Vaccination history against other flaviviruses (yellowf ever or tick borne encephalitis)

did not significantly influence PRNT50titers. • A two-step log-linear decline model predicted protection against JE of approximately

14 years after the booster dose.Conclusion: • Six years after a booster dose against JE, long-term protection could be

demonstrated.• According to our results, further booster doses should be scheduled 10 years

following the first booster dose.

2015

Ixiaro ® is available in Belgium since the summer of 2010

A first booster has been given 12-24 months after the start of the primovaccination.

So in the summer of 2017 the first clients for a second booster may show up.

What will be the advice ? 6 years ? 10 years ? we will wait EMA

EMA 13/08/2015 (website consulted 01/10/2015) “Data on the need for further booster doses are not available”

2015

Ixiaro ® is not available in many countries in Asia, but it might be available under another name : e.g. JEEV (from India), Jespect (from Australia)

Other inactivated Vero cell-derived vaccines are produced in Asia : e.g., Genovax® (Bharat Biotech India), …

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Live JE vaccines in Asia • 1 injection for “lifelong” protection (20 y ? 30 y ?)

- BUT longterm immunogenicity data are limited - in children a second injection might be indicated

• Might be useful for expats • Different types / very variable local prices :

– live attenuated (Chengdu – made in China)

– live recombinant - chimeric (Imojev® - made by Novartis-Australia)

2015

Scientific details :

TBE FSME

2015

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2014 = 15

2014


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2014

NECTM BERGEN 2014

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CISTMQuébec

2015

“The serological response is thought to persist after the first booster dose. Therefore, it probably is never necessary to re-vaccinate with a complete series if one was administered before”

DichtbijreizenVoyager vers les destinations proches

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DichtbijreizenVoyager vers les destinations proches

2015

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PART 1• 1.A - Vaccination for Yellow Fever• 1.B - Malaria


2015

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2015

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Background• More than 300 million travelers visit regions with poor hygiene annually. A significant percentage of

them become colonized by resistant intestinal bacteria such as extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) and may transmit the strains to others and to medical care settings when they return home. .

Methods• Stool samples were collected from 430 Finns before and after traveling outside Scandinavia. • All specimens were analyzed for ESBL- and carbapenemase-producing Enterobacteriaceae (CPE). • Questionnaires were used to survey volunteers about use of antimicrobials as well as other potential

risk factors.

Results • 21 % (90/430) of the travelers became colonized by ESBL-PE -

none by CPE. • Were identified as independent predisposing risk factors

(1) Geographic region (2) occurrence of travelers’ diarrhea (TD) (3) age (4) use of antimicrobial (AB) for TD

Antimicrobials Increase Travelers’ Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae

• 11 % of those in subgroup TD−AB−, 21% in TD+AB−, and 37% in TD+AB+ acquired ESBL-PE.

• The risk proved to be highest in South Asia (46%); 23% became colonized in subgroup TD−AB−, 47% in TD+AB−, and 80% in

TD+AB+. • In Southeast Asia, the rates were 14%, 37%, and 69%, respectively.

Antimicrobials Increase Travelers’ Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae

21 % (90/430) of the travelers became colonized by ESBL-PESouth Asia (46%) Southeast Asia

TD−AB−, 11% 23% 14%TD+AB−, 21% 47% 37%TD+AB+ 37% 80% 69%

Conclusions• TD and antimicrobials for TD proved to be independent risk factors,

with up to 80% of TD+AB+ travelers contracting ESBL-PE. • In modern pre-travel counseling for those visiting high-risk regions,

travelers should be advised against taking antibiotics for mild or moderate TD.

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2015

Selftreatmemt Travelers’ Diarrhea in Belgian travellers ?

2015

The present Belgian recommendations have been drawn up years ago by infectiologists after intense discussions. The recent publication of Kantele et al. has however forced us to rethink in 2016 the recommendations, and asks for a balanced discussion, taking into account the following:

– What is the impact of a one-day antibiotic treatment, the schedule most often advised for (uncomplicated) diarrhea,

– In which circumstances? To prevent ruining the trip?– Clinical evidence suggests that the Belgian traveler sparsely takes

antibiotic treatment rather than overusing it.– Restricting antibiotic self-treatment may increase (avoidable)

hospitalization in low income country setting (& wrong antibiotic use)– Reviewing the TD treatment policy would preferentially be based on

prospective study data, that are not yet available…..

Belgium does not follow the recommendations to treat TD with antibiotics as liberally as the US does, but the treatment policy is not as restrictive as in Scandinavia and in the Netherlands.

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2015

Quid role in travel medicine ?

2013

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14.05-14.35 Yellow fever vaccination issues CHARLOTTE MARTIN









Chikungunya

2015

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2014

Eurosurveillance, Volume 19, Issue 28, 17 July 2014

2015

CDC

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Dengue

2015

2014=5

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Although rather “suboptimal” efficacySanofi-vaccine will be available in endemic regions end 2015 ???

2015

Hajj

2014 = 2015

No change of the health advice in • 2014• 2015 (= 20/9-25/9)

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2015

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General advice for Mecca pilgrims -required/recommended vaccines• Vaccination with a tetravalent, conjugated ACYW135

meningococcal vaccine is required to obtain a visa.

• Available vaccines in Belgium: Nimenrix® and Menveo®

• The unconjugated 4-valent meningococcal vaccine is not available anymore in pharmacy (July 2013) – it might still be available in the travel clinics and be used in pilgrims

• It remains unclear if children till the age of 2 years are obliged to be vaccinated, but it correct to vaccinate also the little children – on the other hand, see further : children under 12 yrs are discouraged to come to Mecca.

2013 = 2014 = 2015

General advice for Mecca pilgrims -required/recommended vaccines• Incompletely vaccinated individuals should update

their vaccine status.• Vaccination against the seasonal flu is

recommended when available (around mid-September, the pilgrimage starts October 4th).

• Pneumococcal vaccine for the known risk groups• Hepatitis A vaccination is recommended,

depending on age and medical history.• For journeys exceeding 3 weeks stay, a

vaccination against typhoid fever may be advisable.

2013 = 2014 = 2015

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Some former slides

2014

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Kingdom of Saudi Arabia Ministry of Health

Health Regulations for travellers to Saudi Arabia for Umrah &

Pilgrimage (Hajj)-1435 (2014).

2014

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http://www.who.int/wer/2013/wer8832.pdf

Varia– Hajj 2013

Varia– Hajj

MEKKA http://www.hajinformation.com/main/p3001.htm -

• meningococcal vaccine remain obligatory• influenza vaccine remain imperatively

advised

2013

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2012

… & Mers

2015

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2014

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Promedmail - Morocco 19-6-2014• Advice not to go on the Hadj … !!

2014

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Because of the MERS-Cov : The Saudi Ministry of Health

recommends that people• aged over 65 years and • those with chronic diseases (e.g. heart disease, kidney disease,

respiratory disease, diabetes) and • pilgrims with immune deficiency (congenital and acquired), • malignant and • terminal illnesses, • pregnant women and • children aged under 12 years

planning to come for Hajj and Umra this year, to postpone the performance of the Hajj and Umra for their own safety.

2013

Schistosomiasis Corsica ?

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2014

EID sept 2014 Letter

2015 “ …Until today, no cases had been identified with exposure in 2014. None of 3 534 Bulinus snails in the Cavu River tested in summer 2014 were infected. In addition, 38 bathing sites in 19 other rivers in Corsica were investigated for the presence of snails. Bulinus snails were found in two bathing sites in Solenzara, two sites in Osu and one site in Tarcu. None were found positive for Schistosoma spp.” ECDC risk-assessment 23-7-2015

The swimming ban in Cavu River was lifted on 4 June 2015.Surveillance for schistosomiasis is still ongoingDr J. Clerinx ITG/IMT

2014

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PART 1• 1.a - Vaccination for Yellow Fever• 1.b - Malaria


2015

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14.05-14.35 Yellow Fever Immunization: where are we up to now?CHARLOTTE MARTIN









END

2015

Documents

BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE … · 27/11/2015 2 REPORT BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 26, 2015 – PART 2 2015 • The consensus meeting was chaired