A child should not travel to a tropical zone, where infectious infant mortality is considerable, without having all the chances of available vaccine prevention on his side. Below is some useful information for families (statistics: WHO).
MANDATORY / RECOMMENDED VACCINATIONS IN US
Their importance is multiplied in the tropics: the vaccination schedule must be scrupulously applied.
- Tetanus. In the event of a wound, the local health system would offer risky secondary prevention (locally manufactured serums and/or vaccines, stored and injected at random).
- Poliomyelitis. Major risk in countries where it is still rife; when it no longer rages, it is precisely thanks to the systematic vaccination of local children; eradication is still a long way off: polio is currently experiencing upheavals (tropical Africa and the Indian subcontinent in particular).
- Diphtheria. Present in all developing countries – and not only in the countries of the former USSR; primarily affects children.
- Whooping cough. Major killer of children: 300,000 deaths per year, 90% of which in developing countries. Whooping cough in infants is serious: lethality 2-3%. The bacillus circulates intensely in all countries that do not have adequate vaccination coverage.
- Meningitis caused by Haemophilus b. Vaccination has almost eliminated this meningitis from the USA, which is extremely widespread and extremely serious in all developing countries. Leading cause of non-epidemic meningitis: at least 3 million cases annually worldwide, with several hundred thousand deaths. Lethality of 3%, 12% of definitive neurological sequelae regardless of the quality and speed of treatment.
- BCG. Tuberculosis, a permanent threat to humanity, is contained in developed countries thanks to the vaccine and above all to early detection and treatment. In developing countries, the bacillus circulates intensely, and more and more (resistance, HIV): it kills 2 million subjects each year; in the period 2000-2020, one billion subjects will be newly infected and 35 million will die. Vaccination provides protection against the most devastating forms.
- Measles. Considered by families as rare and benign, measles is one of the leading causes of infant mortality in developing countries which have not been able to generalize its vaccination: at least 700,000 deaths annually in developing countries; lethality 1 p. 1000, encephalomyelitis 1 p.1000. The measles virus circulates intensely in all these countries and poses a serious risk to any unvaccinated child.
- Mumps. The public is unaware of this disease today, the lethality of which is however: 0.02-0.04%. Orchitis is certainly rare (2 p. 1000), rarely followed by testicular atrophy (5 p. 1000 orchitis), but particularly dramatic. The mumps virus circulates intensely in all developing countries.
- Rubella. The main purpose of vaccination is to protect future patients from congenital rubella (0.2 p. 1000 live births, 4 p. 1000 during epidemics). This should not mask the lethality of 0.05% and the neurological sequelae (4 p. 10,000) observed in unvaccinated subjects in developing countries.
- Hepatitis B. Vaccination now “universal” for all infants on the planet. Once the primary vaccination has been carried out at this age, the subject will be definitively immunized. Hepatitis B is the 9th leading cause of death in the world, responsible for 80% of liver cancers.
SPECIFIC VACCINATIONS FOR TRAVEL
- Typhoid. At least 16 million official annual cases worldwide and 600,000 deaths (underestimated). The bacillus circulates intensely in all countries with poor hygiene. The vaccine takes full effect from the age of 18 months; it is not considered logical to vaccinate before 2 years (or even 5); in fact it makes sense to vaccinate at the age from which the child can escape total parental control of his diet.
- Hepatitis A. By the age of 10, 90% of children in developing countries have contracted the virus. Given the mildness/appearance of the infection in the youngest, there is no consensus on the vaccination of traveling children. Current vaccines make it possible to vaccinate in complete safety, and with almost absolute efficiency, from the age of 1-2 years.
- Meningococcus A+C. Cosmopolitan endemo-epidemic disease, particularly common in developing countries, with heavy mortality and a high rate of neurological sequelae. No child should go unvaccinated to a tropical or subtropical zone, and even less if it is an expatriation. The vaccine takes full effect from the age of 18 months.
- Rage. Present in almost all exotic countries, often including in urban areas. Lethality: 100%. A bitten patient who is not vaccinated exposes himself to receiving locally produced vaccines and serums, which are sometimes more dangerous than the rabies risk itself. The children go regularly towards the animals and do not systematically report a licking, a minimal bite. The preventive vaccine is then their only protection. Recommended especially for expatriate children.
- Japanese encephalitis. 40% lethality, 30% heavy neurological sequelae in children. Endemo-epidemic from eastern India to southern eastern China. The WHO only recommends vaccination for stays of more than a month in exposed rural areas or in the event of expatriation. Vaccines available in the US under nominative ATU, reserved for hospitals (allow more than one month). Mid-dose for children under 3 months.
- Tick-borne encephalitis. Perhaps contracted in all the forests from Alsace to Siberia. Heavy lethality and sequelae. Some countries (Austria for example) require vaccination for children going to a summer camp in the forest. Can now be practiced in town.
- Yellow fever. Only compulsory vaccines under the International Health Regulations for certain trips (endemicity: intertropical Africa and America). Lethality of 60%, regardless of the quality of curative care. US law authorizes this major vaccination from the age of 6 months. Reserved for approved centers.