Travel Clinic

Main Menu

logo TP updated





Introduction & Overview

If you have already made an appointment to see our travel doctor, please read this page as it will make your visit easier to understand and more pleasant when discussing travel vaccinations 

  • We stock all vaccines, including the yellow fever vaccine (costs $110)
  • If you are unsure of what vaccines you may have had in the past or lost your vaccine records or plunket book, we can request a blood test to test for immunity.
  • Our travel doctor will advise you on the vaccines necessary depending on you, your health, your trip and your activities.
  • We only give you what you really need; we minimise your pain and expense by tailoring your immunisations for you, your health and your trip.
  • We will offer you combination vaccines if possible (i.e.one injection with several vaccines)
  • You decide what vaccines you wish to have depending on your budget and the degree of protection you want
  • Please don't commit to a course of vaccinations if you cannot complete e.g. hepatitis A
  • It is important to be up-to-date with your usual routine vaccinations e.g. tetanus, pertussis (whooping cough-  'the 100 day cough'), hepatitis B (~ 110 000 New Zealanders have chronic hepatitis B), measles, chicken pox, pneumonia, shingles
  • Recommended vaccines vary for different countries, and you will be advised by the travel doctor
  • Hepatitis A is the most commonly recommended vaccine, followed by typhoid, rabies ID, and the oral E.Coli vaccine (for travellers diarrhoea).
  • Hepatitis A $105, Hepatitis B $40, Hepatitis a+B (Twinrix) combination $105, Typhoid $65
  • Vaccine costs vary in price from $35 to as high as ~$250 for specialised vaccines like Japanese Encephalitis
  • Some vaccines appear expensive, however provide you with long term to lifelong immunity eg rabies and hepatitis A+B ( protection for this trip and future travel for the rest of your life)
  • Our advice may differ from your GP, your friends, other members of your tour party. This is not unusual and will be explained during your appointment

Yellow Book

We supply you with the official International Health Regulations Certificate of Vaccination or Prophylaxis (NZ Ministry of Health approved).

The 'yellow book' has been in circulation since the 1960's and should be kept with your passport, as it is a 'medical passport of sorts'. You may be required to show it before you are permitted to enter certain countries.

The yellow book is included in the initial appointment costs if vaccines are administered; and we hand it over to you at your last appointment before your trip. It documents : the immunisations you have had, how long they last and immunity from blood testing eg measles, chicken pox, hepatitis A& B, rabies

For your regular chronic medication, a small 'yellow medication card' will be attached with details of medical conditions, medication, allergies (signed off by us for customs)

 


img 2903 

 

 

 

 

 

 

 

Lost Records

Always keep a photocopy or scan of your original 'yellow book'

New clients: if you lost your previous vaccine records we can request blood tests at your intitial appointment for some of the common travel vaccines. The blood results i.e. antibody levels need to be interpreted in the context of what you may or may not have had (vaccines or disease) in the past. The blood tests are chargeable by the lab eg. hep B is $20 (+ blood collection fee of $10). Lab results take about 24-48 hours (except rabies).

Existing clients: please email your request direct to This email address is being protected from spambots. You need JavaScript enabled to view it. and we will send you your electronic copy within 48 hours. No vaccine records will be released over the telephone. Our doctor authorises the release of all vaccine records. Retrieval of archived records i.e. > 10 years prior will incur a fee of $25.

If you need us to reissue a yellow fever certification or replace the official 'yellow book', the fee is $55

Reminders & Recalls

  • Booster shots are important to follow through for long lasting immunity
  • Hepatitis and rabies vaccines are a lifetime investment in future travel
  • Please don't commence a series of vaccinations if you cannot complete timeously
  • If you fail to complete a series you may need to restart the series if you wish to travel at a later stage
  • We will inform you when boosters are due (automated email reminder generated)
  • It is 'never to late' to complete some vaccines eg. hepatitis and rabies (we will advise if otherwise)
  • There is a follow up and administration fee of $25 per traveller + the cost of the booster dose (eg hep B $40, rabies $75, hep A $105, hep A/B $105)
  • Please bring in your International Certificate of Vaccination when you come in

 

Vaccination Schedule

Routine                                         Length of Protection        # Doses per Course   

Chicken Pox/ Shingles Life  2/1
Measles, Mumps, Rubella Life 2
Hepatitis B
Life, with + hep B Ab 3 +1*
Polio
Life 1
Tetanus, Diphtheria, Pertussis (3:1)  10 years  1

Tetanus, Diphtheria, Pertussis + Polio (4:1)

Polio : life

1
BCG Life 1

 

 

 

 

 

 

 

 

 

Recommended

Hepatitis A

Possibly life 2

  *** with Hepatitis B

Life, with proven hep B antibody + 3 + 1*
  *** with Typhoid  Hep A booster in 1 year 1
Typhoid     2-3 years  1 inj or 3 caps 
Rabies Long term   3 +1
Meningitis ACWY > 5 years   1 
Japanese Encephalitis >3 years  2
E.Coli & Cholera 6 months   2 
Influenza 4 strain (not 3) 1 year   1 
Pneumonia PCV13 >PPV 23 ? Long term 2
Tick Bite Encephalitis  3-5 years  2
 
Required 
 
Yellow Fever ? Lifetime (11 July 2016) 1

 ***    refers to combination vaccines

#        doses depends on your previous vaccine history and immunity

   *      dosing schedules vary ie.standard (0,1, 6 months) or accelerated (0, 7, 21 days)

 

Rabies - the facts you need to know

  • Any mammal can get rabies (wild + domestic) and infect humans; the animal may appear well even with the virus in saliva
  • Consider for all travellers for peace of mind (especially children) even if the duration is short to rabies endemic countries and higher risk activities eg cycling, trekking, local homestays, runners, caving and 'off the beaten' travel.
  • Rabies is almost always fatal if untreated and ~10% of strays in Thailand are rabid
  • Two travellers per annum die of rabies & Bali has a bite rate of as high as 5%
  • Our clinic advises and manages approximately 2+ travellers per month with accidental animal bites; rabies is a risk wherever dogs are allowed to roam free
  • New Zealand does not have any rabies, however Australia has rabies
  • Immunisation route may be ID - intradermal or IM - intramuscular
  • Dosing schedules and route of administration vary (ID vs IM : pros and cons).
  • ID is the most popular route: is a series of 3 separate doses over a few weeks (see picture below for clinical response); at a reduced cost of $75 per dose, followed by a blood test if clinically necessary to check for rabies virus neutralising antibodies (and a booster in a year for long term immunity).
  • ID rabies is offered daily at dedicated travel clinics and you do not need to 'gather' other travelling companions (as it's not cost effective or feasible at non travel clinics)
  • ID rabies is safe, low cost and effective (only if done with the correct expertise)
  • There are other schedule options 'off label' or accelerated schedules for travellers who cannot do the 3 dose series (over approximately 0,7, 21 -28 days)
  • Preferably make your own antibodies by immunisation in New Zealand, so if ever you are bitten, scratched or licked by a dog, monkey, cat, bat, you will need only two rabies vaccinations (which is easily obtainable) on days 0 & 3 after the animal bite, but you will never need any human rabies immunoglobulin ie. a blood product injected into the bite wound.
  • If you are scratched, bitten or licked and unimmunised ie. no antibodies, this is almost certainly a trip ruining experience as the treatment is a lot more dramatic! You have to stop what you are doing and travel to a centre where the appropriate post-exposure therapy is available; and request human rabies immune globulin HRIG which needs to be injected into the bite wound to prevent early entry of the rabies virus into nerve endings, then try to time 5 x rabies vaccinations required on days 0, 3, 7, 14, and 28 around your remaining travels.
  • All bites, scratches and licks should be immediately flushed out, washed and then disinfected. Doing so can enable efficient elimination of the rabies virus at the infection site.

 

In summarythe advantages of getting your own rabies antibodies before travel is to reduce the urgency, trip disruption and complexity of treatment
  • to prevent uncertainty and 'ruining' this trip and future holidays !
  • totally eliminating the need for blood products ie. human rabies immune globulin which is difficult if not impossible to obtain in many developing countries 
  • reducing the need for post bite vaccines from 5 to 2 shots
  • reducing the post bite treatment period from 28 days to 3 days
  • and allows for a delay in treatment 

rabies ID x 3 1

 

Yellow Fever

Yellow fever is a serious mosquito borne viral infection and occurs in Africa and South America.

You may need the yellow fever vaccination ($110) for your protection if visiting ‘at risk’ countries.

You definitely need it for your protection if you are visiting Iguazu Falls (Argentina) and some cities eg Sao Paulo.

Proof of yellow fever vaccination may also be required to enter certain countries e.g. Australia to prevent the introduction and spread of contagious diseases.

Best to get the yellow fever vaccine done first and well before travel.

It is a very effective (>95%) and safe vaccine.

It is not available from any doctor except approved Yellow Fever Vaccination Centres and accredited travel medicine practitioners.

You need to have an appointment with the travel doctor as this vaccine is not without risks.

Please bring in your passport (or a copy) and your 'yellow vaccination book' to your appointment.

The yellow fever vaccination takes place subsequent to a formal medical consultation as per the New Zealand Ministry of Health Policy for the Approval of Vaccinators.

The vaccination can only be documented in the International Health Regulations Certificate of Vaccination or Prophylaxis issued by the Ministry of Health (ie. the yellow book)

The vaccine certificate is legally valid 10 days after the injection.

A single yellow fever vaccine is considered to confer lifetime immunity and countries cannot require revaccination at entry. However revaccination may be indicated in specific cases eg travel to an area with ongoing outbreaks or travel for a prolonged period in an endemic area.

The International Health Regulations concerning yellow fever are unequivocal, and unvaccinated travellers may face denial of entry, vaccination at port of entry or even quarantine in certain circumstances.

This strict control is maintained to ensure that both the individual traveller and the broader communities are protected against outbreaks of this disease.

  • If the vaccine is medically contraindicated, the fee for preparing a yellow fever vaccine waiver is $50. 
  • Waivers can only be issued by yellow fever vaccinators with medically supported documents; advancing age is not a reason for a waiver.

International Health Regulation Certificate : "Yellow Book"

We supply you with the official International Health Regulations Certificate of Vaccination or Prophylaxis (NZ Ministry of Health approved). This is included in the initial appointment costs if vaccines are administered. You may be required to show it before you are permitted to enter certain countries. It has space for other pertinent medical details e.g. medical conditions, medication, allergies.

It documents : all immunisations you have had , how long they last and immunity from blood testing eg measles, chicken pox, hepatitis A & B, rabies. 

Yellow Fever Vaccine

The Yellow Fever Vaccine has been in use since the 1930’s and over 400 million vaccines have been given since then.

The current vaccine is called Stamaril. It is an attenuated (disabled) , live-virus preparation of the 17D strain of yellow fever virus grown in chick embryos and is very effective in preventing the disease. A single dose correctly given confers immunity in basically 95+% of recipients. 

This vaccine is given as a single injection given subcutaneously. If a country requires the vaccine for entry, travellers must allow at least 10 days before entering the country for vaccination.

If other live virus vaccines are necessary for travel, they should be completed on the same day as the yellow fever vaccination (we will advise accordingly). Otherwise, travellers may have to wait for one month before other live virus vaccines can be administered. The live-virus vaccines suppresses the immune system, and will reduce the effectiveness of the Yellow Fever vaccine.

This vaccine is a safe and highly effective vaccine against this deadly disease.

200,000 cases of Yellow Fever are estimated to occur yearly on this planet.

  • There is no known treatment to cure the disease.
  • The fatality rate of the disease is reported as 10-50%.
  • Deaths from Yellow Fever disease have occurred in unvaccinated tourists.

Side Effects of the Yellow Fever Vaccine

Reports of serious side effects are extremely rare and generally include fever, headache, and muscle ache. The risks of vaccination are not  zero and the current best estimates of the risk from yellow fever vaccination are: 

Mild Side Effects

  • Most people will get a slight sore arm
  • 3-10% may feel tired, headache, muscle aches, fever for 24 hours starting 3-7 days after the vaccine
  • 1% need to curtail regular activities

More Serious Side Effects

  • 1 in 130,000 will get immediate hypersensitivity – rash, itching, faint or asthma – this is why you need to wait  20 minutes in the clinic
  • 0.09-2.5 per million will get inflammation of multiple organs e.g. lungs, kidney, liver, spleen, skin, blood stream
  • 1 in 8 million will get encephalitis (inflammation of the brain)
  • There have been a few deaths reported from the more serious side effects of the vaccine, but this seems to occur in those over 70 years age with certain risk factors

After vaccination, you need to remain at the clinic for 20 minutes in case you have a serious allergic reaction (anaphylaxis). This reaction is rare (about one in a million), but may be very serious. It can be easily treated at the clinic, but is not so easy to treat if it happens while you are driving home.

Symptoms of anaphylaxis include:

  • feeling warm
  • feeling itchy (or developing a rash) away from the injection site
  • feeling faint (especially on standing up) or dizzy
  • a shortness of breath, or a wheeze or cough developing
  • swelling in the throat, face, hands or limbs
  • sudden tiredness

Symptoms usually develop within 20 minutes of vaccination, hence the need to wait in the clinic after receiving the Yellow Fever vaccine.

Occasionally allergic symptoms may occur up to 10 days later. If you develop one or more of the above symptoms within 10 days, immediately call your doctor or go to the nearest casualty department or well equipped medical centre.

Who Should Not Use The Yellow Fever Vaccine

Children younger than 6 months of age, people who have had a previous severe reaction to the vaccine and those who are extremely allergic to eggs should not receive this vaccine. Persons who have a moderate illness (with or without a fever) should postpone receiving this vaccine until they are well.

The following circumstances may increase your risk of reacting badly to the Yellow Fever Vaccine. It is extremely important you notify us if any of the following apply to you:

  • You have a true egg allergy
  • You have had an adverse reaction to Yellow Fever Vaccine before
  • You are, or could be, HIV positive or have AIDS
  • You suffer from a serious weakness of the immune system
  • You have cancer, are taking drugs to control cancer, or are undergoing chemotherapy
  • You have any major liver or kidney disease
  • You are currently taking steroid drugs or cortisone. Recent injections into a joint and steroid asthma puffers are NOT a problem.
  • You are pregnant, or could be pregnant now or in the next three weeks

Yellow Fever Risk Countries

map2-4-2010  map2-3-2010

 

 

 


 
 

© 2017 Travel Clinic North Shore, Auckland, New Zealand. Please read our Website Terms.