Inflammatory bowel disease in travelers: Choosing the right vaccines and check-ups

Table 1 Current recommended vaccination program for adult inflammatory bowel disease patients[1-3]

Illness	Vaccine	Recommendation	Schedule
Tetanus	Purified anatoxin	Recommended	Every 10 yr
Diphteria
Poliomyelitis	Injectable: inactivated	Recommended	Every 10 yr
Pertussis	Acellular antigen	Authorized	Every 10 yr
Hepatitis B	Recombinant peptide	Recommended	Single/double doses?
			Booster?
Pneumococcal disease	23-valent purified antigen	Recommended	Every 5 yr
			Single/double doses?
			Booster?
Influenza	Inactivated virus	Recommended	Annually
Human papillomavirus infection	Recombinant L1 protein	Authorized	??
Measles,mumps and rubella	Live attenuated	Contraindicated during immunosuppression	??
Varicella	Live attenuated	Contraindicated during immunosuppression	Double dose (4 wk interval)
Haemophilus influenzae B disease	Conjugated capsular polyosidique antigen	Authorized	Single dose

Table 2 World distribution of travel-related preventable illnesses and current recommended vaccination program for adult inflammatory bowel disease patients

Illness	Regions with high and intermediate endemicity	Vaccine/schedule	Recommendation
Hepatitis A	High: Africa	Inactivated virus (every 10 yr)	Authorized
	South America, Middle East Southeast Asia, China
	Intermediate: Southern and Eastern Europe
Yellow fever	Africa: Sub-Saharan Africa	Live attenuated (every 10 yr)	Contraindicated during immunosuppression
	America: Central and South America	17D strain (17D-204 /17DD)
Meningococcal disease	Europe: Serogroups B, C	Conjugate polysaccharide C	Authorized
	Americas: Serogroups B, C, Y	Polysaccharide combined A+C	Authorized
	Africa and Asia: serogroups A, C, W135	Polysaccharide combined A+C+W+Y (single dose among persons aged 11-55)	Authorized
Typhoid	High: Southern Africa	Vi Capsular polysaccharide (single dose IM. Booster dose every 2-3 yr for those at risk)	Authorized
	Western, Eastern South central and Southeastern Asia
	Intermediate: Eastern, Middle and Northern Africa, Western Asia, Latin America/Caribbean, Oceania
Cholera	Africa: Congo, Kenya, Mozambique, Uganda, Tanzania and West Africa	Oral Killed (2 doses at 1-6 wk interval with a buffer to protect the B-subunit against stomach acidity)	Authorized
	South and Central America: Peru, Ecuador, Guatemala, Nicaragua	Oral live	Contraindicated during immunosuppression
	Asia: Afghanistan, India, Cambodia, Malaysia, Nepal, Sri Lanka
Rabies	High: Africa, Asia, parts of Central and South America	Cell culture-derived vaccine (travellers, not handling animals: 2 doses, at days 0-28. If risk continues booster dose at 6-12 mo)	Authorized
	Intermediate: Eastern Europe, parts of central and South America (Chile, Argentina)
Japanese encephalitis	Southeast Asia	Cell culture-derived vaccine (2 doses, at days 0-28 booster dose?)	Authorized
	Far East
Tick-borne encephalitis	Europe: Central and Eastern	Inactivated virus (3 doses at 0,1 and 12 mo)	Use with caution
	Europe, Russia
	Asia: China, Siberia, Russian Fareast

Table 3 Preventive measures for inflammatory bowel disease patients coming from developing countries (mainly while taking immunosuppressants or before starting)

	South America	Maghreb and Western Orient	Sub-Saharan Africa	Southeast Asia and India	Other
Thick drop	Consider	No	Always	Consider	No
Stool parasite	Always	Consider	Always	Always	No
Urine parasite	No	No	Always		No
Strongyloides (culture, serology)	Always	Consider	Always	Always	No1
Trypanosoma (serology)	Always	No	No	No	No
Histoplasma (serology)	Always	No	Always	No	No
HBV and HCV (serology)	Always	Always	Always	Always	Always
Tuberculin skin test or IGRA	Always	Always	Always	Always	Always

¹Consider in case of Chinese individuals with eosinophilia. HBV: Hepatitis B virus; HCV: Hepatitis C virus.