Handout slides consensus 2015 – part Ia

27/11/2015
BELGIAN
CONSENSUS MEETING
on TRAVEL MEDICINE
June 26, 2015
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 1a yellow fever version 25/11/15
Belgian
Scientific Study
Group on Travel
Medicine
2015
REPORT
BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE
June 26, 2015 – PART 1a
• 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
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2015
Not an exhaustive review of travel medicine
• What has changed ?
• Answers to questions, asked in the last months
• Tips
• All slides of the consensus document, as well as the hand-outs
will be available on the website of the ITM, and may be used for
teaching purposes
URL’s former years www.itg.be
Reisgeneeskunde Æ informatie voor deskundigen
http://www.itg.be/itg/GeneralSite/Default.aspx?l=n&WPID=293&MIID=679
Médecine des voyagesÆ information pour experts
http://www.itg.be/itg/GeneralSite/Default.aspx?L=F&WPID=293&MIID=679
2015
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2015
2015
• Sources for the update
– the international literature
– the 2015 congress & discussion forum of the ISTM
– the “2012 & 15” edition of International Travel and Health (WHO)
– the 2016 edition of Health Information for International Travel (CDC)
• The updated 2014-15-edition of “Medasso”, edited by A. Van Gompel and
the staff of the medical service of the Institute for Tropical Medicine Antwerp,
is also recommended as a valuable source of information.
www.who.int/ith
http://wwwn.cdc.gov/travel/
contentYellowBook.aspx
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http://www.who.int/ith/en/
WHO 15-06-2015
Only a few chapters since 2012 are updated Æ 2014 & 2015
Only these chapters are updated
They are freely downloadable
2015
Gebruik geen verouderde versies, daar ze
onbruikbaar zijn geworden en check
steeds de meest recente electronische
versie !
Les éditions imprimées anciennes sont
dépassées et donc inutilisables ! Consultez
toujours la version électronique la plus
récente.
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1995 Å
Æ2015
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 Immunization: where are we up to now?
CHARLOTTE MARTIN (CHU. St. Pierre - ULB)
The last-minute traveler: an update on accelerated vaccine schedules
PATRICK SOENTJENS (Defence & ITG/IMT)
14.35-15.05
15.05-15.25
Epidemiologic flashes & edge cutting news / new vaccines
STEVEN CALLENS (UZ.-.U.Gent)
15.25-16.00
Coffee break
16.00-16.25
Travellers diarrhea
LUCIE SEYLER (UZ.-Brussel),
16.25- 16.50
Malaria: when prevention is not clear-cut
ULA MANIEWSKI (ITG/IMT)
16.50-17.15
Traveller's Thrombosis
PETER VERHAMME (U.Z.-K.U.Leuven)
17.15-17.45
What did change (drastically) in the last 20 years in travel medicine ?
FONS VAN GOMPEL (ITG/IMT) & YVES VAN LAETHEM (CHU. St. Pierre, ULB)
Have a look at http://www.sbimc.org for the pdf’s of the powerpoints of all the lectures since 2009
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2015
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
2015
Yellow Fever
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2015
Adaptation june 2015
• Countries requiring yellow fever vaccination for entry do so in
accordance with the International Health Regulations.
• Yellow fever is currently the only disease for which proof of
vaccination may be required for travellers as a condition of entry to
a State Party under Annex 7 of the International Health Regulations
(2005).
• An important change in May 2014 was the adoption by the World
Health Assembly of an updated Annex 7, extending the validity of a
certificate of vaccination against yellow fever from 10 years to life.
• Although this requirement will come into force only from July 2016,
several countries have started implementing these new rules.
• When available, this information is included in this annex 1
(http://www.who.int/ith/2015-ith-annex1.pdf?ua=1)
• This section contains information on yellow fever requirements as
provided by countries.
• Country requirements are subject to change at any time.
Updates can be found at: http://www.who.int/ith.
Some countries already agree with this statement - amongst the countries with
risk of yellow fever : Angola, Cameroon, Congo-Brazzaville (but not the
Democratic Republic of Congo), Ghana, Soudan, Ecuador, Suriname
Paraguay and British Guyana (but not French Guyana).
2015
The WHO published a very practical list :
http://www.who.int/ith/2015-ith-annex1.pdf?ua=1
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http://www.who.int/ith/2015-ith-annex1.pdf?ua=1:
2011 & 2012
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•Le Rwanda est devenu une région endémique à «faible risque» de fièvre jaune 2015
•Le R.D Congo: vaccination contre la fièvre jaune recommandée dans tout le pays
2015
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3 Feb 2015
2015
28 Jan 2015
YELLOW FEVER - AFRICA (03): ZAMBIA CERTIFICATION CHANGE
*******************************************************
A ProMED-mail post <http://www.promedmail.org>
2015
A program of the International Society for Infectious Diseases http://www.isid.org
Date: Wed 28 Jan 2015
Source: Times of Zambia [edited] <http://www.times.co.zm/?p=49194>
The Tourism Council of Zambia (TCZ) is pleased that South Africa and Botswana have finally agreed to drop yellow fever certification as a
requirement for travellers from Zambia, following the World Health Organisation (WHO) declaring Zambia a yellow fever free zone.
TCZ chairperson Felix Mulenga said the decision, which was long-awaited, would significantly increase international tourist arrivals. South
Africa is Zambia's leading source market for international arrivals, accounting for around 20.1 per cent of total arrivals in 2013. Health Minister
Joseph Kasonde announced on Monday this week that South Africa and Botswana had with immediate effect lifted the requirements of yellow
fever certification for travellers from Zambia.
The WHO found from scientific research that Zambia had reduced cases of the yellow fever. Mr Mulenga said in an interview that the
removal of the yellow fever certification for travellers from South Africa or through South Africa to Zambia would significantly improve the tourist
arrivals from that country. "We are happy that South Africa and Botswana have decided to drop their demands on the yellow fever certification
because this was creating a negative impact on the growth of the tourism sector in Zambia. As you know, South Africa is an important market
for Zambia and currently is Zambia's leading source market for tourists," Mr Mulenga said.
In 2013, the Southern Africa region recorded total arrivals of more than 22 million, representing a market share of global arrivals of
approximately 2.5 per cent and a 39.9 per cent share of Africa's total arrivals. South Africa accounted for 191 048 tourist arrivals in the year
under review, followed by Tanzania with 184 187.
Mr Mulenga said the yellow fever issue was an impediment to tourist arrivals as it affected the growth of the sector and that with the new
development Zambia would attract desired levels of tourists and compete favourably in the region and beyond.
[Byline: Maimbolwa Mulikelela] Communicated by: ProMED-mail from HealthMap Alerts <[email protected]>
[Zambia now has been recognized as yellow fever (YF) free by the WHO.
The South Africa requirements for proof of vaccination status has recently led to the sale of fake YF vaccination cards in Zambia and Zimbabwe.
The change in South African requirements should end this illegal and unfortunate practice. It is good to see government vaccination status
policy brought into line with this change in YF status recognized by WHO. As the facts change, then policies and regulations should change
along with them and not be locked into place in perpetuity. It is important to recognize that policies can have negative economic and social
consequences. One hopes that Zambia will benefit from the change in yellow fever vaccination requirements in South Africa.
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2013 = 14 = 15
WHO 2013
Colombia
2014 = 2015
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Transit in aeroport
2015
In principle yellow fever vaccination is not required
if the traveler stays in the transit zone of the
airport for maximum 12 hours with an entry and
exit record of the same day.
Some countries require vaccination certificate for
any transit in an endemic country, irrespective
of the duration.
The recommendation must also take into
consideration that flight itineraries can change
unannounced (e.g. stopover in Ethiopia or
Senegal).
See who-country list – not in annex 1
1 dose = lifelong ?
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2013
2013
WER 17-05-2013
WHO-SAGE
scientific advice
“YELLOW FEVER
VACCINATION
induces LIFELONG
PROTECTION”
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May 2013 scientific advice by the WHO SAGE
(= Strategic Advisory Group of Experts on Immunization)
2013
WER 17-05-2013“
WER 17-05-2013
2013
“specific risk groups
(such as infants or HIV-infected patients)
could benefit from a second primary or booster dose”
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WER 17-05-2013
2013
BELGIAN SCIENTIFIC STUDYGROUP TRAVEL MEDICINE
“specific risk groups such as
Will there be a task force
1.infants (below 2 years ?)
within the WHO ????
2.HIV-infected patients
3.other (not-severely) immunosuppressed patients ?
4.pregnant women ?
5.children who got MMR and YF vaccine within less than 30 days ?
6.immunoscenescence ?
… on the one hand the situation may now
become more simple
2013
– For countries with risk of yellow fever
transmission not requiring proof of
vaccination: one vaccination is valid for life
– For persons with an actual absolute or relative
contra-indication, but formerly vaccinated
against yellow fever before becoming
immune-depressed, the immunity is
supposedly also longstanding possibly for life
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… on the other hand the situation may now
become temporarily also more complex
2013
– At this moment many countries (with or without
risk of YF transmission) still require a renewed
proof of vaccination after 10 years
– if a person plans to cross the border(or in transit)
from one country with (a real or supposed)
risk for YF transmission to another country
she/he will then need an up-to-date Certificate ...
she/he may think to be in order “immunologically”,
but not “politically” or “legally” or administratively”
– No waiver can be delivered but for proper medical
reasons (absolute or relative contra-indication)
2014
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Scientific articles
PRO
• WER 2013
• AJTMH 2013
2014
“CONTRA”
( = question marks)
• Clin Microbiol Infect. 2013
• Travel Med Infect Dis. 2013
POSITION PAPER 05-07-2013
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2013
PRO
2014
Am J Trop Med Hyg. 2013 Sep;89(3):434-44.
doi: 10.4269/ajtmh.13-0264.
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“Contra”
2014
Clin Microbiol Infect. 2013 Oct;19(10):885-6.
doi: 10.1111/1469-0691
Epub 2013 Aug 8.
“Contra”
2014
Travel Med Infect Dis. 2013 Sep-Oct ;11(5):266-73.
doi: 10.1016/j.tmaid.2013.08.007.
Epub 2013 Sep 5
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2014 – 15
How did other countries
managed this situation ?
in 2014 ? 2015 ?
WHO
2015
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2015
2015
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2015
2015
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2014
UK
UK Green Book
p. 447
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/30694/G
reen_Book_Chapter_35_v3_3.pdf
2014
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2014
UK Green Book p. 447
https://www.gov.uk/government/uploads/system/uploads/attachme
nt_data/file/30694/Green_Book_Chapter_35_v3_3.pdf
2015
UK Green Book
p. 447
But when ?
https://www.gov.uk/government/uploa
ds/system/uploads/attachment_data/fi
le/30694/Green_Book_Chapter_35_v
3_3.pdf
After 2nd birth day
After pregnancy
After 1 month
After 10 years
Before next travel
….
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2014
France &
Switzerland
FRANCE SMV
e-mail de 7/5/2014
[email protected]
SWISS
Tropimed®
News Epidemiologiques
Juin 2014
ou qui ont reçu leur vaccination initiale contre la
fièvre jaune:
• à un âge de moins de deux ans
• pendant la grossesse
• avant une greffe de moelle osseuse
• au cours d’une infection par le VIH
• en cas d’immunodépression
2015
France BEH juin 2015
France
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USA
2015
!
2015
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?
2014
How to inform the traveler ?
he/she read on internet :
“YF-vaccine is lifelong valid”
he/she is confused
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How to inform the traveler ?
2014
If vaccinated more than 10 years ago and
now traveling to a country for which no proof
of YF-vaccination is needed :
• a choice exists :
to update the vaccination or not
• discuss thorougly with the client about
crossing borders, future travels, unforeseen
change of itinerary or long stop over, etc
• there is a low treshold for revaccination
• let him/her make the informed choice
2014
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2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
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2014
We will ask WHO for a working group to work this officially out
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
2014
2 Examples of
pitfalls & errors
There is a high risk for errors when crossing
borders as was illustrated recently in some cases
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2014
From: Travel Medicine Clinical Discussion List
[[email protected]]
On Behalf Of David O Freedman sent: zondag 20 april 2014 20:06
…… we heard of an ICID delegate
(16th International Congress on Infectious Diseases • Cape Town,SA)
who was rightfully denied boarding by South African Airways
for the Sao Paulo Æ Johannesburg flight
because he didn't have his International certificate of vaccination or
prophylaxis (for yellow fever vaccination) with him
and had just been in Peru for several days.
I hope this is helpful to all, remains a difficult and confusing area to
keep updated on.
David O. Freedman, MD Managing Senior Director Shoreland, Inc USA
2014
•
From: Membre-smv [mailto:[email protected]]
Sent: vrijdag 25 april 2014 18:46
Subject: [Membre-smv] plainte
Bonjour,
Je voudrais vous faire part d'une plainte déposée par un patient à l'encontre de ma collègue du CVI, pour "défaut
d'information".
Cette situation doit nous rendre sans doute plus vigilant vis à vis de ces obligations administratives, totalement en
décalage avec la réalité du risque encouru par nos voyageurs!
Elle voit en consultation en octobre dernier une famille :
•
•
père, mère, 3 enfants dont un bébé de 3 mois
pour un départ prévu en décembre pour 4 mois :
Cuba, Pérou, Costa Rica, Guatémala, Mexique, New York.
•
Mise à jour du calendrier vaccinal, y compris BCG pour les enfants, hépatite A
etc.. conseils palu, dengue, hygiène etc...une longue consultation.
En ce qui concerne la Fièvre Jaune :
– elle vaccine les 2 grands, pas le bébé bien sûr, ni la maman qui allaite
– pour les parents qui ont été vaccinés en 2002 elle fait réaliser une sérologie, qui
revient bien sûr positive
– les 4 partent donc protégés par leur vaccination
– pour le bébé elle renforce les conseils de protection anti moustiques
– le risque est de toutes façons négligeable, ils ne vont pas aller en zone à risque,
en particulier pas en zone amazonienne
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2014
There is a high risk for errors when crossing
borders as was illustrated recently in some cases
From: Membre-smv [mailto:[email protected]]
Sent: vrijdag 25 april 2014 18:46
Subject: [Membre-smv] plainte
Bonjour, Je voudrais vous faire part d'une plainte déposée par un patient à l'encontre de ma collègue du CVI, pour "défaut d'information".
Cette situation doit nous rendre sans doute plus vigilant vis à vis de ces obligations administratives, totalement en décalage avec la réalité du risque encouru par nos voyageurs!
Elle voit en consultation en octobre dernier une famille :
•
•
père, mère, 3 enfants dont un bébé de 3 mois
pour un départ prévu en décembre pour 4 mois : Cuba, Pérou, Costa Rica, Guatémala, Mexique, New York.
Hélas ! à la frontière entre le Pérou et le Costa Rica
ils sont renvoyés au Pérou,
doivent se faire vacciner sur place & attendre 12 jours "d'incubation"
et repayer 5 billets d'avion pour revenir au Costa Rica.
Bref aujourd'hui : une lettre de plainte, une demande de contact avec
l'assurance pour une indemnisation des frais engagés.
Mon analyse est :
- Rien à dire sur le plan médical.
- Sur le plan administratif :
Certes une obligation administrative qui avait dépassé la limite de validité des
10 ans (11 ans à la date du départ...) mais en décalage avec les
recommandations de l'OMS .
Il aurait sans doute fallu expliquer plus cette contrainte administrative, et faire
un certificat de CI pour la maman
2014
Tip
Fill in the name and date of birth
Make a scan of the
yellow fever vaccination attestation
Put it in “the cloud”
If a booster : when ?
After 2nd birth day
After pregnancy
After 1 month
After 10 years
Before next travel
….
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2006 = 2015
NB. What about the “cholera stamp” in the
yellow-fever-booklet (“cholera vaccine not
indicated – validity indefinitely”) ?
The habit of putting it on the vaccination
certificate or travelers to sub-Saharan Africa
should be maintained.
Never needed for other regions in the world.
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2015
Reminder about
YF & MMR
vaccination
2011
Vaccine 2011
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combination of measles and yellow fever vaccination
2011
Subjects injected YFV and MMR simultaneously had
lower seroconversion rates
– 90% for rubella,
– 70% for yellow fever
– 61% for mumps
compared with those vaccinated 30 days apart
– 97% for rubella,
– 87% for yellow fever
– 71% for mumps.
• Seroconversion rates for measles were higher than 98% in
both comparison groups.
Geometric mean titers
• for rubella and for yellow fever were approximately three
times higher among those who got the vaccines 30 days
apart.
• For measles and mumps antibodies GMTs were similar
across groups.
combination of measles and yellow fever vaccination
2011
• These conclusions apply to primary
vaccination in children less than two years
old.
• As primary vaccination against yellow
fever in older children and adults, and a
booster dose at any age induce stronger
immune response, interference from other
live virus vaccines should be less
pronounced and possibly irrelevant.
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POSITION PAPER 05-07-2013
2013
2013
12-07-2013
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2014
CDC 2014
Simultaneous Administration of Other
Vaccines and Drugs
• ACIP recommends that yellow fever vaccine be given at the
same time as other live-virus vaccines.
• Otherwise, the clinician should wait 30 days between
vaccinations, as the immune response to one live-virus
vaccine might be impaired if administered within 30 days
of another live-virus vaccine.
• A recent study involving the simultaneous administration of
yellow fever and measles-mumps-rubella (MMR) vaccines in
children found a decrease in the immune response against
yellow fever, mumps, and rubella when the vaccines were
given on the same day versus 30 days apart.
• Additional studies are needed to confirm these findings, but
they suggest that if possible, yellow fever and MMR
should be given 30 days apart.
2015
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2013
2015
Background:
•
The use of 2 live attenuated vaccines (LAV) is recommended
to be simultaneous or after an interval of at least four weeks between injections.
•
The primary objective of this study was to compare the humoral response to yellow fever (YF) and measles
vaccines among children vaccinated against these two diseases,
either simultaneously or separated by an interval of 7–28 days.
Subjects and methods:
•
A prospective, multicenter observational study was conducted among children aged 9–15 months.
•
The primary endpoint was the occurrence of positive yellow fever antibodies after YF vaccine by estimating
the titers of neutralizing antibodies from venous blood samples.
•
Children vaccinated against YF 7–28 days after receiving the vaccine against measles (test group) were
compared with children vaccinated the same day against these two diseases (referent group).
Results:
Analysis was performed on 284 children. Of them, fifty-four belonged to the test group.
•
Measles serology was positive in 91.7% of children.
•
Neutralizing antibodies against YF were detected in
– 90.7% of the test group
– 92.9 of the referent group (p =0.6).
•
In addition, quantitative analysis of the immune response did not show a lower response to YF
vaccination when it took place 1–28 days after measles vaccination.
Discussion:
In 1965, Petralli showed a lower response to the smallpox vaccine when injected 4–20 days after measles vaccination.
Since then, recommendations are to observe an interval of four weeks between LAV not injected on the same day.
Other published studies failed to show a significant difference in the immune response to a LAV injected 1–28 days after
another LAV.
These results suggest that the usual recommendations for immunization with two LAV (simultaneously or interval of 28
days) may not be correct.
Conclusion:
In low income countries, the current policy should be re-evaluated.
This re-evaluation should also be applied to travelers to yellow fever endemic countries.
2014 = 2015
CDC “2016”
Simultaneous Administration of Other
Vaccines and Drugs
• ACIP recommends that yellow fever vaccine be given at the
same time as other live-virus vaccines.
• Otherwise, the clinician should wait 30 days between
vaccinations, as the immune response to one live-virus
vaccine might be impaired if administered within 30 days
of another live-virus vaccine.
• A recent study involving the simultaneous administration of
yellow fever and measles-mumps-rubella (MMR) vaccines in
children found a decrease in the immune response against
yellow fever, mumps, and rubella when the vaccines were
given on the same day versus 30 days apart.
• Additional studies are needed to confirm these findings, but
they suggest that if possible, yellow fever and MMR
should be given 30 days apart.
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Quid WHO ? UK ? Other countries ?
2014
Reminder about
YF vaccination
in young children
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Relapsing remitting MS ???
2012
2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
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2014
intervals for YF vaccination
after interrupting
immunosuppressive
treatment
2014
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2014
Tijdschrift voor geneeskunde – W Peetermans, H Schoemans, A Van Gompel
Vaccinaties bij immuungecompromitteerde en chronisch zieke patiënten
references 6,10,11,12
6. Tomblyn M , Chiller T , Einsele H, et al. Guidelines for preventing infectious complications among
hematopoietic cell transplant recipients: a global perspective. Bone Marrow Transplant 2009; 44: 453-455.
10. Rahier JF , Moutschen M , Van Gompel A , et al. Vaccinations in patients with immune-mediated
inflammatory diseases. Rheumatology 2010; 49: 1815-1827.
“As a rule of thumb, a period of 3 months is estimated for the immune status to be completely
restored (evidence Level D), except for corticosteroid therapy, where a waiting period of 1 month
is thought to be sufficient (evidence Level D).”
11. Visser LG. TNF-α antagonists and immunization. Curr Infect Dis Rep 2011; 13: 243-247.
12. Visser LG. The immunosuppressed traveler. Infect Dis Clin North Am 2012; 26: 609-624.
“The duration of the immunosuppressive effect depends on
1.the half-life of the active drug component
2.the recovery from the immunological effect (e.g. depleting cytotoxic effect
caused by apoptosis or clonal deletion of B- or T- cells).
For most immunosuppressive medications this time point has not been clearly
defined”
2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
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2014
Auto-immune disease in itself
is not a contra-indication for
YF-vaccination
CDC – MMWR-2010
2014
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CDC – Yellow Book -2016
2015
http://wwwnc.cdc.gov/travel/yellowbook/2016/advising-travelers-withspecific-needs/immunocompromised-travelers
Medical conditions
without significant immunologic compromise …
Travelers should be prepared as any other traveler
3.Travelers with a history of cancer who received their last chemotherapy treatment ≥3 months
previously and whose malignancy is in remission.
4.Hematopoietic stem cell transplant recipients who are >2 years post transplant, not on
immunosuppressive drugs, with no evidence of ongoing malignancy, and without graft-versus-host
disease.
5.Travelers with autoimmune disease (such as systemic lupus erythematosus, inflammatory bowel
disease, or rheumatoid arthritis) who are not being treated with immunosuppressive or
immunomodulatory drugs, although definitive data are lacking.
6.Travelers with multiple sclerosis (MS) who are not on immunosuppressive or immunomodulatory
agents and those who are not experiencing an exacerbation of disease. Although the risks of using livevirus vaccines for those with MS have been debated, the National MS Society and CDC recommend
following CDC guidelines for vaccination in those who lack prior immunity, who are not on
immunosuppressive or immunomodulatory agents, and who are not experiencing an exacerbation of
disease.
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2014
Exploring possible severe
side effects
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2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
2014
46
27/11/2015
2014
2014
47
27/11/2015
2014
2014
Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015
Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013
48
27/11/2015
2014
Will the price of Stamaril be higher in the near future ?
Mail récent de la SMV-France
La discussion avec Sanofi-Pasteur-MSD (SPMSD) nous a
permis d’obtenir un étalement de l’augmentation qui va
s’étendre sur 3 ans selon l’échéancier ci-dessous et ne
sera donc pleine que début 2017.
• 28€50 jusqu’au 1er janvier 2015 (ou mars car certains
marchés se passent à ce moment)
• 32€30 jusqu’au 1er janvier (mars) 2016
• 36€10 jusqu’au 1er janvier (mars) 2017
• 38€ à partir de début 2017
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 schedules
PATRICK 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 diarrhea
LUCIE SEYLER
16.25- 16.50
Malaria: when prevention is not clear-cut
ULA MANIEWSKI
16.50-17.15
Traveller's Thrombosis
PETER 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
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2014
End Yellow Fever
50