Introduction

Vaccination is the administration of agent-specific, but relatively harmless, antigenic components that in vaccinated individuals can induce protective immunity against the corresponding infectious agent. In practice, the terms “vaccination” and “immunization” are often used interchangeably.

Prevention of disease

Vaccination is a highly effective method of preventing certain infectious diseases. Vaccines are generally very safe, and serious adverse reactions being uncommon. Routine immunization programs protect most of the world’s children from several infectious diseases that previously caused millions of deaths each year. For travelers, vaccination offers the possibility of avoiding some infectious diseases that may be encountered abroad. However, satisfactory vaccines have not yet been developed against several of the most life-threatening conditions.

Precautions in vaccination

Despite their success in preventing disease, vaccines rarely protect 100% of the recipients. No vaccinees, including travelers, should assume that there is no risk of contracting the disease(s) against which they have been vaccinated. For example, vaccination is not a substitute for avoiding potentially contaminated food and water. Consequently, all additional precautions against infection should be carefully considered.

Safe injections

The administration of vaccines requires the same high standard of injection safety as any other injection. A sterile needle and syringe should be used for each injection and both should be disposed of safely. WHO recommends the exclusive use of single-use (“auto-disable”) syringes and preferably devices with sharps injury protection features whenever possible. Syringes should not be recapped (to avoid needle-stick injuries) and should be disposed of in a way that is safe for the recipient, the provider, and the community.

Co-administration of vaccines

Inactivated vaccines do not generally interfere immunologically with other inactivated or live vaccines. However, administration of multiple injections at a single visit requires separate sites (different limbs) for each injection or spacing of injection sites by at least 2.5 cm (or 1 inch), to distinguish the cause of any local reaction. Most live vaccines can be given simultaneously if they are administered at different anatomical sites. If injectable live-virus vaccines are not administered on the same day, their administration should be separated by an interval of at least 4 weeks.

Adverse reactions and contraindications

Reactions to vaccines

Vaccines are generally both effective and safe, but no vaccine is totally safe for all recipients. Vaccination may sometimes cause mild side-effects: local reaction, slight fever and other systemic symptoms may develop as part of the normal immune response. In addition, certain components of the vaccine (e.g. aluminum adjuvant, antibiotics, or preservatives) occasionally cause reactions. A successful vaccine reduces these reactions to a minimum while inducing maximum immunity.

Common mild vaccine reactions

Most vaccines produce some mild local and/or systemic reactions relatively frequently. These reactions generally occur within a day or two of immunization. The systemic symptoms (mainly fever and/or rash) that are reported in 5−15% of recipients of measles or measles, mumps and rubella vaccine 5–12 days after vaccination are commonly attributable to background events that are normal events during childhood.

Uncommon, serious adverse reactions

 Most of the rare vaccine reactions are self-limiting and do not lead to long-term problems. Anaphylaxis, for instance, although potentially fatal, can be treated and has no long-term effects. All serious reactions should be reported immediately to the relevant national health authority and should be marked on the vaccination card. In addition, the patient and relatives should be instructed to avoid the vaccine in the future.

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