Business Travelers

Vaccination Considerations for This Population

Lin H Chen; Karin Leder; Mary E Wilson

Expert Rev Vaccines. 2013;12(4):453-466.

Abstract and Introduction

Abstract

Illness in business travelers is associated with reduced productivity on the part of the employee as well as the employer. Immunizations offer a reliable method of preventing infectious diseases for international business travelers. The authors review the travel patterns of business travelers, available data on illnesses they encounter, their potential travel-associated risks for vaccine-preventable diseases and recommendations on immunizations for this population. Routine vaccines (e.g., measles, tetanus and influenza) should be reviewed to assure that they provide current coverage. The combined hepatitis A and hepatitis B vaccine with a rapid schedule offers options for those with time constraints. Other vaccine recommendations for business travelers need to focus on their destinations and activities and underlying health, taking into account the concept of cumulative risk for those with frequent travel, multiple trips or long stays.

Introduction

The number of travelers undertaking international trips has increased markedly over the last few decades, with an estimated 982 million international tourist arrivals in 2011. Several sources on traveler demographics have shown that the business travelers comprise 14–21% of the traveler cohorts,^{[1–3,101,102]} equating to almost 150 million international business trips annually. Business travel is generally defined as travel for business or professional reasons.^[103] It is sometimes referred to as occupational travel. However, people who travel for work are a heterogeneous group, ranging from business executives to expatriates.^[4] In this paper, the authors will focus on corporate travelers on short-term assignments (up to several months) and will only comment briefly about expatriate corporate travelers. Those traveling to attend conventions/conferences are likely traveling for business, although their risk may be modified by virtue of spending most of their time with other travelers. The authors do not address this group separately but recommendations would be similar to those for business travelers.

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Table 1. Vaccines and their special considerations for business travelers, and precautions and contraindications.
Vaccine	Special considerations for business travelers	Duration of protection (after completion of a series, if applicable)	Precautions	Contraindications
Routine
Haemophilus influenzae type b	Verify that the asplenic traveler has been vaccinated	Lifelong		Severe allergic reaction to vaccine components
Hepatitis B	Consider cumulative risk for frequent international travel or long trip durations	>20 years, but likely lifelong		Severe allergic reaction to a previous dose or yeast
HPV	Follow age-appropriate recommendations	Lifelong	Pregnancy	Severe allergic reaction to a previous dose or yeast
Influenza	Vaccines may differ between northern and southern hemispheres; consider arranging vaccination at destination if outbreak is occurring	Current influenza season	History of Guillain–Barré syndrome within 6 weeks of previous inactivated influenza vaccine	True egg allergy; severe allergic reaction to a previous dose or vaccine components
Measles, mumps, rubella	Follow age-appropriate recommendations	Lifelong	Recent receipt of antibody-containing blood product <11 months (recommended interval depends on product); history of thrombocytopenia or thrombocytopenic purpura	True egg allergy; pregnancy; immune suppression; severe allergic reaction to a previous dose or gelatin or neomycin
Meningococcal	Vaccine may be required for some travelers (i.e., Saudi Arabia during Hajj); main risk region is 'meningitis belt' in sub-Saharan Africa. Travelers who previously received monovalent vaccine may still need quadrivalent vaccine. Verify that the asplenic traveler has been vaccinated according to current guidelines	5 years (pilgrims to Saudi Arabia for Hajj or Umra are required to be vaccinated with quadrivalent vaccine within 3 years)	Pregnancy (for conjugate vaccines, due to lack of data)	Severe allergic reaction to a previous dose or diphtheria toxoid (for conjugate vaccine) or dry natural rubber latex
Pneumococcal	Verify that the asplenic traveler has been vaccinated according to current guidelines	5 years ^[28]	Pregnancy	Severe allergic reaction to a previous dose or vaccine components
Polio	Main countries with active poliovirus circulation are Afghanistan, Nigeria and Pakistan, but other countries in Africa and Asia are considered at risk, including China, where an outbreak occurred in 2011	One booster dose at age 18 years is considered sufficient for lifelong protection	Pregnancy	Severe allergic reaction to a previous dose or streptomycin, polymyxin B or neomycin
Tetanus, diphtheria, pertussis (or tetanus diphtheria)	Follow age-appropriate recommendations	10 years	Guillain–Barré syndrome <6 weeks after a previous dose of tetanus toxoid-containing vaccine. History of Arthus-type hypersensitivity reactions with previous dose. Unstable neurologic disorder (cerebrovascular events, encephalopathy)	Severe allergic reaction to a previous dose or vaccine components. History of encephalopathy within 7 days of prior pertussis vaccination
Varicella	Follow age-appropriate recommendations.	Lifelong		Pregnancy; immune suppression; severe allergic reaction to gelatin or neomycin
Zoster	Follow age-appropriate recommendations	Lifelong	Avoid administration within 24 h after antiviral medications such as acyclovir, famciclovir and valacyclovir, and wait >14 days after vaccination if these antivirals are to be used. In patients to be initiated on immunosuppressive therapy, administer vaccine >14 days to 1 month before the therapy	Pregnancy; immune suppression; severe allergic reaction to gelatin or neomycin
Travel
Cholera	Consider vaccination for business travelers who will be working under austere conditions in regions with cholera epidemics	2 years	Pregnancy	Severe allergic reaction to vaccine components
Hepatitis A	Vaccine is indicated for nearly all international business travelers due to the possible widespread presence of infection and the availability of safe and immunogenic vaccines	Lifelong		Severe allergic reaction to a previous dose or vaccine components
Japanese encephalitis (inactivated Vero cell-derived)	Business travelers who plan to spend significant periods of time in endemic countries, stay in rural areas or plan long or repeated trips may have exposure	1–2 years	Pregnancy	Severe allergic reaction to a previous dose or vaccine components
Rabies	Consider cumulative risk for frequent international travel or long trip durations	Boostable lifelong (two doses of vaccine are needed after possible rabies exposure)	Administration during immunosuppressive therapy or in immune-suppressed hosts may result in reduced response	Anaphylaxis to previous rabies vaccine (applies to pre-exposure prophylaxis only)
Tick-borne encephalitis	Business travelers at risk should be advised regarding avoiding tick bites and unpasteurized dairy in endemic areas, and consider vaccination for those with potential intense exposure	3–10 years, variable depending on national recommendations	Pregnancy or lactation	True egg allergy; severe allergic reaction to vaccine components
Typhoid polysaccharide (ViCPS)	Travel to the Indian subcontinent, a common destination for business travelers, was highly associated with resistant infections	2 years for polysaccharide vaccine	Pregnancy	Severe allergic reaction to a previous dose or vaccine components
Typhoid live-attenuated (Ty21a)	Travel to the Indian subcontinent, a common destination for business travelers, was highly associated with resistant infections.	5 years for live-attenuated oral vaccine	Concurrent antibiotic use may inactivate the vaccine. Administer 24 h from mefloquine dose to avoid possible inhibition by mefloquine	Pregnancy; immune suppression
Yellow fever	Risk of disease is present in sub-Saharan Africa and Central and South America. Travelers may be required to show proof of yellow fever vaccination or yellow fever waiver in those who should not receive vaccine	10 years	Age 60 years; infants aged 6–8 months; pregnancy; breastfeeding (avoid until infant age >6 months)	True egg allergy; age <6 months; immune suppression; thymus disorder; severe allergic reaction to a previous dose or vaccine components