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Vaccinations and other preventive measures for students, who undertake an studentship or research studentship in a developing country.
- Vaccinations and medical advice for an studentship or research studentship in another country are provided by the Occupational Health and Safety (AMD) service, Erasmuslaan 17, (tel. 3615400). An official declaration is required for this. You can obtain it through the NIIH secretariat. A prescription is given for malaria prevention. Please note the importance of starting the necessary vaccination programme in good time.
- Information regarding post-exposure prophylactic (PEP) measures, and a PEP kit, will be provided to you just before your departure. You will receive an invitation from the NIIH by email.
- International health insurance, and repatriation, legal liability and travel insurance is your own responsibility, (perhaps via the VVAA Medical Insurance Association): for more information see ‘insurance policies.’
The advice below has been prepared in consultation by Mrs Antoinette van Summeren, Mrs Bea Groenenberg, Mrs. A. van der Geest (AMD) and Mrs M. Keuter (Infectious disease specialist, UMCN, and coordinator of the Rotation Programme for Student Doctors in low-income countries).
Malaria prophylactics and treatment
- Malaria Bulletin 2011: The National Coordination Centre for Travellers’ Health (LCR) www.lcr.nl. This complete bulletin is available at the NIIH secretariat.
- Appendix 3: 'Information for the traveller,' is recommended.
BCG vaccination
- We advise that students in the Rotation Programme for Student Doctors in low-income countries should have a BCG vaccination (if your PPD reaction or Mantoux is now negative). This is also shown in the table; if you do not chose to have a BCG vaccination, then have a Mantoux check before and after the journey. If you do have a BCG or if your Mantoux was already positive before departure, have an chest X-ray screening 3 months after your return.
What do most students do?
- So far as we know, most students going to the tropics have a BCG vaccination. BCG is especially valued because it protects against the serious post-primary complications of TB (extrapulmonary TB and TB-meningitis), but recently there have been indications from The Gambia that BCG also ameliorates the effects of pulmonary TB.
- In view of students almost daily and intensive contacts with patients with open TB, especially in hospitals in Africa and Indonesia (and occasionally in the streets or markets), it is advisable to take advantage of the protection offered by BCG vaccination, despite the disadvantage of not being able to use the Mantoux test for early detection.
How high is the risk of being infected with M. Tuberculosis?
- In The Lancet Dr. F. Cobelens et al. report on TB in 656 travellers, a positive Mantoux induration was found in 12 (1.8%). This indicates latent TB and is an indication for a 6-month prophylactic course of INH. Two travellers had active TB. As one would expect, working in health care was an independent risk factor for TB. The incidence was 3.5 (CI 2.0-6.2) per 1000 months of residence in the tropic, and 2.8 (CI 1.2-5.5) if health care workers were excluded. That means that students have a 1 in 100 risk of contracting a Mycobacterium tuberculosis infection.
Is it advisable to have a Mantoux test during my studentship?
- In third world countries, the Mantoux test is seldom used because every child is given a BCG one day after birth. There is no point in having a Mantoux test in the middle of your studentship, because a Mantoux reaction is only reliable 2 months after exposure. The only reason for having a test during the three months of your studentship is if you display symptoms.
- Other vaccinations (http://www.ru.nl/amduk/health/advice-vaccinations/)
DTP
- Whether you need DTP depends on when you had your last vaccination (take your vaccination book with you!).
Hepatitis-A
- In prophylactic treatment for hepatitis A, there is a choice between active vaccination with Havrix (expensive, almost 100% protection and effective for 5-10 years) or passive protection with gamma-globulin (around 70% protection, effective for a maximum of 3 months). Active vaccination is recommended, especially if you expect to return to the tropics in the future.
Hepatitis-B
- Hepatitis B immunisation is recommended for studentships if the student will be working with patients or with material in the lab. Most medical students will have this vaccination. If you have not sero-converted after HBV vaccinination, participation in COWL is strongly disencouraged.
Yellow fever
- Yellow fever immunisation is recommended for Tanzania, Ghana and Suriname; it is compulsory for all named countries, for travellers returning from endemic areas in the named countries in the LCR list.
Typhoid fever
- Routine vaccination is not recommended.
Meningcoccal disease
- Vaccinate, if an epidemic of meningitis has been officially reported for the country concerned (Ghana, Tanzania).
Rabies
- Routine vaccination is recommended. N.B. Even after vaccination, a post-exposure vaccination is required after being bitten.
Post-exposure prophylaxis (PEP)
- A protocol regarding post-exposure prophylaxis (PEP) to prevent HIV infection following a needle stick accident has been developed for students abroad.
- See the information sheet on PEP for UMC students going overseas: Informatieblad PEP profylaxe voor studenten van het UMC St Radboud in het buitenland (see under Downloads-Voorbereiding Coschap-PEP protocol).
- See also the UMC St Radboud protocol for needle stick accidents: Protocol Prikaccidenten.
- An information and instruction meeting for departing students is held 4 times per year at the AMD. A PEP-kit is handed out at this meeting. An invitation to the meeting will be mailed to you. Students from other universities can obtain the PEP kit at their own university.
Insect nets
- Notitie van augustus 2011: Onze leverancier ‘de Klamboeman’ levert geen klamboes meer en daarom stoppen wij met de verkoop van klamboes. De voorraad is op. Alternatieven zijn:
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