Wednesday, 22 May 2019

Yellow Fever Vaccination Certificate for Travelers

Yellow Fever Vaccination Certificate for Travelers
Unless you have been in India during the months of May-June, you won't be able to fathom how overwhelming the subcontinental summer can be. Well, it has been more than a month since I published my last travel story on backpacking Sri Lanka. Due to some pending professional dilemma I've been in a state of complete psychological inaction, and it would be grossly unfair to shift the blame on ruthless summer for my blogging ceasefire. Although I could not unite my patience and determination to pen down travel blogs, I could intermittently research on upcoming travel destinations. One of my friends, a wildlife enthusiast, keeps traveling to Africa, and I tell you, his casual Instagram photos can turn any backpacker Africa-minded. After a brief research, I found Kenya to be the easiest wildlife-hub to visit among other east-African countries, especially for an Indian traveler.

Reasons being- cheaper flights, ease of e-visa and availability of abundant group departures for safari from Nairobi. Apart from these routine stuffs, one needs to carry a yellow fever vaccination as well as an oral polio vaccination certificate in his travel pouch to pass the immigration with a smile. Health being my domain, I did a thorough study on the significance of these vaccinations before taking a prick myself. Do not confuse yellow fever vaccination certificate with other immigration formalities which often lack logic. Yellow fever vaccination is carried out to prevent the international spread of the disease by safeguarding countries from the risk of importing or spreading the virus. Sounds confusing? Wait, I'll give you a basic idea of yellow fever as a notorious disease, its easy vaccination option, target group, a bit of polio, my personal experience of getting vaccinated, and finally documentations needed for international travelers.

Yellow Fever Vaccination Certificate for Travelers
The Yellow Fever risk areas of Africa and South America, as depicted by WHO.
Yellow fever is a mosquito-borne (Aedes aegypti) acute viral disease which manifests as a spectrum of presentations ranging from asymptomatic illness to life-threatening jaundice, and sometimes death. Yellow fever (YF) occurs in 47 endemic countries in Africa, central and south America. About 90% of cases reported annually occur in Sub-Saharan Africa. It is usually a mild, self-limiting illness comprising usual symptoms of fever, shivers, headache, uneasiness, muscle pain, loss of appetite etc. Majority of patients improve in 3-4 days. Unfortunately, 15% of patients get into more serious stage of this disease, marked by high fever, jaundice, severe tummy pain, vomiting and bleeding from different orifices of the body. Half of these patients eventually die. Bad news is, till now there's no specific treatment available for yellow fever, apart from supportive care. Worst part is, due to its non-specific symptoms it is not an easy disease to be clinically diagnosed at early stage. That simply means, once you're infected you're at the mercy of your own fate.

Vaccination is the single most vital preventive measure against yellow fever. The currently available YF vaccine is safe, affordable and confers near lifelong immunity in 95% of patients. Frankly, do you even have a choice? A traveler's risk of acquiring yellow fever depends on the location of travel, immunization status, season, duration of travel and types of activities. World Health Organization (WHO) recommends vaccination for all travelers visiting areas where there is risk of yellow fever. The Centers for Disease Control and Prevention (CDC) recommends the same. Interestingly, YF is the only disease specifically designated in the International Health Regulations (2005) for which proof of vaccination or prophylaxis may be required as a condition of entry to a State Party. It must be appreciated that this requirement is a public health measure to prevent the international spread of the disease by protecting countries from the risk of importation and spread of yellow fever virus within their jurisdictions.

Yellow Fever Vaccination Certificate for Travelers
Countries requiring Yellow Fever Vaccination, as per WHO.
Many countries require proof of vaccination against yellow fever before issuing a visa, particularly if travelers come from, or have visited a country where YF occurs. The countries that require proof of vaccination are those where the disease may or may not occur, and where the mosquito vector and potential non-human primate hosts of YF are present. Proof of vaccination is often required for travelers arriving from countries with risk of YF transmission, and sometimes for travelers in transit through such countries. As India is not a yellow fever endemic area, routinely we do not require this vaccination. However, if an Indian traveler plans to visit a yellow fever endemic area, he needs to get vaccinated and collect the certificate.

Travelers who have medical grounds for not being vaccinated must have those clearly certified by appropriate authorities. It is to be understood that exemption or contraindication to yellow fever vaccination does not provide any immunity from quarantine. This vaccination is contraindicated for you if:
* You're allergic to eggs, chicken proteins, or gelatin.
* You had severe allergic reaction to a previous dose of YF vaccine.
* You're either pregnant or going to get pregnant very soon.
* You're a nursing mother.
* You've a weak immune state due to any of these several conditions like- cancer, HIV/AIDS, post-transplant, under radiation or drug therapy.
* You've any thymus disorder, major liver, or kidney disease.
* You're suffering any acute illness.
* You're under nine months of age. Well, your parents must be scrolling down this list then.

Yellow Fever Vaccination Certificate for Travelers
International Certificate of Vaccination or Prophylaxis for Yellow Fever.
The official portal of CDC explicitly states that, yellow fever is currently the only disease for which proof of vaccination, in the form of an International Certificate of Vaccination or Prophylaxis (ICVP) might be required of travelers as a condition of entry into a country. Vaccination certificate requirements of countries are published by WHO in International Travel and Health. Information on designated yellow fever vaccinating centers is available from local or national health offices. This certificate is valid only if the vaccine used has been approved by the WHO. ICVP must be signed in the hand of the clinician, who shall be a medical practitioner or other authorized health worker, supervising the administration of the vaccine. The certificate must also bear the official stamp of the administering center. The ICVP is valid for yellow fever for lifetime, beginning 10 days after the primary vaccination.

Any amendment of this certificate, or erasure, or failure to complete any part of it, may render it invalid. The validity of this certificate shall extend until the date indicated for the particular vaccination. Hopefully, now you can appreciate the gravity of this travel document. In addition to vaccination against yellow fever, which may be mandatory to enter some countries, protective measures may be advisable against malaria, poliomyelitis, infectious hepatitis, diphtheria, tetanus and typhoid fever. It is very common for travelers to encounter diseases in a foreign country which either do not exist or have become rare in their native land. So, before traveling abroad, it is always advisable to consult your physician and check updates in the international portal of WHO.

Yellow Fever Vaccination Certificate for Travelers
A typical Certificate of Oral Polio Vaccination for International Traveler.
Our Ministry of Health and Family Welfare (MOHFW) has published a list of authorized yellow fever vaccine centers in India which is updated quite sluggishly. You can easily find out the vaccination center nearest to your home and ring up to book an appointment. Do not rely much on the outdated data tabulated in the list provided by MOHFW. Trust on your ability to web-search and find contact details of the vaccine center where you want to visit. Luckily, I had the option to choose from 3 vaccine centers located in Kolkata. Although I had come across good online reviews on the Port Health Organization at Marine House, getting vaccinated at the Airport Health Organization was more convenient to me due to the availability of Thursday slot which happens to be my usual off day. I had taken a telephonic appointment on a fine Monday. On the following Thursday, I reached there by 11 am, with my original passport and a photocopy of it. Yes, you do not need any other travel or medical record.

We were made to sit in a waiting hall with glass windows. Few more travelers were waiting with sweaty faces. Blame it on the non-functional air-conditioner. Although the tortoise speed of service providers kept us baking in that lounge for few hours, the entire procedure was pretty simple- filling a simple form, submitting the passport along with a self attested photocopy of it, paying the official fee of 300 INR, getting the oral polio vaccine dose, getting a shot of intramuscular yellow fever vaccine, receiving certificates and lot of impatient moments of waiting in between each of these subsequent steps. It took little less than 3 hours to get our certificates. The needle prick was absolutely painless and none of us experienced any vaccine-related side-effect. What more could we have asked for! You must be wondering why we were administered the oral polio vaccine, right?

Yellow Fever Vaccination Certificate for Travelers
My Yellow Fever Vaccination Center in Kolkata, very close to the airport.
Presently India enjoys a Polio-Free status. However polio continues to circulate in Afghanistan, Nigeria and Pakistan. There have also been recent outbreaks following importation in Ethiopia, Kenya, Somalia and Syria. India faces the risk of importation of polio virus from countries that have ongoing transmission. Since 2000, more than 45 countries that were earlier polio-free had wild polio virus importations. International travel between India and these polio infected countries can bring the polio virus back to India. Obviously, we don't want that. To mitigate this risk, the Ministry of Health and Family Welfare, Government of India has put in place, the requirement of a dose of oral polio vaccine (OPV) for all travelers to India from polio endemic countries and countries with polio virus circulation following importation. The same holds true for all travelers from India going to polio endemic countries.

Indian residents traveling from India to the 7 polio infected countries are required to receive a dose of OPV at least 4 weeks prior to departure, regardless of age and vaccination status. Each district in India has designated at least one center where OPV is provided to travelers free of cost, and OPV vaccination certificate is issued. This single dose of OPV provides protection for one year only. Apart from these district immunization centers, OPV is also administered by all designated YF vaccination centers. Both these vaccines are administered on the same day or within 24 hours. But remember, if these vaccines are not taken on the same day, then individual vaccines can be taken only after a gap of 28 days. Relive your childhood memories while savoring the taste of OPV drops. Although I'm vaccinated for Africa, I'm still unsorted, and have no idea when I can actually fly to Kenya. Meanwhile, do not hesitate to throw me your mails of curiosity.   

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