ARCHIVED - Guidelines for the Prevention and Control of Meningococcal Disease

9.0 Recommendations for Travellers

9.1 Travellers to Destinations Within Canada

Under most circumstances, Canadians travelling within Canada do not need to take special precautions to protect themselves from meningococcal disease. The risk of acquiring IMD as a traveller in North America is low, even in areas with higher than usual rates of disease. Therefore, preventive measures, including the use of vaccine, are not warranted.

Special circumstances under which a Canadian travelling within Canada should consider vaccination include the following:

• the individual is travelling to an area where there is an outbreak for which an immunization program is in progress AND
• the individual travelling is of an age that falls within the population targeted for immunization by the local health authorities AND
• the individual’s duration of stay in the outbreak area is for an extended period of time (e.g. attendance for a school term).

These persons are more likely to interact with the population at increased risk of transmission (the population targeted for immunization). The decision to recommend vaccination for travellers within Canada who meet these criteria should be based on individual risk assessment. The nature of the travel and the type of contact with the population at risk are important factors to consider (e.g. a child staying in a hotel has a different risk from a teenager attending parties). The traveller should be appropriately counselled on the risk-benefit in order to make an informed decision. In most circumstances, immunization upon arrival at the outbreak or hyperendemic area is sufficient, but consideration could be given to immunization before arrival.

9.2 Students Attending Colleges in the United States

The Advisory Committee on Immunization Practices in the United States (US) has recommended that all US college students should be informed of the risk of meningococcal disease and the availability of a vaccine, so that they are able to make informed individual decisions regarding vaccination against serogroup C meningococcal disease⁽⁴⁰⁾. These recommendations were made in light of outbreaks that have occurred in US colleges. No such outbreaks have occurred in Canada. Canadian students who will be attending college in the US should inform themselves of the policies of the institution that they will be attending, as they may be required to provide proof of serogroup C immunization before starting their studies. NACI recommends that all Canadian adolescents and young adults be immunized with meningococcal C conjugate vaccine⁽³³⁾. As students attending colleges and universities are included in this recommendation by virtue of their age, there is no need to make special recommendations for this group of people.

9.3 Travellers to International Destinations

International travellers should be aware of the risk of IMD at their destination of choice. IMD occurs sporadically worldwide and in focal epidemics. The traditional endemic or hyperendemic areas of the world (the “meningitis belt”) include the savannah areas of sub-Saharan Africa extending from Gambia and Senegal in the west to Ethiopia and Western Eritrea in the east. Health care professionals advising Canadian travellers should remain current with global meningococcal activity. Current meningococcal outbreak information can be obtained through the Public Health Agency of Canada, Travel Medicine Program (<www.travelhealth.gc.ca>) and the World Health Organization (WHO) (<http://www.who.int/ csr/don/archive/disease/meningococcal_disease/en/>).

Quadrivalent meningococcal vaccine is recommended for Canadian international travellers requiring meningococcal vaccine. Meningococcal C conjugate vaccine alone is not appropriate for protection of travellers, as it does not protect against serogroups A or W135, which are endemic in selected regions of the world. The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides guidelines for health care providers counselling Canadian international travellers on meningitis vaccination. For complete information on CATMAT’s Statement on Meningococcal Vaccination for Travellers visit <www.catmat.gc.ca>.

9.4 International Travellers Arriving in Canada

Under the authority of the Quarantine Act, international travellers arriving in Canada who are ill and assessed as possibly having IMD will be referred for medical examination at local health facilities. Information about these travellers will be transferred to appropriate public health authorities.