”47 These include not only the African meningitis belt countries Luminespib clinical trial (the guidelines note that the dry season varies from country to country and extends the time frame to 9 months—from October to June) but also those countries in sub-Saharan Africa outside the traditional meningitis belt where recent epidemics have occurred, including the Congo and Tanzania.47 The guidelines also recommend vaccination for the usual groups of travelers who may have prolonged close contact with the local population

in these areas, but specify this may include medical personnel and those using public transportation. In addition to areas with active epidemics, vaccination may also be warranted for travelers to areas with “heightened disease activity,” including industrialized nations where sporadic cases of disease have been reported in the previous 6 months. In developed countries, S1P Receptor inhibitor travelers should

follow the recommendations of the destination country.47 Although vaccination against serogroup C with a monovalent vaccine is required for all Canadian children, CATMAT notes that this routine vaccination does not provide sufficient protection to individuals traveling to destinations where disease due to other serogroups is reported. Broad serogroup protection is warranted due to this risk, and the preferred vaccine is a glycoconjugate quadrivalent meningococcal vaccine due to its “significant advantages over polysaccharide vaccines including better immune memory, longer duration of efficacy, lack of hyporesponsiveness Non-specific serine/threonine protein kinase with booster doses, and possible reduction of bacterial carriage rates.”47 For the vast majority of travelers, ie, those not making pilgrimages to Saudi Arabia or those not entering college where vaccination is required (chiefly in the United States), the decision to vaccinate is based essentially on an assessment of the risk to the individual of developing

disease and/or of becoming a carrier of infection. This assessment must account for destination, nature and duration of potential exposure, age, and overall background health of the traveler (ie, host factors) (Figure 4). Because meningococcal vaccines are associated with relatively few adverse events and contraindications, these aspects hardly ever need to be considered. Obviously, vaccination should be recommended for all travelers visiting destinations with outbreaks or epidemic situations, wherever that might be, except those who have been vaccinated within the past 3 years. There are Web sites that can advise clinicians on active areas, such as http://www.meningvax.org/epidemic-updates.php, developed by a WHO/PATH partnership. As noted above, most expert groups recommend vaccination against meningococcal disease for at least some travelers with destinations in the African meningitis belt.