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Bringing a baby or child to Nigeria? What immunizations and malaria prophylaxis are needed? The best source for this information is the US government CDC site, including the page Health Information for Travelers to Nigeria, International Travel with Infants and Young Children and a page with links to other health information about children and travel. You should read carefully the general information in Traveling Safely with Infants and Children which covers malaria, diarhheal disease, road safety, air travel, and more.
Some of the information relevant to Nigeria is summarized below but you should be sure to check with your doctor and perhaps the CDC websites, as information may change and your baby is an individual.
Summary of recommendations: (click on read more)
- Children should have all the usual immunizations appropriate to their age. In the US this includes hepatitis B, DTP/DTaP, Hib (Haemophilus influenzae type b), polio, pneumococcal conjugate (PCV), influenza yearly for children older than 6 months, and, for children older than a year, varicella and hepatitis A.
- Malaria prophylaxis for all children, using mefloquine (Lariam), or, for children 11 kg [22 pounds] or more, Malarone. (Primaquine may be considered also though not approved for this purpose, see Primaquine for malaria prevention).
- Meningococcal immunization for children 3 months or older
- Yellow fever immunization for children 9 months or older
- Typhoid immunization for children 2 years or older
- Consider rabies immunization for all infants and children (see below)
- Consider immune globulin for children less than 2 years old (see below)
- My own recommendation: Measles or MMR immunization for children 9-11 months old (normally recommended from 12-15 months).
Rabies
Rabies is a significant problem in Nigeria. Children old enough to be be at risk of contact with animals such as dogs and cats (even unimmunized pets at friends' houses) should be immunized. Any age child can be immunized, but it would be most important beyond one year of age, when children are becoming more independent.
Immune globulin for prevention of hepatitis A
The CDC recommends, "Children less than 1 year of age who are traveling to high-risk areas should receive immune globulin (IG)" to prevent hepatitis A. This is because they are too young to receive hepatitis A immunization. Hepatitis A is transmitted through contaminated food and water. It is rarely serious in young children and the CDC says, "Although HAV is often not severe in infants and children younger than 5 years of age, those infected efficiently transmit infection to older children and adults, who are at higher risk of severe disease."
My personal feeling is that children under 1 year who are coming to reside with their parents in Nigeria may not need IG. They are unlikely to be exposed at home, and if exposed are very unlikely to become seriously ill. If their family members are immunized, they won't contract hepatitis from a silently-infected child, either. A single IG injection provide protection for 3-5 months only. If IG is given, it must be timed carefully so as not to interfere with other immunizations (see the CDC page above). You should discuss the options with your own pediatrician or family physician before deciding not to use IG.
Measles
Measles is a serious disease in young children and can be fatal. There is no antibiotic to treat it since it is a viral disease. There are frequent outbreaks of measles in Nigeria, so it must be taken seriously. In the US, measles immunizations are given after 12 months of age, even though many infants are at risk sooner as their maternal antibodies disappear. The problem is that the vaccine will fail in some younger babies because the maternal antibodies block it. In the US, there is little risk of infection so the 12 months age limit is fine. In Nigeria, though, the standard is to give the vaccine at 9 months, to protect most of the large number of susceptible children in the 9-12 months group.
My recommendation is that children coming to Nigeria should be immunized for measles at 9 months or before they arrive in Nigeria. To ensure protection, and to satisfy US requirements, they should be re-immunized at 12 months. There is no risk to re-immunization. If it is not possible to immunize the child before coming to Nigeria, a measles immunization should be given as soon as possible after arrival.
-- Mike Blyth, MD |
