What immunizations does my baby or child need for travel to Nigeria?

Travel health experts advise preparing for a trip four to six weeks before you travel, especially if you need vaccinations.

Bringing a baby or child to Nigeria? What immunizations and malaria prophylaxis are needed? The best online source for this information (for Americans, at least) 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, breastfeeding considerations, 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 or NHS websites, as information may change and your baby is an individual. The guidelines are complex when it comes to timing of doses and selection of specific vaccine types, so it is very important to consult with a medical professional who is familiar with travel health for children.

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), rotavirus, influenza yearly for children older than 6 months, for children older than a year, measles, varicella and hepatitis A, and HPV for girls older than 10.
• 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)
• MMR immunization for children older than 6 months; those over 1 year children should have two doses before traveling.

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 routinely given after 12 months of age, even though many infants are at risk sooner as their maternal antibodies disappear. The reasons it is not given earlier are that

• the vaccine will fail in some younger babies because the maternal antibodies block it and
• the risk of getting measles in the US is low since immunization is so widespread

In the US, there is little risk of infection so the 12 months age limit is fine. When traveling to areas where measles is more common, however, such as Nigeria, it is important to immunize younger children. Therefore, children above six months should be immunized before traveling to such areas.

-- Mike Blyth, MD