The vaccination program and chemoprophylaxis in Tropics

Abstract

Introduction : military deployment to a tropical country will expose soldiers to infectious diseases. Some of these diseases can be avoided by immunization before departure. Our objective is to establish an immunization and chemoprophylaxis planning to protect deployed troops. Methods : first step is to gather medical intelligence from institutional website as WHO, Atlanta CDC, to identify preventable infectious diseases frequent in the country of deployment. Second step is to make the list of vaccines. Vaccination can be divided in two groups: mandatory vaccines depending on national policy (boost) and specific vaccine depending on the geographical area of the deployment (complete vaccination). Finally, we create a timeline for vaccination. For malaria, the chemoprophylaxis is required and must be continued for some time after the end of mission. Results : we deploy 5000 Tunisian soldiers in DR of Congo with MONUC from 2000 to 2010 (500 every year). The timeline of vaccination was: boost for mandatory vaccination: Diphtheria-Tetanus, Typhoid, Polio and Meningitis > 3 months before deployment; complete vaccination for specific immunization: Hepatitis A, Hepatitis B and Yellow Fever >30 to 15 days before deployment; boost at 6 months, in mission, for Hepatitis A and B; chemoprophylaxis: Doxycyline or Mefloquine, begins at day-7 and until 30 days after returning. Conclusion : the results of this vaccination program was satisfying, with a protection of 100% and no lethal case of malaria. Side effects were minor fever and local symptoms, with no immune or neurologic reaction. For chemoprophylaxis, observance was not good, especially for doxycycline.