Travel vaccinations for Rwanda

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong. All travellers should take care with personal, food and water hygiene. As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch. Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil. Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection. Vaccination is recommended for most travellers, particularly travellers visiting friends and relatives, those in contact with an infected person, young children, frequent or long-stay travellers visiting areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work. All travellers should take care with personal, food and water hygiene. Oral and injectable typhoid vaccinations are available.

Chikungunya is a viral infection spread by mosquitoes which bite mainly during daytime hours. It causes a flu-like illness and can cause severe joint and muscles pains which usually improve in 1–2 weeks but may persist for months or years. It is rarely fatal. This country has not reported chikungunya cases but shares a large land border with a country that has evidence of recent transmission.Information on current outbreaks, where available, will be reported on our outbreak surveillance database. Travellers should avoid mosquito bites, particularly during daytime hours. Vaccination is not usually recommended. Exceptionally, vaccination can be considered for individuals aged 12 years and older. In these situations, further expert advice should be considered. The final decision on vaccination rests with the health professional and the traveller after a detailed risk assessment has been performed. Detailed advice about the use and contraindications of the chikungunya vaccines will be available in the green book chikungunya chapter in the coming months. For now please see our chikungunya in brief page for details.

Cholera is a bacterial infection spread by contaminated food and water. Cholera can cause severe watery diarrhoea, although mild infections are common. The risk of cholera for most travellers is low. All travellers should take care with personal, food and water hygiene. This oral vaccine is recommended for those whose activities or medical history put them at increased risk of infection or complications. This includes: humanitarian aid workers persons going to areas of cholera outbreaks who have limited access to safe water and medical care other travellers to cholera risk areas, for whom vaccination is considered potentially beneficial (e.g. due to their occupation, activities or underlying health problems)

Dengue is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travellers. The mosquitoes that spread dengue are more common in towns, cities and surrounding areas. There is a risk of dengue in this country.Information on current outbreaks, where available, will be reported on our outbreak surveillance database. Travellers should avoid mosquito bites, particularly during daytime hours. Vaccination can be considered for individuals aged 4 years of age and older who have had dengue infection in the past and who are: travelling to areas where there is a risk of dengue infection or areas with an ongoing outbreak of dengue, or are exposed to dengue virus through their work, such as laboratory staff working with the virus Exceptionally, vaccination can be considered in those who have not had dengue in the past. In these situations, further expert advice should be considered. Detailed guidance on how to ascertain previous infection is available in the UK Health Security Agency Immunisation against infectious disease the 'Green book'. The final decision on vaccination rests with the health professional and the traveller after a detailed risk assessment has been performed and the potential risks of vaccination explained.

Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. This country is considered to have an intermediate or high prevalence of hepatitis B. Travellers should avoid contact with blood or body fluids. This includes: Avoiding unprotected sexual intercourse. Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used). Not sharing needles or other injection equipment. Following universal precautions if working in a healthcare or other higher risk setting. A sterile medical equipment kit may be helpful when travelling to resource poor areas. Vaccination could be considered for all travellers and is recommended for those whose activities or medical history put them at increased risk. This includes: Those who may have unprotected sex. Those who may be exposed to contaminated needles through injecting drug use. Those who may be exposed to blood or body fluids through their work (e.g. health and aid workers). Those at high risk of requiring medical or dental procedures or hospitalisation e.g. those with pre-existing medical conditions, those who may require travelling for medical care abroad, or those travelling to visit families or relatives. Long-stay travellers. Those who are participating in contact sports. Families adopting children from this country.

Measles is a highly infectious viral illness, spread by airborne or droplet (coughing, sneezing, drops from mouth/nose) transmission. Measles usually starts with cold-like symptoms e.g. fever, cough, runny nose and conjunctivitis (sore, red eyes). This is followed by a blotchy rash starting on the face/head and spreading to the rest of the body. Complications of measles infection can include ear infections, diarrhoea, pneumonia and convulsions (fits). Life-threatening complications such as encephalitis (brain inflammation) can occur on rare occasions. Measles can have serious consequences especially in children under 1 year of age, immunosuppressed individuals (those with a weakened immune system) and during pregnancy. Measles is either 'endemic' (continuous transmission in a 12-month period) and/or the measles risk is assessed to be greater than in the UK due to current outbreaks, conflict, damaged infrastructure, travel-related cases or poor vaccine coverage. All travellers should follow good respiratory hygiene rules and avoid contact with individuals with measles infection. All travellers should make sure they are up to date with the measles, mumps and rubella (MMR) or measles, mumps, rubella and chickenpox (MMRV) vaccines, according to current UK recommendations. Guidance on vaccinating adults can be found in Measles: the green book chapter – GOV.UK.Consider early Measles Mumps Rubella (MMR)/Measles Mumps Rubella Varicella (MMRV) vaccination for infants and children. Infants from six months of age who are likely to be mixing with local people, should receive a MMR vaccine. The MMRV vaccine can be given from nine months of age if MMR is not available at the time of the appointment. Not all children will respond to MMR/MMRV given in the first year of life. When the vaccine has been given before one year of age this dose should be discounted and two further doses of MMR/MMRV should be given at the recommended ages. Children who are travelling and have already received one dose of MMR/MMRV at the routine age should have the second dose brought forward to at least one month after the first. If a child is given the second dose less than three months after the first dose and is less than 18 months of age, then the routine 18-month dose (which would constitute a third dose) should be given in order to provide optimum protection.

Invasive meningococcal disease (IMD) is a serious bacterial infection spread by close or direct contact with respiratory droplets from an infected (usually asymptomatic) person, often through coughing and sneezing or sharing cooking utensils. This is usually after lengthy and/or frequent close contact. The most common types of IMD are meningococcal meningitis (infection of the protective lining around the brain) and septicaemia (blood poisoning). Non-invasive meningococcal disease includes conjunctivitis, which can put the individual traveller (and any of their close contacts) at risk of developing IMD. Travellers at increased risk include health workers, people visiting friends and relatives and long-stay travellers in close contact with local people. This country is part of the extended meningitis belt of sub-Saharan Africa. Whenever possible, travellers should avoid overcrowded conditions and follow good respiratory hygiene rules. Meningococcal ACWY conjugate vaccine is recommended for travellers whose activities or medical condition put them at increased risk of meningococcal disease, including: healthcare workers people visiting friends and relatives 'rough' travellers such as backpackers long-stay travellers who have close contact with local people travellers with certain rare immune system problems called complement disorders people whose spleen does not work properly (hyposplenia) or who do not have a spleen (asplenia)

Rabies is a viral infection which is usually transmitted following contact with the saliva of an infected animal most often via a bite, scratch or lick to an open wound or mucous membrane (such as on the eye, nose or mouth). Although many different animals can transmit the virus, most cases follow a bite or scratch from an infected dog. In some parts of the world, bats are an important source of infection. Rabies symptoms can take some time to develop, but when they do, the condition is almost always fatal. The risk of exposure is increased by certain activities and length of stay (see below). Children are at increased risk as they are less likely to avoid contact with animals and to report a bite, scratch or lick. Rabies is considered a risk and has been reported in domestic animals in this country. Bats may also carry rabies-like viruses. Travellers should avoid contact with all animals. Rabies is preventable with prompt post-exposure treatment. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Post-exposure treatment and advice should be in accordance with national guidelines. A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply world-wide. Pre-exposure vaccinations are recommended for travellers whose activities put them at increased risk including: those at risk due to their work (e.g. laboratory staff working with the virus, those working with animals or health workers who may be caring for infected patients). those travelling to areas where access to post-exposure treatment and medical care is limited. those planning higher risk activities such as running or cycling. long-stay travellers (more than one month).

TB is a bacterial infection most commonly affecting the lungs but can affect any part of the body. When a person with TB in their lungs or throat coughs or sneezes they could pass TB on to other people. TB is curable but can be serious if not treated. The BCG vaccination helps to protect some people, particularly babies and young children who are at increased risk from TB. This country has reported an annual TB incidence of greater than or equal to 40 cases per 100,000 population at least once in the last five years (further details). Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) or laryngeal (throat) TB. Those at risk during their work (such as healthcare workers) should take appropriate infection control and prevention precautions. BCG vaccine is recommended for those at increased risk of developing severe disease and/or of exposure to TB infection. See UK Health Security Agency Immunisation against infectious disease, the 'Green Book'. For travellers, BCG vaccine is recommended for: Unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country. A tuberculin skin test is required prior to vaccination for all children from 6 years of age and may be recommended for some younger children. Unvaccinated, tuberculin skin test-negative individuals at risk due to their work such as healthcare or laboratory workers who have direct contact with TB patients or potentially infectious clinical material and vets and abattoir workers who handle animal material, which could be infected with TB. There are specific contraindications to BCG vaccine. Health professionals must be trained and assessed as competent to administer this vaccine intradermally. Following administration, no further vaccines should be administered in the same limb for 3 months. The BCG vaccine is given once only, booster doses are not recommended.

Yellow fever is a viral infection transmitted by mosquitoes which predominantly feed between dawn and dusk, but may also bite at night, especially in the jungle environment. Symptoms may be absent or mild, but in severe cases it can cause internal bleeding, organ failure and death. There is a low potential for exposure to yellow fever throughout this country (see below). Travellers should avoid mosquito bites at all times. Areas with low potential for exposure to yellow fever only (see green areas on the map) Vaccination is generally not recommended for travel to Rwanda as there is a low potential for exposure to yellow fever. People aged 60 years or older should not be given the vaccine for travel to Rwanda due to a higher risk of life-threatening side effects. Vaccination could be considered for a small subset of travellers (aged 9 months to less than 60 years of age) to areas with a low potential for exposure who are at increased risk because of: prolonged travel. heavy exposure to mosquito bites. inability to avoid insect bites. See vaccine recommendation map below. The yellow fever vaccine is not suitable for all travellers, there are specific undesirable effects associated with it. This vaccine is only available at registered yellow fever vaccination centres. Health professionals should carefully assess the risks and benefits of the vaccine, and seek specialist advice if necessary. Click on map to open in a new window