Vaccines for Foreign Travel

When you travel overseas, your need for a particular vaccine depends on several factors, including your age, the season, the countries you would be visiting, the length of your stay, the reason for your trip, your accommodations, lifestyles, and overall health. Do keep in mind that some vaccines are not appropriate for children, pregnant women, and people with certain medical conditions.

Getting vaccinated before traveling would require a consultation two to three months in advance with your physician or a health care provider, who would review your travel plans and decide if you need any vaccines. The immunization shots you got when you were a child may also need to be updated if you are not fully protected.

Remember that most frequent health problems faced by international travelers are not preventable by vaccines. Also, remember that immunization is not a substitute for careful selection and handling of food and water. Vaccines that may be needed to protect you and your loved ones include the following.

Accelerated primary vaccination – If your infant will join you on your overseas travel, the primary vaccination series with diphtheria, tetanus, acellular pertussis, polio, Haemophilus influenza type b, and pneumococcal conjugate can be started as young as six weeks of age.

Cholera – Some travelers to parts of Africa may be required to get vaccinated against cholera. It is best to get your shot in your home country rather than overseas, as there are related risks of immunization in some countries.

Hepatitis A – It is the most common vaccine-preventable disease among travelers. Protecting yourself against hepatitis A is highly recommended for all travelers to developing countries, especially to rural areas or places with inadequate sanitary facilities in countries where the disease is endemic.

Hepatitis B – Vaccine for hepatitis B is recommended particularly to travelers (both adults, infants, and children) who would be residing in areas with high levels of endemic hepatitis B or working in health care facilities, as well as adults who are likely to have contact with blood or to have sexual contact with residents in the area.

Influenza – People with high risks of influenza who are embarking on foreign travel to destinations where influenza is likely to be circulating should be immunized with the most current available vaccine. Influenza transmission is enhanced in crowded conditions associated with air travel, cruise ships, and tour groups.

Japanese encephalitis – It is the leading cause of viral encephalitis in Asia, but the disease is rare among travelers. Its incidence has been decreasing in China, Korea, and Japan, but increasing in Bangladesh, India, Nepal, Pakistan, northern Thailand, and Vietnam.

It occurs in epidemics in late summer and early fall in temperate areas and sporadically throughout the year. Getting vaccinated should be considered for those who will spend at least a month in endemic or epidemic areas during the transmission season, especially if travel would include rural areas.

Measles, mumps, rubella – These three diseases are endemic in many countries. Protection against measles is especially important for people who are planning to travel in a foreign land, including adolescents and adults who have not had measles disease and have not been adequately immunized.

Two doses of vaccine against measles, or MMR, are recommended for all unimmunized adult travelers who were born in or after 1970, as well as infants as early as six months of age, and who are going to a measles-endemic area, unless there is proof of immunity or physician documentation of prior measles (as having measles as a child develops your own immunization against future measle attacks).

Similarly, protection against rubella is especially important for women who are not immune to the disease.

Meningococcal disease – Some countries, such as Saudi Arabia, require proof that you have been immunized against meningococcal disease. Quadrivalent polysaccharide vaccine is recommended for this illness.

Pertussis – Also known as whooping cough, acellular pertussis is a highly contagious disease caused by a certain bacteria, characterized by a severe hacking cough followed by a high-pitched intake of breath. For adults who have not previously received a dose of acellular pertussis vaccine, it is recommended that the tetanus and diphtheria booster dose be replaced by the combined Tdap vaccine.

Poliomyelitis – The risk of polio among travelers may have substantially decreased, but it is best to contribute in the global eradication of this disease. A single booster shot of poliomyelitis vaccine, or IPV, in adulthood is recommended for international travelers who plan to visit places where the polio virus continues to circulate in either epidemic or endemic fashion.

Rabies – Pre-exposure vaccination should be considered for travelers who are intending to live or work in areas where rabies control programs for domestic animals are inadequate. Children, particulalry those who are too young to understand the need to avoid animals or to report bites, should also be considered for immunization. After exposure to a rabid animal, having two additional doses of rabies vaccine is imperative as soon as possible.

Tetanus and diphtheria – Tetanus is characterized by a prolonged contraction of skeletal muscle fibers, while diphtheria is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane on the tonsils, pharynx, or nasal cavity. Both are now rare in North America, but it still are fatal and widespread in other countries. Adult traveler should be vaccinated against tetanus and diphtheria with a Td vaccine booster dose every 10 years for optimum protection.

Tuberculosis – Immunization with Bacille Calmette-Guerin vaccine, or BCG, may be considered for travelers who are planning to extend their stays in areas of high prevalence of tuberculosis. Travelers are advised to consult a specialist in travel medicine or infectious diseases when considering a deicison for or against BCG immunization.

Typhoid – Vaccine against typhoid is recommended for travelers who will have prolonged exposure to potentially contaminated food and water, especially those traveling to smaller cities and villages that are off the usual tourist itineraries in countries with a high incidence of the disease. Immunization is also considered for those with reduced or absent gastric acid secretion, while it is not recommended for business travelers or short-term holiday seekers in resort hotels in such countries.

Yellow fever – This is the only vaccine required as a condition for entry under the World Health Organization’s International health Regulations. A valid certificate of vaccination, which is issued within the previous 10 years, is mandatory for entry into certain countries in Africa and South America. Contact your local health clinic regarding centers that can provide the International Certificate of Vaccination.