Overview of Travel Health and Safety

Vaccines

When planning a trip, one of the first things to do is set up an appointment with a health care provider. ("Health care provider" refers to the physician, physician assistant, nurse, or pharmacist that travelers consult to determine their travel health needs; this might be a general practitioner or a travel medicine specialist.) Ideally, the appointment should take place about 4 to 6 weeks before the departure date. Some vaccines and preventive medications need to be started well in advance of travel to be fully effective by the time the destination is reached. Travelers who are not able to plan that far ahead should schedule an appointment as soon as possible to ensure their personal health is protected while traveling.

Along with food, water, insect, and respiratory precautions, vaccines most often eliminate the risk for certain diseases. Many travelers have been vaccinated against "childhood" diseases such as measles and mumps and may already be immune to them. However, not all countries have been able to achieve a high rate of vaccination, and some diseases that are no longer a threat in developed countries are serious problems in developing countries.

Routine Vaccines

Check family records or with a health care provider to ensure dates of past vaccination against measles, mumps, rubella; diphtheria, tetanus, pertussis; varicella; and polio. One type of meningococcal vaccine is given routinely to some children, teens, and college students.

Adults and adolescents who are not immune to common childhood diseases should discuss appropriate protective measures with their health care providers.

Even for travelers who have been previously vaccinated, a health care provider may recommend a booster dose of tetanus/diphtheria/pertussis (Tdap). A booster dose of polio vaccine may also be recommended for those traveling to an area where polio still occurs. (See Tetanus; Polio.) All persons 6 months and older should receive an annual influenza vaccination. All adults 65 years and older should receive an appropriate pneumococcal vaccine(s).

Vaccines that protect against human papillomavirus are available for use in persons 9-45 years old. Vaccines that protect against herpes zoster virus (shingles) are available for persons 18 years and older.

Individuals who are traveling with children whose vaccinations are not complete can usually have those schedules accelerated to provide protection during travel.

Required Vaccines

Under the International Health Regulations, health officials of some countries require proof of yellow fever vaccination as a condition of entry. Some countries require yellow fever vaccination for entry if a traveler has also visited (even if just to change planes) certain other countries during their trip. Check requirements carefully to avoid problems. The vaccine must be given at least 10 days before entry into the country with a requirement. If a required yellow fever vaccine cannot be given (e.g., because of immunocompromise or an allergy to the vaccine), a health care provider may choose to provide a medical exemption letter. (See Yellow Fever.)

Cholera vaccination is rarely recommended for travelers. No country currently requires cholera vaccination for entry, although some local government representatives may ask for it despite official policy. (See Cholera.)

To document receipt of a required vaccine (e.g., yellow fever vaccine), travelers need an International Certificate of Vaccination or Prophylaxis (ICVP), signed and dated when the vaccine was given. Although the entire yellow-colored “booklet” is frequently called the “certificate of vaccination,” the official Certificate is the page itself on which the name and details of the required vaccine are entered, which is recognized worldwide; travelers without one may be denied entry to countries or quarantined for 6 days. Vaccination on the spot, which is not desirable, may be offered in lieu of quarantine. If any injections are offered, insist that sterile disposable needles and freshly opened vaccine vials are used. Some people bring their own needles and syringes when they travel. Other vaccines (e.g., cholera, polio, or meningococcal vaccines) may be documented on a separate page in the booklet.

COVID-19 vaccination is required for entry into many countries and the required documentation of vaccination is variable by country, but for most, a nationally recognized vaccine card (e.g., US CDC COVID-19 vaccination record card, ICVP card) is acceptable.

Special Considerations

Under special circumstances, a traveler may be required or advised to receive additional vaccines or testing for entry to a specific country. For example, most countries have COVID-19 entry procedures in place (e.g., proof of a negative viral test result [PCR or antigen], proof of vaccination, or quarantine upon arrival) and proof of vaccination may be a defacto requirement if unwilling to quarantine for up to 21 days. Travelers who participate in an annual pilgrimage to Mecca (Hajj or Umra) should be vaccinated against influenza and are required to produce proof of vaccination against meningococcal meningitis; travelers living in or staying for long periods in polio-affected countries may be required to produce proof of vaccination against polio when exiting the country. Many countries have additional health-related requirements for long-term visitors; in some cases, these apply to persons staying just a few weeks. When receiving a visa application, review it in detail and check for all health measures required for entry. (See Visas.) Travelers who will be affiliated with any agency, institution, or organization during their stay should ask their contacts if they know of any official or unofficial requirements.

Travel-Related Vaccines

Depending on the destination and the length and nature of the stay, a health care provider might recommend additional vaccines or preventive medications to help reduce the chance of contracting specific illnesses. The 2 most important factors are whether the traveler will be transiting areas where the risk of disease is greater than it is at home and whether certain activities there will put the traveler at risk of contracting these diseases. Search for up-to-date information about current conditions in the countries that will be visited. (See Resources.) Some travel-related vaccines that might be recommended are listed in the vaccine table with the number of doses required and the duration of immunity in those who have previously received that vaccine.

Travel-Related Vaccines That May Be Recommended

Disease	Vaccine Brand Name (US only)	Standard Schedule	Booster	Estimated Duration of Protection
Cholera	Vaxchora	1 dose given 10 days before potential exposure	6 mos if at continued risk	3-6 mos
COVID-19 Multiple other vaccines are in development and some may become available during 2022-23.	Pfizer	2 doses; 1 each at day 0 and 21	Interval not established	> 8 mos
	Moderna	2 doses, 1 each at day 0 and 28	Interval not established	> 8 mos
	Janssen/Johnson & Johnson	1 dose	Interval not established	> 6 months
Hepatitis A	Havrix	2 doses; 1 each at day 0 and at 6-12 mos	None	> 20 yrs
	Vaqta	2 doses; 1 each at day 0 and at 6-18 mos
Hepatitis B	Recombivax HB Engerix-B	3 doses; 1 each at day 0 and at 1-2 mo and 6-18 mos	None	30 yrs
	Heplisav-B	2 doses; 1 each at days 0 and 28 days
Hepatitis A/B	Twinrix	3 doses; 1 each at day 0 and at 1 mo and 6 mos1	None	> 15 yrs
Japanese encephalitis	Ixiaro	2 doses; 1 each at days 0 and 7-28 (depending on age), given 1 wk prior to potential exposure	1 yr after completion of primary series	≥ 10 yrs
Measles, mumps, and rubella	MMR II	2 doses; 1 each at days 0 and 28	None	Lifelong, after 2 doses given at any time in life
Meningococcal meningitis	Menactra Menveo MenQuadfi	1 dose	3-5 yrs	3-5 yrs
Poliomyelitis	IPOL	1 dose in those who received primary childhood series	None	Lifelong, after primary childhood series and a booster in adulthood (age ≥ 18 yrs)
Rabies	RabAvert Imovax	Preexposure: 2 doses; 1 each at days 0 and 7	Travelers: Vaccine response (titer laboratory test) should be checked once 1-3 yrs after primary series completion and a booster received only if response is inadequate or Receive 1 dose 21 days to 3 yrs after primary series completion (no laboratory test needed) Postexposure: 2 additional doses on days 0 and 3 may be required after possible exposure; otherwise, no booster is needed	3 yrs with only 2-dose preexposure series without a titer check or booster (third dose)
Tetanus, Diphtheria, and Pertussis (Tdap)	Adacel Boostrix	1 dose in those who received primary childhood series	10 yrs	10 yrs; 5 yrs for those at high risk for wounds (e.g., those traveling for adventure, those who may be involved in injury-causing activities, or those going to areas with poor medical care)
Typhoid	Typhim Vi (injectable)	1 dose 2 wks prior to exposure	2 yrs if at continued risk	2 yrs
	Vivotif (oral)	4 capsule series: 1 capsule every other day	5 yrs if at continued risk	5 yrs
Yellow fever	YF-VAX	1 dose	10 yrs only for persons at high risk	10 yrs only for persons at high risk or long-stay travelers
Not Currently Available in the US
Cholera	Dukoral	2 doses given 1-6 wks apart	2 yrs if at continued risk	2 yrs
Monkeypox	Jynneos (available in the US from 2023)	2 doses; 1 each at 0 and 4 wks	Interval not established	2 yrs
Tick-borne encephalitis	Encepur FSME-IMMUN/TicoVac (available in the US from 2022)	3 doses; 1 each at day 0, at 1-3 mos, and at 5-12 mos	3 yrs after third primary dose, then subsequent booster every 3-5 yrs if at continued risk	3 or 5 yrs
	TBE-Moscow	2 doses given 5-7 mos apart	12 mos after second primary dose, then subsequent booster every 3 yrs if at continued risk	3 yrs
	EnceVir	2 doses; 1 each at days 0 and 14		3 yrs