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 a traveler consults 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 immunization, and some diseases that are no longer a threat in developed countries are serious problems in developing countries.

Routine Immunizations

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) or tetanus/diphtheria (Td). 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 immunization. All adults 65 years and older should receive a complete series of 2 doses of pneumococcal vaccine.

Vaccines that protect against human papillomavirus are available for use in persons 9-26 years old. Vaccines that protects against herpes zoster virus (shingles) are available for persons 50 years and older.

Individuals who are traveling with children whose immunizations 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 can 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 where it is required. (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, signed and dated when the vaccine was given. The Certificate is recognized worldwide, and 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 titled "Other Vaccinations" in the WHO-issued Certificate; in the CDC-issued Certificate, this page is referred to as "Other Immunizations/Prophylaxis Received."

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.

Special Considerations

Under special circumstances, a traveler may be required or recommended to receive additional vaccines or testing for entry to a specific country. For example, 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.

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 (U.S. only) Standard Schedule Booster Estimated Duration of Protection
Cholera Vaxchora 1 dose given 10 days before potential exposure 6 mos with continued risk 3-6 mos
Hepatitis A Havrix 2 doses at day 0 and at 6-12 mos None > 20 yrs
Vaqta 2 doses at day 0 and at 6-18 mos
Hepatitis B Recombivax HB, Engerix-B 3 doses at day 0 and at 1 mo and 6 mos1 None 30 yrs
Heplisav-B 2 doses at day 0 and 1 mo
Hepatitis A/B Twinrix 3 doses at day 0 and at 1 mo and 6 mos1 None > 15 yrs
Japanese encephalitis Ixiaro 2 doses at days 0 and 28, given 1 wk prior to potential exposure2 1-2 yrs after 2nd dose ≥ 10 yrs
Measles, mumps, and rubella MMR II 2 doses at days 0 and 28 None Lifelong, after 2 doses given at any time in life
Meningococcal meningitis Menactra, Menveo 1 dose 3-5 yrs 3-5 yrs
Poliomyelitis IPOL 1 dose in those who received primary childhood series   Lifelong, after primary childhood series and a booster in adulthood (age ≥ 18 yrs)
Rabies RabAvert, Imovax Preexposure: 3 doses at days 0, 7, and 21-28 Postexposure: 2 additional doses on days 0 and 3 may be required after possible exposure; otherwise, no booster is needed 2 yrs
Tetanus, Diphtheria, and Pertussis Adacel, Boostrix (Tdap) 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 2-3 yrs 2-3 yrs
Vivotif (oral) 4 capsule series: 1 capsule every other day 5 yrs 5 yrs
Yellow fever YF-VAX 1 dose 10 yrs for high-risk persons 10 yrs for high-risk persons, long-term for others
Stamaril
Not Currently Available in the U.S.
Cholera Dukoral 2 doses given 1 wk apart 2 yrs 2 yrs
Tick-borne encephalitis Encepur, FSME-IMMUN 3 doses at day 0, at 1-3 mos, and at 5-12 mos 3 yrs after 3rd primary dose, then subsequent booster every 3-5 yrs with continued risk 3 or 5 yrs
  1. Accelerated schedule: Days 0, 7, and 21.
  2. Accelerated schedule: Days 0 and 7.