Everything you need to know about travel vaccines

International travel is fun and exiting but with it comes some risk of infections and illnesses that you may not be exposed to at home.   Healthcare systems are not the same the world around, so the best policy is to be well prepared and optimally protected before you travel.  A key component of ‘being prepared’ is to ensure you are appropriately vaccinated.

Most vaccines take 4-6 weeks to be effective, so you need to plan ahead and not leave this to the last minute.   Some such the hepatitis A vaccine takes even longer.  The advice on this page is very generic, and not intended as individual medical advice but can provide a starting point that can be used as a discussion point with your family physician or travel doctor.

Most of the content on this page is adapted and summarized from information provided on the CDC and from the WHO websites.

Make sure all your standard vaccines are up-to-date

The following vaccines are part of routine childhood vaccinations in most industrialized nations.  They cover important preventable diseases that are still common in parts of the world.  It is important to make sure you have had them and in some cases it may be worthwhile getting a booster.

  • Measles Mumps and Rubella (MMR)
  • Diphtheria-tetanus-pertussis (Tdap)
  • Polio vaccine (IPV)
  • Hepatitis A
  • Hepatitis B
  • Meningococcal (Menectra)
  • Yearly influenza vaccine
Man with post polio syndrome
Man with post polio syndrome affecting his right leg. Photo Credit: CDC/NIP/ Barbara Rice

Summary of routine vaccines and the diseases they cover

DiseaseMost common vaccineSymptoms of the diseaseWorst areasIs it a live vaccine
MeaslesMMRVery contagious viral illness presenting with high fever, head cold, spots in mouth, red flat rash which is wide spread. 1/3 people can get complication such as diarrhoea, pneumonia, blindness, hearing loss, brain inflammation and occassionaly death.Africa, South East Asia and Western Pacific but there are regular outbreaks elsewhere. WHO figures sugges approx. 90,000 deaths in 2016 globallyYes
MumpsMMRViral illness that causes fever, and swollen inflammed salivary glands, especially the parotid gland. Usually mild in childhood, but if you get it as an adult can cause meningitis, encehpalitis (brain inflammation), deafness, pneumonia and orchitis (inflammation of testicles - resulting in infertility).Common in many parts of the world including Europe, Africa, Asia and the Pacific.Yes
RubellaMMRSimilar symptoms to the flu but with a rash that starts on the face and spreads to the trunk and limbs. Usually a mild illness. Main concern is if a pregnant woman gets Rubella, there is high risk of fetal death, but if fetus survives high chance of major organ abnormalities.Regular outbreaks world wide, but more common in developing areasYes
TetanusTdapLock Jaw. Starts as muscle spasm that at the jaw but progresses to involve the whole body. Up to 10% of people can die! Caused by the a bacteria called clostridium tetani which is commonly found in soil, dust, and manure. Port of entry is a break in the skin - usually a puncture wound.All parts of the world, but more common in hot and wet climatesNo
DiptheriaTdapResult of a toxin produce by Corynebacterium diphtheriae. The bacterial infection is aquired when some with the disease coughs or sneezes on you. Symptoms include fever, sore throat, swollen lymphnodes, blue discolouration of the skin, difficulty swallowing and difficulty breathing. Airway obstruction is usually cause of death. It can cause heart muscle inflammation and arrythmias. Overall mortality is 5-10%, but higher in the young and elderly.Highest rates seen in South East Asia, the Middle East, and RussiaNo
PertusisisTdapKnow as Whooping Cough or the 100 day cough. Caused by a contagious bacteria Bordatella pertussis which is carried in droplets from infected people coughing or sneezing. Main symptom is intermittent bouts of uncontrollable coughing. The severity of coughing can cause rib fractures, hernias and urinary incontinnence. Infection in newborns can be very severe and fatal.Africa, Middle East and South East AsiaNo
PolioOPV and IPVCaused by the poliomyelitis virus. Spread from infected fecal material entering mouth (i.e. from unwashed hands contaminating food). Causes muscle weakness and paralysis in a small proportion. If paralysis occurs, then mortality is as high as 30% in adults.Pockets of Africa and Asia.OPV is live
IPV is not
Hepatitis AHep ATransmitted through the fecal oral route - i.e. with someone not washing hands and preparing food is the most common example. Causes inflammation of the liver (hepatitis). Symptoms are stomach pain, fever, diarrhea, nausea, going yellow (jaundice) and rarely liver failure and deathWorld wide but highest rates in Africa, South America and Asia.No
Hepatitis BHep BViral infection of the liver. Usually a mild illness in adults and usually short lived. There is mother to baby transmission at birth and is endemic in parts of the world. If aquired at birth it becomes a chronic infection that can cause liver cirrhosis and liver cancer. Trasmission is through exchange of body fluids - so usually sexual transmission or use of used needles.......Could potentially skip this vaccine unless you intend on taking part in behaviours that put you at riskAfrica, Asia, Parts of South America and Pacific Islands.No
MeningitisMenectraInfection by a bacteria called Neisseria Meningitides. Causes inflammation of the lining of the brain and spinal cord and/or blood poisoining (sepsis). Transmission is by someone infected coughing or sneezing on you. Early symptoms are severe headache and neck stiffness. Untreated the mortality is 50%. If treated death rate is still 10-15% within 3-4 days.Highest risk is in Sub-Saharan Africa, but outbreaks occur worldwide.No

Destination specific travel specific vaccines

Typhoid

Typhoid fever is caused by Salmonella Typhi which is found in contaminated drinking water and food.  Endemic in India, other parts of Asia and Africa.  Causes a febrile illness that may include diarrhea, headaches, muscle aches and nausea.  Severity varies, but in severe cases can cause death.    There are 2 forms of the vaccine available – the live oral vaccine provides cover for about 5 years; the inject-able  dead one provides 2 years of cover.

Yellow fever

The yellow fever virus is transmitted by mosquitoes.  It is common in tropical and subtropical areas of South America and Africa.  Most cases of yellow fever are mild with flu like symptoms, but in about 15% there is a more serious toxic phase that causes liver damage and kideny injury.  This is manifest as the person going yellow and hence the name.   About 50% of people who get this ‘toxic’ phase die.  There is no treatment.   The vaccine is a live attenuated vaccine that is effective within 10 days, and lasts about 10 years.  Some countries require proof of vaccination if you have traveled to an area where there is yellow fever prior to being allowed in.

Aedes aegypti mosquito is the common vector for the yellow fever virus
Aedes aegypti mosquito is the common vector for the yellow fever virus

Rabies

Rabies is a viral illness that causes inflammation of the brain in humans and other mammals.  It is normally transmitted by the bite or scratch of an infected animal.   The time period from the bite or scratch to developing symptoms is 1 to 3 months.  The symptoms are usually fever of water, confusion, uncontrolled violent movements or inability to move body parts.  Once symptoms start the end result is almost always death.  Most rabies deaths occur in Asia and Africa.  Vaccination reduces risk of developing the disease but is not perfect.  The recommendation is that if you are bitten you still get anti-rabies immunoglobulin as soon as possible and a further 4 vaccine doses.

Bats are now an important carrier of rabies. Beware a scratch or a bite! Photo credit: USFWS/Ann Froschauer

Special considerations when receiving live vaccines

It is important to know if the vaccine is a live vaccine.  This means the vaccine contains a live (but attenuated) organism that can cause the disease if you are immune compromised.  In general, if the vaccine is live and you are immune compromised through illness (such as HIV) or on an immune suppressant mediation, then you should not have the vaccine.  Immune suppressants include medications that are used to treat arthritis such as methotrexate.   There are some exceptions, but you will need to discuss this carefully with the travel doctor.  If you are in this category you may need to get a yellow fever exemption certificate if traveling through a yellow fever area and you can’t get the vaccine.

Other vaccines to consider

Travels with chronic diseases and on immune suppressant medication should consider vaccination against Streptococcus pneumoniae infection.   This is a routine vaccine combination given to those over 65 in some industrialized countries to prevent pneumonia, septicemia and  meningitis caused by this bacteria.  It is now on the childhood vaccination schedule but is a relatively recent addition so it is unlikely that if you are an adult that you would have had this vaccine.

 

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