For some countries no immunizations are necessary, but the further off the beaten track you go the more necessary it is to take precautions. Be aware that there is often a greater risk of disease with children and in pregnancy.
Leave plenty of time to get your vaccinations before you set off: some of them require an initial shot followed by a booster, and some vaccinations should not be given together. It is recommended you seek medical advice at least six weeks prior to travel.
Record all vaccinations on a International Health Certificate, which is available from your physician or government health department.
Discuss your requirements with your doctor, vaccinations which may be required include:
Cholera:
Despite its poor protection, in some situations it may be wise to have the cholera vaccine eg for the trans-Africa traveler. Very occasionally travelers are asked by immigration officials to present a certificate, even though all countries and the WHO have dropped a cholera immunisation as a health requirement. You might be able to get a certificate without having the injection from a doctor or health centre sympathetic to the vagaries of travel in Africa.
Hepatitis A:
The most common travel-acquired illness after diarrhea which can put you out of action for weeks. Havrix is a vaccination which provides long term immunity (possibly more than 10 years) after an initial injection and a booster at six to 12 months. Gamma globulin is not a vaccination but is ready-made antibody collected from blood donations. It should be given close to departure because, depending on the dose, it only protects for two to six months.
Hepatitis B:
This disease is spread by blood or by sexual activity. Travelers who should consider a hepatitis B vaccination include those visiting countries where there are known to be many carriers, where blood transfusions may not be adequately screened or where sexual contact is a possibility. It involves three injections, the quickest course being over three weeks with a booster at 12 months.
Japanese B Encephalitis:
This mosquito-borne disease is not of great risk to travelers. It occurs in Asia. Consider the vaccination if spending a month or longer in a high risk area, making repeated trips to a risk area or visiting during an epidemic. It involves three injections over 30 days. The vaccine is expensive and has been associated with serious allergic reactions so the decision to have it should be balanced against the risk of contracting the illness.
Meningococcal Meningitis – Healthy people carry this disease; it is transmitted like a cold and you can die from it within a few hours. There are many carriers and vaccination is recommended for travelers to certain parts of Asia, India, Africa and South America. It is also required of all Haj pilgrims entering Saudi Arabia. A single injection will give good protection for three years. The vaccine is not recommended for children under two years because they do not develop satisfactory immunity from it.
Polio:
Polio is a serious, easily transmitted disease, still prevalent in many developing countries. Everyone should keep up to date with this vaccination. A booster every 10 years maintains immunity.
Rabies:
Vaccination should be considered by those who will spend a month or longer in a country where rabies is common, especially if they are cycling, handling animals, caving, traveling to remote areas, or for children (who may not report a bite). Pre-travel rabies vaccination involves having three injections over 21 to 28 days. If someone who has been vaccinated is bitten or scratched by an animal they will require two booster injections of vaccine, those not vaccinated require more.
Tetanus & Diphtheria:
Tetanus can be a fatal wound infection and diphtheria can be a fatal throat infection Everyone should have these vaccinations. After an initial course of three injections, boosters are necessary every 10 years.
Tuberculosis:
TB risk to travelers is usually very low. For those who will be living with or closely associated with local people in high risk areas such as Asia, Africa and some parts of the Americas and Pacific, there may be some risk. As most healthy adults do not develop symptoms, a skin test before and after travel to determine whether exposure has occurred may be considered. A vaccination is recommended for children living in these areas for three months or more.
Typhoid:
This is an important vaccination to have where hygiene is a problem. Available either as an injection or oral capsules.
Yellow Fever:
Yellow fever is now the only vaccine which is a legal requirement for entry into many countries, usually only enforced when coming from an infected area. Protection lasts 10 years and is recommended where the disease is endemic, eg Africa and South America. You usually have to go to a special yellow fever vaccination centre. Vaccination poses some risk during pregnancy but if you must travel to a high-risk area it is advisable; note that people allergic to eggs may not be able to have this vaccine.
Before you travel discuss immunizatio with your doctor.
