Special Vaccination Requirements
Before traveling outside the United States, it's important to review your vaccination schedule with your health care provider. This should be done as far in advance as possible so that any special vaccinations can be scheduled and given. The Centers for Disease Control and Prevention (CDC) sas if you are yplanning to travel, review the vaccines below with your health care provider at least 4 to 6 weeks before travel begins. Some vaccines can't be given at the same time as others. Some require more than 1 dose, and some must be given as much as 1 month before travel to be protective. These vaccines are not for all people, and there may be specific situations in which they should not be used.
The primary vaccine series
Review your immunization history with your health care provider and be sure that infants and children are on schedule with their vaccine series. Adults should have completed the primary series of all childhood vaccines. A booster of the adult tetanus-diphtheria (Td) is recommended every 10 years. If an adult has not yet received a tetanus booster containing the pertussis (whooping cough) vaccine known as Tdap, he or she should receive that vaccine instead of a Td booster alone. After the one-time administration of the Tdap vaccine, the Td alone every 10 years is appropriate.
What additional vaccines are recommended?
The CDC divides travel vaccines into routine, recommended, and required categories. Your provider will review all categories with you, specific to the area where you will be traveling.
The following is a list of vaccines to be considered:
A yearly influenza (flu) vaccine is recommended by the CDC for everyone age 6 months and older.
Two pneumococcal vaccines are also recommended for people 65 years or older and for other people at high risk (those with heart disease, cancer, diabetes, lung problems including asthma, kidney problems, or problems with their immune systems).
Infants, children, and adults traveling to countries where polio is still active, and staying for more than 4 weeks, should get age-appropriate polio vaccines or a polio booster within 12 months before travel.
Two doses of the measles-mumps-rubella (MMR) vaccine are recommended for people born after 1956 who are traveling outside the United States.
What other vaccinations may be needed?
Yellow Fever vaccination may be required for travel to certain countries in Africa and is recommended for several areas in South America. A certificate of vaccination may also be needed.
Hepatitis B should be considered for people who will be in an area where high rates of hepatitis B exist. This includes Asia, Africa, some areas of the Middle East, the islands of the South and Western Pacific, some areas of South America, and certain areas in the Caribbean (such as the Dominican Republic and Haiti). Children who have not received this vaccine previously should do so. For those who have completed the primary vaccination series, a booster is not recommended.
Hepatitis A and/or immune globulin (IG) is recommended for travelers to all areas where there is significant risk of hepatitis A, even for travelers staying in urban areas and luxury hotels in those regions. For those who have completed the primary vaccination series, a booster is not recommended.
Typhoid vaccine is recommended for travelers spending time in areas where food and water precautions are recommended, including South Asia (which has some drug-resistant forms) and in Asia, Africa, and Central and South America.
Meningococcal vaccine is recommended for people traveling to sub-Saharan Africa during the dry season (from December to June), and is required for visitors to Saudi Arabia during the Hajj, especially if anticipating close contact with locals.
Japanese encephalitis or tick-borne encephalitis vaccine should be considered by those undertaking long-term travel or who plan to live in areas of risk, including rural farming areas.
Rabies vaccination may be needed if you will be in unprotected rural outdoor areas where rabies is common and may be exposed to wild animals.
Currently, the risk for cholera is very low for people visiting areas with epidemic cholera when simple precautions are observed, including drinking and using safe water, cooking foods safely, and thorough hand-washing. The cholera vaccine is not very effective, is not recommended for most travelers, and is not available in the U.S.
Travelers to countries with malaria are advised to take antimalarial medication. However, none of the antimalarial medications are completely effective and travelers in areas of risk must also use personal protective measures including insect repellent, long sleeves, long pants, sleeping in a mosquito-free setting or using an insecticide-treated bed net.
Many of these vaccines can be given at the same time without any decrease in their effectiveness. Consult your doctor for more information regarding the proper administration of these vaccines and medications.
- Bowers, Nancy, RN, BSN, MPH
- Holloway, Beth, RN, M.Ed.
- MMI board-certified, academically affiliated clinician