Vaccination guide by destination
The following guide is broken down into geographic zones and matched to the vaccines needed for that region.
| Zone 1: Western Europe, Canada, Australia, New Zealand | Zone 2: Central and South America, the Caribbean Islands and Pacific Islands, the former Soviet Union | Zone 3: Africa, the Middle East, Asia (not including Japan), Eastern Europe, the Indian Subcontinent | |
| Diptheria, tetanus, pertussis | Travelers should have completed a primary series with booster within past 10 years. | Travelers should have completed a primary series with booster within past 10 years. | Travelers should have completed a primary series with booster within past 10 years. |
| Measles, mumps, rubella | Vaccinate if traveler was born in 1957 or later and has had fewer than 2 doses. | Vaccinate if traveler was born in 1957 or later and has had fewer than 2 doses. | Vaccinate if traveler was born in 1957 or later and has had fewer than 2 doses. |
| Varicella | Vaccinate if not immune. | Vaccinate if not immune. | |
| Influenza | Vaccinate if traveler is at risk for complications from disease and seasonal risk exists. | Vaccinate if traveler is at risk for complications from disease and seasonal risk exists. | Vaccinate if traveler is at risk for complications from disease and seasonal risk exists. |
| Pneumococcal | Vaccinate if traveler is at risk of disease. | Vaccinate if traveler is at risk of disease. | Vaccinate if traveler is at risk of disease. |
| Cholera | Vaccine not recommended, although may rarely be. | Vaccine not recommended, although may rarely be. | |
| Hepatitis A | Vaccinate. | Vaccinate. | |
| Hepatitis B | Vaccinate if traveler is at risk. | Vaccinate if traveler is at risk. | |
| Malaria | Check current level of risk to traveler, including drug resistance. | Check current level of risk to traveler, including drug resistance. | |
| Meningococcal disease | Check risk, including current outbreaks. | ||
| Polio | Vaccination may be recommended for travel to Eastern Hemisphere. | Vaccination may be recommended for travel to Eastern Hemisphere. | |
| Rabies | Vaccinate if itinerary and/or activity places traveler at risk. | Vaccinate if itinerary and/or activity places traveler at risk. | |
| Typhoid | Vaccinate if itinerary places traveler at risk. | Vaccinate if itinerary places traveler at risk. | |
| Japanese encephalitis | Vaccinate if itinerary places traveler at risk. | Vaccinate if itinerary places traveler at risk. | |
| Yellow fever | Vaccination may be required to or from countries in Africa and South America. | Vaccination may be required to or from countries in Africa and South America. |
Timing for vaccinations
Choosing the appropriate timing for vaccines for international travel is very important. All routine vaccinations should have been completed prior to matriculation. The following list of vaccinations may be given, depending on the region of travel as outlined above.
- Diptheria, tetanus, pertussis. All travelers should have completed a series of DTaP, DTP, or Td shots. If 10 years have elapsed since completion of primary series or since the last booster dose, administer a Td booster.
- Measles, mumps, rubella. All travelers born in 1957 or later should have a history of MMR vaccine. Persons > 10 years old should have received 2 doses.
- Varicella. Vaccination should be considered for travelers who do not have evidence of immunity to varicella zoster virus, especially if the traveler expects to have close personal contact with local populations. Two doses 4-8 weeks apart are given to those 13 years and older.
- Influenza. Persons wishing to reduce the likelihood of becoming ill with influenza during travel, especially those at risk of complications from the disease and who are traveling to the tropics at any time of year or to southern hemishperic countries from April through September, should be given the most current influenza vaccine if not vaccinated in the preceding season.
- Pneumococcal. Unvaccinated persons at high risk of pneumococcal disease should receive the vaccine.
- Cholera. For most destinations, the risk of cholera is low. Persons traveling to cholera-infected areas are advised to avoid eating uncooked food, especially fish and shellfish, to eat only peeled fruits, and to drink bottled beverages. A vaccine for cholera is available; however, it provides only brief and incomplete immunity and is not recommended fro travelers. No country or territory requires vaccination as a condition for entry, although some local authorities may require it. In such cases, one dose of vaccine will usually satisfy entry requirements. A complete series, consisting of 2 doses, separated by 1-4 weeks, with a booster 6 months later, may be given only for special high-risk groups that work and live in highly endemic areas under less than sanitary conditions.
- Hepatitis A. Persons traveling to countries with high or intermediate endemicity of hepatitis A virus infection should be vaccinated. Adults should receive a 1.0 mL dose. All travelers should receive vaccine booster doses after 6 months for long-term protection.
- Hepatitis B. Travelers at risk of Hepatitis B virus infection include health care workers, persons who might need medical care while traveling in endemic countries, those who expect to have sexual or other intimate contact with the local population in countries where hepatitis B virus in endemic, and long-term travelers (>6 months) to endemic areas. Ideally, vaccination should be initiated 6 months prior to departure in order to complete a 3-dose schedule. If time does no permit, either 1 or 2 doses should be given and the remaining doses may be completed at a later date.
- Malaria. Travelers whose itinerary places them at risk of malaria should take measures to avoid mosquito bites, especially between dusk and dawn. Patients should be advised to wear protective clothing, remain in a well-screened area (if not possible, a bed net, preferably sprayed with permethrin, should be used while sleeping), use a repellent containing 30-35 percent DEET concentrations, receive an appropriate prophylactic medication, and seek immediate treatment is symptoms develop.
- Meningococcal disease. Vaccine is indicated for travelers to countries having epidemic meningococcal disease (e.g., sub-Saharan Africa) and is required for pilgrims to Mecca, Saudi Arabia, for the annual Hajj. Adults should receive a 0.5 mL dose of vaccine with boosters after 3-5 years, if traveler remains at risk of disease.
- Polio. Travelers to areas where poliomyelitis is endemic should complete a series of IPV or OPV. Adults who have previously completed a primary series with any one or combination of vaccines should be given an additional dose of IPV or OPV. Unvaccinated adults should be given vaccine as follows: if less then 4 weeks to travel, give one dose of OPV or IPV; if 4-8 weeks give 2 doses of IPV 4 weeks apart; if 8-12 weeks, give 3 doses of IPV 4 weeks apart; if 3 or more months, give 2 doses of IPV 4-8 weeks apart, and a third dose 6-12 months after the second dose. Adults who have a history of incomplete IPV or OPV should be given the remaining doses.
- Rabies. Pre-exposure vaccination for rabies is recommended fro travelers planning to live or visit (>30 days) areas of the world where dog rabies is endemic (e.g., parts of Central and South America, Asia, and Africa). Vaccination consists of 3 doses of human diploid cell rabies vaccine (HDCV) or Rabies Vaccine Adsorbed (RVA), 1.0 mL, one each on days 0, 7, and 21 or 28. If the traveler will be taking chloroquine or mefloquine for malaria chemoprophylaxis, the 3-dose series must be completed before initiation of the antimalarials. Travelers should be advised to seek immediate attention should an animal bite occur since pre-exposure vaccination does not eliminate the need for additional therapy.
- Typhoid. Vaccination against typhoid is recommended for travel to countries where there is a recognized risk of exposure to Salmonella typhi, such as the developing countries of Latin America, Asia, and Africa. Three types of typhoid vaccine are available (Ty21a, VICPS, and whole cell). Either live or inactivated vaccine may be given, depending on the age of the patient and the length of time remaining before departure. Booster doses are indicated to maintain immunity.
- Japanese encephalitis. Vaccine is recommended for travelers planning to live for prolonged periods in rural areas of Asia (China, Japan, Korea, and eastern areas of Russia). A 3-dose series of inactivated viral vaccine should be given at 0, 7, and 30 days; booster doses, if needed, should be given 3 years after the completion of the primary series. Patients needing vaccination will be referred to Barnes Care.
- Yellow fever: Vaccination against yellow fever may be a requirement for entry into countries with areas reporting yellow fever or within endemic zones (e.g., parts of Africa and South America). Patients needing vaccination will be referred to Barnes Care.
For more information on specific diseases and vaccines available for travelers, as well as additional travel tips, visit the Centers for Disease Control (CDC) website.