Travel-Related Vaccinations

Prescriptions can not be given without a travel consult appointment - See "First Visit" page for more details

Hepatitis A virus causes liver infection with fever and jaundice. Although rarely life-threatening, this illness can be severe and recovery can be prolonged. Infection is passed by consuming contaminated food or water. The initial dose of vaccine protects for a year or more and a second dose (booster) given at least 6 months after the first dose will confer life-long protection. Mild side effects include injection site soreness and headache. A combined hepatitis A/B vaccine is also available.

Hepatitis A/B combination vaccine is given in 3 doses (at 0, 1, and 6 months). An accelerated schedule used by many travel medicine practitioners is 3 doses (given on days 0, 7, and 21), which then necessitates a fourth dose at 1 year. Pain, redness, and swelling may occur at the injection site.

Typhoid fever is a serious bacterial infection that spreads through the bloodstream, resulting in high fever, belly pain, and either diarrhea or constipation. Infection is acquired by consuming contaminated food or water. One dose of injectable typhoid vaccine protects for 2-3 years. Four doses of the oral vaccine (given on days 0, 2, 4, and 6) provide 5-6 years of protection. Nausea and cramps may occur with the oral vaccine. Side effects of the injectable vaccine can include soreness, redness, and swelling at the injection site.

Hepatitis B virus causes severe liver infection with fever and jaundice; if the infection becomes chronic it can lead to liver failure or cancer. Hepatitis B virus can be transmitted by nonsterile needles, contaminated blood products, and sexual contact. Three doses are usually given at 0, 1, and 6 months. Two accelerated schedules available for travelers consist of 3 doses given either at 0, 1, and 2 months or on days 0, 7, and 21. While protection is obtained after 3 doses, if an accelerated schedule is used, a fourth dose is required 12 months later for lifelong immunity. The most common side effects are injection site soreness and fever. A combined hepatitis A/hepatitis B vaccine is available.

Yellow fever is an often life-threatening viral illness spread by mosquitoes in the Amazon basin of South America and sub-Saharan Africa. Yellow fever vaccine may be recommended or required for travel to or from these countries. One dose is given and becomes effective in about 10 days and protects for 10 years or more. Flu-like symptoms might occur 5-14 days after vaccination (in about 2-5% of persons), and rarely, encephalitis can occur. This vaccine cannot be used by persons allergic to eggs.

Japanese encephalitis is a viral infection of the brain that is transmitted by the bite of an infected mosquito in certain rural areas of Asia. Two vaccines are available: IXIARO and JE-VAX. Two doses of IXIARO are given 28 days apart (last dose given at least 1 week before entering risk area); 3 doses of JE-VAX are given on days 0, 7, and 30 (last dose given at least 10 days before entering risk area.) An accelerated schedule of 3 doses JE-VAX given on days 0, 7, and 14 may be used if necessary. Duration of protection for IXIARO is not known; JE-VAX provides protection for about 3 years. Flu-like symptoms may occur after vaccination in about 10% of people. Serious (but delayed) allergic reactions can occur up to 10 days after vaccination with JE-VAX (in less than 1/2 of 1% of persons) and may be more likely in persons with multiple severe allergies; neurologic complications are very rare.

Tick-borne encephalitis (TBE) is a viral infection usually transmitted by tick bites (rarely, it can be acquired by consuming unpasteurized milk or milk products from infected cows, goats, or sheep). TBE infection causes flu-like symptoms which usually resolve in about a week, but some people experience a second phase that can include neurological symptoms (seizures, paralysis, and coma) resulting from brain infection. TBE occurs in many countries in central and western Europe, usually in forest and rural areas. A vaccine is available in Europe and Canada but not in the U.S.; 3 doses are required and are given over a period of 1 year. Vaccine side effects are usually mild and can include redness and swelling at the injection site. Less often, fever, headache or muscle aches, dizziness, nausea, vomiting, and diarrhea can occur. Neurological reactions are rare. Persons with egg allergy should not use this vaccine.

Rabies is a fatal disease transmitted by animals (most commonly dogs and bats) or other humans; rabies is more common in developing countries. Preexposure vaccination consists of 3 doses given on days 0, 7, and 21-28. (Booster doses may be needed in some cases.) Mild side effects may include injection site pain, redness, swelling, and itching, headache, nausea, abdominal pain, muscle ache, mild fever, and dizziness. A few persons may experience hives up to 21 days later. If you are exposed or if there is a potential that you have been exposed to rabies, you must seek medical attention immediately, even if you have had the preexposure series. Additional injections are needed after an exposure to rabies. Neurologic reactions can be a concern with some rabies products made abroad.

Meningococcal infection is spread by respiratory secretions and causes a severe illness with fever, rash, and (often) meningitis that may lead rapidly to death. Risk is highest from December through June in certain areas of sub-Saharan Africa. A single dose of quadravalent meningococcal vaccine appears to provide protection in adults for at least 5 years. Side effects are mild and can include pain or redness at the injection site, fatigue, and headache. Some persons may need a monovalent vaccine (meningococcal conjugated C) when traveling to countries where this vaccine is part of the routine childhood schedule. Discuss the possible need for this vaccine with your doctor.

Cholera is spread by contaminated food or water and causes diarrhea that can range from mild to very severe. Outbreaks occur mostly after natural and man-made disasters. Infection is rare in typical travelers, and vaccination is no longer required for entry into any country. Cholera vaccine is not available in the U.S., but oral cholera vaccines are available in Canada and elsewhere and may often be obtained en route. Depending on your age and the type of vaccine used, 1 to 3 doses are given (doses are given at least 1 week apart), followed by a booster dose. Side effects may include mild gastrointestinal symptoms. Very rarely, headache, dizziness, or shortness of breath have been reported.

Seasonal Infections

Influenza, including H1N1
Influenza is a viral infection that causes fever, headache, muscle aches, and lung infection and occurs year round in the tropics. The virus usually enters one's body through mucus membranes in the mouth, nose, or eyes when an infected person coughs or sneezes. One dose of influenza vaccine is given and lasts only for the current flu season. In addition to the seasonal vaccine, a 2009 H1N1 flu vaccine is also available. Vaccine is available as an injection (inactivated) or a nasal spray (live weakened virus). After the injection, flu-like symptoms might occur for 1-2 days; after the nasal spray immunization, mild symptoms such as runny nose or nasal congestion, cough, headache, sore throat, chills, and a feeling of tiredness or weakness might occur. Persons with egg allergy should not use this vaccine.

Routine Vaccinations

Diphtheria, Tetanus, and Pertussis: Diphtheria is a potentially fatal infection that is common in developing countries. Tetanus (lockjaw) is caused by contamination of cuts or wounds. Pertussis (whooping cough) is a highly contagious respiratory disease caused by bacteria. All travelers should have completed the primary series (DTaP, DT, or Td, as appropriate) and receive Td boosters (of which 1 is a Tdap dose) every 10 years thereafter. More frequent booster doses may be suggested in some cases. All adolescents and adults should have had 1 dose of Tdap vaccine. Side effects can include soreness, redness, and swelling at the injection site.

Human papillomavirus (HPV) are viruses transmitted through sexual contact; these viruses can cause cervical cancer, abnormal cells in the lining of the cervix, and genital warts. Two vaccines are available. One (HPV2) is licensed for females aged 11-26 and one (HPV4) is licensed for males and females aged 10-25. The vaccine only protects when given prior to infection and does not protect against all types of HPV. Three injections are given over a period of 6 months. Side effects can include slight fever, pain, redness, or tenderness at the injection site, and fainting.

Hib disease (Haemophilus influenzae type b) is a serious bacterial illness that usually strikes children less than 5 years of age; it can cause ear infections, pneumonia, severe swelling in the throat, infection of the brain and spinal cord coverings (that can lead to brain damage and deafness), and death. A child can start Hib vaccine as early as 6 weeks of age, with subsequent doses as little as 4 weeks apart, so that 3 doses can be administered before travel. Unvaccinated persons older than 5 years of age receive a single dose. Side effects are usually mild, including soreness at the injection site, fever, irritability, runny nose, itchiness, and a tired feeling.

Measles, Mumps, and Rubella(MMR): Measles is a potentially serious illness with fever, cough, and rash. Mumps may cause brain infection or infertility in males. Rubella (German measles) usually causes mild fever and rash but can be devastating to a developing fetus. These diseases are common in developing countries and can be prevented with live measles/mumps/rubella (MMR) vaccine. Persons born before 1957 in the US or 1970 in Canada may be immune already. Non-immune persons need 2 doses given at least 28 days apart. (Children age 1-4 years receive 1 dose, with a second usually given at age 4-6 years.) Fever and/or rash may occur 7-12 days after vaccination.

Pneumococcal disease is caused by bacteria transmitted from person to person through droplets and, presumably, by direct contact. It can lead to serious infections of the lungs (pneumonia), the blood (bacteremia) and the covering of the brain (meningitis). Most adults who need the vaccine will get 1 dose; some adults and children older than 10 years of age may need another dose after 5 years. Young children who need the vaccine usually receive 3 doses, each dose separated by 2 months, plus a booster dose 12-15 months later. Mild side effects commonly occur, such as redness, swelling, or pain where the shot is given.

Polio is a viral illness that is spread by contaminated food and water and can result in paralysis or death. Everyone should have a primary series (3 doses). A one-time adult booster dose is advisable for persons traveling to risk areas who have completed the primary series. If time is short, unimmunized or partially immunized travelers should complete as many doses as time allows, with doses given at least 4 weeks apart. An injectable killed vaccine is used routinely in the United States and Canada. Minor local reactions (pain, redness, swelling) may occur at the injection site, often within 6-12 hours.

Rotavirus is a serious viral illness that usually strikes infants and young children. It can cause severe diarrhea, vomiting, fever, and dehydration, and causes a half million deaths in children each year, mostly in developing countries. Infection can occur as early as 2-3 months of age and is most severe in children ages 6-24 months. An oral rotavirus vaccine is available as a 3-dose series, starting as young as age 6 weeks, with subsequent doses a minimum of 4 weeks apart. The vaccine is not for use in children younger than 6 weeks or older than 32 weeks of age. Side effects can include diarrhea, vomiting, runny nose, sore throat, ear infection, or coughing.

Varicella (chickenpox) is a viral illness spread by respiratory droplets; it causes an itchy blister-like rash. Bacterial infections commonly follow the illness. Non-immune adults are at increased risk of severe illness. Persons born before 1980 in the US may already be immune. Non-immune persons age 13 years and older are given 2 doses, given 4-8 weeks apart. Unvaccinated children ages 12 months to 4-6 years are given 1 dose, with a second dose given at age 4-6 years. Vaccination provides prolonged protection. Uncommonly, a blister-like rash might occur after vaccination.

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Herpes zoster (shingles) is an outbreak of rash / blisters caused by a reactivation of the chickenpox virus. Anyone who has had chickenpox is at risk for shingles. The first symptom is often burning / tingling pain or sometimes numbness in or under the skin; fever, chills, headache, or upset stomach may occur; within days a rash of small fluid-filled blisters appears on reddened skin. The pain associated with shingles can be intense. A vaccine is available for the prevention of shingles in persons 60 years of age and older who have had chickenpox. One dose is given as an injection under the skin. The most common side effects reported were redness, pain, swelling, itching, warmth, and bruising at the injection site and headache.