The Travel Doctor - vaccines & immunizations, routine immunizations, flu shot

Consult your physician or a travel medicine specialist for immunizations that may be recommended for your destination and specific itinerary. It is important to realize that the health and sanitation conditions for the country you are visiting are not the same as here in the US. Thanks to decades of public health initiatives in the United States, many contagious diseases have been eliminated. But when a traveler goes to a country that is not similarly protected, a person can be at dangerous risk of contracting a disease. The principle behind a vaccine or immunization is to expose your body's system to the disease after it has been rendered harmless. By doing so, the body can build up its own natural protection so that if it encounters the virus, the body will be "immune" to its effects. This immunization effect takes time, so it is a good idea to give your body at least a month head start to condition itself before getting on the plane or boat.
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The Immunization Practices Advisory Committee of the Centers for Disease Control and Prevention (CDC) recommends that all persons be up-to-date on routine immunizations, regardless of travel plans. Outbreaks of measles, polio, and pertussis have occurred in developed countries where populations were inadequately immunized, and susceptible visitors have been stricken with travel-acquired measles and poliovirus infections.

The primary series of tetanus, diphtheria, pertussis, MMR and polio vaccines is customarily given in childhood. Surveillance data suggest that a significant percentage of North Americans over the age of 20 do not update their tetanus/diphtheria immunizations at the recommended 10-year interval. Although polio boosters are not routinely given in North America, they are recommended before travel to known polio endemic and developing areas.

Tetanus/Diphtheria (Td): This combination vaccine is used for immunization of persons aged seven years and older. Primary immunization with Td involves three doses given by injection (the first 2 doses given 4 to 8 weeks apart and the third dose given 6 to 12 months later). Booster doses to this vaccine are recommended at 10-year intervals.

Measles/Mumps/Rubella (MMR): This triple vaccine for these viral diseases is usually given in childhood (a single dose at 15 months of age). The American Academy of Pediatrics now recommends that a second dose of measles vaccine routinely be given to children at the age of 12. It is likely that individuals born before 1957 acquired immunity to measles, mumps, and rubella through natural infection with the viruses and do not need vaccination. Persons born after 1956 who received their initial MMR vaccination before 1980 should be revaccinated before international travel.

Polio was a crippling disease in the 1950s. Thanks to a national immunization effort, however, polio was all but eradicated in the United States over the next three decades. Unfortunately, that is not the case worldwide. Consequently, even if you have been previously immunized, your health care provider may recommend a booster dose of polio vaccine if you are traveling to an area where it still occurs.
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According to World Health Organization (WHO) requirements, yellow fever vaccination is the only immunization that may be required for entry into certain countries. Even when it is not required, yellow fever vaccine may be highly recommended for persons traveling to countries within endemic zones. The vaccine is highly effective at preventing the disease. After primary immunization with a single injected dose, booster doses are needed at 10-year intervals. The yellow fever vaccination is valid 10 days after the primary dose and immediately after booster doses.

Cholera vaccine is no longer required for international travel. However, contrary to WHO regulations, proof of cholera vaccination may occasionally be required as a condition of entry into some countries. Some countries with cholera-infected areas may still require evidence of a full primary series and a current booster dose. Thus, travelers to cholera endemic areas should be advised to check with the appropriate embassies or consulates before departure, particularly if they anticipate travel between two countries with active cholera outbreaks.

To avoid cholera vaccination at a border (or even quarantine in some countries), travelers may need a validated cholera certificate or a physician's signed statement (on letterhead) that cholera vaccine is contraindicated because of underlying health conditions. Some travel clinics routinely use this latter approach.

Your immunizations should be documented in an International Certificate of Vaccination (Yellow Card). It is a good idea to keep this Certificate with your passport so you don't misplace it. It is recognized internationally and may be required before entry to certain countries.
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Pre-travel immunizations may be recommended when exposure to infectious disease is anticipated when en route or at a destination. The following vaccines are not covered by WHO regulations and are not required for entry into any country. Decisions regarding their use are based on geographic area, the purpose and duration of travel, and the anticipated level of contact with the local population.

Meningococcal Vaccine - Meningococcal meningitis is caused by a bacterium that enters the body through the respiratory system. Meningococcal vaccine is currently recommended for travelers to Nepal, Saudi Arabia, Kenya and Tanzania. In recent years, sporadic outbreaks have also occurred in Brazil, Ethiopia and sub-Saharan African countries. It is also required who those who travel to the annual pilgrimage to Mecca (Hajj). Those travelers must be vaccinated at least 10 days before arriving to Saudi Arabia.

Japanese Encephalitis is a viral infection spread by Culex mosquitoes in many infected areas of Southeast Asia and the Indian subcontinent. The disease occurs in epidemics during summer and fall in northern parts of Asia and is endemic year-round in Southeast Asia. Since infection is spread by mosquitoes, it is important to protect yourself from insect bites.

Hepatitis B is spread by contact with blood or bodily fluids. The vaccine should be given to travelers who anticipate close contact with indigenous populations in areas with a high frequency of hepatitis B carriage. In Africa, Asia, Southeast Asia and South America, it is much more common among the general population. The standard dosing regimen consists of intramuscular injections at 0, 1, and 6 months.

Plague is a serious bacterial infection that does not present a risk to the usual international traveler. Vaccination should be considered only for workers, naturalists and others who expect to have direct contact with wild rodents or rabbits in rural areas where plague is present.
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