What vaccinations should you consider?

Immunisation to protect against a number of diseases is recommended before travelling to countries or regions where there is a high risk for that disease. Talk to your doctor or a travel medicine professional well in advance of your trip so you know what vaccinations are needed, and to ensure you have enough time to complete the course or have any booster doses required (and for vaccines to take effect). Anyone travelling overseas should also be up-to-date with routine childhood immunisations. 

Sterile administration

Having vaccinations administered by a health professsional within New Zealand allows for safe needle and sterilisation techniques. If you do need a vaccination overseas make sure it is administered with a single-use sterile needle under hygienic conditions, if possible.

Vaccination certificates

Some countries require proof of vaccination against certain diseases (eg, yellow fever) before they will allow you entry and these requirements change according to the status of outbreaks (also see 'Vaccination/travel resources' at end of article).

The following are the most common vaccinations required by travellers:

Tetanus and diphtheria

This vaccination is recommended for many people (especially if working in high risk areas). It is normally given as a triple vaccine - diphtheria, tetanus and pertussis (whooping cough) - in childhood in New Zealand, with a booster at age 11 years. Boosters of tetanus and diphtheria (adult vaccine) are recommended at ages 45 and 65 years.

However, more frequent intervals may be needed for travellers who will be in higher risk areas or situations such as jungle expeditions, working with animals, or undertaking active or outdoor travel in countries where there is a known risk.

Measles

Measles is caused by a virus and, unfortunately, it is still one of the most common causes of vaccine preventable childhood disease in many developing countries. It is spread by droplets when an infected person breathes, coughs or sneezes and is highly infectious.

If you have not had measles or been immunised against measles, you should discuss with your doctor whether you are at risk when travelling in countries where measles is prevalent. Routine childhood immunisation against measles is usually given as part of the MMR (measles, mumps, rubella) vaccine at ages 15 months and four years.

Women who are not pregnant or who are planning to get pregnant should also consider having rubella (German measles) vaccination if they have not already done so. However, women having the rubella vaccination must leave a gap of at least three months before getting pregnant.

Poliomyelitis

Poliomyelitis (or polio) is still prevalent in many developing countries. The condition is an acute infectious disease caused by a virus. Polio in young children is often mild, but in older children it can attack the central nervous system and then cause paralysis which most often affects the legs, but can also paralyse the muscles needed for breathing or swallowing.

Polio vaccine is a routine childhood immunisation in New Zealand, recommended to be given as three doses in infancy, and then at four years. Any person who has never been vaccinated against polio should be vaccinated regardless of travel plans. Booster doses are recommended for those who have been vaccinated in the past if they are travelling to areas or countries where polio still occurs (including India, Nigeria and Pakistan). For those exposed to a continuing risk of infection, booster doses are recommended every 10 years.

Hepatitis A

Hepatitis A is a liver disease caused by the hepatitis A virus. It is one of the most serious risks for travellers as it is extremely contagious and can be passed on through people putting into their mouths any food or objects contaminated by the stool (faeces) of an infected person (called faecal-oral transmission).

Hepatitis A immunisation is used as a preventive treatment (prophylaxis) for this disease. You should discuss with your doctor or travel medicine professional whether this vaccination is relevant to the areas in which you will be travelling. 

A single dose of hepatitis A vaccine is usually given as primary vaccination and then a booster dose can be given six to 18 months after the first vaccination to prolong its effect. Ideally, the vaccination should be given several weeks before travel.

A combined hepatitis A and hepatitis B vaccine is also available in New Zealand. It is given as a course of three doses of vaccine, over a period of six months. It is also possible to have the combined vaccine in a rapid-dose schedule (eg, if limited time before travel) - talk to your doctor or travel medicine professional for details.

There is also a combined hepatitis A and typhoid vaccine.

Hepatitis B

This form of hepatitis is caused by the hepatitis B virus and is one of the most serious forms of viral hepatitis. It can lead to chronic liver disease, cirrhosis or liver cancer. Hepatitis B can be spread by blood, infected blood transfusions, needle sharing among intravenous drug users or sexual contact with an infected person.

Vaccination to prevent hepatitis B is usually recommended if you are staying for more than six months in a high-risk area, you anticipate sexual contact, or blood transfusions are unscreened in the country you are visiting.

For hepatitis B vaccination you will require a series of three injections, preferably six months before you travel. However, a rapid dose schedule can also be undertaken if you have limited time before travel - with dosing over 3 weeks, and a fourth dose given at one year - talk to your doctor for more details. 

Typhoid

Typhoid is an infection caused by a bacterium called Salmonella typhi and is usually caused when contaminated food, milk or water is consumed. Symptoms of the condition do not usually appear for 10-14 days. Typhoid is still a problem in many countries so you should discuss with your doctor the areas you will be travelling through and if this vaccination is required.

Typhoid vaccination is usually recommended for travellers to countries with unsafe drinking water and poor hygiene, and high levels of the disease in the population.

There is a combined hepatitis A and typhoid vaccine as well as a single typhoid vaccine. Your doctor or travel medicine professional will advise which is the right one for you.

Influenza

Influenza is a common viral infection that can be spread from person to person very easily. As such, this is an important vaccination for travellers over the age of 65 as flu infection can be passed very quickly in crowded areas or areas of close contact (such as air travel).

Other people who are at risk and should consider the vaccination include people with respiratory conditions (eg, asthma, COPD), heart disease, cancer, diabetes, kidney disease, and diseases affecting the immune system.

The vaccine is reviewed every year to create immunity to the most likely strains of flu to be circulating that year/winter. Influenza vaccination in adults requires one injection, and it takes two weeks for the vaccine to become effective. It is recommended to have the latest flu vaccine each year.

Meningococcal meningitis

The meningococcal meningitis vaccine is not usually necessary if travelling to developed countries such as the United States, but is required for travel in endemic areas such as many areas of sub-Saharan Africa, especially for those living in rural accommodation, hitchhiking, backpacking and trekking.

A certificate of meningitis vaccination is also required for all Hajj pilgrims entering Saudi Arabia. The vaccination is a single dose and immunity generally lasts for two to three years.

Rabies

Rabies is a serious viral infection that is life threatening. Rabies is transmitted by the bite or scratch of an infected animal, such as a dog, cat, bat, fox, raccoon, skunk or monkey. It is quite prevalent in some developing countries but is not usually a required vaccination.

However, if you are planning to hike, cycle or go on adventure trips where you may come in contact with animals, vaccination may be advisable. Your doctor will be able to advise you. Pre-exposure vaccination consists of three injections with a booster after one year.

Vaccination after a bite or exposure to a rabid animal consists of a series of injections at set intervals.

Japanese encephalitis

Japanese encephalitis is a viral infection that results from the bite of a carrier mosquito and is commonly seen in areas of Asia such as the Philippines, Korea, China, Nepal and India. Outbreaks have also occurred in the Torres Strait and north Queensland, Australia. 

Japanese encephalitis is not of great risk to short-term travellers (those staying less than two weeks) but vaccination may be recommended if you are staying in rural areas of Asia or Papua New Guinea, particularly in the wet season, for more than a month or making repeated visits. It is also recommended for travellers spending a year or more in urban areas of Asia (excluding Singapore).

The vaccination schedule is three doses over a month (on days 0, 7 and 28). The last dose should be given at least 10 days before starting travel to ensure that immunity is complete and that, in the event of delayed adverse reaction, you are close to good medical care. An accelerated vaccination schedule may also be given over 14 days, but this should be followed by a fourth dose several months later. A booster dose may be given after three years if necessary.

Yellow fever

Yellow fever is another condition that is contracted through the bite of an infected mosquito. The name comes from some of the symptoms - fever and jaundice (yellowing of the skin and eyes). It is fatal in 50% of cases.

The vaccination is required only if travelling through endemic areas, eg, some areas of Africa and South America, or if you are staying long term in high-risk areas. Some neighbouring countries to those where the disease is present may require you to have a vaccination certificate before allowing entry.

Vaccination is carried out only at special licensed yellow fever vaccination centres. People with allergy to egg cannot be vaccinated. The vaccine is very effective and usually offers protection for at least 10 years after a single dose.

Cholera

Cholera is a type of gastroenteritis that is commonly contracted through contaminated water supplies. There have been outbreaks in South America, sub-Saharan Africa and the Indian subcontinent. Cholera produces profuse watery diarrhoea of sudden onset that leads to profound dehydration and collapse, and can cause death if not treated promptly. There is little or no fever or vomiting.

An oral cholera vaccine is available. Vaccination may only be needed if you will be in high-risk situations in high-risk areas. Discuss this with your doctor or travel medicine professional. The vaccine is given in two doses, one to six weeks apart.

Malaria prevention

Medicine to protect against malaria is not available as an immunisation, but instead involves taking antimalarial tablets. There are several varieties of tablet available, some taken once a day, others taken once a week. It is usual to start taking them before entering an area where malaria occurs, and to continue them for a period after leaving that area (the length of time before and after depends on the tablet).

Individual health, age (children), whether a woman is pregnant or breastfeeding, your destinations, tablet cost, and possible side effects will influence which is correct for you. Talk to your doctor or travel medicine professional.

Vaccination/travel resources

The World Health Organization (WHO) provides a country-by country list of vaccination requirements and malaria situation in its International Travel and Health online publication.

The New Zealand government website www.safetravel.govt.nz gives current information about disease outbreaks and related alerts (eg, flooding or other hazards) for travellers.

You can also consult a specialised travel medicine clinic for advice and vaccinations tailored to your individual travel plans.

Related topics

See also Travel health checklist and Food and water safety 

Original content from MyDr. Edited by everybody, November 2011.