What vaccinations are recommended for travellers prior to departure?

Traveller Vaccination Recommendations

Travelers should ideally seek pre-travel medical consultation 4-6 weeks before departure to ensure adequate time for vaccination and immune response development, with routine vaccinations updated first, followed by destination-specific vaccines based on travel itinerary, activities, and individual risk factors. 1, 2

Timing of Pre-Travel Consultation

• Schedule appointments 4-6 weeks before departure to allow sufficient time for multi-dose vaccine series and optimal immune response development 1, 2, 3, 4
• Multiple vaccines can be administered simultaneously on the same day without reducing effectiveness 3, 4
• Last-minute travelers (≤7 days before departure) comprise 16% of all travelers and face challenges with multi-dose vaccines like Japanese encephalitis and rabies, which are most likely to be deferred 5

Priority 1: Update Routine Vaccinations

Before considering travel-specific vaccines, ensure all routine immunizations are current 1, 2, 3:

• Measles-Mumps-Rubella (MMR): Critical priority, as approximately 61% of imported measles cases occur among returning citizens, with measles remaining uncontrolled in many countries 2, 3
• Tdap (Tetanus-Diphtheria-Pertussis): Review and update as needed 2, 3
• Influenza: Particularly important for high-risk individuals; consider timing relative to destination hemisphere (Northern vs Southern) and season 1, 2, 3
• Poliomyelitis: Travelers to developing countries should be immune; use inactivated (killed) vaccine only 1, 2

Common pitfall: Many travelers focus exclusively on exotic travel vaccines while neglecting routine immunizations—this is a critical error that leaves them vulnerable to preventable diseases 2, 3

Priority 2: Destination-Specific Vaccines

High-Priority Travel Vaccines (Most Common)

Hepatitis A:

• Recommended for most travelers to developing regions including Africa, Asia, Central/South America, and Eastern Europe 1, 2, 3
• Transmitted via contaminated food or water 2
• Critical for last-minute travelers: Can be administered even on the day of travel, as seroconversion occurs in most vaccinees within 12-14 days, and hepatitis A has a 28-day incubation period 6
• Single dose provides significant protection and has proven effective in outbreak control 6

Typhoid:

• Recommended for travelers to South Asia (highest risk: 1 per 3,000 trips) and other endemic areas, especially those visiting smaller cities, rural areas, or engaging in "adventurous eating" 1, 2, 7
• Two formulations available: oral live-attenuated (three capsules) or single-dose injectable Vi polysaccharide vaccine 1
• For immunocompromised travelers: Use inactivated parenteral vaccine only, not oral live preparation 1
• Vaccination 1 week prior to departure provides protection in >70% of travelers 8

Hepatitis B:

• Recommended for travelers who may have sexual contact with new partners, receive medical/dental treatment, or have potential blood/body fluid exposure 2, 3, 7
• Standard schedule: three intramuscular injections 1
• Accelerated schedule for last-minute travelers: 0,7, and 21 days induces early protection 8

Region-Specific Vaccines

Yellow Fever:

• Required for entry to certain African countries (e.g., Cameroon, Zambia) and South American countries (e.g., Bolivia) 1, 7
• Live, weakened virus given as single shot; must be administered at least 10 days before travel for certificate validity 7
• Requires International Certificate of Vaccination from approved vaccination center 7, 4
• Contraindications: Severe egg allergies, immunosuppression, symptomatic HIV, pregnancy 7
• For immunocompromised travelers who cannot avoid yellow fever zones: provide vaccination waiver letter and mosquito bite prevention education 1

Japanese Encephalitis:

• Two doses of inactivated Vero cell-derived vaccine for travelers to Southeast Asia (e.g., Indonesia) and Western Pacific (e.g., Japan) 1
• Consider for those with outdoor exposure in endemic areas 1
• Frequently deferred in last-minute travelers due to multi-dose requirement 5

Meningococcal Disease:

• Meningococcal conjugate vaccine for travelers to sub-Saharan Africa meningitis belt (especially December-June dry season) 1
• Required for pilgrimage to Mecca, Saudi Arabia (A, C, W, Y strains) 4
• Consider for travel during meningitis season or current outbreaks 7

Rabies:

• Series of three vaccines for travelers to Africa, Asia, and Central/South America with potential close contact with wild or domestic animals 1, 2
• Consider for outdoor activities, working with animals, or extended stays 2
• Often deferred in last-minute travelers; accelerated schedules now available 5

Poliomyelitis:

• Inactivated vaccine (three doses) for travelers to endemic countries in Africa (e.g., Benin) and Asia (e.g., Philippines) 1

Special Populations

Immunocompromised Travelers (Including HIV-Infected)

• Live-virus vaccines should generally be avoided 1, 7
• Exceptions with caution: Measles vaccine for nonimmune persons (but not if severely immunosuppressed); varicella for asymptomatic nonimmunosuppressed children 1
• Inactivated vaccines are usually safe: Diphtheria-tetanus, rabies, hepatitis A, hepatitis B, Japanese encephalitis 1, 7
• Yellow fever vaccine has uncertain safety/efficacy; if unavoidable exposure, offer vaccination choice to asymptomatic HIV-infected travelers with counseling 1

Pregnant Women

• Live virus vaccines should generally be avoided 3, 7
• Inactivated vaccines can be administered as needed 3

Last-Minute Travelers (≤7 Days Before Departure)

• Prioritize single-dose vaccines: hepatitis A (can give day of travel), typhoid (injectable form) 8, 6
• Consider accelerated hepatitis B schedule (0,7,21 days) 8
• Multi-dose vaccines (Japanese encephalitis, rabies) most likely to be deferred but accelerated schedules now available 5
• Do not defer hepatitis A vaccination—evidence strongly supports protection even with same-day administration 6

Risk Assessment Factors

Vaccination recommendations should be individualized based on 1:

• Destination specifics: Urban vs rural, endemic disease patterns
• Duration of travel: Extended stays (>1 month) increase exposure risk 5
• Activities planned: Outdoor exposure, adventure travel, animal contact
• Accommodation type: Luxury hotels vs backpacking
• Season of travel: Affects mosquito-borne diseases, meningitis risk
• Purpose: Tourism, business, visiting friends/relatives (VFR travelers have higher risk) 5

Additional Preventive Measures

• Avoid direct skin contact with soil/sand by wearing shoes and protective clothing in areas with fecal contamination risk 1, 2
• Wash hands thoroughly after any soil contact 2
• Consider malaria chemoprophylaxis and arthropod vector protection as appropriate 1
• Carry vaccination documentation, especially International Certificate of Vaccination for yellow fever 3, 7
• Blood donation should be deferred for 2 weeks after yellow fever vaccine 7

Critical Pitfalls to Avoid

• Starting vaccination process too late: Ideally begin 4-6 weeks before departure 2, 3, 7, 4
• Focusing only on exotic vaccines while neglecting routine immunizations: This leaves travelers vulnerable to measles and other preventable diseases 2, 3
• Not carrying proper vaccination documentation: Yellow fever certificate may be required at border crossings 7
• Assuming last-minute travelers cannot be protected: Hepatitis A and typhoid can provide protection even with late vaccination 8, 6