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 frequently 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
• Tetanus-Diphtheria-Pertussis (Tdap): Review and update booster status 2, 3
• Influenza: Particularly important for high-risk individuals; consider timing relative to destination hemisphere (Northern vs Southern) 1, 2, 3
• Poliomyelitis: Travelers to developing countries should be immune; use inactivated vaccine only 1, 2, 3

Priority 2: Destination-Specific Required Vaccines

Yellow Fever

• Required for entry to certain countries in Africa and South America, or when traveling from yellow fever-endemic countries 1, 6, 4
• Must be administered at least 10 days before travel for certificate validity 6
• Requires International Certificate of Vaccination from approved vaccination center 6, 4
• Contraindicated in severely immunosuppressed individuals, symptomatic HIV, severe egg allergy, and generally avoided in pregnancy 1, 6
• Defer blood donation for 2 weeks post-vaccination 6

Meningococcal Disease

• Required for pilgrimage to Mecca, Saudi Arabia 4
• Recommended for travelers to sub-Saharan Africa meningitis belt, particularly December-June dry season 1
• Consider during outbreaks or meningitis season 6

Priority 3: Highly Recommended Travel Vaccines

Hepatitis A

• Recommended for most travelers to developing countries due to foodborne/waterborne exposure risk 1, 2, 3, 6
• Can provide adequate protection even if first dose given on day of travel, as seroconversion occurs within 12-14 days and hepatitis A has 28-day average incubation period 7
• This addresses the common pitfall of last-minute travelers avoiding vaccination due to perceived insufficient time 7

Typhoid Fever

• Recommended for travelers to South Asia, South America, and Africa, especially those visiting rural areas or engaging in "adventurous eating" 1, 2, 6
• Immunity develops in >70% of travelers within 1 week of vaccination 8
• Use inactivated parenteral vaccine (not live oral preparation) in immunocompromised individuals 1

Hepatitis B

• Recommended for travelers with potential sexual contact with new partners, medical/dental treatment exposure, or blood/bodily fluid contact 1, 2, 3, 6
• Accelerated schedule (0,7,21 days) provides early protection for last-minute travelers 8

Priority 4: Risk-Based Vaccines

Japanese Encephalitis

• For travelers to Southeast Asia and Western Pacific with outdoor/rural exposure 1
• Two-dose series; frequently deferred in last-minute travelers due to time constraints 5

Rabies

• Pre-exposure prophylaxis for travelers with animal contact, outdoor activities, or extended stays in endemic areas of Africa, Asia, Central/South America 1, 2
• Three-dose series limits feasibility for short-notice travel 5

Poliomyelitis Booster

• For travelers to endemic countries in Africa (e.g., Benin) and Asia (e.g., Philippines) 1

Tick-Borne Encephalitis

• For travelers with outdoor exposure in endemic areas of Europe; second dose should be given at least 2 weeks before departure 1

Special Population Considerations

Immunocompromised Travelers

• Avoid live-virus vaccines (yellow fever, oral polio, live typhoid, oral cholera) 1, 2
• Inactivated and recombinant vaccines (hepatitis A/B, rabies, Japanese encephalitis, injectable typhoid) are generally safe 1, 2
• Yellow fever vaccination in asymptomatic HIV-infected persons requires individual risk-benefit assessment; if not administered, provide vaccination waiver letter and mosquito avoidance counseling 1

Pregnant Women

• Generally avoid live-virus vaccines 3, 6
• Tdap can be administered during pregnancy after informed discussion 1

Last-Minute Travelers

• Business and VFR (visiting friends/relatives) travelers comprise disproportionate share of last-minute presentations (26% vs 16% and 15% vs 8% respectively) 5
• 18% of last-minute travelers have at least one vaccine deferred due to insufficient time 5
• Hepatitis A can still be administered on day of departure 7

Critical Pitfalls to Avoid

• Focusing only on exotic travel vaccines while neglecting routine immunizations is the most common error 2, 3
• Delaying consultation until <7 days before departure results in inability to complete multi-dose series 2, 5
• Failing to carry vaccination documentation, particularly yellow fever certificate, which may be required at border crossings 3, 6
• Not considering hemisphere-specific influenza timing for travelers to Southern Hemisphere during April-September 1
• Assuming cholera vaccine is needed for routine tourist itineraries; it is not recommended even for countries reporting cholera cases 1

Documentation Requirements

• Maintain written records of all vaccinations 1
• Carry International Certificate of Vaccination for yellow fever when required 6, 4
• Obtain physician waiver letter if medically exempt from required vaccinations 1, 6