What vaccines are needed before traveling to a developing country?

Vaccines Needed Before Traveling to a Developing Country

All travelers to developing countries should ensure routine vaccinations are current and receive hepatitis A vaccine, with additional vaccines determined by specific destination, activities, and individual risk factors. 1

Essential Routine Vaccinations (Update Before Any Travel)

• Measles-Mumps-Rubella (MMR): Ensure immunity before travel, as approximately 61% of imported measles cases occur among returning citizens, with measles remaining uncontrolled in many countries 1
• Tetanus-Diphtheria-Pertussis (Tdap): Review and update as needed 1
• Poliomyelitis: Travelers to developing countries should be immune; use inactivated (killed) poliovirus vaccine rather than oral live vaccine 2, 1
• Influenza: Particularly important for high-risk individuals 1

Universally Recommended for Developing Countries

• Hepatitis A: Recommended for most travelers to developing countries due to risk of foodborne and waterborne exposure 2, 1
  • Complete the normal two-dose schedule preferably before travel 2
  • Even if first dose given on day of travel, provides adequate protection 3
  • For immunosuppressed patients, check serological response after vaccination 2

Destination and Risk-Based Vaccines

High Priority Based on Specific Regions

• Yellow Fever: Required for entry to certain African and South American countries where transmission is endemic 2, 4

  • Must be administered at approved Yellow Fever Vaccination Center at least 10 days before travel 4, 5
  • Single dose provides long-lasting immunity; boosters no longer required for most individuals 4
  • Contraindicated in infants <6 months, persons with immunodeficiency including symptomatic HIV 2, 4
  • Adults ≥60 years have increased risk of serious adverse events with first-time vaccination 4
  • If contraindicated, provide medical waiver letter and emphasize mosquito bite prevention 4

• Typhoid Fever: Recommended for travelers visiting smaller cities, rural areas, or those with "adventurous eating" 1, 5

  • Use inactivated parenteral vaccine instead of live-attenuated oral preparation for immunosuppressed patients 2
  • Can provide immunity in >70% of travelers when given 1 week prior to departure 3

• Hepatitis B: Recommended for travelers who may have sexual contact with new partners, receive medical/dental treatment, or have potential blood/bodily fluid exposure 1, 5

  • Accelerated schedule (0,7,21 days) induces early protection for last-minute travelers 3

Additional Considerations

• Rabies: Consider for travelers involved in outdoor activities, working with animals, or extended stays 1
• Meningococcal (A, C, W, Y): Required for pilgrims to Saudi Arabia; recommended if traveling during meningitis season or to outbreak areas 5, 6
• Japanese Encephalitis: May be recommended depending on destination and activities 6, 7

Special Populations

Immunosuppressed Patients (Including HIV-Infected)

• Avoid live-virus vaccines (oral polio, oral typhoid, yellow fever in severely immunosuppressed) 2
• Exception for measles vaccine: Recommended for nonimmune persons, but not for severely immunosuppressed; consider immune globulin for measles-susceptible severely immunosuppressed travelers to endemic countries 2
• Use inactivated vaccines (killed polio, parenteral typhoid, inactivated hepatitis A/B, rabies, Japanese encephalitis) as for non-immunosuppressed persons 2
• Yellow fever vaccine: For asymptomatic HIV-infected travelers who cannot avoid exposure, offer choice of vaccination; if not vaccinated, provide waiver letter and mosquito avoidance instructions 2

Pregnant Women

• Generally avoid live virus vaccines like yellow fever 5
• Seroconversion rate may be markedly reduced; consider serologic testing to confirm immune response 2

Infants and Children

• Yellow fever vaccine contraindicated in infants <6 months due to encephalitis risk 2, 4
• For infants 6-8 months, postpone travel to endemic areas if possible 4
• Varicella vaccine can be administered to asymptomatic nonimmunosuppressed children 2

Timing and Administration

• Start vaccinations 4-6 weeks before departure to ensure adequate time for all necessary doses and immune response 1, 5, 6
• Multiple vaccines can be administered simultaneously without reducing effectiveness 5
• Yellow fever certificate valid only if administered by approved vaccination center 2, 5

Critical Pitfalls to Avoid

• Insufficient lead time: Failing to start vaccinations early enough is the most common error 1, 5
• Neglecting routine vaccinations: Many travelers focus only on travel-specific vaccines but fail to update routine immunizations 1
• Improper documentation: Not carrying International Certificate of Vaccination for yellow fever, which may be required at border crossings even for transit 2, 5
• Using live vaccines in immunosuppressed patients: This can cause serious complications 2

Additional Protective Measures

• Avoid direct skin contact with soil/sand by wearing shoes and protective clothing in areas with fecal contamination 2, 1
• Use mosquito bite prevention measures (DEET repellent, permethrin-treated clothing, screened accommodations) especially if yellow fever vaccination contraindicated 4
• Carry adequate IBD or chronic disease medications and instructions for emergency self-treatment 2