What vaccinations are recommended for travel to a high-risk location per Centers for Disease Control and Prevention (CDC) guidelines?

Travel Vaccination Recommendations

All travelers should ensure routine vaccinations are current and receive hepatitis A vaccine, with additional vaccines determined by specific destination risk factors, travel duration, and planned activities. 1, 2, 3

Routine Vaccinations (Required for All Destinations)

Update these core vaccines regardless of destination:

• MMR (measles, mumps, rubella) - Approximately 61% of imported measles cases occur among U.S. citizens returning home, as measles remains uncontrolled in many countries 1, 2, 3
• Tdap (tetanus, diphtheria, pertussis) - Review and update before any international travel 1, 2, 3
• Influenza - Particularly critical for high-risk individuals; consider timing based on destination (tropics year-round, southern hemisphere April-September) 4
• Polio - Essential for travelers to developing countries; unvaccinated adults need at least 2 doses of inactivated vaccine 1 month apart, or single dose if time is limited 4

Universal Travel Vaccines for Developing Countries

These vaccines are recommended for virtually all travel to developing regions:

• Hepatitis A - Recommended for most travelers due to foodborne/waterborne exposure risk; provides protection even if first dose given on day of travel 4, 1, 2, 3, 5
• Typhoid - Especially important for smaller cities, rural areas, or "adventurous eating"; provides >70% protection within 1 week of vaccination 4, 2, 5

Risk-Based Vaccinations

Hepatitis B - Recommended for travelers who may: 4, 1, 2, 3

• Have sexual contact with new partners
• Receive medical or dental treatment
• Have potential blood/bodily fluid exposure
• Travel >30 days or are <35 years old 6
• Accelerated schedule (0,7,21 days) available for last-minute travelers 5

Rabies - Consider for travelers who: 1, 2

• Engage in outdoor activities or trekking
• Work with animals
• Stay for extended periods in endemic areas
• Travel to remote areas with limited medical access 6

Yellow Fever - Required by law for: 4, 1, 2

• Travel to endemic areas (parts of Africa and South America)
• Entry from countries with yellow fever transmission risk
• Must be administered at approved vaccination center for valid international certificate 4, 7, 8
• Contraindicated in infants <6 months, persons with thymus disorders, severe immunosuppression, or egg allergy 4

Japanese Encephalitis - Consider for: 6, 8, 9

• Rural Southeast Asia travel >30 days
• Low-standard accommodations in endemic areas

Meningococcal (A, C, W, Y) - Required for: 4, 7, 8

• Pilgrims to Saudi Arabia
• Travel to meningitis belt regions
• Persons with anatomic/functional asplenia 4

Critical Timing Considerations

Start vaccinations 4-6 weeks before departure to ensure adequate immunity development 1, 2, 3, 7

• Multiple vaccines can be administered simultaneously without reducing effectiveness 1, 6, 7
• Some vaccines require multiple doses for full protection 3
• Last-minute travelers can still receive partial protection with accelerated schedules 5

Special Population Considerations

Immunocompromised Travelers: 4, 2

• Avoid all live-virus vaccines (measles exception for nonimmunosuppressed, varicella for asymptomatic children) 4
• Use inactivated vaccines: killed poliovirus (not oral), inactivated typhoid (not oral live-attenuated) 4
• Yellow fever vaccine contraindicated in severe immunosuppression; provide waiver letter instead 4

Pregnant Women: 3

• Generally avoid live virus vaccines
• Inactivated vaccines safe as needed

HIV-Infected Persons: 4

• Vaccinate as close to diagnosis as possible for pneumococcal disease 4
• Yellow fever vaccine has uncertain safety; offer choice if exposure unavoidable 4

Common Pitfalls to Avoid

• Waiting too long to start vaccinations - Begin 4-6 weeks before departure, not days before 1, 2, 3
• Focusing only on exotic vaccines while neglecting routine immunizations - Update MMR, Tdap first 1, 2, 3
• Failing to carry vaccination documentation - Required at some borders, especially yellow fever certificate 1, 3, 7
• Using live vaccines in immunocompromised patients - Always use inactivated alternatives 4, 2
• Assuming cholera vaccine is needed - Virtually never indicated for routine tourist travel 4, 6

Additional Preventive Measures

Beyond vaccination, travelers should: 4

• Avoid direct skin contact with soil/sand in areas with fecal contamination (wear shoes, use towels on beaches) 4, 2
• Consider malaria chemoprophylaxis for endemic areas 4
• Prepare for traveler's diarrhea management (avoid antiperistaltics if fever/bloody stools present) 4