The world of vaccines and Infectious diseases
I’m planning out my RTW trip and have been looking at what vaccines to get, usually they list a ton of them and I can’t get them all. I’m starting in Southeast Asia, then may go to India, Turkey and possibly somewhere in Northern Africa. What vaccines should I get?
Right, I’ll get back to basics here. First of all I am a qualified staff nurse, so I hope my advice will be of some use to you.
Vaccinations are basically split into three categories. Routine vaccinations, which are the ones everyone should already have such as MMR regardless of any travel or not, and are offered for free in the UK on the NHS. Recommended vaccinations are the ones most backpackers need to think about. They are not offered routinely on the NHS and will cost you, and the severity of the recommendation depends on what countries you are visiting. Required vaccinations are a little bit misleading, the vaccinations themselves are the same as the recommended vaccinations, the requirement part refers to the fact that proof of immunisation is needed for entry into particular countries but there are not many of these.
These are the basic vaccinations that most people should have as routine and are often routinely administered in childhood or throughout adult life for at risk groups such as the elderly or health workers. When giving advice on recommended vaccinations, it may be assumed that you will already have these routine vaccinations and are up to date on any boosters. They are available on the NHS in the UK, so if you do not have them for whatever reason or if you had them more than 10 years ago and may need a booster, go and get them. Check with your GP or practice nurse who will have access to your notes.
Recommended travel vaccinations.
These vaccinations are not always required in every country, and recommendations do change from time to time as the spread and nature of certain diseases change. Dependent on the specific country or countries you are visiting, any or all of these vaccinations may be classed as not required at all, sometimes recommended, strongly recommended or recommended (which is to be read as essential).
Some vaccinations are very specific to certain countries and are technically only recommended if you are visiting that region or put yourself within a risk category. However it is wise to get inoculated against these diseases regardless, especially if you are travelling extensively throughout different regions and will be heading to more rural parts of certain countries.
It is up to you to assess the risk for yourself and decide whether you want the recommended vaccines or not, no one can force you to get them after all, but from a health professional point of view it simply isn’t worth taking risks when it comes to your health. So despite the fact that certain vaccinations may not be required in certain countries, and obviously you should pay attention to the vaccinations that are recommended first, I would still strongly recommend you get all of them if you can. The chances of getting rabies for example may be extremely low, and you will still need to seek treatment, but it can be fatal if you are one of the few who do get it and the vaccine can buy you more time to get treated. It is up to you whether you want to take that chance.
Cholera is rare in backpackers, but is spread by contaminated food and water in areas with poor sanitation. It is recommended to travellers heading to rural areas in particular, slum or refugee areas or conflict zones where access to medical facilities is limited. Outbreaks occur sporadically throughout the world.
The vaccination is administered over a period of 2 to 3 months. Once you have the vaccination, you will be immune for up to 2 years, after which you will need another vaccination.
This is a virus present in faeces and is usually caught by consuming contaminated food or water. It is common throughout Asia, Africa and Central and South America. The vaccination is particularly recommended to those travelling to any developing country where sanitation is poor. Good personal hygiene is also important.
This vaccination should be administered at least 2 weeks before travel, and a further reinforcing dose will be required 6 to 12 months later. Once you have it the duration of immunity can be up to 20 years. You can also get this as combined vaccination with hepatitis B or Typhoid.
This virus attacks the liver and is spread through blood to blood contact and is prevalent throughout the world. Those travellers who may place themselves at risk by undertaking activities such as unprotected sex, injected drug use, contact sports, medical or dental treatment or undertaking relief aid/work are highly recommended to get this vaccination.
You will need three spaced doses of this vaccine at least 6 months prior to travel, and the immunity lasts for approximately 5 years. You can also get this as combined vaccine with hepatitis A.
Japanese encephalitis is a viral disease causing a severe flu like illness spread by mosquitoes throughout South East Asia, particularly in rural areas such as rice and paddy fields, and can be more prevalent in wetlands. Chances of contracting the disease are low, but the consequences if you do get it can be fatal. It is recommended to all travellers to the region, but particularly those travelling to rural areas for extended periods or those travelling during the monsoon seasons.
You will need two doses of this vaccine spaced 28 to 30 days apart, so you should get your first dose at least a month before travelling. The immunity period is approximately 1 year.
There are two types of meningitis vaccine for the four different strains of meningitis, A, C, W and Y. The meningitis C vaccine is a routine vaccination for all UK children, and most travellers will have had this during their childhood. Vaccination against the other strains are recommended on top of this routine protection. Outbreaks have occurred in many regions throughout the world and in many cases the chances of contracting the disease are significantly higher than in the UK.
The vaccines are administered as a single dose and immunity lasts for 5 years.
Rabies is spread through the bite or saliva of an infected animal (especially if you have open wounds such as a cut or graze). It is not normally a recommended vaccine for travellers unless they are travelling for extended periods in areas with rabies and will have limited access to immediate post exposure medical facilities. The vaccine does not grant immunity to rabies, but it does give you extra time to get treated with post exposure prophylaxis (PEP). Even if you have the vaccine, you will still need this. If you get bitten or suspect the saliva of an infected animal has entered your bloodstream (such as through an open cut), then seek help immediately even if you have the vaccine, as cases are almost always fatal once you become symptomatic.
The vaccine is administered in three doses, spaced a week, then a month after the first dose, and will last for 3 to 5 years.
Tick borne encephalitis.
This is a potentially serious virus spread by the bite of infected ticks found in wooded or forested areas of Central, Northern and Eastern Europe, with sub types found in Russia, Siberia and parts of China and Japan. Backpackers who travel to these areas and spend extended periods outdoors, especially in forested areas, are at risk.
The vaccine is administered in three doses, spaced 1 month then 6 months after the initial dose, so will need to be started at least 6 to 7 months before travel, and is effective for approximately 3 years.
Typhoid is called by bacteria called Salmonella and can contaminate food or drink in areas of poor sanitation. It can be very serious and even potentially fatal and the vaccination is recommended for all travellers to affected regions, especially the Indian subcontinent, Asia, South America and Africa, and particularly if they will be spending extended periods exposed to poor sanitation or hygiene conditions.
There are two types of vaccine, an oral and injectable variety, but the injectable variety is recommended. It is administered in a single dose and lasts for up to 3 years. It can also be administered in a combined injection with hepatitis A.
This is a serious disease that is spread through the bite of infected mosquitoes that tend to feed during daylight hours. It is prevalent throughout tropical Africa and South America. Symptoms can range from flu like fever to vomiting, jaundice or bleeding which can be fatal. The vaccination can only been given at accredited centres such as most GP practices and can take at least 10 days to become effective. The certificate is only valid 10 days after your injection too, so leave enough time to get your vaccination before you fly.
The vaccine is administered as a single dose injection, and a booster dose is required every ten years.
Required travel vaccinations.
Whilst these vaccinations remain recommended in a health sense for most countries where the disease is prevalent, certain visa restrictions by the governments of particular countries have made proof of these vaccinations mandatory for approved entry, which is what makes them required.
Proof of vaccination is required by many countries throughout South America and Africa as a condition of entry if you are coming from a country where yellow fever is present. Failure to provide a valid certificate may lead to you being denied entry and turned away, or even quarantined and immunised.
Meningococcal disease and polio.
Proof of vaccination is required for visitors to Saudi Arabia who visit Mecca and Medina during Hajj or Umrah.
When getting any of these vaccines, plan well in advance. Some take a few doses and months to administer, and you can’t get them all at once either, so start getting thema good few months at least before you travel.
Also look into Malaria tablets too.
I hope this answers your questions.
Really depends on where exactly you’re going as well as other risk factors – eg, if you’re planning to spend lots of time in rural areas may mean rabies is worth getting, visiting parts of Myanmar will mean malaria pills essential. Check out www.fitfortravel.nhs.uk/destinations.... as a first reference. If you’re based in the UK visit your GP to get advice 4-6 weeks before you leave. There’s also a good private travel clinic at www.fleetstreetclinic.com/
You can get typhoid, polio and tetanus/diphtheria free from your GP, so you might as well go ahead and get those!
Hepatitis A is the fourth strongly recommended vaccine for travelling in nearly all countries in Asia and Africa (including India and Turkey) so that would be the next one I definitely wouldn’t travel without.
If you are only going to North Africa, you shouldn’t need Yellow Fever, but if you decide to wander further south on that continent, check that out too.
For the rest, it is purely a matter of where you are heading and what kind of travelling you will be doing – you really need expert advice, specific to your travel plans. Have a look at www.traveldoctor.co.uk/vaccines.htm ; as well as being a helpful site it has a handy Travel Clinic locator for the UK. Fees vary in different clinics, so it can also be worth shopping around a bit.
I also check wwwnc.cdc.gov/travel/notices.htm which tells you if there are any active health warnings anywhere in the world – can be a good source of places to avoid travelling – for now!
Do be sure to get the vaccines you require well in advance…. some need 2 or 3 doses and these can be 4-6 weeks apart (i.e. rabies). If you’re going to visit an area at risk of malaria, I’d recommend forking out the cash for Malarone… no dodgy side effects and easier to remember to take!
Thanks for all the advice everyone, I appreciate it. Now I gotta get all those vaccinations.
And since no one mentioned it. Get the yellow International Certificate of Vaccination (as approved by the World Health Organization) and have the inoculations entered on that card. And keep it with your important things (like your passport, as I do).
Then keep up with your immunizations. www.cdc.gov/vaccines/ has easy to read information and other countries likely have similar.