The Ultimate Guide To Travel Vaccinations

Editor’s Note: This is general travel health advice and is not intended to replace individual advice from your GP, specialist nurse or another qualified travel health professional, that has been tailored to your past medical history, medication or travel plans. This article was reviewed and updated on November 2026. It is routinely reviewed every 3 years unless new clinical evidence emerges.

Working out which travel vaccinations you need can feel more complicated than planning the trip itself. You look up your destination, find a list of diseases you would rather not bring home as souvenirs, and start thinking that world travel requires a whole set of infectious disease protocols and a hazmat suit.

As a former nurse, with my background in emergency care, travel and tropical medicine, I spent ten years running my own online travel health clinic, helping people prepare for their trips and advising those already travelling. And vaccinations were always one of the biggest causes of concern for those dreaming of travelling the world. Don’t worry, it isn’t as scary or as confusing as it first appears, and it is all about protecting yours and others health and reducing any potential risk so that you can get on with the job of enjoying your trip.

The truth is every individual is different, and whilst there are general public health issues to consider for specific areas, all vaccination advice should be personal and unique to you. Your medical history, previous vaccinations and travel plans all help shape the recommendations, so a country’s vaccination list is a starting point for a conversation, rather than a shopping list of everything you must have.

Whether or not you have a vaccination is your choice. Your bodily autonomy and informed consent are absolute rights. I will never argue otherwise or judge your decision either way. A clinician’s role is to explain the evidence, offer recommendations tailored to you and discuss the benefits, risks, alternatives and implications of declining vaccination, so you can make a freely informed decision.

It is perfectly reasonable to have questions about side effects, costs or whether a particular vaccine is worthwhile for your trip. You deserve clear answers and the opportunity to talk through your concerns. You don’t need to arrive at an appointment already knowing the answers. With clear explanations and a little support, you can make sense of the advice, decide what is right for you and get back to looking forward to your adventure.

What Are Travel Vaccinations And How Do They Work? Quick Answer

Travel vaccinations help protect you against certain infectious diseases you may encounter abroad. They train your immune system to recognise a particular infection and respond more effectively if you are exposed to it, reducing your risk of illness or serious complications.

Different vaccines do this in different ways. Some use an inactivated germ, a weakened version or selected parts of it; others protect against a toxin produced by bacteria. Protection takes time to develop, may require several doses and is never guaranteed, so vaccination works alongside precautions such as avoiding insect bites and taking care with food and water.

What Is The Difference Between Routine And Travel Vaccinations?

Routine vaccinations are those offered through national immunisation programmes to protect people at particular ages or stages of life, or because their health, work or other circumstances put them at increased risk. In general, people in the UK and many other countries get most of these throughout childhood or routinely at specific ages. Travel vaccinations are offered because of the risks associated with a particular trip. There is some overlap between the two, so a vaccine you received through a routine programme may also help protect you abroad.

For example, measles protection is important whether you are at home or travelling, whilst hepatitis A vaccination may be recommended because of your destination. Hepatitis B vaccination is now part of the UK childhood programme, but that does not mean every adult traveller received it as a child. What you have already had depends partly on when and where you grew up, as well as your individual circumstances.

Preparing for travel is therefore a good opportunity to check your vaccination history, including routine vaccinations appropriate for your age and health. Having had your childhood injections does not necessarily mean you have protection against everything relevant to your trip, but neither does travelling abroad mean starting again or automatically needing extra doses.

If you are unsure what you have had, ask your GP practice and bring any vaccination records you hold to your travel consultation. Gaps or missing records are something a qualified professional can help you work through, so do not worry if you cannot remember the name of an injection you had twenty years ago.

Which Travel Vaccinations Do I Need?

The vaccinations appropriate for your trip depend on where you are going, what you will be doing and your own health and vaccination history. There is no standard set that every backpacker needs, and travelling through several countries does not automatically mean having every vaccine available.

Start with your itinerary, even if it is only a rough one. Country-specific recommendations help identify the diseases that may be relevant, but they need to be considered alongside your past medical history and the details of your trip. A short city break, several months staying with family and a placement working with animals can involve different exposures, even within the same country.

A travel health consultation helps you put those recommendations into context. Bring your vaccination records if you have them, explain your plans and mention any activities or possible changes of route. You do not need every night booked, but knowing that you might spend a few weeks trekking or volunteering is more useful than simply saying you are going to Asia.

You may find that your existing vaccinations are sufficient for your plans, that a further dose is appropriate or that additional vaccines are worth considering. Ask why each vaccine is being suggested, how much benefit it is likely to offer you and what the alternatives involve. A useful recommendation should come with an explanation you understand.

Also check whether your itinerary involves proof-of-vaccination requirements, including those affected by transit stops or countries you have recently visited. These are separate from recommendations made for your health. A vaccine can be worth considering even when no certificate is required, whilst a certificate requirement does not, by itself, establish whether that vaccine is medically suitable for you.

What Should You Consider When Choosing Travel Vaccinations?

You are not expected to assess all the medical risks of your trip yourself. A travel health professional will consider your health, vaccination history and travel plans alongside current guidance, then explain which vaccines may be appropriate and why. Their role is to help you understand the evidence, benefits, risks and alternatives, so you have the information and support you need to make your own decision.

Choosing travel vaccinations involves weighing your likelihood of encountering an infection, how seriously it could affect you and the benefits and risks of vaccination in your circumstances. An infection that is unlikely to affect you can still have serious consequences if it does, but that does not mean every vaccine is appropriate for every traveller. The aim is to understand which precautions offer a worthwhile benefit for you and your trip.

Your Health And Previous Vaccinations

Your age, medical conditions, medication and vaccination history can affect both your risk from an infection and which vaccines are suitable. Tell your travel health professional if you are pregnant, planning a pregnancy or breastfeeding, have a condition or treatment that affects your immune system, or have previously had a serious reaction to a vaccine. Bring details of any allergies and medicines you take, including those prescribed by another clinic.

These details do not automatically mean you cannot be vaccinated. Some circumstances call for a different vaccine, a change in timing or specialist advice. A previous reaction also needs to be understood properly: a sore arm after an injection is very different from a confirmed severe allergic reaction.

Where And When You Are Travelling

The country name is only part of the picture. Someone staying in a city may receive different advice from someone spending time in a rural part of the same country where a particular infection occurs. That does not mean cities are free of risk or rural travel is inherently dangerous; it means the specific places you visit help determine which precautions are useful.

The timing of your trip matters too. For some mosquito-borne infections, transmission varies with the season, so two people visiting the same region at different times of year may receive different advice. A local outbreak can also change recommendations, making current information more useful than what someone was advised before a trip several years ago.

Explain your route, travel dates and any likely side trips. If you are keeping your plans flexible, say so. You do not need to invent a detailed itinerary, but discussing the places you might visit helps you prepare for the journey you are realistically likely to take.

How Long You Will Be Away

The length of your stay matters because spending more time somewhere can create more opportunities to encounter an infection. A few days in an area and several months living there may therefore lead to different vaccination recommendations, even when the destination is the same.

That does not mean a short trip is automatically low risk or that a longer trip requires every vaccine. Exposure can happen early in a visit, and duration needs to be considered alongside the disease, local conditions and your activities. There is no universal number of days after which travel vaccinations suddenly become necessary.

Mention repeat visits as well as the trip immediately ahead. If you regularly return to the same region, or expect to spend several months there across a series of shorter visits, that is useful information for your consultation. It can also help you discuss whether a vaccination course offers benefits for future travel as well as your next departure.

What You Will Be Doing And How You Will Be Travelling

Your activities can change the type and intensity of exposure, independently of how long you are away. A short volunteer placement working with animals may involve more opportunities for bites or scratches than a much longer trip without animal contact. Providing healthcare, camping or spending substantial time outdoors can also introduce risks that would be less relevant to someone with different plans.

Explain what those activities involve. ‘Volunteering’ could mean helping with office administration or providing hands-on clinical care, while ‘trekking’ could mean a day on a well-used trail or weeks camping in remote countryside. Those details help make the advice relevant to what you will actually be doing.

Your accommodation and living arrangements matter too. Staying with friends or relatives, sleeping outdoors and moving between remote communities can involve different exposures from a short hotel stay. Comfortable accommodation does not remove every risk, just as backpacking does not automatically make a trip dangerous. The point is to understand your plans and find sensible precautions that let you enjoy them.

Access To Medical Help

Consider how easily you could get appropriate treatment if something happened. Being several hours from a clinic, or somewhere that a particular treatment is difficult to obtain, can affect the balance of a vaccination recommendation.

Rabies is an important example. Difficulty accessing treatment after a possible exposure can strengthen the case for vaccination before travel, but having that vaccination does not remove the need for urgent medical assessment and further treatment after an exposure.

The Benefits, Risks And Practicalities For You

For each vaccine being considered, ask what protection it offers, its limitations, the possible side effects and whether your health affects its suitability. You should also understand how many doses are needed, how long protection takes to develop and whether further doses may be appropriate.

Cost and the time available before departure are reasonable parts of that conversation. If you cannot afford every vaccine suggested, explain that openly and ask for help understanding the priorities and other ways to reduce your risk. You deserve a recommendation you can understand and discuss, with room to ask questions and make your own decision.

Making An Informed Choice About Vaccination

If you are unsure about having a vaccination, you should be able to talk it through openly with someone who listens, answers your questions and respects your decision. You do not have to arrive at your appointment ready to say yes, and asking for advice does not commit you to having an injection.

Whether or not you have a vaccination is your choice. Your bodily autonomy and informed consent are absolute rights. I will never argue otherwise or judge your decision either way. However strongly a vaccine is recommended, the decision about whether to have it remains yours.

You have the right to understand what is being offered, why it is being recommended and what accepting or declining it could mean for you. That information should be explained in a way you understand, with the opportunity to ask questions and consider your options freely, without pressure, coercion or judgement. Being handed a leaflet or asked to sign a form is not a substitute for that conversation.

A recommendation on a country information page is general advice. A travel health professional should help you understand how it applies to your health and travel plans, including the likely benefits, possible side effects, important uncertainties and reasonable alternatives, including not having the vaccine. They should also explain what precautions remain useful whichever decision you make.

If you are unsure, these are useful questions to ask:

• Why are you recommending this vaccine for my particular trip?
• How likely am I to encounter the infection, and how seriously could it affect me?
• What protection does the vaccine offer, and what are its limitations?
• What are the common side effects and the important rarer risks?
• Does anything in my medical history or medication change the advice?
• What would declining or delaying vaccination mean, and what other options do I have?
• What will the full course cost, including any consultation fees or further doses?

You do not need to justify feeling nervous about an injection or worried about a side effect. Equally, asking about cost does not mean you are being careless with your health. Explain what is troubling you so the conversation can address your actual concerns. Asking questions is part of making an informed decision, and you deserve to have them answered respectfully.

If something is unclear, ask for it to be explained differently. You can ask for written information, take time to consider your options or get another qualified opinion. If departure is close, ask how much time you have to decide and what a delay would mean for the vaccination schedule or your plans. A practical deadline should be explained honestly, without being used to pressure you into agreeing.

You can decline a vaccine or withdraw your consent before it is given, even if you previously agreed. You should still receive respectful advice about reducing your risk and recognising when to get help. The purpose of the consultation is to give you the information and support to make your own decision. It is your body, and the final decision belongs to you.

Where Can You Get Reliable Travel Vaccination Advice?

A travel health consultation with a suitably trained nurse, doctor or pharmacist is the best place to get vaccination advice tailored to your health and your trip. Your GP practice is a useful starting point, particularly because it holds your medical records, but the travel health services and expertise available vary between practices. Ask whether it offers appointments with someone trained in travel health. A specialist travel clinic or pharmacy with a travel health service may be more appropriate for detailed advice about your itinerary.

If you have complex medical needs, your GP or usual specialist may also need to contribute to that advice. They understand your ongoing care, while a travel health professional can assess how your conditions and treatment interact with the risks of your trip. Sometimes the most useful advice comes from those professionals working together.

For your own research, Bemused Backpacker’s destination guides provide an introduction to relevant travel health considerations, while TravelHealthPro provides current country-specific health information and vaccination recommendations. The NHS is also a good resource for explaining individual vaccines. These resources can help you understand the advice and prepare questions, but a country page cannot account for your medical history or every detail of your plans.

Check that the information applies to travellers from the UK and look for its latest review or update. Advice from another country may reflect different vaccination programmes, available products or national recommendations. It is not necessarily wrong, but it may need interpreting before you apply it to yourself.

You do not need to spend hours comparing every website before asking for help. Use them to build a basic understanding, then bring your plans, any vaccination records and the questions that are bothering you. A good consultation should help make the information clearer and leave you understanding the reasons behind the advice.

Where Can You Get Travel Vaccinations And Which Are Free?

You can get travel vaccinations through NHS services, private travel clinics and pharmacies offering travel health appointments. Some GP practices also provide paid travel vaccinations. Where you go will depend on which vaccines are appropriate for you, local services and appointment availability.

Which Travel Vaccinations Are Free On The NHS?

When recommended following an individual assessment, the following travel vaccinations are available free through NHS provision:

• Hepatitis A.
• Typhoid.
• Polio, given in the combined tetanus, diphtheria and polio vaccine.
• Cholera.

Being on this list does not mean everyone needs them. Cholera vaccination, for example, is appropriate only in particular circumstances.

Ask your GP practice how to access NHS travel vaccination services locally. Arrangements vary across the UK, so the appointment may be provided by your practice or another commissioned service. Check that you are booking an NHS appointment, as a private clinic may charge for a vaccine that you could otherwise receive free through NHS provision.

Routine vaccinations are also available through NHS programmes for eligible people. If your records suggest you have missed doses, ask your practice to check what is appropriate for you rather than assuming you need to pay privately.

Which Travel Vaccinations Do You Pay For?

Vaccines provided specifically for travel outside NHS-funded provision generally need to be paid for. Depending on your individual recommendations, these may include hepatitis B, rabies, Japanese encephalitis, tick-borne encephalitis, meningococcal ACWY, yellow fever, dengue and chikungunya.

The reason for vaccination matters. A vaccine that you would pay for solely for travel may be available through an NHS programme or occupational health service if you meet separate eligibility criteria. Hepatitis B is one example, so it is worth checking before booking.

Private travel clinics and pharmacies can provide paid vaccinations, although not every service stocks every vaccine or vaccinates every age group. Check availability when making your appointment, particularly if departure is close.

Comparing Costs And Booking Your Appointment

It is reasonable to compare prices, especially when several doses are needed. Ask for the total cost of the recommended course, including consultation charges, administration fees, certificates and any later doses. A price advertised for one injection may be only part of the overall cost.

You can use NHS and private services for different vaccinations, but tell each provider what you have already received and what is booked elsewhere. Keep a shared record of the vaccine names and dates so your course can be coordinated properly.

If the cost is difficult to manage, say so during your consultation. Ask which recommendations offer the greatest benefit for your circumstances and what other precautions or changes to your plans could reduce risk. A useful conversation should help you understand your options without making you feel judged for having a budget.

Where Can You Get A Yellow Fever Vaccination?

Yellow fever vaccination is available only at designated yellow fever vaccination centres. Some travel clinics and pharmacies have this designation, but not all do, so check before booking.

The centre should assess whether vaccination is suitable for you and provide an International Certificate of Vaccination or Prophylaxis, or ICVP, if you are vaccinated. Ask whether the quoted price includes the certificate and keep it safely with your travel documents.

When Should You Arrange Your Travel Vaccinations?

Arrange a travel health consultation at least four to six weeks before departure if you can. Some vaccines need a course of doses spaced apart, and your immune system needs time to develop a response. Planning ahead also gives you time for any short-lived side effects to settle before you travel, rather than spending your flight feeling under the weather. An appointment does not commit you to having any vaccination; it gives you time to understand the advice and consider your options.

Four to six weeks is a useful starting point, rather than a guarantee that every course can be completed in that time. Earlier advice can be helpful if you have complex medical needs, are pregnant or are planning a long or complicated trip. It also gives you more flexibility with appointments and vaccination courses. You do not need to wait until your itinerary is final before asking for advice.

Allow Time For The Course And For Protection To Develop

Completing a vaccination course does not mean protection is immediate. For example, the standard Japanese encephalitis course involves two doses given 28 days apart, with the second dose at least a week before potential exposure. That means allowing around five weeks from the first injection to entering an area where you may be exposed, rather than simply fitting both injections in before your flight.

Explain when you leave and when you expect to reach each destination. If you are spending the first month of a longer trip somewhere that a particular vaccine is not relevant, that may affect the planning. Your travel health professional can work backwards from your likely exposure dates and explain what is appropriate.

Some vaccines have accelerated schedules for particular ages or circumstances, but these are not available for every vaccine. A shorter schedule may also involve a later dose to complete the course or maintain protection. Ask for the dates in writing so you know what needs to happen before departure and what may be due afterwards.

What If You Are Travelling At The Last Minute?

Book an appointment anyway. Even if you leave in a few days, a consultation can still help you understand your options and the precautions most relevant to your trip. Some vaccinations may still offer useful protection, and an appropriate accelerated schedule may be possible.

Be realistic about what can be achieved in the time available. Having a vaccine shortly before departure does not mean you will be protected immediately, and an incomplete course may not provide the protection expected from a completed one. Your travel health professional should explain those limitations and help you consider other precautions or adjustments to your plans.

Tell the clinic your departure date when you contact them so they can advise on appointment availability and what may be possible. There is no benefit in feeling embarrassed about booking late; getting advice now is more useful than assuming you have missed your chance.

Check Certificate Dates As Well As Vaccination Dates

If proof of vaccination is relevant to your itinerary, check when the certificate becomes valid. After a first yellow fever vaccination, the International Certificate of Vaccination or Prophylaxis becomes valid ten days later and remains valid for life. If you arrive somewhere that requires it before those ten days have passed, having the injection recorded in your booklet is not enough: you may be refused entry.

Other vaccination documentation may have different timing rules. Check the requirements for your particular journey rather than assuming that having an injection the day before departure will satisfy them.

Which Vaccines Are Available For Travellers?

The vaccines relevant to your trip depend on where you are going, the infections you may encounter and your individual circumstances, but seeing a long list of disease names on a country specific recommendation list can make it difficult to understand what is actually being offered. Knowing what each infection is, how it spreads and what the vaccine can do helps make that advice clearer.

You generally will not need every vaccine listed here. Some may be relevant to your trip, others may already be in your vaccination records, and some will offer little benefit for your particular plans. The aim is to help you understand the options and have a useful, informed conversation with your travel health professional.

Hepatitis A

Hepatitis A is a viral infection that causes inflammation of the liver. It usually spreads through the faecal–oral route when microscopic traces of an infected person’s faeces contaminate food, water or hands, and can also spread through close contact, including some sexual contact. It can leave you unwell for weeks or months, making it rather more than an inconvenient upset stomach.

Vaccination is recommended for most travellers visiting countries where hepatitis A is common, including parts of Africa, Asia, the Middle East, Central and South America and Eastern Europe, although recommendations vary between countries.

Poor sanitation increases the risk because human sewage can contaminate drinking water, water used to grow or wash produce, and coastal waters where shellfish are harvested. Food can also become contaminated if someone handling it has not washed their hands properly after using the toilet. That is how uncooked salads, fruit washed in unsafe water and raw or undercooked shellfish can become sources of infection. You cannot reliably tell whether food contains the virus by its appearance, smell or taste, and a good hotel or restaurant does not eliminate the risk.

Older travellers and people with existing liver disease are at greater risk of serious illness if they catch hepatitis A. This matters when considering vaccination, because the recommendation should account for both your chance of encountering the virus and the consequences if you become infected.

The hepatitis A-only vaccine is inactivated, meaning it cannot cause hepatitis A, and is given by injection, usually in the upper arm. The usual course is an initial dose followed by a second six to twelve months later for long-term protection. You do not normally need both doses before travelling. A combined hepatitis A and B vaccination may be appropriate when protection against both infections is needed, but follows a different schedule.

Ideally, have the first dose at least two weeks before departure. If you are leaving sooner, vaccination can still be given up to the day you travel. Protection is not immediate, but vaccination may still offer useful protection and a last-minute appointment can still be worthwhile. Explain your departure date and any health conditions so the clinician can advise on the most appropriate option.

After a completed course, including the second dose, protection is expected to last at least 25 years. UK guidance recommends a further dose at 25 years for people who remain at risk. Those with weakened immune responses may need additional assessment or earlier doses. If you had the first injection years ago but missed the second, bring your records. A delayed course does not normally need restarting.

Side effects are usually mild and short-lived, such as soreness where the injection was given, a headache or feeling unwell. A previous serious allergic reaction to a dose or one of its ingredients needs assessment before vaccination.

Vaccination works best alongside other basic precautions that interrupt the faecal–oral route. Wash your hands with soap and water after using the toilet and before preparing or eating food, use safe drinking water and choose food that has been thoroughly cooked and served hot. Peel fruit yourself with clean hands and avoid raw shellfish or uncooked food washed in water of uncertain safety. These precautions also help reduce the risk of other infections that the hepatitis A vaccine does not prevent.

Hepatitis B

Hepatitis B is a viral infection of the liver spread through infected blood and certain body fluids, including during sex. Some people develop a long-term infection that can cause liver scarring and liver cancer.

It occurs worldwide, with higher levels of infection in parts of Africa, Asia and the Pacific. Vaccination is recommended for travellers whose activities, length of stay or medical needs put them at risk, particularly in countries where infection is more common.

Relevant exposures include sex without a condom, tattoos or piercings using contaminated equipment, sharing injecting equipment and contact with infected blood through healthcare work or contact sports. Medical or dental treatment can also transmit infection if equipment is not properly sterilised or blood products are inadequately screened. An unexpected accident can therefore create an exposure you had not planned for.

Long stays and repeated travel deserve consideration because they provide more opportunities for exposure. Hepatitis B vaccination has been included in the UK routine infant programme since 2017, but many adult travellers will not have received it unless vaccinated separately.

The vaccine contains no live virus and cannot cause hepatitis B. It is given by injection, usually in the upper arm, either alone or combined with hepatitis A vaccination.

The schedule depends on your age, the vaccine and how soon protection is needed:

• A commonly recommended accelerated course uses doses at the first appointment, one month, two months and twelve months.
• A three-dose course at the first appointment, one month and six months may be suitable when rapid protection is unnecessary.
• Some adult vaccines allow a very rapid course on days zero, seven and twenty-one, followed by a fourth dose at twelve months.
• A two-dose adult option, with doses one month apart, is also available.

Ask which schedule you are following and record every appointment, including doses due after your return. Starting a course does not mean immediate protection. If a dose is late, the course can usually be continued without restarting.

Protection is long-lasting. People with normal immune function who complete an established three- or four-dose course do not normally need routine boosters. Follow-up advice can differ for newer schedules, kidney disease, weakened immunity or occupational exposure. Blood tests to check the response are not routinely needed for ordinary travel vaccination, but may be appropriate for particular groups.

Side effects are usually mild, particularly soreness or redness at the injection site. Tell the clinician about previous serious allergic reactions.

Vaccination complements precautions such as using condoms, avoiding shared needles or razors and choosing services with proper infection control. If you sustain a needlestick injury or another possible exposure, get medical advice as soon as possible, even if previously vaccinated: treatment after exposure may be needed.

Combined Hepatitis A & B Vaccination

A combined hepatitis A and B vaccine protects against both infections in the same injection. The adult vaccine used in the UK is called Twinrix Adult. If both vaccinations are appropriate for your trip, it can reduce the total number of injections compared with completing the courses separately.

The usual adult course involves three doses, given at the first appointment, one month and six months. For adults aged 18 and over who need a faster schedule, doses can be given on days zero, seven and twenty-one, followed by a fourth dose twelve months after the first.

Whether the combined vaccine makes sense depends on your previous vaccinations, travel plans and time before departure. If you already have protection against one infection, a separate vaccine for the other may be more appropriate. When rapid protection against hepatitis A alone is needed, UK guidance recommends the hepatitis A-only vaccine for adults rather than assuming one combined dose offers equivalent early protection.

Tetanus, Diphtheria And Polio

Tetanus, diphtheria and polio are different diseases, but vaccination against all three is commonly given together as a single injection for older children and adults. These vaccines form part of routine UK immunisation, although additional doses may be appropriate for particular travel plans.

Tetanus develops when bacterial spores, found in soil worldwide, enter a wound and produce a toxin that affects the nervous system. It can cause severe muscle spasms and difficulty breathing. A contaminated cut, puncture wound or injury during outdoor activities can provide an entry point; tetanus is not spread between people.

Diphtheria is a bacterial infection that can affect the nose, throat or skin. It spreads through respiratory droplets and close contact, or contact with infected skin lesions. Toxin-producing strains can cause breathing difficulties and damage the heart or nerves. It remains a concern where vaccination coverage is low or outbreaks occur.

Polio is a viral infection spread mainly through the faecal–oral route, including contaminated food and water. Most infections cause no symptoms, but some cause permanent paralysis. Although global vaccination programmes have dramatically reduced polio, transmission and outbreaks still occur, so advice should reflect your current itinerary rather than an old list of affected countries.

For most adult UK travellers vaccinated through the childhood programme, a completed routine schedule means five appropriately spaced doses: three initial doses in infancy, a pre-school booster and a teenage booster. A booster is an additional dose given after the initial course to reinforce protection. Younger children should be up to date for their age; they are not expected to have received doses scheduled for later childhood. Recent changes also mean some younger children follow a six-dose routine schedule.

If an adult has never been vaccinated, the catch-up schedule generally starts with three combined injections, leaving four weeks between appointments. A first booster is preferably given five years after completing those three doses, followed by a second ideally ten years later, with a minimum interval of five years. If you have already received some valid doses, the clinician can build on those rather than automatically starting again.

Completing that routine schedule does not mean having another injection every ten years for the rest of your life. Additional travel doses depend on your destination, previous vaccination dates and circumstances:

• A tetanus-containing booster is recommended when travelling where medical facilities may be limited if your last dose was more than ten years ago. This is a precaution because treatment needed after a contaminated injury may be difficult to obtain.
• A polio-containing booster is recommended for relevant polio-affected destinations if your last dose was ten or more years ago.
• Diphtheria protection should be reviewed alongside your vaccination history, destination and any outbreak-related advice.

The combined vaccine is given by injection, usually in the upper arm. If a travel booster is appropriate, this is normally one dose. It contains no live organisms and cannot cause these infections.

Polio vaccination can also involve documentation requirements separate from these clinical recommendations. Temporary recommendations issued under the International Health Regulations call for certain affected countries to ensure that residents and visitors staying longer than four weeks receive a polio dose between four weeks and twelve months before leaving for another country, with vaccination documented on an International Certificate of Vaccination or Prophylaxis, or ICVP. The measures differ according to the country’s polio situation; not every outbreak creates identical requirements.

For example, a childhood course or a travel booster several years ago may provide established protection but fail to meet a requirement for a dose within the previous twelve months. If travel is urgent, advice should be obtained even when fewer than four weeks remain.

Destinations may impose their own entry requirements too. Saudi Arabia’s Hajj requirements include proof of polio vaccination for arrivals from specified polio-affected countries. This is not a universal polio certificate requirement for everyone travelling directly from the UK. Pilgrims should check the current Hajj or Umrah rules for their route, including travel through affected countries.

Give your clinic the order of countries you will visit, transit stops and the length of each stay. Ask whether you need a recent polio dose, an ICVP and particular timing before entry or departure. These rules can change as outbreaks develop.

Vaccination does not remove the need to have injuries assessed. Clean wounds thoroughly and get medical help for deep, dirty or puncture wounds, bites or injuries containing foreign material. Depending on the wound and your vaccination history, additional tetanus prevention may be needed.

Typhoid

Typhoid fever is a bacterial infection caused by Salmonella Typhi that can enter the bloodstream and affect several organs. It spreads through the faecal–oral route, usually when food or drinking water becomes contaminated with faeces from unsanitary conditions or an infected person, including someone carrying the bacteria without symptoms

Vaccination is recommended for travellers visiting countries where typhoid occurs, taking account of local infection levels and planned activities. South Asia, particularly India, Pakistan and Bangladesh, is an important risk area for UK travellers. Typhoid also occurs in parts of Africa, elsewhere in Asia and Central and South America.

Poor sanitation allows the bacteria to contaminate water supplies and food. Exposure can occur through unsafe drinking water, ice made from it, uncooked food washed in contaminated water or food prepared with inadequate hand hygiene. Longer stays and frequent trips can increase opportunities for exposure, but a short trip does not rule out the need for vaccination.

There are two established vaccination options for UK travellers:

• An injectable vaccine, usually offered from two years of age. This contains no live bacteria and is given as a single injection, preferably at least two weeks before potential exposure.
• An oral vaccine, offered from five years of age. This contains weakened live bacteria and involves three capsules taken on alternate days, on days zero, two and four. Protection develops approximately seven to ten days after the final capsule.

The oral vaccine needs a little more planning than simply remembering three tablets. Capsules must be refrigerated and swallowed whole, without chewing, with cool or lukewarm water about an hour before food. Follow the supplied instructions and ask the clinic what to do if you miss a dose or become unwell during the course.

The oral vaccine is unsuitable for people who are immunosuppressed. Antibiotics and some antimalarial medicines also affect how it should be scheduled, so tell the clinician what you are taking or expect to start. Pregnancy, breastfeeding and previous serious allergic reactions should be discussed when choosing either option.

If you remain at risk, repeat vaccination is generally recommended every three years. For the injectable vaccine this is one further injection; for the oral option it is another three-capsule course. Check your previous vaccination date before assuming you need another dose.

Neither option protects everyone, and typhoid vaccination should not be relied on to prevent paratyphoid, a similar infection. Food, water and hand hygiene therefore remain important. Side effects can include a sore arm after the injection, while the oral vaccine can cause abdominal discomfort, nausea or diarrhoea; headache or fever can also occur.

Typhoid is treatable, but increasing antibiotic resistance can make treatment more complicated. If you develop a persistent fever during or after travel, get medical help as soon as possible and explain where you have been, even if you were vaccinated. Do not assume it is just another stomach bug or try to manage it solely with leftover antibiotics.

Cholera

Cholera is a bacterial infection that can cause profuse watery diarrhoea and rapid dehydration. It is mainly caught through contaminated drinking water or food, particularly where sewage enters water supplies or sanitation systems have broken down.

Outbreaks occur particularly in parts of Africa and southern Asia, although affected areas change. For the average traveller, including most backpackers, the risk is very low and vaccination is not routinely recommended. Simply visiting a country where cholera occurs is not usually enough reason to have it: what matters is whether your plans bring you into affected areas and how reliably you can access safe food, drinking water and sanitation.

Vaccination becomes more relevant when those basic protections are difficult to maintain, particularly during an outbreak. Travellers planning to volunteer in disaster-affected communities, displacement camps or areas with damaged water and sanitation systems should discuss the conditions and their role during a travel health consultation.

Vaccination may be appropriate for humanitarian workers, people entering outbreak areas with limited access to safe water and medical care, and others whose activities or health increase their risk. For example, working in a displacement camp after flooding involves different exposure from visiting an unaffected city with reliable water and sanitation. In these circumstances, there is a stronger reason to consider vaccination because exposure may be harder to avoid and treatment more difficult to reach.

Two oral vaccines are available in the UK. Both are taken as a drink, but their schedules differ:

• The inactivated vaccine contains no live bacteria. Adults and children aged six and over need two doses, at least one week apart and completed within six weeks. Children aged two to under six need three doses at these intervals. Finish the course at least one week before potential exposure.
• The live vaccine contains weakened bacteria and is available from two years of age. It is given as one dose at least ten days before potential exposure. It must not be given to people who are immunosuppressed.

Avoid food and drink for one hour before and after either vaccine. The inactivated option also requires a gap around oral medicines. The live option has specific interactions with antibiotics, some antimalarial medication and oral typhoid vaccination, so give the clinician your full medication and vaccination plans. Follow the preparation instructions carefully rather than treating the vaccine like an ordinary drink.

For continued protection with the inactivated vaccine, a single booster is given within two years for those aged six and over, or within six months for children aged two to under six. Longer gaps generally mean repeating the initial course. An interval exceeding six weeks between initial doses also means restarting. A repeat-dose schedule has not been established for the live vaccine, so future travel needs reassessment.

Neither vaccine should be treated as general protection against travellers’ diarrhoea. Safe water, thoroughly cooked food and handwashing remain essential. Possible side effects include abdominal discomfort, diarrhoea or headache; discuss pregnancy, breastfeeding and previous serious allergic reactions when assessing suitability.

If you develop profuse watery diarrhoea, start oral rehydration solution and get medical help as soon as possible. Severe dehydration needs urgent treatment, particularly if you cannot keep fluids down, pass very little urine or become faint or confused. Cholera is treatable, and replacing lost fluids quickly is crucial.

Rabies

Rabies is a viral infection that attacks the nervous system. It spreads through the saliva of infected mammals, usually through bites or scratches, but also when saliva reaches broken skin or the eyes, nose or mouth. Once symptoms develop, rabies is almost always fatal, but appropriate treatment after exposure can prevent the disease.

Rabies occurs in many countries, with most human deaths in Asia and Africa. Dogs cause most human infections worldwide, but cats, monkeys, bats and other mammals can also transmit it. An animal does not have to look ill or behave aggressively to be infectious.

Vaccination before travel is particularly worth considering if you will have difficulty reaching appropriate treatment, spend more than a month in an affected area or undertake activities that increase animal contact. Working or volunteering with animals is an obvious example, but simple everyday contact can count as well. A short trip does not remove the risk of an unexpected bite.

The important benefit of vaccination before travel is that it prepares your immune system and simplifies treatment afterwards. You still need urgent assessment and further vaccine doses following a possible exposure, but people with normal immune function who have completed an appropriate course generally do not need rabies immunoglobulin. This provides immediate antibodies after exposure and can be difficult to obtain in some countries.

The vaccine is inactivated, cannot cause rabies and is usually injected into the upper arm. Current UK guidance recommends:

• Three doses on days zero, seven and twenty-eight. The third can be brought forward to day twenty-one if necessary.
• When time is short, an accelerated course on days zero, three and seven may be appropriate, with an additional dose at one year if travel to high-risk areas will continue.

Routine boosters are not recommended for most travellers. A further dose may be considered after an individual assessment if the original course was completed more than a year ago and you are returning to a high-risk area. People with regular occupational exposure need different follow-up. Keep your vaccination record: the course and dates affect decisions about treatment after exposure.

Side effects are usually mild, such as soreness or redness around the injection site; headache, fever or feeling unwell can also occur. Discuss previous serious allergic reactions and any condition or treatment affecting your immune system, as these may change the vaccination plan.

Avoid touching or feeding animals, including apparently friendly dogs and monkeys at tourist attractions. Vaccination does not make animal encounters safe.

If you are bitten or scratched, or animal saliva reaches broken skin, your eyes, nose or mouth:

• Immediately flush and wash any wound thoroughly with soap and running water.
• Rinse exposed eyes or other mucous membranes with plenty of clean water.
• Get medical help immediately, even if the injury seems trivial and even if you have been vaccinated.
• Do not wait for symptoms or until you return home.

Contact your travel insurer for help locating suitable treatment, but do not delay medical attention while waiting for authorisation. Further travel may be necessary if treatment is unavailable locally. Keep written records or photographs of every vaccine and other treatment given.

Rabies deserves a clear plan rather than panic. Knowing how to avoid exposure and what to do immediately afterwards is important for every traveller, whether or not you choose vaccination before departure.

Japanese Encephalitis

Japanese encephalitis is a viral infection spread through the bites of infected mosquitoes in parts of Asia and the Western Pacific. Most infections cause no symptoms, but a small proportion cause inflammation of the brain, which can be fatal or leave lasting neurological problems.

Despite its name, the disease is not confined to Japan. Risk is associated particularly with rural areas where rice cultivation, wetlands and pig farming support the cycle of infection between mosquitoes, birds and pigs. The mosquitoes responsible feed mainly between dusk and dawn. Transmission can occur throughout the year in tropical areas, often increasing during rainy periods, while elsewhere it is more seasonal.

For most travellers, particularly those making short visits to cities, the risk is very low. Vaccination is recommended for people moving to an affected area, staying for a month or more in a risk area, particularly during transmission season, or travelling there frequently.

It may also be appropriate for shorter trips involving substantial rural, outdoor or night-time exposure. Camping near rice-growing areas, agricultural fieldwork or an extended rural stay can make vaccination more relevant than the overall length of your holiday suggests. Flexible plans are worth discussing too, especially if you may spend considerably more time in rural areas than your initial itinerary indicates.

The vaccine is inactivated, cannot cause Japanese encephalitis and is given by injection. It can be used from two months of age, with the dose adjusted for young children. The usual course is:

• Two doses given 28 days apart.
• For adults aged 18 to 65, an accelerated course can use two doses seven days apart.
• With either schedule, finish the course at least one week before potential exposure.

An accelerated schedule outside that age range requires individual clinical advice because it is outside the vaccine’s licence. If departure is close, ask what is appropriate rather than assuming one injection will provide the protection expected from the completed course.

Further doses depend on your age and future exposure. People with ongoing risk are generally offered a first booster twelve months after the initial course. For others returning to a risk area, the first booster is usually offered twelve to twenty-four months after the course, before re-exposure. For adults aged 18 to 64, a second booster is offered ten years after the first booster if risk continues. Children and adults aged 65 or over need separate advice because longer-term protection is less certain.

If your course has been interrupted, it can generally be resumed rather than restarted. Keep your records and discuss future trips before paying for another course.

Side effects commonly include soreness around the injection site, headache or muscle aches and usually settle within a few days. Pregnancy, breastfeeding and previous serious reactions require an individual assessment of whether vaccination is appropriate.

Vaccination complements mosquito bite prevention, it definitely does not replace it. Use suitable repellent, cover exposed skin and use screened accommodation or an appropriate mosquito net, particularly overnight. These precautions remain useful whether or not vaccination is recommended for your trip.

Meningococcal Disease

Meningococcal disease is a bacterial infection that can cause meningitis, an infection of the protective lining around the brain and spinal cord, and septicaemia, a bloodstream infection that can lead to sepsis. It can progress rapidly and become life-threatening, although it is uncommon in travellers.

The bacteria spread through respiratory droplets and throat secretions, particularly during close or prolonged contact. Someone can carry them without feeling ill. Crowded accommodation, mass gatherings and prolonged close contact can increase opportunities for transmission.

The highest rates occur in the ‘meningitis belt’ across sub-Saharan Africa, particularly during the dry season. Vaccination may be recommended when your destination and activities create increased exposure, such as healthcare work, extended stays in crowded conditions or travel during an outbreak. It is also recommended for Hajj and Umrah pilgrims, where large gatherings have previously been associated with outbreaks.

The vaccine usually recommended for travel is MenACWY. The letters refer to four groups of meningococcal bacteria it protects against: A, C, W and Y. It does not protect against every cause of meningitis or sepsis. A previous MenC vaccination does not provide the same coverage, and the separate MenB vaccine is not a substitute.

MenACWY is given by injection, usually in the upper arm, and contains no live bacteria. Most travellers aged one year or over need one dose. Infants and people with particular medical risks need an individually checked schedule. Tell the clinician if you have no spleen, a poorly functioning spleen or a condition or treatment affecting the complement system, part of your immune defences.

Check your records before booking: you may already have received MenACWY through the teenage vaccination programme. If you remain at increased risk through travel, a booster is generally recommended every five years. This does not mean everyone needs lifelong five-yearly boosters.

For Hajj, current Saudi requirements specify vaccination at least ten days before arrival, with a conjugate MenACWY certificate accepted for five years. The certificate should identify the vaccine type as well as the vaccination date; if the type is missing, it may be treated as valid for only three years. Check the current requirements for your particular Hajj or Umrah journey and carry the certificate with your travel documents.

Side effects are usually mild and short-lived, including a sore or swollen arm, headache, nausea or feeling unwell. A previous severe allergic reaction to a dose or an ingredient needs assessment before vaccination.

Whatever your vaccination history, get emergency medical help if you suspect meningitis or sepsis. Warning signs can include fever with a severe headache, stiff neck, confusion, unusual drowsiness or a rash that does not fade under pressure. Symptoms can appear in different combinations: do not wait for a rash or for every symptom to develop.

Tick-Borne Encephalitis

Tick-borne encephalitis, or TBE, is a viral infection usually spread through the bite of an infected tick. Most infections cause no symptoms, but some lead to inflammation of the brain, its surrounding membranes or the spinal cord, with potentially lasting complications.

Risk areas extend across parts of central, northern and eastern Europe, through Russia and into parts of Asia. Risk varies within countries and is generally greater during the warmer months when ticks are active. Infection can also occur through unpasteurised milk or dairy products from infected animals.

Vaccination is particularly relevant if you will be hiking, camping, cycling, doing fieldwork or spending substantial time in woodland and grassland in an affected area. Ticks also occur in parks and gardens, so exposure is not confined to remote wilderness. A short walking holiday can justify vaccination if it involves suitable tick habitats; a longer visit spent mainly indoors may involve much less exposure.

The vaccine is inactivated, cannot cause TBE and is given by injection. Adult and child formulations are available from one year of age. The initial course consists of:

• A first dose on your chosen date.
• A second dose one to three months later.
• A third dose five to twelve months after the second.

When protection is needed sooner, the second dose can be given fourteen days after the first. Allow another fourteen days after that second dose for the expected short-term protection to develop, meaning you should start at least a month before potential exposure.

You do not normally need all three doses before your first trip. The first two can provide useful protection for the current tick season, while the third completes the course for longer-term protection. If you received two doses previously but missed the third, current UK guidance advises a dose to complete the course rather than automatically restarting.

If exposure continues, the first booster is due three years after the third dose. Subsequent boosters are generally given every five years for people under sixty, or every three years for those aged sixty and over.

Side effects are usually mild, including a sore arm, headache, tiredness or muscle aches. Fever can occur in children. Discuss severe egg allergy, previous serious vaccine reactions, pregnancy, breastfeeding and conditions affecting your immune system before vaccination.

Vaccination does not replace tick precautions or protect against Lyme disease. Wear suitable clothing, use repellent and check your skin and clothing regularly. Remove attached ticks as soon as possible using fine-tipped tweezers or a suitable tick-removal tool. Avoid unpasteurised dairy products in risk areas.

If you become unwell after a tick bite or visiting tick habitats, get medical advice and explain your travel history. A severe headache with a stiff neck, confusion, seizures or new weakness needs emergency medical help.

Yellow Fever

Yellow fever is a viral infection spread by infected mosquitoes in parts of Africa and Central and South America. Illness can range from mild symptoms to severe liver damage, jaundice, bleeding and organ failure. There is no specific antiviral treatment, although hospital treatment can support someone symptomatically through the illness.

Vaccination may be recommended because your itinerary takes you into an area where infection occurs. Separately, proof of vaccination may be required because of countries you have visited or travelled through, even when your destination has no yellow fever risk of its own. These are different considerations: no certificate requirement does not necessarily mean no disease risk.

Recommendations can vary within a country. Explain your route, including rural excursions, forest visits and transit stops, so the clinician can assess your actual exposure and any documentation requirements.

The vaccine contains a live, weakened virus and is given as a single injection at a designated yellow fever vaccination centre. It is normally offered from nine months of age following an individual assessment. Arrange vaccination at least ten days before entering a risk area so protection has time to develop.

After a first vaccination, your International Certificate of Vaccination or Prophylaxis, or ICVP, becomes valid ten days later and remains valid for life. Older certificates remain valid even if they show a ten-year expiry date. Keep the original safely and retain a copy.

One dose provides long-lasting protection, generally lifelong, for most people. Further vaccination may be appropriate for some travellers at continued risk, particularly those first vaccinated under two years of age, during pregnancy, while living with HIV or while immunosuppressed, or before a bone marrow transplant. This requires reassessment of current suitability. Occasionally, another dose may be considered for prolonged exposure in a high-risk setting.

Suitability deserves particular attention because this is a live vaccine. Certain immune deficiencies and treatments that weaken the immune system, such as chemotherapy or some medicines used for inflammatory conditions, can rule out vaccination. Other contraindications include previous anaphylaxis to the vaccine or its ingredients, and a history of thymus disease or removal. Tell the clinician about previous chest or heart surgery so they can check whether it affects suitability, including whether your thymus was removed. Egg allergy needs specific assessment and may require specialist advice.

For people aged sixty or over, UK guidance restricts vaccination to circumstances involving significant and unavoidable infection risk because serious adverse reactions are more likely. Pregnancy, breastfeeding and vaccination of infants aged six to eight months also need careful assessment. Babies under six months must not receive it.

Common reactions include a sore arm, headache, muscle aches or fever. Very rarely, the vaccine can cause serious illness affecting the brain and nerves or several internal organs, which can be fatal. The consultation should explain these risks and provide written information about symptoms that need medical attention.

Get urgent medical help if you become very unwell in the days or weeks after vaccination, particularly with a high fever and marked weakness, persistent vomiting or yellowing of the skin or eyes. Confusion, seizures, new weakness or difficulty breathing need emergency help. Tell the healthcare professional when you received the yellow fever vaccine rather than assuming these symptoms are an ordinary reaction.

If vaccination is unsuitable and your journey requires a certificate, a medically justified exemption letter may be issued. Check acceptance with the destination’s embassy or consulate before travelling and carry the original letter. Acceptance is not guaranteed, so have a backup plan, including alternative routes, somewhere to stay and sufficient funds if entry is refused. An exemption addresses the documentation issue; it does not protect you against infection, so discuss the health risks of your intended route separately.

Mosquito precautions remain essential, including during daylight hours. Use suitable repellent, cover exposed skin and choose accommodation with effective screens or air conditioning.

Dengue

Dengue is an infection caused by the dengue virus and spread through the bites of infected Aedes mosquitoes. It occurs in tropical and subtropical regions, including parts of Asia, Africa, Central and South America, the Caribbean and the Pacific. Unlike malaria, which is caused by a parasite, dengue is caused by a virus, so antimalarial tablets do not protect against it. The mosquitoes that spread dengue mainly bite during daylight hours and are common around towns and cities, making it a consideration for city breaks and beach holidays as well as longer backpacking trips.

Many infections cause no symptoms, but symptomatic dengue can cause a sudden high temperature, severe headache, pain behind the eyes, intense muscle and joint pain, nausea, vomiting and a rash. Even without complications, it can leave you feeling thoroughly miserable and disrupt your travel plans. Severe dengue is uncommon in travellers, but can cause dangerous fluid leakage from blood vessels, bleeding, shock and organ damage, requiring hospital treatment.

There are four types of dengue virus. Infection gives lasting immunity against the type you caught, but only temporary protection against the others. This means you can catch dengue more than once. A subsequent infection with a different type carries a greater risk of severe dengue, although severe illness can also occur during a first infection. This distinction is central to the vaccination advice.

Qdenga, the dengue vaccine available in the UK, was licensed here in January 2023 for people aged four and over. It is a live, attenuated vaccine, meaning it contains weakened viruses, and is designed to stimulate an immune response against all four dengue types. However, protection is not equally well established against every type or in everyone receiving it. The evidence is stronger for people who have previously had dengue; protection against some dengue types remains uncertain in people without previous infection.

Vaccination can be considered for suitable travellers aged four or over with a confirmed or likely history of dengue who are visiting an area where infection is a risk. Previous infection is important because a subsequent infection with a different dengue type carries a greater risk of severe disease.

If you have never had dengue, vaccination is not usually recommended, but it can be considered after discussion with a travel health clinician experienced in assessing Qdenga’s benefits and risks. Your destination, current transmission or outbreaks, season, duration of exposure and repeated travel all influence that assessment. Vaccination is not recommended for destinations where only sporadic local cases have been reported.

The caution reflects limited evidence against dengue types three and four in people without previous infection, and a theoretical risk of severe dengue if they encounter either type after vaccination. No safety signal confirming this has emerged, but the uncertainty should be explained before you decide.

As a live vaccine, Qdenga must not be given during pregnancy or breastfeeding, or to people with certain immune deficiencies or treatments that suppress their immune system. Pregnancy should be avoided for at least one month after each dose. Previous anaphylaxis to the vaccine or an ingredient also rules out vaccination. There are no clinical study data in people over sixty, and data in people with chronic medical conditions are limited.

If you are seeing a travel health professional about getting the dengue vaccine, bring any records or test results from a previous dengue diagnosis. If you were never tested, your travel and illness history may help establish whether previous infection is likely. Blood tests for past dengue can sometimes help, but are not always conclusive because related infections or vaccinations can affect the results. Following laboratory-confirmed dengue, delaying vaccination for a year may be appropriate because infection provides temporary protection against the other types.

If it is suitable for you, the course itself consists of two injections three months apart. Discuss the timing before booking, particularly if you will be abroad when the second dose is due. Both doses should be Qdenga; another dengue vaccine available overseas should not be substituted to complete the course. The need for a booster, and when one might be required, has not yet been established.

Common side effects include injection-site pain or redness, headache, muscle aches, feeling unwell and fever, usually lasting one to three days. Some people develop temporary flu-like symptoms or a rash during the second week after the first dose. Serious allergic reactions have also been reported, and the consultation should explain the possible adverse effects alongside the expected benefits.

Whether or not you choose vaccination, avoiding mosquito bites remains an essential part of prevention. Protection is incomplete, and daytime repellent, clothing that covers exposed skin and screened accommodation remain useful throughout your trip.

Chikungunya

Chikungunya is a viral infection spread through the bites of infected Aedes mosquitoes, which mainly bite during daylight hours. It occurs in parts of Africa, Asia, the Americas, the Caribbean and the Indian Ocean and Pacific islands. Local outbreaks have also occurred in Europe, including France and Italy. Exposure can happen in towns and cities as well as rural areas.

The illness typically causes a sudden fever, severe joint pain, muscle aches, headache and a rash. Most people improve within one to two weeks, but joint pain can persist for months or even years, affecting walking, everyday activities and travel long after the initial infection. Serious complications are uncommon, but older people, newborn babies and people with certain underlying health conditions are more vulnerable.

Vimkunya, licensed in the UK in May 2025 for people aged twelve and over, is the chikungunya vaccine currently available here. It uses virus-like particles to stimulate an immune response. These cannot reproduce or cause chikungunya.

Another vaccine, IXCHIQ, had its UK marketing authorisation withdrawn following a safety review announced in October 2026. Serious adverse reactions included chikungunya-like illness and neurological complications, with some resulting in hospitalisation or death. It must no longer be prescribed, supplied or administered in the UK. This decision concerns IXCHIQ specifically; Vimkunya is a different type of vaccine.

Vaccination is not routinely needed for every traveller visiting a country where chikungunya has occurred. Current UK guidance allows it to be considered for:

• Travellers visiting an area with an active chikungunya outbreak.
• Long-term or frequent travellers to regions where transmission has occurred within the previous five years.
• People exposed through laboratory work involving the virus.

Your consultation should relate that advice to your actual route and dates. A short visit to an area experiencing an outbreak can be relevant, while prolonged or repeated travel creates more opportunities for exposure. Recommendations can change as outbreaks develop, so an old country-wide recommendation may not reflect the situation where you intend to stay.

Vimkunya is given as a single injection into the upper arm. It does not provide immediate protection. Clinical studies assessed the main antibody response around three weeks after vaccination, so discuss your departure date when arranging it. The need for another dose, and when one might be required, has not yet been established.

The evidence also needs explaining accurately. Approval was based on the vaccine producing antibodies expected to protect against chikungunya, rather than trials directly measuring how many infections it prevented. An antibody response is encouraging, but it should not be presented as a guaranteed level or duration of protection.

Previous serious allergy to the vaccine or an ingredient can rule out vaccination. Pregnancy and breastfeeding require an individual assessment because evidence is limited. Unlike a live vaccine, Vimkunya is not automatically ruled out by immunosuppression, but its safety and effectiveness have not been established in this group, and the immune response may be reduced.

The most frequently reported side effects include injection-site pain, tiredness, headache and muscle aches. Your clinician should explain the expected benefits, possible adverse effects and remaining uncertainties before you decide.

If you previously received IXCHIQ, its withdrawal does not by itself mean you need another vaccination or medical treatment. Discuss any suspected adverse reaction with a healthcare professional.

Whether or not vaccination is appropriate, use repellent, cover exposed skin and choose accommodation with effective screens or air conditioning. The mosquitoes responsible can bite indoors and outdoors during the day, so precautions should extend beyond the evening.

Tuberculosis

Tuberculosis, usually called TB, is a bacterial infection that mainly affects the lungs but can affect other parts of the body. It spreads through the air from someone with infectious TB, usually following prolonged close contact. Symptoms can include a persistent cough, fever, night sweats, weight loss and tiredness. Infection can also remain inactive, without symptoms, before developing into active disease later.

TB occurs worldwide, with particularly high rates in parts of sub-Saharan Africa and Asia. Most travellers are at low risk; prolonged close contact with someone who has infectious TB is more relevant than simply visiting an affected country.

The vaccine is called BCG, short for Bacillus Calmette–Guérin. Previously offered routinely to UK schoolchildren, it is now targeted at people at higher risk. It contains live, weakened bacteria and is particularly useful against severe childhood TB, including TB meningitis. Protection against the lung disease more commonly seen in adults is less reliable.

Most travellers are not routinely advised to have BCG. Travel recommendations mainly concern previously unvaccinated children under sixteen spending more than three months in a high-risk country while living closely with local households, and healthcare workers or volunteers whose duties involve substantial exposure to patients with TB, particularly drug-resistant TB. A long backpacking trip alone is not usually a reason for vaccination.

If you are arranging healthcare volunteering, a clinical placement or laboratory work involving TB as part of your travels, discuss your duties with occupational health before departure, even for a shorter placement.

If it is recommended, BCG is given as a single injection into the skin of the upper arm. Everyone aged six or over needs a tuberculin skin test, also called a Mantoux test, beforehand; some younger children need testing too. The skin test needs to be checked forty-eight to seventy-two hours after it is given, so allow for a return appointment. A positive result needs assessment rather than vaccination. Arrange this early and mention other recent vaccinations, as injectable live viral vaccines can affect the test’s timing.

If you have already had BCG, another dose is not recommended. Protection may diminish over time, but repeat vaccination has not been shown to provide significant additional benefit and increases the risk of adverse reactions. Check your records rather than assuming you need another dose because your original vaccination was decades ago.

BCG must not be given during pregnancy or to people with certain immune deficiencies or treatments that suppress their immune system. Previous TB, a positive pre-vaccination skin test or a previous serious allergic reaction to an ingredient can also rule it out.

A small raised area usually develops at the injection site, followed by a sore that can take weeks or months to heal and may leave a scar. This is expected. Leave it uncovered where possible; if it weeps, use a dry dressing rather than an adhesive plaster. Swollen glands can occur, while abscesses and serious allergic reactions are less common. Ask the clinic to assess a worsening wound or a reaction that concerns you.

Travel Vaccination Quick-Reference Table

This table summarises common adult schedules so you can understand your vaccination record and plan appointments. It is not a list of vaccines everyone needs. Your age, health, previous doses and itinerary determine which recommendations apply to you.

Day zero means the day you receive the first dose. Timing before exposure allows an immune response to develop; it does not guarantee protection.

Children may need different products, doses or intervals. People with weakened immune systems, kidney disease or occupational exposure may also need different schedules or follow-up.

If departure is close, get advice with the time available. Some vaccines have accelerated schedules, while others can still be useful before a course is complete. The clinic can explain what protection is realistic for your departure date and arrange any remaining doses.

Disease	Vaccine brand name(s)	Initial course or travel dose	Timing and protection	Further doses
Hepatitis A	Avaxim, Havrix Monodose, VAQTA Adult	One initial injection, followed by a second dose, usually six to twelve months later.	The initial dose provides protection for the immediate trip; the second extends protection. Arrange vaccination before departure, even if travelling at short notice.	After a completed course, a further dose at twenty-five years is recommended if risk continues.
Hepatitis B	Engerix B, HBVAXPRO	Commonly four doses at zero, one, two and twelve months. A three-dose course at zero, one and six months is another option.	Protection develops through the course. A very rapid Engerix B schedule uses days zero, seven and twenty-one, with a further dose at twelve months.	Most people with normal immune function do not need routine boosters after completing the recommended course. Certain medical and occupational circumstances require separate advice.
Hepatitis B	HEPLISAV B	Two doses one month apart, for adults aged eighteen and over.	Both doses are needed to complete this schedule.	The need for a booster has not been established.
Hepatitis A and B combined	Twinrix Adult	Three doses at zero, one and six months. For adults aged eighteen and over, a rapid option uses days zero, seven and twenty-one, plus a fourth dose at twelve months.	Protection develops through the course. One combined injection should not be assumed to provide the protection of a completed course.	Hepatitis A guidance recommends a further dose at twenty-five years if risk continues. Hepatitis B follow-up depends on the completed schedule and individual circumstances.
Tetanus, diphtheria and polio	Revaxis	Usually one travel booster when indicated after previous routine vaccination. Missing routine doses require a catch-up course.	Previous vaccination matters; one booster does not replace an incomplete primary course.	A booster may be recommended when the last dose was over ten years ago, depending on destination and risk. Polio documentation rules can require a more recent dose.
Typhoid — injection	Typhim Vi	One injection.	Give at least two weeks before potential exposure. Protection is incomplete and does not cover paratyphoid.	Another injection every three years if risk continues.
Typhoid — oral	Vivotif	Three capsules, taken on alternate days.	Finish at least one week before exposure; protection begins approximately seven to ten days after the final capsule.	Repeat the three-capsule course after three years if still at risk.
Cholera — inactivated oral vaccine	Dukoral	Two drink doses, at least one week and no more than six weeks apart.	Finish at least one week before exposure.	A single booster within two years if protection is still needed. If more than two years have elapsed, repeat the initial course.
Cholera — live oral vaccine	Vaxchora	One drink dose.	Give at least ten days before exposure.	A revaccination interval has not been established.
Rabies	Rabipur, Verorab	UK guidance recommends three doses on days zero, seven and twenty-eight; the third may be given on day twenty-one. A rapid option uses days zero, three and seven.	Complete the recommended course before exposure where possible. Vaccination simplifies treatment after an exposure; it does not remove the need for urgent treatment.	Routine boosters are unnecessary for most travellers. Rapid courses and continued high-risk travel require advice about a further dose, including at one year.
Japanese encephalitis	IXIARO	Two injections twenty-eight days apart. Adults aged eighteen to sixty-five can use a seven-day interval.	Finish either course at least one week before exposure.	First booster generally twelve to twenty-four months later if further exposure is expected, or at twelve months for ongoing exposure. Later boosters depend on age and continuing risk.
Meningococcal disease — ACWY	Menveo, Nimenrix, MenQuadfi	Usually one injection for adults.	Allow time before exposure for an immune response. Entry-certificate timing must be checked separately.	Reassessment depends on continuing exposure, previous vaccination and entry requirements.
Tick-borne encephalitis	TicoVac	Three injections: the second one to three months after the first, and the third five to twelve months after the second. The second can be brought forward to fourteen days.	The first two doses provide protection for the current tick season; complete the third for longer protection.	First booster within three years of the third dose; later intervals depend on age and continuing risk, usually three or five years.
Yellow fever	Stamaril	One injection at a designated vaccination centre.	Arrange at least ten days before exposure. After a first vaccination, the ICVP becomes valid ten days later and remains valid for life.	Most people do not need another dose. Certain circumstances require reassessment, despite lifelong certificate validity.
Dengue	Qdenga	Two injections three months apart.	Suitability depends particularly on previous dengue infection and planned exposure. Protection varies between dengue types and groups of recipients.	The need for a booster has not been established.
Chikungunya	Vimkunya	One injection.	The main antibody response was assessed around three weeks after vaccination. This is not a guarantee of protection by a particular day.	The need for another dose has not been established.
Tuberculosis	BCG Vaccine AJV	One injection, with pre-vaccination skin testing when required.	Mainly relevant to selected children and people with occupational exposure. Protection against adult lung TB is less reliable.	Repeat vaccination is not recommended.

What Side Effects Can Travel Vaccinations Cause?

It is reasonable to want to know how a vaccination might make you feel, especially when you are fitting appointments around work or preparing to leave. Most reactions are mild and short-lived, but serious adverse effects can occur. Your consultation should explain the risks of the particular vaccine being offered, including anything in your medical history that changes those risks.

Obviously every vaccine is different but common reactions include soreness, redness or swelling around the injection site, headache, tiredness, muscle aches or a mild fever. Oral vaccines can also cause digestive symptoms. The reactions and their timing differ between vaccines: some appear within a day or two, while others can develop later. Ask what to expect, how long it should last and which symptoms need medical advice, and keep the patient information leaflet.

If you feel uncomfortable afterwards, ask the clinic or a pharmacist which pain relief is suitable for you. There is no need to push through an ambitious sightseeing day if you feel unwell. Where practical, leave yourself some flexibility around vaccination appointments, particularly before a long journey or remote excursion.

Tell the clinician about previous reactions before another dose. Explain what happened, how soon it started and whether you needed treatment. A sore arm after an earlier vaccination is different from a serious allergic reaction, and the details help establish whether another dose is appropriate.

A severe allergic reaction, called anaphylaxis, is rare but needs immediate treatment. Sudden swelling of the lips, tongue or throat, difficulty breathing or swallowing, or collapse are emergency symptoms. Alert clinic staff immediately if you are still there; otherwise call 999 in the UK or the local emergency number abroad. Do not wait to see whether it passes.

For other symptoms, contact the vaccination clinic or get medical advice if they are severe, worsening, lasting longer than expected or worrying you. If you become seriously unwell, get urgent help rather than assuming it is an ordinary vaccine reaction. Tell the person assessing you which vaccine you received and when.

You can also report a suspected side effect through the Yellow Card scheme, either yourself or with help from a healthcare professional. You do not need proof that the vaccine caused it to make a report. Reporting supports safety monitoring, but does not replace medical assessment or treatment.

Concerns about side effects deserve a proper conversation. Ask about their likelihood, possible severity and what they could mean for your own health and travel plans, alongside the expected benefit of vaccination.

Can Outbreaks Change Travel Vaccination Advice?

Yes. An outbreak can change the risk at your destination and make a vaccination worth considering when it would not normally be recommended for your trip. Advice may apply to a particular region, season, activity or group of people rather than everyone visiting the country.

The useful question is whether the outbreak affects where you will actually be and how you could be exposed. A report from one province does not automatically change the advice for an unaffected city hundreds of miles away. Equally, a short stay in an outbreak area can deserve reassessment even if your original consultation did not identify a reason for vaccination.

Check current advice when planning your trip and again before departure. If you are travelling for several months, check before moving into a new country or changing your route. If an outbreak affects your plans, contact a travel health professional with your itinerary and vaccination record so they can explain whether the recommendation has changed for you.

Countries can also introduce or change temporary health measures, including vaccination documentation requirements. These are separate from a clinical recommendation. A border requirement does not establish whether a vaccine is medically suitable for you, and the absence of a requirement does not mean vaccination would offer no benefit.

Check the current entry rules for your whole journey, including transit countries and places you will enter after visiting an affected area. Confirm any unclear requirements with the destination’s embassy or consulate, particularly which documents are accepted and when a vaccination must have been given.

Whether you accept a vaccination remains your decision. If you decline one that is required for your intended route, or cannot receive it for medical reasons, establish the practical options before travelling. These might include an accepted medical exemption where available, a different route or an alternative destination.

What Vaccination Records Should You Keep?

Keep a record of every vaccination you receive, including the date, vaccine name and clinic that administered it. This helps a clinician establish what protection you already have, whether a course needs completing and when another dose may be appropriate. It can also save you paying for injections you do not need.

Before leaving an appointment, check that each dose has been recorded and that you know when any remaining doses are due. Put those dates in your calendar, particularly if a course continues after departure or includes a dose months after your return. An early series of injections is not necessarily the complete course.

Carry a copy of your vaccination record and keep a secure digital backup. If you need an International Certificate of Vaccination or Prophylaxis, or ICVP, carry the original document; a photograph is useful if it is lost but may not be accepted at a border. Check that your personal details and the vaccination entries are correct before leaving the clinic.

If you receive a vaccine while travelling, ask for written documentation showing:

• The vaccine’s name and manufacturer.
• The date it was given.
• The batch number.
• The dose and how it was administered.
• The clinic’s details.

Photograph the record and bring it to your next appointment. This is especially important for treatment following an animal bite or scratch, where the products and dates affect decisions about further treatment.

If your records are missing or incomplete, start with your GP and any clinics that previously vaccinated you. Private appointments and vaccinations received abroad may not appear in your GP record or NHS App. Bring whatever information you can find rather than trying to reconstruct a course from memory.

An overdue dose does not automatically mean starting again, but the answer depends on the vaccine and the gap between doses. Ask a clinician to review the record and arrange the remaining doses appropriately.

Before another trip, have your record checked against your new itinerary. A vaccine recommended for one journey may not be needed for the next, while a different destination, activity or change in your health may create a new reason to consider vaccination.

Be Prepared, Not Scared

If you have been wondering how many injections you need, what they might cost or whether you have left it all a bit late, take a breath. You do not have to work it all out on your own, and you certainly do not need to become an expert in tropical diseases before getting on a plane. A good travel health consultation gives you time to talk through your plans and concerns with someone who can help make sense of it all.

The aim is to prepare for the trip you want to take. That means considering vaccination alongside everyday precautions such as avoiding mosquito bites, taking care with food and water and keeping your distance from unfamiliar animals. No injection removes every risk, but sensible preparation can reduce the likelihood of illness and make problems easier to manage.

Ask questions, explain any concerns and take the time you need to understand a recommendation. Cost, side effects and the practicalities of completing a course are all reasonable things to discuss. You deserve advice that helps you make an informed decision and get on with enjoying your travels.

And remember, this is general travel health advice and is not intended to replace advice tailored to your medical history, medication and travel plans from your GP, specialist nurse or another qualified travel health professional.