Everything You Need To Know About Travel Vaccinations But Were Afraid To Ask.

Are you heading out on your first backpacking trip or gap year? Unsure what travel vaccinations you need? Get all your questions and concerns answered here with this ultimate professional guide to travel vaccinations.

Travel vaccinations are one of the most popular topics of conversation in my Travel Clinic, and are often the source of a lot of confusion, misinformation and sometimes even fear. Well, there’s nothing to be worried about, as this article will explain to you everything you need to know about travel vaccinations. What you need, what you don’t need, where to get them and many more of the most commonly asked questions besides.

Do I Really Need Vaccinations?

First of all we do need to address the question of whether or not you need vaccinations in the first place. Well that would depend entirely on what vaccinations you have had in the past, whether they need booster shots, where you are going, what vaccinations are recommended for that particular destination, what you will be doing and your own specific cirrcumstances.

It is important to take the basic stance that in general terms travel vaccinations are important, but it is always your choice whether to take them or not. You can take qualified advice and assess different risks to see if they are completely necessary for specific circumstances because there are situations where certain vaccinations may not be needed, but never dismiss the idea of getting them completely.

The fact is that there is no absolute answer here. As a travel health professional I can only ever recommend you get certain vaccinations based on the most up to date clinical advice and your individual, personal travel circumstances. The final decision on whether you actually take that advice or not rests entirely on your shoulders, as does the potential risk and the consequences if you don’t.

The important thing is that you are making a fully informed decision based on qualified fact.

So often I hear (unqualified) travellers saying things like ‘well I’ve never had the vaccination and I’m fine’, which is all well and good, but they are not qualified to give that advice and just because they have been lucky, it doesn’t mean you or others will be too. I have never been run over whilst crossing the road, that doesn’t mean I’m not going to take precautions when doing so because the risk of a truck colliding with my face if I don’t look will always exist.

Staying safe and healthy on the road is mostly about reducing risk as much as possible and taking sensible precautions as much as possible. Vaccinations are an important part of that.

Like most things in health and safety risk will always be there, staying safe and healthy means minimising that risk as much as possible, and that means following the correct vaccination advice where it is available. You won’t always need to be immunised for every trip no, but if it is recommended, and risk exists, the smart choice would be to have the vaccination.

What Factors Determine Whether You Need Travel Vaccinations?

As a travel nurse I give advice on travel vaccinations all the time, and there is a wide variety of things that I have to risk assess when talkng to individual patients.

When advising patients on what vaccinations they will need – or even if they will need them at all – it really isn’t just a case of looking at a chart for a particular country and saying you need X, Y and Z. It is far more individual than that and what you will need will be dependent on your specific circumstances as much as external risk factors.

Things I generally take into account are:

• The patients age and health – your age, your past medical history including what vaccinations you have, general health and fitness, whether you have any allergies or sensitivities, all this has to be taken into account.
• What countries will be visited – each and every country (and regions too) have their own unique set of health issues, and diseases will be more prevalent in some countries as opposed to others.
• What parts of each country will be visited – Countries are often huge, and the risk of catching certain diseases may be much higher in some parts than others (for example rural, out of the way areas with no access to sanitation or medical facilities as opposed to large, well equipped cities).
• The length of the trip – a long, extended stay will increase your potential exposure to disease whilst a quick stop in a city hub may not be as much of a risk factor.
• The time of year – Some diseases are common year round, but some are more common at certain times of the year such as the rainy season.
• WHO and CDC updates – There are sometimes outbreaks or surges of certain diseases in different parts of the world, or other mitigating factors (such as a shortage of the rabies post exposure prophylaxis in Bali for example) that will affect my diagnosis.
• Accommodation options – Backpacking or camping through rural areas may increase your exposure to more or different diseases than if you were staying exclusively in city centre air con hotels.
• Activities – I will also ask what you will likely be doing on your trip, activities such as extended jungle trekking, visiting animal sanctuaries, caving, working in rural areas, all of these and many more beside may increase your risk of being exposed.
• Volunteering or Aid Working – It should go without saying that if you are vounteering with animals, or volunteering with an NGO in a refugee camp or after a natural disaster as a medic or anything like that, you are more likely to be exposed to different diseases.

It is important to note that there is absolutely nothing at all wrong with any of the examples above, you can visit anywhere for as long as you want and still do all those awesome activities that are a quintessential part of any gap year adventure. All I’m saying is they will all factor into my risk assessment of how you can best protect yourself with vaccinations.

What Travel Vaccinations Do I Need?

Vaccination requirements vary from destination to destination dependent on the level of specific risks and diseases present there, and these requirements do change from time to time too, so it is really important you get the most up to date information you can from qualified medical staff from a Travel Clinic. The Travel Health Pro (formerly NaTHNaC) website, the Centre of Disease Control and Prevention (CDC) website, or the NHS’ Fit For Travel website are also excellent resource for travellers.

It is important to check first of all that you are up to date with all of your routine vaccinations, which are the ones everyone should already have regardless of any travel or not, (most people – dependent of course on where they live and what the current health programmes of that country are – will get these throughout childhood and their teens and they are offered for free in the UK on the NHS as part of the routine vaccination programmes). Your personal GP should have access to your medical records which can tell you this, and you can request this information and take it to a specialised travel clinic for more detailed information.

Some vaccinations are offered for free on the NHS in the UK because they are considered to be significant public health risks, and some are not and you will have to pay for these seperately at a travel clinic or your GP surgery. I advise you to shop around as prices can vary.

Routine Vaccinations.

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.

These routine vaccinations include the BCG, Diptheria, Tetanus and Pertusis (DTP), Hepatitis B, Hepatitis A (for at risk groups), Heamophilus Influenzae Type B (HIB), Pneumococcal Conjugate, Rotavirus, Measles, Mumps and Rubella (MMR) and Human papillomavirus HPV (for young girls only to prevent cervical precancers and cancers).

When giving any advice on recommended vaccinations for travel to a specific destination your specialist nurse or doctor will first confirm that you have had all of these and are up to date on any boosters. Any written advice may generally assume you already have these and concentrate on the non routine vaccinations. That is why the recommended vaccination lists for any given destination do not list these.

If you don’t have these vaccinations or boosters, then it should be assumed that it is always recommended to get them. 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 have not had a booster (for those ones that require it) go and get them now.

If you are unsure, check with your GP or practice nurse who will have access to your past medical history and notes.

Recommended 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 country or countries you are visiting and a variety of other individual risk factors, 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. However it may be wise to get inoculated against these diseases regardless, especially if you are travelling long term and 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 yourselves 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 more strongly recommended first, as a health professional I would still strongly recommend you get all of them if you can.

The chances of getting rabies on your travels 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, you are not vaccinated and can’t get treatment in time. It is up to you whether you want to take that chance.

Hepatitis A.

This is a virus present in faeces and is usually caught by consuming contaminated food or water. It is common throughout Asia, Africa, the Middle East and Central and South America. The vaccination is recommended for most travel if you haven’t received it as part of your routine schedule, but is particularly recommended to those travelling to any developing country or region where sanitation is poor and there is a noted risk of the disease. Good personal hygiene is also important to prevent the disease as it is spread through the feca oral route and yes, that means hand washing and is exactly how it sounds.

This vaccination should be administered at least 2 weeks before travel although can be administered up to the day before in an emergency but this is not ideal. A further reinforcing dose will be required 6 to 12 months later and if you can plan ahead and get this second dose before you travel that is the best option. Once you have the second dose the duration of immunity can be up to 20 years. You can also get this as  combined vaccination with hepatitis B or Typhoid.

Hepatitis B.

Hepatitis B is spread through blood and body fluids, so any action such as unprotected sex, injecting drugs or contact sports are a risk factor. This vaccine should be given as part of your routine schedule but if not it is recommended for most travellers who are travelling for long periods and will be engaging in activities that raise their risk factor.

Vaccination against hepatitis B is recommended if you’re travelling in parts of the world where hepatitis B is common, especially if you’ll be doing activities that increase your risk of developing the infection.

The hepatitis B vaccination is given over a course of 3 injections taken 3 weeks to 6 months apart, depending on how quickly you need protection. A combined hepatitis A and hepatitis B jab is also available if you’re likely to be at risk of both these conditions while travelling.

Polio.

Poliomyelitis is an infectious disease that can in rare cases affect the central nervous system and cause temporary or sometimes permanent paralysis. It is very rare now because of vaccination efforts and the vaccinne is part of the routine vaccination programme for children in the UK. It is always highly recommended that you are up to date with your routine vaccinations and boosters.

Despite common misconceptions that it has been eradicated, Polio does still exist and in the small pockets where it is still present such as in Pakistan, Afghanistan and Nigeria, it can be recommended that travellers get a further booster. Additional doses of the vaccination are given in a single 3-in-1 Td/IPV (tetanus, diphtheria and polio) injection.

Cholera.

Cholera is a bacterial infection that is spread by contaminated food and water in areas with poor sanitation such as sub Sharan Africa, South and Southeast Asia, the Middle East and Central America and the Caribbean.

Cholera is generally not recommended for the vast majority of travellers unless they are in a specific at risk group or an aid or medical worker.

The cholera vaccine is mixed with water and given orally as a drink. You should avoid eating, drinking or taking oral medication for an hour before and after having the vaccination and the final dose should be completed a week before you travel. Two doses of the vaccine taken 1 to 6 weeks apart are needed to protect against cholera for two years. After this, a booster is required if you continue to be at risk.

Rabies.

Rabies is a viral infection that is present worldwide and is spread through the bite or saliva of an infected animal (especially if you have open wounds such as a cut or graze). Most commonly a dog but other animals such as cats, monkeys and bats can carry it too. There is no treatment or cure for rabies once it becomes symptomatic, and at this stage it is almost always fatal, but treatment and vaccination before this is extremely effective.

For many countries it is not recommended for travellers to get the vaccine at all because of the low risk and chance of contracting it. However, the vaccine becomes much more strongly recommended for any traveller who falls into an at risk group, including those who are travelling for extended periods in countries where Rabies is present and problematic, or conducting activities that may expose them to the disease such as volunteering or working with animals and will have limited access to immediate post exposure medical facilities.

The pre exposure vaccine is administered in three doses via an intramuscular injection. You need to start these injections at least one full month before travelling. The second dose will be given 1 week after the first, and then the final dose will be given 21 – 28 days after the first. The vaccination once administered will last for for up to ten years, after which time a booster should be considered.

You may still need to be treated with post exposure prophylaxis (PEP) if you contract it or there is a chance you may have done.

The vaccine does have some rare side effects in some people including fever, headache, muscle pain and vomiting. Not everyone will get these symptoms and they are temporary.

Japanese Encephalitis.

Japanese encephalitis is a viral brain infection causing a severe flu like illness spread by mosquitoes throughout South and Southeast Asia and beyond. Despite it’s name it is not only found in Japan (where it is rare thanks to mass immunisation).

It is recommended for any traveller travelling for longer than a month in any given region, particularly in rural areas such as rice and paddy fields, and can be more prevalent in wetlands and during the rainy seasons. Anyone with increased exposure to mosquito bites (ie extended time camping or working in rural areas) is at higher risk.

Chances of contracting the disease are low, very rare in fact, but the consequences if you do get it can be fatal. That is why it is important to discuss your personaal risk factor with a professional.

You will need two doses of this vaccine spaced 28 to 30 days apart, and the final dose should be given at least a week before your departure date to ensure you are fully protected from any exposure. The immunity period is approximately 1 – 2 years after which time a booster will be required.

Meningococcal Meningitis.

Meningococcal meningitis is an acute bacterial disease that can cause a severe flu like disease and is transmitted by sneezing, coughing or direct contact with respiratory secretions. There are 13 different serogroups of meningitis of which groups B and C are most common in the UK, and vaccinations for various strains of meningitis form part of the routine vaccinations for life in the UK and other Western countries.

Epidemics of the disease predominantly occur in the African meningitis belt from Senegal in the west to Ethiopia in the east. These serotypes have also been responsible for outbreaks in Saudi Arabia and other countries as far as Russia.

If travelling to a high-risk area, you should be vaccinated against meningococcal meningitis A, C, W and Y with a MenACWY vaccine, also known as the quadrivalent meningococcal meningitis vaccine. This includes those who have already had the meningitis C vaccine as a child.

This is a single injection that should be given 2 to 3 weeks before you travel and immunity lasts for 5 years.

Pilgrims travelling to Saudi Arabia for Hajj are required to have a valid certificate of vaccination against the disease for visa purposes

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.

It is a viral infection that can cause flu like symptoms. Many travellers will recover from this initial phase, however there is a risk that the virus can spread to the protective layer of tissue that covers the brain and spinal cord (meningitis) or the brain itself (encephalitis). This can lead to some serious complications including paralysis and even in rare cases, death.

The vaccination requires a course of 3 injections for full protection. The second dose is given 1 to 3 months after the first and provides immunity for about a year. A third dose, given 5 to 12 months after the second, provides immunity for up to 3 years.

The course can sometimes be accelerated if necessary. This involves 2 doses being given 2 weeks apart. Booster doses of the vaccine are recommended every 3 years, if necessary.

Typhoid Fever.

Typhoid fever is a potentially serious bacterial infection that can affect multiple organs with severe complications and in some cases be fatal.

It is caused by a bacteria called Salmonella Typhi (not to be confused with the Salmonella that causes food poisoning) and can contaminate food or drink in areas of poor sanitation or through infected fecal matter or urine on the hands of anyone who doesn’t wash their hands properly after going to the toilet.

The vaccination is recommended for all travellers going 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.

In the UK, there are two types of licensed vaccine, an injecatble vaccine and an oral one.

• Vi vaccine – given as a single injection
• Ty21a vaccine – given as three capsules to take on alternate days

Both are effective for up to three years, after which a booster is required, but the injection is often preferable due to simple convenience. Combined typhoid and hepatitis A injections are also available for people aged 15 or older.

Yellow Fever.

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 but is actually very rare in travellers. There have been less than 50 cases since 1970, but it is at constant high risk of outbreaks and has a significant fatality rate, which is why ICVP procedures are enforced. Symptoms can range from flu like fever to vomiting, jaundice or bleeding which can be fatal.

The vaccination can only been given at accredited Yellow Fever Vaccination centres and can take at least 10 days to become effective. You should be issued with an International Certificate of Vaccination or Prophylaxis when you have the vaccine. This certificate is valid for life. 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, a booster is no longer required for the majority of people as it has been found the single dose gives lifelong immunity. A booster may still be given for very specific at risk groups but this is not common.

Required Vaccinations.

This term is slightly misleading as the term required doesn’t refer to the health risk or vaccine recommendation, but the necessity of an ICVP, or International Certificate of Vaccination or Prophylaxis for visa and border entry purposes.

The reason for the ICVP is to control the spread of very specific diseases that pose a significant public health risk. They do not apply to all recommended vaccinations, in fact they are only currently required for Yellow Fever, Meningococcal disease and Polio, and are only required in some countries or under very specific circumstances. If you are heading to or from a country that has disease control restrictions in place you will need to show this proof of vaccination before entry.

Yellow Fever ICVP.

If you are heading to any country where yellow fever is present, it is strongly recommended that you are vaccinated against it. Proof of vaccination via an International Certificate of Vaccination or Prophylaxis (or ICVP)  is required for some countries in Africa and South America for entry, and by many countries throughout the world 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.

There are exemptions to this condition of entry for those who cannot get the vaccine for clinical reasons such as those with a risk of anaphylactic reactions to the vaccine or any of the components of it such as egg or chicken enzyme, those who have a weakened immune system due to disease or treatment, those with Thymus disorder or a wide range of other clinical contraindications.

Meningococcal Meningitis ICVP.

Proof of vaccination is required for visitors to Saudi Arabia who visit Mecca and Medina during Hajj or Umrah, and is sometimes required by other countries such as Libya or Gambia during outbreaks. This is because with the sheer amount of pilgrims in such a small area (over 2.5 million Muslims attended Hajj in 2019 for example), there is a significant rise in public health risk.

This ICVP may look slightly different to the normal yellow booklet. If you have the yellow booklet when you recieve this vaccine it may be recorded in their, but if you don’t you may be issued with a seperate certificate that will be officially stamped by the prescribing nurse.

Polio ICVP.

For the exact same reason as the Meningococcal Meningitis ICVP, proof of vaccination in your yellow book may be required by certain countries if you are travelling from somewhere wehere there is a significant risk or outbreak, or for travel to certain events such as Hajj or Umrah.

Note: This section was written from a UK perspective where the NHS provides a lot of care that is free at the point of delivery. If you live elsewhere you may or may not receive subsidised healthcare dependent on your own country’s health policy. Despite the cost issue, the information on the vaccines themselves remains relevant.

Do I Have A Choice?

Yes, always. This is called informed consent and is a fundamental principle of all medical ethical and legal practice. As medical professionals we can say vaccines are in general a fgood thing (although they obviously aren’t right for everyone), we can recommend them, we can give you all the necessary information, the pros and cons and answer any questions you may have on the vaccines, the diseases themselves or anything else. What we will never do is push you to a decision either way, we will never coearce, threaten or bribe you into a decision either way and we will never judge you for whichever choice you make.

Bodily autonomy is your fundamental right, as is informed consent.

What About Side Effects?

This is something that are a lot of people are afraid of, and in most cases that level of fear is unwarranted.

Every medication has potential side effects and vaccinations are no different. However it is important to remember that everyone reacts differently to vaccinations, the serious side effects are actually extremely rare and if they do occur they can be dealt with by medical professionals.

Most importantly many people will not receive any side effects at all.

For those that do experience side effects of vaccinations (especially those getting multiple shots at the same time), these are generally limited to mild muscle aches or low grade flu symptoms such as a headache dependent on what vaccination it is. For the absolute majority of people who do get these symptoms, they usually pass within 24 – 48 hours.

When Should I Get Travel Vaccinations?

The quick answer is as soon as possible. The recommended time to go and see a health professional is 6 – 8 weeks before you actually travel. Personally I would recommend going even sooner than that, especially if you think you will need a lot of vaccinations. This is because some vaccinations need to be given well in advance to allow your body to develop immunity and preferably this immunity should have developed before you leave. Some also involve multiple doses spread over several weeks or even months, and if you need a number of them at the same time it is just sensible to give yourself time to do that.

Can I get Different Vaccines At The Same Time?

Yes you can. Many vaccines can be administered at the same time if really necessary although I generally recommend spacing them apart if possible, particularly if you know you are prone to suffering the side effects.

This is why it is important to go and see a health professional at least 6 – 8 weeks before you travel. The earlier the better.

This does not however include receiving doses of the same vaccine that may need to be time days or weeks apart.

Where Should I Go To Get Travel Vaccinations?

Your first stop should be your own GP or travel clinic to see what vaccinations you have and what you need.

You can get travel vaccinations from your GP surgery, but they may not have them in stock as standard procedure and may need to order them in, so it may increase your waiting time and this is something that you should factor in.

You can also go to a specialised travel health clinic. This is often a better choice because you can speak to a health professional who has a specific specialty in travel health and they will probably have most if not all of what you need in stock because that is what they specifically deal in.

Specialised travel health clinics are still not very common, although many are starting to open up in larger pharmacies and even some travel agents, and all are private so you will generally have to pay for your consultation.

The Yellow fever vaccinations can only be given at designated centers that are specifically registered to administer it.

In the UK, you can find specialised yellow fever vaccination centres here.

The US has a list of all vaccination centres through the CDC here.

Can I Save Money By Getting The Vaccinations Abroad?

Yes you usually can is the short answer. Depending where you go of course.

There are many countries such as Bangkok or Singapore where the quality of healthcare is excellent and extremely cheap compared to the US or the UK for example, and you can absolutely get your immunisations in these countries and save yourself a lot of money.

The downside to this however is that first of all you will have to devote the first few weeks of your trip at least to getting all of your vaccinations (depending of course on what you need), possibly a few days of side effects and you will also be running the risk of travelling whilst not being fully protected by those vaccines as they take time to take effect.

If you are travelling for a limited amount of time and want to do as much as possible this is not recommended and you have to ask yourself is the money saved worth the risk?

If however you are travelling long term and are in no rush, and can devote the time needed for the vaccinations to become effective staying in one low risk area (such as a major city like Singapore) before going off and exploring, then the risk balances out a little.

I cannot tell you which way is better, I can only give you the pros and cons and you have to weigh up the risks for yourself.

It is also worth noting that depending on where you are going and where you are coming from, many countries may not let you in without proof of having the yellow fever vaccine.

Can I Get A Vaccine For Malaria?

No. At least not yet. The only approved vaccine at the time of writing is RTS, S, known by the brand name Mosquirix. This has only been approved for specific circumstances and is not yet widely available for travellers, although hopefully this will change in the coming years.

Antimalarial prophylaxis (the technical term for antimalarials) are a course of medication you take whilst travelling that give you some protection against contracting the disease if you are bitten by an infected mosquito, and using mosquito bite prevention techniques are the only way to protect yourself against getting bitten in the first place.

Is There A Vaccine For Dengue?

No. At least not yet.

You may have heard in the media that there is a dengue vaccine available. CYD -TDV, otherwise known by its brand name Dengvaxia. This is currently undergoing trials in certain endemic regions. The results of the phase 3 trials do look extremely positive and there is very likely to be a vaccine that covers all four virus serotypes relatively soon, but as of yet it is not 100%.

So whilst we may be getting a vaccine soon, we still don’t have one yet.

I hope this answers all of your questions about travel vaccinations. If not, and you still have questions after reading all of this, then please feel free to contact me or ask me in the comments section below, or if you need a more detailed one to one consultation please feel free to make an appointment at my Travel Clinic. I’ll do my best to help you.

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Related Articles.

Common Backpacker Illnesses And Diseases.

The Most Common Travel Ruining Illnesses And How To Beat Them.

Why All Travellers To Bali Should Get The Rabies Vaccine.

Why Travel Vaccinations Are Important.

Have you read all the information but still need a little more specific advice? Is there a travel health issue that you are worried about and need a little reassurance on? Need some information on malaria, or which vaccinations you will need? Is there a travel health issue you would like to ask about in complete confidence?

Well I am here to help.

Apart from being an experienced backpacker with over 20 years travel experience, I am also a qualified nurse who specialises in emergency nursing and travel medicine.

The Bemused Backpacker Travel Clinic is an indispensable online resource for you to gain a one on one consultation with a medical professional giving you personal reassurance, expert information and qualified advice for any and all of your travel health related questions. To head into the Travel Clinic, click here