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 and what you will be doing.
It is important to take the basic stance that travel vaccinations are important. 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 decide if I 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 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.
These are the routine non travel vaccinations that you should have (and be up to date on) regardless of whether you are travelling or not. Various public health programmes exist dependent on where you are from to try and ensure that these are delivered throughout childhood and teenage years.
- Five in One Vaccine (also known as the DTaP/IPV/Hib vaccine) – This is one of the first vaccines given as a baby as part of the childhood vaccination schedule and protects against Tetanus, Diptheria, Pertussis, Polio and Haemophilus influenzae type b (Hib).
- Diptheria, Polio and Tetanus Combined Booster – Given around 14 years of age in the UK as the 3 in 1 teenage booster, but can be given later if this is missed.
- Measles, Mumps, Rubella (MMR) – Given as a baby in two doses, one at around one year old and again at around 3 years old. If adults have missed one or more of these doses (which is common) and did not catch up with the doses with a booster as a teenager, then they will need to get the booster as an adult before travelling.
- Varicella (chickenpox) – This is not part of the routine vaccination schedule but is commonly recommended as routine for the vast majority of people and most should have had this vaccination during there childhood. If not (and you have not had chickenpox as a child) it is highly recommended you get this as an adult before travelling.
- Meningitis (meningocaocal disease) – There are several strains of meningitis, many of which are covered by the vaccinations given as part of the childhood vaccination programme mentioned above, or the Meningitis ACWY vaccine given to young teenagers at school or those going to college or university. These are usually free on the NHS. If you haven’t had that vaccination or are not up to date with your childhood vaccinations or booster mentioned above, then it is important you get this as an adult before you travel and you may have to pay for this at a travel clinic.
Other free vaccinations on the NHS (UK).
You may or may not need these vaccinations dependent on where you are going and what you are doing, but if they are needed then they are considered important enough that they are offered free on the NHS in the UK or as part of other programmes elsewhere in the world.
- Typhoid – There are two types of typhoid vaccine, the VI vaccine which is given as a single injection, and the Ty21a vacine which is given as an oral vaccine. Both will need boosters every 3 years at least if you continue to travel to high risk areas. Neither vaccine is 100% effective and other measures such as strong hand hygiene and precautions with food and drinking water are still advised.
- Cholera – This is an oral vaccination usually given for free on the NHS but not always, and is also given on a private prescription (paid) at various travel clinics.The cholera vaccine is given as a drink, where the vaccination ingredients are mixed with water. For adults and children over the age of six, two doses of the vaccine taken up to six weeks apart are needed to protect against cholera for two years. After this, a booster is required if you continue to be at risk.
- Hepatitis A – There are three main types of hepatitis A vaccination. A vaccine for hepatitis A only, a combined vaccine for hepatitis A and hepatitis B, and a combined vaccine for hepatitis A and Typhoid. Which one is best for you will often depend on what other vaccines you need too. If taken alone, an optional booster dose can be taken 6 – 12 months later which will then give you immunity for up to 20 years.
Private travel vaccinations.
These vaccinations can be bought from travel clinics or your GP surgery, and are often expensive so shopping around is always advised. The strength of the recommendation to get them is dependent on a variety of factors.
- Hepatitis B – The Hepatitis B vaccination is commonly combined with either Hepatitis A or Typhoid and this is what is generally recommended. If you have this on it’s own however the vaccination will require 3 injections spaced over 4 to 6 months.
- Twinrix – This is the combined Hepatitis A and Hepatitis B vaccination, the second dose 7 days and third dose 21 days after the first dose, and fourth dose 12 months after the first dose (can be considered a booster). This will give you protection for up to 20 years. You may or may not have to pay for this dependent on circumstances.
- Japanese encephalitis – You will need two doses of this vaccine spaced 28 to 30 days apart, so you should get your first dose at least a month before travelling. The immunity period is approximately 1 year, after which you will require a booster.
- Tick borne encephalitis – The vaccination involves three individual doses. The second dose will be given 1 to 3 months after the initial dose and the third needs to follow one year afterwards. Once you have completed this course, you will be protected for three years.
- Rabies – The vaccine is administered in three doses, spaced a week, then a month after the first dose, and will last for 3 to 5 years. * It is really important to note that although there are ongoing studies investigating whether this vaccination will give long term immunity, the current evidence suggests that it will not. This is why it is essential that if you think you may have contracted rabies through a cut or a bite it is still essential you get post exposure prophylaxis and treatment even if you have the vaccination.
- Yellow fever – The vaccine is administered as a single dose injection, and up until very recently a booster dose used to be required every ten years. Now the yellow fever ‘booster’ vaccination given ten years after the initial vaccination is not necessary. The World Health Organisation (WHO) has stated that the Strategic Advisory Group of Experts on immunization (SAGE) has reviewed the latest evidence and concluded that a single dose of vaccination is sufficient to confer life-long immunity against yellow fever disease.
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.
What about the 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 can is the short answer.
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. 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), 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. This is a fairly common misconception but there is in no way any vaccination for Malaria. 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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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 10 years travel experience, I am also a qualified nurse with an interest in emergency nursing and travel medicine and practical experience volunteering as an expedition medic.
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.