Immunization Information for Foreign Travel

Some infectious diseases can be prevented by vaccines or other methods. The extent and risk of such diseases are often higher in countries outside the United States. This is most true in low-income, developing nations. United States citizens face great risk for exposure when they travel to certain places.

Required and advised vaccines and other preventive measures are based on sources such as:

  • International Health Regulations (IHR).

  • Special requirements, by country.

  • Travel plans and order of travel, by country.

  • Risk of disease in each country.

  • Personal health history.

The Centers for Disease Control and Prevention (CDC) may be helpful. It offers full information on vaccines and health protection. This is true for travelers to any part of the world. You may contact the CDC via:

  • Telephone: 800-CDC-INFO (800-232-4636).

  • TTY: 888-232-6348.

  • Website: www.cdc.gov

Immunization recommendations change over time. For the most up-to-date information, see a specialist in Travel Health to find out which vaccines are needed.

WHAT VACCINES ARE MANDATORY UNDER THE INTERNATIONAL HEALTH REGULATIONS (IHR)?

  • Countries may require mandatory yellow fever vaccination and a certificate. Yellow fever is the only vaccine required by IHR. This is true for travel to certain countries in sub-Saharan Africa and tropical South America.

  • Meningococcal vaccine is required by Saudi Arabia for annual travel during the Hajj (religious travel to Mecca).

  • Smallpox and cholera vaccine are not required for entrance into any country. Cholera vaccine may be recommended if you will be traveling where this disease is known to exist or traveling to areas at risk for outbreaks. You and your caregiver can decide if you need cholera vaccine.

Your required vaccines must be entered in the official yellow booklet. This is the International Certificate of Vaccination ("Yellow Card"). Each entry must be dated and signed by the responsible caregiver. Entry for Yellow Fever Vaccine must be validated by the local health authority or by the administering caregiver or clinic that has a "Uniform Stamp."

Most governments will allow an unvaccinated traveler to proceed if he or she carries a signed statement from a caregiver. This must include a legitimate medical reason for not being immunized. These statements should be certified by the local health authority. However, some countries may quarantine such persons or place them under watch.

VACCINE GUIDELINES

  • See your doctor at least 4 to 6 weeks before your trip. This allows time for immunizations to take effect. If it is less than 4 weeks before you leave, you should still see your caregiver. You might still benefit from shots or medicines. You may receive information about how to protect yourself while traveling.

  • Your caregiver will ask you where you intend to travel, how long you plan to stay, and whether you may visit rural areas. This determines what vaccines should be considered. Know your travel schedule when you visit your caregiver.

  • Adolescents and children should seek vaccine status guidance from a caregiver. So should women who are breastfeeding or pregnant and people with altered immunity (such as HIV, AIDS, or diabetes).

CDC RECOMMENDS THE FOLLOWING VACCINES (AS NEEDED BY AGE AND BY WORLD REGION):

  • Routine Vaccines: Be up to date on your routine vaccines. Get boosters, if needed.

  • Typhoid: If you are visiting low-income or developing countries.

  • Yellow Fever: If you are traveling to an area where the disease is prevalent (endemic).

  • Rabies: If you might be exposed to wild or domestic animals. Pre-exposure rabies vaccine is urged for people doing more than short-term travel in countries where rabies is common (including Mexico).

  • Meningococcal: This is advised for travel to developing countries, where risk is high. For example, parts of sub-Saharan Africa ("meningitis belt"). Saudi Arabia requires vaccine for all pilgrims attending the Hajj.

  • Malaria: A vaccine does not yet exist. Oral medicines can prevent the usual types of malaria and drug-resistant strains. These include chloroquine and doxycycline.

  • Japanese B Encephalitis (JE): This is a moderately toxic vaccine. Use is often limited to travelers to Asia who will have long rural exposure to mosquitoes in areas with high likelihood of disease spreading. This includes rice paddies.

HOW SOON SHOULD THE VACCINES BE GIVEN?

  • Immunizations protect you for a few months to many years. This length depends on the type of vaccine. You must plan ahead.

  • After the first dose of vaccine, it takes 2 to 3 weeks for the body to build up the needed level of immunity.

  • Some shots are given in a series. This requires multiple shots, several days to weeks apart.

  • Certain vaccines cannot be given while some medicines are being taken. Tell your caregiver about any medicines you are currently taking.

SHOULD OTHER PRECAUTIONS BE TAKEN?

Immunizations provide only partial protection against certain diseases. Travelers must be careful and selective with food, drink, and lodging. They must minimize the potential for exposure to infectious diseases. For example, by protecting against mosquito bites.