Travel Immunization

Aka: Travel Immunization, Vaccines for Travelers, Immunization in Travelers

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II. Precautions

  1. Check CDC website at least 4 weeks before travel
    1. Contains specific recommendations per area of travel
  2. CDC Website
    1. http://www.cdc.gov

III. Management: Update routine Immunizations

  1. Measles Mumps Rubella Vaccine (MMR)
    1. Documentation of 2 doses if born after 1956
  2. Tetanus Toxoid Vaccine (Td)
    1. Consider booster if last dose more than 5 years ago
  3. Inactivated Polio Vaccine (IPOL)
    1. Consider booster if over age 65 years
    2. Booster if travel to endemic area
      1. India, Pakistan, Afghanistan, Egypt
      2. Nigeria, Niger, Somalia
  4. Hepatitis A Vaccine
    1. Consider in all travelers with age >1 year
  5. Hepatitis B Vaccine
    1. Unvaccinated children and adults up to age 59 years (older adults traveling to endemic regions)
  6. Varicella Vaccine
    1. Consider if not immune
  7. Pneumococcal Conjugate Vaccine (PCV20 or PCV21)
    1. Age over 50 years (previously >65 years)
    2. Asplenia, Cirrhosis, Diabetes Mellitus
    3. Cardiopulmonary illness
    4. Prolonged travel to remote area
    5. Significant exposure to animals
  8. Influenza Vaccine
    1. Travel to northern hemisphere in November to March
    2. Travel to southern hemisphere in April to September
    3. Travel near equator, year round
  9. Covid19 Vaccine
    1. As with Influenza Vaccine, consider annual Covid19 Vaccine
  10. RSV Vaccine
    1. Immunize all adults age >=75 years (and those with severe RSV risk age >60 years)
    2. All pregnant women age 32 to 36 weeks during RSV season

IV. Management: Immunizations required for entry in some countries

  1. Meningococcal Vaccine
    1. Travel to "Meningitis belt" of Africa (band from Senegal and Guinea in the east, to Ethiopia in the west)
    2. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/meningococcal-disease
  2. Yellow Fever Vaccine
    1. Required in equatorial Africa and South America
    2. Vaccine certification form may be needed (or provide a waiver)
    3. Not recommended in pregnancy unless high risk area
    4. Women should try to delay travel until post-pregnancy

V. Management: Special Vaccination Indications

  1. Contaminated food or water exposure
    1. See Waterborne Illness Prevention
    2. See Foodborne Illness Prevention
    3. Typhoid FeverVaccine
    4. Hepatitis A Vaccine
    5. Cholera Vaccine (in endemic regions)
  2. Long-term travel
    1. Place Tuberculin Skin Test (PPD) for baseline
    2. Hepatitis B Vaccine
      1. Endemic travel
      2. Anticipating medical care abroad
      3. U.S. Immigrants returning to country of origin
    3. Rabies Vaccine
      1. Remote travel
      2. Young or disabled traveler
  3. Travel to India or southeast asia
    1. Japanese EncephalitisVaccine

VI. Management: Adult Immunizations Available

  1. Hepatitis A Vaccine
  2. Hepatitis B Vaccine
  3. Japanese Encephalitis Vaccine
    1. Travel to endemic regions of Asia and Western pacific (especially rural travel, or duration >1 month)
    2. Safe in HIV; avoid in pregnancy
  4. Measles Mumps Rubella Vaccine (MMR)
  5. Meningococcal Vaccine
  6. MPox Vaccine
    1. Travelers with high risk sexual activity
  7. Polio Vaccine
  8. Rabies Vaccine pre-exposure
    1. Travel to Rabies enzootic regions (especially remote travel for extended periods)
  9. RSV Vaccine
  10. Tetanus Diphtheria Vaccine
  11. Typhoid Vaccine (Live oral or subcutaneous)
  12. Yellow Fever Vaccine
  13. Cholera Vaccine
    1. Ages 2 to 64 years old traveling to Cholera affected areas to perform high risk activities such as healthcare

VII. References

  1. Re (2004) Am Fam Physician 70:89-104 [PubMed]
  2. Sanford (2016) Am Fam Physician 94(8): 620-7 [PubMed]
  3. Rupert (2025) Am Fam Physician 111(3): 245-53 [PubMed]

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