Travel Vaccines: How to Get Vaccinated for Yellow Fever, Malaria, and More

Jennifer Gershman, PharmD, CPh, PACS

Key takeaways: 

Yellow fever, MMR (measles, mumps, rubella), and hepatitis A are a few examples of vaccines you may need before traveling. The specific vaccine(s) you’ll need depends on your destination.

Some travel vaccines are given more often than others. For instance, the yellow fever vaccine offers lifelong protection for most people. But typhoid vaccine boosters are recommended every 2 to 5 years.

The typical yellow fever vaccine cost is around $170 — but this can vary by clinic and location. GoodRx can help make your travel vaccines more affordable.

A healthcare professional fastens a Band-Aid on a woman’s arms after she received a vaccine.

Planning an international trip can be an exciting time for you and your family. Whether you’re traveling by plane or cruising to your destination, you likely have a checklist of fun places to eat and visit. But staying healthy should also be at the top of your priority list.

Depending on where you’re traveling, you may need some vaccinations — like a yellow fever vaccine — to protect you from certain illnesses. Being up to date with your vaccines can help keep you and your loved ones healthy on your trip .

What vaccines do I need for travel?

The vaccine(s) you’ll need depends on your destination. It’s important to make sure you’re current on both routine and travel vaccines before your trip. Reach out to your healthcare provider to see if you need any of these vaccines before your trip : 

Hepatitis A

Hepatitis B

MMR (measles, mumps, rubella)

Tdap (tetanus, diphtheria, pertussis)

Yellow fever

Japanese encephalitis (JE)

If you or your child never received the MMR vaccine, it’s a good one to put at the top of your to-do list before traveling. Routine vaccinations — including those with MMR vaccines — dropped drastically during the COVID pandemic. In fact, almost 40 million kids worldwide missed an MMR dose in 2021. Babies traveling to countries with high rates of measles should get a measles vaccine before traveling.

What factors are involved in choosing the right travel vaccines?

You can search the CDC’s travel health page online to find out which vaccines are important based on where you’re going. Your healthcare provider can also help you with this.

These are some important factors to consider about travel vaccines before you set out on your adventure or business trip:

Which cities/countries are you visiting? For example, if you’re traveling to rural or agricultural areas in Asia or the Western Pacific, then your healthcare provider may recommend the JE vaccine ( Ixiaro ). JE is spread through infected mosquitos and may cause brain swelling.

Where are you staying (hotel, hostel, tent, cabin)? Vaccine recommendations may be different based on whether you’re staying in a hotel or spending more time outdoors. 

How long are you staying there? The longer you stay in areas where certain diseases are more common, the higher your risk.

What season are you traveling? If you’re traveling to the “ meningitis belt ” of sub-Saharan Africa during the dry season (December to June), or performing Umrah or Hajj , your healthcare provider may recommend the meningococcal vaccine ( Menactra ).

What type of foods do you plan to eat? Eating out often not only increases your chances of getting traveler’s diarrhea, but also typhoid fever or hepatitis A.

What current health conditions do you have, if any? If you have a weak immune system , you may not be able to receive certain live vaccines. For example, someone with uncontrolled HIV may not be able to receive the oral typhoid vaccine ( Vivotif ).

Is a malaria vaccine available in the U.S.?

No. While most travel vaccines are available in the U.S., the malaria vaccine is an exception. Malaria is a disease that’s spread through infected mosquitos .

Mosquirix is the world’s first malaria vaccine for young kids. But so far it’s only available in certain African countries where malaria is common. A different malaria vaccine — known as R21/Matrix-M — was also approved in Ghana and Nigeria for kids ages 5 months to 3 years old.

Do I need a yellow fever vaccine?

The only travel vaccine that is required in certain regions of the world is the yellow fever vaccine — specifically for certain areas in Central Africa and South America. A special certificate called the International Certificate of Vaccination or Prophylaxis (“yellow card”) is given to you after vaccination. It will allow you to travel to and from these countries.

This vaccine is currently available in the U.S. You can search for a clinic near you that has the yellow fever vaccine.

Where can I get travel vaccines?

You can get travel vaccines from a variety of places. Your healthcare provider, county public health department , or even your local pharmacy are a few examples.

If you have an appointment through a primary care provider or travel clinic, your visit can usually be billed through your insurance as a medical appointment. The cost for the visit and any vaccines or medications will differ based on your insurance.

Other people like to visit travel-certified pharmacies as a one-stop shop. You can meet with a specially-trained pharmacist for a one-on-one visit and receive all your vaccines and medications at one location.

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How much do travel vaccines cost?

How much you’ll pay out of pocket for travel vaccines depends on your insurance status. Routine vaccines are usually covered by most insurance companies. But some travel vaccines — like yellow fever — may not be covered. So the yellow fever vaccine cost may be on your mind. It’s unknown what the malaria vaccine cost would be in the U.S. since it’s not available yet.

The average cost of three popular travel vaccines are detailed in the table below.

There are also other ways to save on vaccinations, including travel vaccines. GoodRx can help you navigate your options, which may include GoodRx discounts or copay savings cards. You can find vaccination prices as low as $18 with a free GoodRx discount.

Do travel vaccines have side effects?

Even though you can’t get sick from travel vaccines, side effects are possible. The most common side effects of injectable vaccines are pain, redness, or swelling at the injection site. These are often mild and go away quickly. Other possible side effects include:

Muscle and joint aches

Serious side effects and reactions are rare. Talk to your pharmacist or healthcare provider if you have any concerns about vaccine side effects.

How long before traveling should I think about travel vaccines?

It’s a good idea to start thinking about travel health at least 1 month before you leave. But you may need more time if you haven’t had any routine vaccines in the past. It takes time for your body to build immunity once you’re vaccinated.

Here are a few examples of vaccines you should get in advance before you travel:

Yellow fever: This vaccine must be completed 10 days prior to travel in order for your yellow fever card to be valid. The vaccine provides lifelong protection against yellow fever for most people.

Typhoid vaccine (shot): You should receive this vaccine ( Typhim Vi ) at least 2 weeks before travel to allow your body time to build immunity. You also need a booster every 2 years before traveling to an area where the typhoid vaccine is recommended.

Typhoid vaccine (oral capsule): Vivotif is an oral version of the typhoid vaccine. You need to take it in 4 separate doses. The last dose should be taken at least 1 week before you travel. Boosters are needed every 5 years.

Hepatitis A vaccine: This vaccine ( Havrix , Vaqta) is given as 2 injections at least 6 months apart. If you don’t have time to get the second shot before traveling, you’ll still receive partial protection from the first shot.

MMR: MMR is a routine vaccine for kids that starts at 12 months. But adults and teens who haven’t been vaccinated can receive 2 doses at least 28 days apart . Babies can receive their first dose early if they’re traveling to a high measles area, but that dose will need to be repeated later on.

Do I need malaria prevention medications?

Sometimes. Depending on where you’re traveling, your healthcare provider may recommend certain medications to prevent malaria . Since there is no malaria vaccine available in the U.S., these medications — along with mosquito repellents and bed nets — serve as extra safety precautions.

Malarone (atovaquone / proguanil), doxycycline , and chloroquine are a few examples of oral medications that prevent malaria. Malarone is started 1 to 2 days before traveling. You continue taking it for 7 days after leaving your destination. Doxycycline is started 1 to 2 days prior to travel. But you keep taking it for 4 weeks (1 month) after leaving the region with malaria. You can start chloroquine 1 to 2 weeks before travel and keep taking it for 4 weeks after you leave.

The bottom line

If you need travel vaccines, it’s best to start the process at least 1 month before you leave. Yellow fever, MMR, and typhoid are a few examples of vaccines you may need before traveling. Routine vaccines are usually covered by insurance, but travel vaccines may not be. The yellow fever vaccine cost, as well as the cost of other travel vaccines, varies by clinic and location.

Centers for Disease Control and Prevention. (n.d.). Destinations .

Centers for Disease Control and Prevention. (n.d.). Search for yellow fever vaccination clinics .

Centers for Disease Control and Prevention. (2021). Malaria’s impact worldwide .

Centers for Disease Control and Prevention. (2022). Transmission of Japanese encephalitis virus .

Centers for Disease Control and Prevention. (2022). Yellow fever .

Centers for Disease Control and Prevention. (2023). Need travel vaccines? Plan ahead .

Centers for Disease Control and Prevention. (2023). Plan for travel - Measles .

Gambrell, A., et al. (2022). Estimating the number of US children susceptible to measles resulting from COVID-19 related vaccination coverage declines . Vaccine.

Hughes, M., et al. (2023). Typhoid & paratyphoid fever CDC Yellow Book 2024 . Centers for Disease Control and Prevention.

McNamara, L., et al. (2023). Meningococcal disease CDC Yellow Book 2024 travel-associated infections & diseases . Centers for Disease Control and Prevention.

National Association of County and City Health Officials. (n.d.). Directory of local health departments .

Parker, S., et al. (2023). Saudi Arabia: Hajj & Umrah pilgrimages CDC Yellow Book 2024 . Centers for Disease Control and Prevention. 

Precision Vaccinations. (2023). Mosquirix malaria vaccine .

Tan, K., et al. (2023). Malaria CDC Yellow Book 2024 travel-associated infections & diseases . Centers for Disease Control and Prevention.

University of Oxford. (2023). University of Oxford malaria vaccine receives regulatory clearance for use in Ghana and Nigeria .

World Health Organization. (2022). Nearly 40 million children are dangerously susceptible to growing measles threat .

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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

  • Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
  • Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
  • The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

  • Travel clinic
  • Health department
  • Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

  • Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
  • Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
  • Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
  • Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

Which Vaccinations Are Required for Travel?

By Cassie Shortsleeve

Mountain hiking

A trip abroad requires you to be up-to-date on a whole checklist of things these days: travel insurance, airline policies, visas, passports , and, as far as your health is concerned, vaccines. Yet while the COVID-19 pandemic has made us acutely aware of the importance of staying healthy on the road, travel vaccines have always been a mainstay of safe travel—a crucial tool in avoiding the (often expensive) headaches of getting sick , and treating sicknesses, abroad.

Whether you have travel on the horizon or want to be prepared for 2023 trips and beyond, this guide will get you up to speed on the vaccinations required for travel depending on your destination, itinerary, and health status. Follow the below steps to protect your immune system in another country.

Make sure you’re current with routine vaccines

The Centers for Disease Control and Prevention (CDC) recommends all travelers be up to date on routine vaccines before travel. Routine vaccines include shots like COVID-19; chickenpox; Hepatitis A and B; Influenza; Measles, Mumps, Rubella (MMR); Polio; and more. The CDC has a full list of routine vaccines here .

“‘Routinely recommended vaccines’ are vaccines that have been considered very important to prevent common diseases in the population to start,” says Lin H. Chen , M.D. director of the Travel Medicine Center at Mount Auburn Hospital in Cambridge, Massachusetts, and the former president of the International Society of Travel Medicine (ISTM).

Routine vaccines protect against disease that exists at low levels (chickenpox) or barely exists at all (measles) in the U.S. They also protect against severe disease from diseases that are still present in the United States (influenza or COVID-19). Generally, they’re given in childhood or adolescence—though some are given through adulthood—so it’s always a good idea to double-check your vaccination records.

When traveling, routine shots are especially important because international travel increases your chances of both contracting and spreading diseases that aren’t common in the U.S. A good example of this is measles. While it’s practically non-existent in the U.S., international travel increases your risk of exposure and popular destinations including Europe still have measles outbreaks.

It’s worth double checking your status even if you think you’re up to date: “During the pandemic, some routine vaccination programs may have suffered lapses, so there is concern that diseases may become more common,” says Dr. Chen.

The routine vaccination recommendations have also changed over the years (the addition of the COVID-19 vaccine to the list is an example) and it’s easy to let vaccines like tetanus ( generally needed every 10 years ) lapse.

“It is even recommended at this time that certain adults who are traveling who have not had a polio vaccine for many years and are traveling to a risk area get an additional dose of the polio vaccine,” says Elizabeth D. Barnett , M.D., a professor at Boston University Medical School and a leader in the field of travel and tropical Medicine.

If you’re traveling with a child , talk to your pediatrician: Rules around vaccination can be different for babies traveling internationally. A baby who is not leaving the U.S., for example, gets their first dose of the MMR vaccine at 12 months; if they will be leaving the country, they get the first dose at six months .

Utilize official resources to learn more about vaccination recommendations around the world

“Understanding the epidemiology of where diseases are circulating is really important,” says Dr. Chen.

That’s why, generally, she sends travelers to the CDC’s website , which outlines exactly what additional vaccines you may need for essentially every country in the world. All you have to do is plug in your destination and you’ll find information about vaccines and medications, health travel notices, COVID-19 travel information, and more.

Start a conversation with your primary care doctor—then consider seeing a travel medicine specialist

It’s always good to start a conversation with your primary care doctor about vaccines before you travel, but if your itinerary is complex, involving multiple countries, being in rural areas, areas without good hygiene, or areas where you may not be able to protect yourself from mosquito- or food-borne illnesses, or if you have questions based on what you found on the CDC website or your own personal health history, consider asking your physician for a referral to a travel medicine specialist or travel clinic.

After all, when it comes to vaccinations required for travel, it’s not just about where you travel, but how you travel.

“The art of travel medicine is listening to where the person is going, what they're going to be doing, and making a decision based on the risk-benefit ratio,” says Dr. Barnett. A travel medicine doctor will be able to analyze disease trends and trip details such as how long you’ll be traveling or how well you’ll be able to protect yourself against mosquitoes. “You have to really dig into those things,” she says.

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Take a vaccine called the Japanese encephalitis vaccine, which prevents a type of encephalitis (inflammation of the brain). “We can't just say the risk is present in a specific country, because the risk depends on the time of year, whether the disease is being transmitted at that time, the exact location—rural areas, especially farming regions are associated with much higher risk — whether there's a local outbreak situation going on, and more.”

You may not be able to get every shot you need at your primary care doctor’s office either. The yellow fever vaccine, for example (which you may need if you’re traveling somewhere like Sub-Saharan Africa or specific parts of South America), is only available at special travel clinics or public health settings, says Dr. Barnett. You can find a list of travel medicine clinics on the CDC’s website.

Your health background (what diseases you’ve had in the past, whether or not you’re immune-suppressed, and if you’re more predisposed to a certain condition) also play a role in what vaccines to consider. (A very small subset of people vaccinated against yellow fever, for example, experience severe adverse events, says Dr. Barnett.)

The bottom line

For many people and many trips, discussing travel plans with your primary care doctor and using the CDC’s destination feature for vaccine guidance will suffice. Other, more complex trips require a visit to a travel clinic. If you’re aiming to get into one, start the process at least a month before your departure date—appointments can be hard to get and your body needs time to build up immunity from any additional vaccines you may require.

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9 common questions about vaccines and travel

Joel Streed

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Travel does more than just transport you to a different place. It can broaden your perspective, increase your happiness, give you a chance to try new things, boost your creativity and help you recharge. Even planning a trip can be an exciting task. The anticipation of mapping an itinerary and scheduling your must-see attractions can bring a lot of joy and happiness.

One of the most important tasks before taking a trip is to make an appointment with a travel medicine specialist. These health care professionals help keep travelers safe and happy before and after their journeys.

Here are answers to common questions about travel medicine:

1. who should make an appointment with a travel medicine specialist.

Anyone planning a trip overseas can benefit from seeing a travel medicine specialist. However, a travel clinic appointment is critical if you are traveling to underdeveloped or developing countries where there's a higher risk of contracting severe communicable illnesses while abroad. It is also important for patients with certain medical conditions that make their immune systems weaker and more vulnerable to infectious diseases.

2. What vaccinations do I need to travel overseas?

All travelers should be vaccinated against the flu and current with COVID-19 vaccines and boosters.

In addition, it's important to complete the adult vaccination schedule that includes vaccinations for:

  • Chickenpox (varicella)
  • Diphtheria, tetanus and pertussis (DTP)
  • Pneumococcal
  • Measles, mumps and rubella (MMR)

Additional vaccines may be recommended depending on your travel itinerary. For example, hepatitis A vaccination is recommended if you are traveling to Southeast Asia. During your appointment, we can discuss which vaccines are appropriate for your itinerary.

3. Are there travel destinations that have different vaccination recommendations?

Yes. Infectious diseases thrive in different climates. If you travel to a new climate, you may be exposed to diseases to which you don't have any immunity.

Some infections are more prevalent in tropical settings compared to temperate climates. For example, typhoid and hepatitis A are more common in Southeast Asia because these communicable diseases can be spread through contaminated water. Some areas of Africa and South America have a higher prevalence of yellow fever and malaria, which are mosquito-borne infections.

The  Centers for Disease Control and Prevention (CDC)  has good information online for travelers for each travel destination.

Recommended vaccines may include:

  • Hepatitis A
  • Hepatitis B
  • Japanese encephalitis
  • Yellow fever

4. Can my primary care provider give me travel vaccinations?

It depends on your travel destinations and vaccine recommendations. I recommend starting the conversation with your primary care provider and reviewing the  CDC recommendations .

If you have a complex itinerary with multiple countries or are traveling to Southeast Asia or Africa, it's better to make an appointment at the travel clinic. I also would recommend patients with organ transplants and immunocompromising conditions seek travel medicine consultation to reduce the risk of illness during travel. During that appointment, we will review your itinerary, provide necessary vaccinations and discuss ways to prevent mosquito-borne or tick-borne diseases.

5. How long before my trip should I go to the travel clinic?

Plan to have an appointment at least four weeks before you travel. Some vaccines require several weeks for immunity to develop, while others require more than one dose of vaccine for full protection.

If your trip is to an underdeveloped or developing country, you may need to schedule an appointment up to two months in advance to receive a complete set of immunizations. This gives your body time to produce the protective antibodies, so you are well protected when you land at your destination.

6. Can I only go to the travel clinic before I travel?

No. The Travel and Tropical Medicine Clinic is available before or after travel. The team can provide consultative services and treatment if you get sick after you return home.

7. I'm going to an all-inclusive resort. Will I have a lower risk of getting sick?

Maybe, but no traveler should take safety for granted. Even in an all-inclusive resort, knowing how food is prepared or the water supply quality is not possible. Mosquitos and other insects could still be a concern. It's important to take all necessary precautions and follow vaccination recommendations when you travel, regardless of your accommodations.

8. How do I lower my risk of malaria when traveling?

Malaria is a disease caused by a parasite. It's spread to humans through the bites of infected mosquitoes. Prophylactic malaria medications are available and are started before the travel, continued during the stay and for a certain duration after returning home. A travel medicine specialist can review the risks and benefits of all prevention and treatment options.

9. How do I stay healthy while traveling?

Nothing can ruin a trip like illness. Make sure all your vaccinations and boosters are up to date, and get any new vaccinations recommended for your destinations.

Food and water safety is important while traveling. Only eat well-cooked food. Avoid eating from roadside stands and uncooked foods, like salad and raw vegetables. Drink bottled beverages only, including bottled water. This is especially important if you travel in resource-limited regions, such as Southeast Asia or Africa.

Hand hygiene is important at home and overseas. Wash your hands often using soap and hot water. Avoid crowded places, follow respiratory etiquette and consider optional masking. Mosquitos and bugs can transmit parasites and diseases, like yellow fever and malaria. Use mosquito repellents. Mosquito nets may be appropriate in some parts of the world, as well.

As you make travel plans, schedule an appointment with a travel medicine specialist to get the vaccinations and information you need to be healthy and safe on your journey.

Raj Palraj, M.D. , is a physician in  Infectious Diseases  and  Travel and Tropical Medicine  in  La Crosse , Wisconsin.

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What vaccines do you need to travel?

The vaccines you need will depend on where you’re traveling and what you will be doing during your travels. Walgreens pharmacists are able to assist in helping you determine which vaccines you may need.

Which travel vaccines are available at Walgreens?

Travel vaccines Walgreens offers include: Yellow Fever, Meningitis, Polio, Typhoid, Japanese Encephalitis, Tick-Borne Encephalitis, Hepatitis A, Hepatitis B and Rabies*.

*Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability.

What other vaccines should I have before traveling?

It’s important to be up-to-date on routine vaccinations before traveling as well—like Measles-Mumps-Rubella (MMR), Tetanus, Flu and COVID-19.

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Travel vaccinations are an essential part of holiday and travel planning, particularly if your journey takes you to an exotic destination or 'off the beaten track'. The risks are not restricted to tropical travel, although most travel vaccines are targeted at diseases which are more common in the tropics.

For more general information about travel see the separate leaflet called Health Advice for Travel Abroad .

This leaflet discusses the vaccinations that are available and gives some idea of the time you need to allow to complete a full protective course of vaccination. Further information specific to your destination can be obtained from your surgery (if they have the resources to offer this service), from specialist travel clinics and from a number of websites. You will find a selection of these listed at the bottom of this leaflet and under references.

In this article

Why do i need travel vaccinations, what travel vaccinations do i need, malaria prevention, diseases for which no vaccine is yet available, who should be vaccinated, where can i get travel vaccinations, free travel vaccinations.

The rise in worldwide and adventurous tourism has seen a massive increase in people travelling to exotic destinations. This leads to exposure to diseases that are less likely to occur at home. These are diseases against which we have no natural immunity and against which we are not routinely immunised in the UK. They include:

  • Insect-borne conditions such as malaria, dengue, yellow fever and Zika virus.
  • Diseases acquired from eating and drinking, such as hepatitis A and traveller's diarrhoea.
  • Diseases acquired from others or conditions of poor hygiene, such as hepatitis B and Ebola virus.
  • Diseases acquired directly from animals, such as rabies.

These are illnesses which might not only spoil your holiday but might also pose a risk to your life. For specific advice on travelling to more remote places: see the separate leaflet called Travelling to Remote Locations .

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Before travelling outside the UK it is important to check whether there are any vaccinations available which could protect you. You can do this by making a travel planning appointment at your GP surgery. During your consultation a specialist travel nurse will complete a risk assessment to determine which vaccines are right for you. If your GP does not offer this service, or does not have an appointment available before you travel, then you will need to seek this advice from a private travel clinic.

There are also several websites which aim to offer up-to-date, country-specific advice on vaccinations and on disease patterns.

You can find out if travel vaccines are recommended for any countries you are planning to visit from the Travel Health Pro website or NHS website Fitfortravel if you are in Scotland.

Vaccination courses need to be planned well in advance. Some vaccinations involve a course of injections at specified intervals and it can take up to six months to complete a course. Some vaccinations can't be given together.

The following table lists the travel vaccinations which are available and in common use in the UK. Always check with your surgery or online before travelling, particularly to unusual destinations, for local outbreaks of disease which mean other specific vaccinations are advised.

Travel vaccinations (adults)

The protection offered by vaccination is not always 100%. Vaccination will greatly reduce your chances of acquiring the disease and in many cases the protection level offered is extremely high. The protection will also not be lifelong. However, there isn't a vaccine available for every disease - for example, there is none at present against malaria.

Even where a vaccine is available, vaccination should not be the only thing you rely on for protection against illness. It is important to know the risks; taking sensible steps to avoid exposing yourself to disease is by far the most useful thing you can do.

Pregnant women

It is important that pregnant women also receive the necessary vaccinations before travelling. Some vaccines, however, are not safe to use in pregnancy - see table below. In some cases your doctor or nurse may ask you to consider whether the journey could wait until after the birth of your baby, as the risks of disease may be very real and you may be unable to fully protect yourself and your baby.

There is currently no vaccine or medicine to prevent Zika virus, which is transmitted by Aedes mosquitoes and which is of particular concern to pregnant women due to its link to birth defects. The recent outbreak of the virus is currently considered a Public Health Emergency of International Concern. See the separate leaflet called Zika Virus.

Off on holiday?

Make sure you get your immunisations ahead of travelling abroad. Speak to a local pharmacist today

No vaccination is available against malaria. People who live permanently in malarial zones have partial protection but they lose this swiftly when they move away. Protection against malaria is through a combination of avoidance of mosquito bites and the use of malaria tablets.

Tablets have to be started before entering the malarial zone and continued for some days or weeks after leaving it. The recommended tablet regime varies by area. Your practice nurse will have access to up-to-date advice on recommendations for your journey. See the separate leaflet called Malaria Prevention for more details.

There are many tropical diseases for which no vaccination is yet available. These include:

  • Insect (arthropod)-borne viruses such as dengue, Zika and chikungunya .
  • Infections carried by water-dwelling organisms such as bilharzia and flukes
  • Parasitic diseases such as leishmaniasis, onchocerciasis, trypanosomiasis and hydatid disease. Parasites are living things (organisms) that live within, or on, another organism.

There is also as yet no vaccine against HIV .

Most of these conditions can be avoided by travellers taking reasonable precautions around:

  • Food and drink.
  • Swimming in water known to be infested with parasitic organisms.
  • Exposure to biting insects.
  • Unprotected sexual encounters.

People often at greatest risk when travelling are those visiting a country which they think of as their place of origin, where members of their family live and roots may be. People often believe - falsely - that as one-time residents who may have been born and raised there, they have a natural immunity. They feel that they are not on holiday but visiting home and that vaccinations aren't needed.

Unfortunately this is not true. We acquire natural immunity by living in a place and being constantly exposed to the diseases that are present. When we leave the area for distant shores that protection is rapidly lost and we need the protection of vaccination, together with the other precautions listed above.

This is particularly true of malaria, where visitors 'going back home' may find their relatives puzzled and even amused that they are taking anti-malarial medication. Even so, it's very important to do so. It's only by living there all the time that you acquire your resident relatives' level of immunity. Your immune system has a short memory for this sort of partial immunity.

Many NHS surgeries offer a full range of travel vaccinations. However, your surgery may not have the resources to fit you in before you travel. Alternatively, you can visit private specialist travel clinics.

The NHS does not usually cover travellers for vaccinations relating to exotic travel, although some vaccinations such as hepatitis A are usually free. Aid workers and healthcare workers are often offered free vaccinations against occupational risks but others have to pay.

Anti-malarial tablets are never free and can add a substantial sum to the cost of your trip. Whilst this may seem expensive, it is usually a small sum relative to the costs of your travel. Safeguarding your health should be considered an essential part of any trip.

If a vaccination certificate is issued keep it and update it over the years so that you have a full record. Your NHS surgery will have a record of vaccines they have administered to you and can often issue a copy. However, the yellow fever vaccination certificate needs to be saved, as this cannot be re-issued.

Further reading

There are many excellent websites offering detailed advice for travellers by country and region. You will find a selection under 'Further Reading and References', below.

Hepatitis A Vaccine

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Further reading and references

Immunisation against infectious disease - the Green Book (latest edition) ; UK Health Security Agency.

Travellers' Health ; US Centers for Disease Control and Prevention

Travel Health Pro ; National Travel Health Network and Centre (NaTHNaC)

Travelling if you have a medical condition ; British Airways (includes downloadable MEDIF forms)

Related Information

  • Yellow Fever Vaccine
  • Japanese Encephalitis Vaccine
  • Rabies Vaccine
  • Cholera Vaccine

Do you need to worry about side effects from vaccines?

What side effects are associated with the yellow fever vaccine?

How long before you travel should you get vaccinated?

Overcoming your fear of needles

Hi All,  I dont know if anyone has come across this.  I have a worm infestation in my face.  They travel around under the skin leaving tracks and bursting holes into my skin.  they create glass like... nicolamc

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions .

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Common Travel Vaccines

Visiting other countries is an exciting and fun way to experience the world. But it may pose some health risks.

To prevent yourself from new diseases you may find in other countries, be sure to get your travel vaccines.

Getting these vaccines before leaving the U.S. can help keep you safe and healthy.

Some countries have vaccine requirements before you visit. They may turn you away without them.

Call 412-647-7228 to make an appointment for travel vaccines through the UPMC Center for Care of Infectious Diseases

What Are Vaccines?

Vaccines are medicines that activate the body's defenses and reduce the chance that you'll get a certain disease.

These diseases are most often infectious, caused by viruses or bacteria.

Most vaccines cause the body to make antibodies against an infectious agent. Antibodies are blood proteins that attack germs and help the immune system fight them off.

The goal of getting a vaccine is to reduce your risk of getting the disease if exposed. Some vaccines do not prevent disease but can reduce how severe it is.

What's the Difference Between Routine, Recommended, and Required Vaccines?

The CDC classifies travel vaccines in those three groups.

Routine vaccines

These are ones the CDC urges all people in the U.S. and overseas to get.

Routine childhood vaccines fight against:

  • Chickenpox.

Adults should get routine flu and COVID-19 vaccines.

Recommended vaccines

The CDC advises people to get these vaccines before going to certain countries.

Required vaccines

These vaccines are ones the country you're visiting requires you to have to enter the country.

Most only require the vaccine against the yellow fever virus. Some countries now also require the COVID vaccine.

Vaccines are vital to your health. They protect you from potentially fatal diseases.

Travel vaccines protect against infections not present in the U.S. that you may come across on your travels.

Reasons to vaccinate against these diseases include:

  • Other countries may not have adequate medical care.
  • Your health insurance may not cover health care costs in another country.<
  • The U.S. may not let you return home while infected with certain diseases. You may have to wait to come home until you're no longer contagious.

What Are the Most Common Travel Vaccines?

The three most commonly recommended travel vaccines are:

  • Hepatitis A vaccine for travel to most other countries in the world. Hepatitis A is a common viral infection that you can get from contaminated water or food.
  • Yellow fever vaccine for travel to some parts of Africa and South America. Yellow fever is a virus that spreads through mosquito bites.
  • Typhoid vaccine for travel to countries where it's circulating. South Asian countries, such as India, Pakistan, and Bangladesh, have a higher risk of typhoid. Typhoid is a disease caused by bacteria in contaminated food and water.

Based on where you're going and what you'll do, other travel vaccines you may need include:

  • Japanese encephalitis.

New recommendations for vaccines may arise as conditions change in different countries. For instance, the CDC may urge the monkeypox vaccine if you're going to a country with an outbreak.

» See the latest disease outbreaks and health notices from the CDC. » Find out what vaccines the country you're visiting say you should get.

How Far in Advance Should I Get Travel Vaccines?

The CDC suggests getting your travel vaccines at least one month before traveling because:

  • You may need more than one dose over the course of weeks before you're fully vaccinated.
  • Most vaccines take at least two weeks to take full effect.
  • You may need to visit a special clinic for certain vaccines your PCP doesn't have.
  • If you need the yellow fever vaccine, most countries require it at least 10 days before you depart.

Why Choose UPMC Infectious Disease for Your Travel Vaccines?

UPMC's Travel Health program:

  • Offers adult travelers world-class preventive health care.
  • Tailors our services to your health status and destination.
  • Has infectious disease experts certified in travel and tropical medicine. They have decades of knowledge about travel vaccines and specialize in the medically complex traveler.

Contact UPMC Travel Health

To make an appointment with an expert at UPMC Travel Health through the UPMC Center for Care of Infectious Diseases , please call 412-647-7228 . Travel health appointments are conducted virtually – by video visit – unless you live outside of the state of Pennsylvania. If you live out-of-state, you must schedule an in-person appointment due to physician licensure requirements.

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What Vaccines are Recommended for You

Updated recommendations for meningococcal and mpox vaccination were voted on at the October 25-26, 2023 ACIP meeting. The content on this page will be updated to align with the new recommendations.

Life Events, Job, and Travel

  • By Health Conditions

Adults need vaccines, too

Getting vaccinated is one of the safest ways for you to protect your health. Vaccines help prevent getting and spreading serious diseases that could result in poor health, missed work, medical bills, and not being able to care for family.

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All adults need these routine vaccines

Everyone should make sure they’re up to date on these routine vaccines:

  • COVID-19 vaccine
  • Flu vaccine (influenza)
  • Tdap vaccine (tetanus, diphtheria, and whooping cough) or Td  vaccine (tetanus, diphtheria)

You may need other vaccines, too

Review the sections below to learn what other vaccines you may need based on:

  • Life events, job, or travel

Health conditions

Vaccines you need All adults ages 19 to 26 years should make sure they’re up to date on these vaccines:

  • Chickenpox vaccine (varicella)
  • Hepatitis B vaccine
  • HPV vaccine (human papillomavirus)
  • MMR vaccine (measles, mumps, and rubella)
  • Tdap vaccine (Tetanus, diphtheria, and whooping cough) or Td  (tetanus, diphtheria)

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to learn which vaccines are recommended for you. These may include:

  • MenB vaccine (meningococcal disease) – for adults up through 23 years of age

Insurance coverage  Under the Affordable Care Act, insurance plans that cover children allow parents to add or keep children on the health insurance policy until they turn 26 years old. For more information, see How to get or stay on a parent’s plan .

Get personalized recommendations Take a short quiz and get a list of vaccines you may need based on your lifestyle, travel habits, and other factors.

Vaccines you need All adults ages 27 to 49 years should make sure they’re up to date on these vaccines:

  • Chickenpox vaccine (varicella) – if born 1980 or later

Vaccines you need All adults ages 50 to 64 years should make sure they’re up to date on these vaccines:

  • Shingles vaccine (zoster)
  • Tdap (tetanus, diphtheria, and whooping cough) or Td  (tetanus and diphtheria)
  • Hepatitis B vaccine – recommended for all adults up through 59 years of age
  • MMR vaccine (measles, mumps, and rubella)—if born 1957 or later
  • RSV (respiratory syncytial virus) – adults aged 60 years or older should talk to their healthcare provider about getting a single dose of RSV vaccine

Vaccines you need As we get older, our immune systems tend to weaken over time, putting us at higher risk for certain diseases. All adults ages 65 and older should make sure they’re up to date on these vaccines:

  • Pneumococcal vaccine

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to learn which vaccines are recommended for you. This may include:

Get the whooping cough vaccine during each pregnancy

  • Tdap vaccine (Tetanus, diphtheria, and whooping cough) — between 27 and 36 weeks of pregnancy to help protect your baby against whooping cough

Make sure you’re up to date on other vaccines, too

  • Flu vaccine (influenza) especially if you’re pregnant during flu season, which is October through May

Talk with your ob-gyn or midwife to find out which vaccines are recommended to help protect you and your baby. Learn more about Vaccines for Pregnant Women .

Vaccines you need If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. All healthcare workers should make sure they’re up to date on these vaccines:

  • Meningococcal vaccine – especially lab workers who work with Neisseria Meningitidis

You may need other vaccines, too Healthcare workers should make sure they’re up to date on any other vaccines routinely recommended for them based on age or other factors. Talk with your doctor to learn which vaccines are recommended for you. These may include:

  • HPV vaccine (human papillomavirus) – recommended for adults ages 18 through 26 years and adults ages 27 through 45 years based on shared clinical decision-making
  • Shingles vaccine (zoster) – recommended for all adults 50 years of age and older

Get vaccinated before you travel The vaccines recommended or required for an international traveler depend on several factors, including age, health, and itinerary.

Take these steps to make sure you are prepared for your trip:

  • Make sure you are up-to-date with all recommended vaccines. Talk with your healthcare provider and get any vaccines that you may have missed. Take a short quiz and get a list of vaccines  you may need based on your lifestyle, travel habits, and other factors.
  • Learn the recommended and required vaccines for your destination. Visit Travelers’ Health: Destinations  for more information about recommendations and requirements for the locations you will be visiting during your travel.
  •  Get vaccinated at least 4 to 6 weeks before your trip. Planning ahead will give you enough time to build up immunity and get best protection.

Find a travel clinic: Many state and local health departments provide travel vaccinations. Get more travel vaccination information as well as where to find travel vaccinations at CDC’s Travelers’ Health Clinic  page.

Immigrants Whether you are applying for an immigrant visa overseas or for legal permanent residence within the United States, you need to meet the Vaccination criteria for U.S. immigration .

Refugees Refugees are not required to have vaccinations before arrival in the United States, but you can start getting certain vaccinations through the Vaccination program for U.S.-bound refugees .

International adoptions

  • Adoptees 10 years of age and under: Immigration law allows for adoptive parents to sign an affidavit stating they will be vaccinated after arrival to the United States.
  • Adoptees over 10 years of age: Immigration law requires proof of vaccination during the overseas medical examination.
  • Parents or close contacts traveling internationally to adopt a child: Make sure you are fully vaccinated according to CDC’s ACIP recommendations. Some vaccine-preventable diseases, such as hepatitis A , are more common in other countries than the United States.
  • Get more International adoption health guidance .

Vaccines you need Vaccines are especially critical for people with chronic health conditions such as asplenia to protect them from vaccine-preventable diseases. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

  • Hib vaccine ( Haemophilus influenzae type b)
  • Meningococcal vaccines – both MenACWY and MenB

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to find out which vaccines are recommended for you. These may include:

  • Chickenpox vaccine (varicella) – recommended for all adults born in 1980 or later
  • Hepatitis B vaccine – recommended for all adults up through 59 years of age, and for some adults 60 years of age and older with known risk factors
  • HPV vaccine (human papillomavirus) – recommended for all adults up through 26 years of age, and for some adults aged 27 through 45 years
  • MMR vaccine (measles, mumps, and rubella) – recommended for all adults born in 1957 or later

Vaccines you need People with diabetes (both type 1 and type 2) are at higher risk for serious problems, including hospitalization or death, from certain vaccine-preventable diseases. Vaccines are one of the safest ways for you to protect your health, even if you are taking prescription medications. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

Vaccines you need People with heart disease and those who have suffered stroke are at higher risk for serious problems or complications from certain vaccine preventable diseases. Other vaccine-preventable diseases, like the flu, can even increase the risk of another heart attack. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your cardiologist or primary care doctor to find out which vaccines are recommended for you. These may include:

Vaccines you need Vaccines are especially critical for people with chronic health conditions such as HIV infection. Vaccine recommendations may differ based on CD4 count. In addition to vaccines recommended for all adults ( COVID-19,   Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

  • Hepatitis A vaccine
  • Meningococcal conjugate vaccine (MenACWY)

If your CD4 count is 200 or greater 1 In addition to the vaccines listed above, you may need these vaccines:

You may need other vaccines, too You may need other vaccines based on your age or other factors, too. Talk with your doctor to find out which vaccines are recommended for you. This may include:

1 If CD4 percentages are available, CD4 percentage should be 15% or greater.

Vaccines you need Vaccines are especially critical for people with health conditions such as liver disease. Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for liver disease. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

Vaccines you need People with lung disease (including asthma or COPD) are at higher risk for serious problems, including hospitalization or death, from certain vaccine-preventable diseases. Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for your condition. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on this vaccine:

Vaccines you need Getting vaccinated is one of the safest ways for you to protect your health, even if you are taking prescription medications for end-stage renal (kidney) disease or on hemodialysis. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), make sure you’re up to date on these vaccines:

Vaccines you need Vaccines are especially critical for people with a weakened immune system from diseases such as cancer or patients taking immunosuppressive drugs. Having a weakened immune system means that it is more difficult to fight off infections or diseases in the body. In addition to vaccines recommended for all adults ( COVID-19, Flu (influenza) , and Tdap or Td ), adults with weakened immune systems caused by immunocompromising conditions such as cancer should make sure they’re up to date on these vaccines:

  • Hib vaccine ( Haemophilus influenzae type b) – Recommended for adults with complement deficiency, which is a specific type of immune deficiency, and for adults who have received a hematopoietic stem cell transplant (HSCT, or a bone marrow transplant)
  • Pneumococcal vaccines (PCV15 or PCV20, PPSV23)
  • Meningococcal vaccines (MenACWY and MenB) – Recommended for adults with complement deficiency, which is a specific type of immune deficiency
  • Who Should NOT Get Vaccinated
  • Adult Vaccine Self-Assessment Tool
  • Vaccines for Military and Dependents

Vaccines quiz

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Travel vaccinations

When travelling outside Canada, you may be at risk for a number of vaccine preventable illnesses.

You should consult a health care provider or visit a travel health clinic preferably six weeks before you travel. This is an opportunity to:

  • review your immunization history
  • make sure your provincial/territorial vaccination schedule is up-to-date
  • discuss any trip-related health concerns you may have
  • assess your needs based on where you plan to travel and what you plan to do

You may need additional vaccinations depending on your age, planned travel activities and local conditions. Preventing disease through vaccination is a lifelong process.

Use the reference below to determine which vaccinations may be recommended or required for your destination.

Vaccination recommendations by destination

Yellow fever vaccination.

Some countries require proof that you have received a yellow fever vaccination before allowing you to enter the country. Consult an embassy or consulate of your destination country in Canada for up-to-date information on its entry and exit requirements before you travel abroad.

Other countries may require you to have been vaccinated for yellow fever if you have passed through an area where yellow fever may occur .

Proof of vaccination must be documented on an International Certificate of Vaccination or Prophylaxis . You must carry the original certificate with you.

In Canada, the vaccination is only given at designated yellow fever vaccination centres .

Immunization records

  • Download the free CANImmunize app from the iOS App Store or Google Play, and manage your family’s vaccination records on the go.
  • Carry copies of your family’s immunization records while you travel and leave the originals at home.
  • Sickness or injury
  • Travel Advice and Advisories
  • If you get sick after travelling
  • Receiving medical care in other countries
  • Travel health kit
  • Travel insurance
  • Well on Your Way - A Canadian’s Guide to Healthy Travel Abroad
  • Yellow Fever Vaccination Centres in Canada , Public Health Agency of Canada (PHAC)
  • Recommended Immunization Schedules , PHAC

Available travel vaccines

The following vaccinations are available for people travelling abroad.

Cholera vaccination

Vaccination against  cholera isn't routinely needed for most travellers.

But in some cases it may be recommended for aid workers and people likely to have limited access to medical services – for example, people working in refugee camps or after natural disasters.

Most cases of cholera are confined to regions of the world with poor sanitation and water hygiene, such as parts of:

  • South America

The vaccine is usually given as a drink in 2 separate doses, taken 1 to 6 weeks apart.

Children aged 2 to 6 years old should have a third dose taken 1 to 6 weeks after the second dose.

You should make sure you have the final dose of this vaccine at least a week before you travel.

A single booster dose or full revaccination is usually recommended if you have previously been vaccinated against cholera and you're planning to travel to an area where the infection is common.

Diphtheria vaccination

A combined vaccination that protects against diphtheria , polio and tetanus is routinely given to all children in the UK.

You should make sure you and your children are up-to-date with your routine vaccinations before travelling.

Further booster doses are usually only recommended if you're going to visit parts of the world where diphtheria is widespread and your last vaccination dose was more than 10 years ago.

Diphtheria is more common in parts of the world where fewer people are vaccinated, such as:

  • Central and Southeast Asia
  • Eastern Europe

Additional doses of the vaccination are given in a single 3-in-1 Td/IPV (tetanus, diphtheria and polio) injection.

Hepatitis A vaccination

Vaccination against  hepatitis A is recommended if you're travelling to countries where there are poor levels of sanitation and hygiene, and hepatitis A is common.

Ask your GP, pharmacy or travel clinic if you should have the hepatitis A vaccine if you're travelling to:

  • Sub-Saharan and North Africa
  • the Middle East
  • South and Central America

The vaccination against hepatitis A is usually given as a single initial injection, with a second dose 6 to 12 months later. Two doses should protect you for at least 25 years.

You should preferably have the initial dose at least 2 weeks before you leave, although it can be given up to the day of your departure if needed.

Jabs that offer combined protection against hepatitis A and hepatitis B or typhoid are also available if you're likely to also be at risk of these conditions.

Hepatitis B vaccination

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.

Hepatitis B is spread through blood and body fluids. Things like having sex, injecting drugs or playing contact sports on your travels can increase your risk.

Anyone travelling for long periods or who's likely to need medical care while abroad is also at increased risk.

Hepatitis B is found worldwide, but it's more common in parts of:

  • Sub-Saharan Africa
  • Southern and Eastern Europe

The hepatitis B vaccination generally involves a course of 3 injections. Depending on how quickly you need protection, these may be spread over a period as long as 6 months or as short as 3 weeks.

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.

Japanese encephalitis vaccination

Vaccination against  Japanese encephalitis  is usually recommended if you're planning a long stay (usually at least a month) in a country where you could get the condition.

It's particularly important if:

  • you're visiting during the rainy season or there's a year-round risk because of a tropical climate
  • you're going to visit rural areas, such as rice fields or marshlands
  • you'll be taking part in any activities that may increase your risk of becoming infected, such as cycling or camping

Japanese encephalitis is found throughout Asia and beyond. The area it's found in stretches from the western Pacific islands in the east, across to the borders of Pakistan in the west.

It's found as far north as Northeastern China and as far south as the islands of the Torres Strait and Cape York in Northeastern Australia.

Despite its name, Japanese encephalitis is now relatively rare in Japan because of mass immunisation programmes.

Find out more about risk areas on the Travel Health Pro website

Vaccination against Japanese encephalitis usually consists of 2 injections, with the second dose given 28 days after the first.

Ideally, you need to have the second dose a week before you leave.

Meningococcal meningitis vaccination

Vaccination against some types of meningococcal meningitis  is usually recommended if you're travelling to areas at risk and your planned activities put you at higher risk – for example, if you're a long-term traveller who has close contact with the local population.

High-risk areas for meningococcal meningitis include:

  • parts of Africa
  • Saudi Arabia during the mass gatherings of Hajj or Umrah

All travellers to Saudi Arabia for the Hajj or Umrah pilgrimages are required to show proof of vaccination.

If travelling to a high-risk area, you should be vaccinated against meningococcal meningitis with a MenACWY vaccine , also known as the quadrivalent meningococcal meningitis vaccine.

This is a single injection that should be given 2 to 3 weeks before you travel. Babies under a year old need 2 injections.

You should have the MenACWY vaccine before travelling to high-risk areas, even if you had the  meningitis C vaccine as a child.

Read more about the  meningococcal meningitis vaccines .

Measles, mumps and rubella (MMR) vaccination

The MMR vaccine that protects against measles ,  mumps and  rubella is routinely given to all children in the UK. 

You should make sure you and your children are up-to-date with routine vaccinations, including MMR, before travelling.

If you haven't been fully vaccinated against these conditions or you're not already immune, you should ask about MMR vaccination before you travel.

The MMR vaccine is given as 2 injections. These are usually given when a child is 3 years and 4 months old.

But if vaccination has been missed previously, adults can have the doses 1 month apart, and children can have them 3 months apart if necessary.

Read more about the MMR vaccine .

Polio vaccination

A combined vaccination that protects against diphtheria,  polio and tetanus is routinely given to all children in the UK.

Further booster doses are usually only recommended if you're going to visit parts of the world where polio is, or has recently been, present and your last vaccination dose was more than 10 years ago.

Currently the condition is most common in Pakistan and Afghanistan, but it's also a risk in other regions of the world.

Read more about the  Td/IPV (3-in-1) vaccine .

Rabies vaccination

Vaccination against rabies is advised if you're travelling to an area where you could get rabies, particularly if:

  • you're staying for a month or more
  • there's unlikely to be quick access to appropriate medical care
  • you plan to do activities that could put you at increased risk of exposure to rabies, such as cycling or running

Rabies can be found in many parts of the world. GOV.UK provides a detailed list of countries that have rabies in domestic animals or wildlife .

Vaccination involves a course of 3 injections before you travel, usually given over a period of 28 days.

If you're bitten, licked or scratched by an animal in a country where rabies is a problem, further doses of rabies vaccine (with or without a special anti-rabies injection given around the wound) may be required as emergency treatment.

Find out more about the rabies vaccine

GOV.UK: Rabies risks for travellers

Tetanus vaccination

A combined vaccination that protects against diphtheria, polio and tetanus is routinely given to all children in the UK.

Further booster doses are usually only recommended if:

  • you're travelling to areas where access to medical services is likely to be limited and your last vaccination dose was more than 10 years ago
  • you've not had two booster doses

Read more about the Td/IPV (3-in-1) vaccine .

Tick-borne encephalitis vaccination

Vaccination against  tick-borne encephalitis (TBE)  is usually recommended for anyone who plans to live or work in a high-risk area, or hike and camp in these areas during late spring or summer.

The ticks that cause TBE are mainly found in forested areas of central, eastern and northern Europe, although at-risk areas also include eastern Russia and some countries in east Asia, including some regions of China and Japan.

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.

Tuberculosis (TB) vaccination

The BCG vaccine (which stands for Bacillus Calmette-Guérin vaccine) protects against tuberculosis , which is also known as TB.

The BCG vaccine isn't given as part of the routine NHS vaccination schedule. It's given on the NHS only when a child or adult is thought to have an increased risk of coming into contact with TB.

When preparing for travel abroad, the BCG vaccine is recommended for any unvaccinated people under 16 who'll be living or working with friends, family or local people for more than 3 months in a country where TB is common or the risk of multi-drug resistant TB is high.

The BCG vaccine is given as a single injection.

Areas of the world where the risk of TB is high enough to recommend BCG vaccination for previously unvaccinated travellers include:

  • parts of South and Southeast Asia

Read more about the BCG vaccine .

Typhoid vaccination

Vaccination against typhoid fever is recommended if you're travelling to parts of the world where the condition is common, particularly if you'll: 

  • have frequent or prolonged exposure to conditions where sanitation and food hygiene are likely to be poor
  • be staying or working with local people

High-risk areas include:

  • parts of South and Central America

Two main vaccines are available for typhoid fever in the UK. One is given as a single injection, and the other is given as 3 capsules to take on alternate days.

It's also possible to have a combined hepatitis A and typhoid jab.

Ideally, the typhoid vaccine should be given at least 1 month before you travel, but it can be given closer to your travel date if necessary.

Booster vaccinations are recommended every 3 years if you continue to be at risk of infection.

Read more about the typhoid vaccine .

Yellow fever vaccination

Vaccination against yellow fever is advised if you're travelling to areas where there's a risk of getting yellow fever.

Some countries require a proof of vaccination certificate before they let you enter the country.

Yellow fever occurs in some areas of tropical Africa and Central and South America. More information about yellow fever and areas where it's found is available on Travel Health Pro .

A single dose of the yellow fever vaccine is thought to provide lifelong protection. For most people, a booster dose is no longer recommended.

You must have a yellow fever vaccination at least 10 days before you travel. You will also need to complete a yellow fever vaccination checklist to make sure you can have the vaccine.

Find out more about the yellow fever vaccination checklist on the Travel Health Pro website

You should be issued with an International Certificate of Vaccination or Prophylaxis when you have the vaccine. This certificate is valid for life.

Some people cannot have the yellow fever vaccine.

Read more about the  yellow fever vaccine and who can have it .

When to get further advice

Speak to your GP before having any vaccinations if:

  • you're planning to get pregnant
  • you're pregnant
  • you're breastfeeding
  • you have an immune deficiency
  • you have any allergies

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

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  • About the Handbook

Vaccination for international travellers

Ensure that travellers are up to date with routine vaccines. Also consider other vaccines based on travel itinerary, activities and risk of disease exposure.

Recently added

This page was added on  09 June 2018 .

Updates made

This page was updated on 23 October 2023 .  View history of updates

Millions of Australians travel overseas every year. More than half of these trips are to destinations other than New Zealand, North America and Europe. 1

This page helps with making decisions about travel vaccines. Also check the disease-specific chapters in this Handbook for details about specific vaccines.

See also Infographic. Vaccination for international travellers .

Health risks of overseas travel

Health risks associated with international travel include exposure to:

  • infective agents
  • altitude and temperature extremes
  • other physical, psychological and environmental hazards
  • poor-quality or limited access to clean water, shelter, hygiene and sanitation facilities, and health and medical care

The level of health risks depends on factors such as:

  • the traveller’s underlying physical and mental health and physiological state
  • the itinerary and activities undertaken
  • the duration of exposure to various hazards during travel

Travellers at increased risk of serious travel-associated infections include:

  • young children and infants
  • pregnant women
  • people with underlying medical conditions, especially immunocompromising conditions due to disease or medical treatment
  • people spending extended periods in multiple regions with poor resources or in remote areas
  • people participating in events where large numbers of people will gather, such as major sporting, cultural, social or religious events
  • migrant families travelling back to their region of origin to visit friends and relatives

Those travelling to visit friends and relatives are more likely to: 2

  • have closer contact with local populations
  • stay in remote or rural areas
  • consume higher-risk food and beverages

Those travelling to visit friends and relatives are less likely to: 2,3

  • recognise the health risks associated with travelling
  • seek pre-travel health advice
  • obtain the recommended vaccines or prophylaxis

Common infections acquired by travellers

Exposure to infectious diseases is one of the many health hazards of international travel. Some of these diseases are vaccine preventable. Although some of these diseases are present in Australia, the risk of acquiring them overseas may be higher because of:

  • higher disease incidence in other countries
  • increased risk of exposure from participating in certain activities while travelling

Foodborne and waterborne infections

It is common for travellers to ingest contaminated food or beverages, resulting in an illness. 4-6  Practicing safe eating and drinking habits is essential to minimise the risk of contracting food and waterborne diseases while travelling. These include treating water or only drinking bottled water, avoiding undercooked meat, and avoiding raw fruit and vegetables (unless they can be peeled or washed in safe water prior to eating). Most infections are diarrhoeal diseases due to enteric pathogens, but some are due to extra-intestinal microorganisms, such as hepatitis A virus and Salmonella enterica serotype Typhi (causing typhoid).

Vaccines are available against hepatitis A, typhoid and cholera.

Vector-borne infections

Insect-borne — especially mosquito-borne — infections, such as malaria and dengue, are important causes of fever in Australian travellers returning from endemic areas, particularly Southeast Asia and Oceania. 4,6

A dengue vaccine (Dengvaxia) is available for the prevention of secondary dengue infections (not primary prevention of initial dengue infection ) in select individuals. See Clinical advice: ATAGI statement on use of Dengvaxia® for Australians .

Japanese encephalitis occurs throughout much of Asia and the Western Pacific region, including eastern Indonesia and Papua New Guinea. 7 Yellow fever occurs only in parts of Africa and South America, 8 and tick-borne encephalitis occurs in parts of Europe and Asia. 9

Vaccines are available against Japanese encephalitis , yellow fever and tick-borne encephalitis .

Some other vector-borne diseases and parasitic (including protozoal and helminthic) diseases are also important for international travellers. Some are preventable through appropriate barrier precautions and chemoprophylaxis (for example, malaria). 9

Aerosol-borne infections

Vaccine-preventable infections transmitted by aerosols and/or droplets include: 9

  • influenza (the most common vaccine-preventable infection among travellers) 10
  • meningococcal disease
  • varicella (chickenpox)

The incidence of measles and mumps is higher in many overseas countries, including some developed countries, than in Australia.

Tuberculosis is a rare infection in travellers. 11 Expatriates who live in endemic areas for a long time are more likely to acquire tuberculosis than short-term visitors. 12

Vaccines are available against all of these diseases.

Bloodborne and sexually transmitted infections

Some Australian travellers may be at risk from bloodborne and sexually transmissible infections, such as chlamydia, gonorrhoea, hepatitis B, hepatitis C and HIV. In some areas, healthcare workers using non-sterile medical equipment or other poor infection control practices may transmit these viruses and other bloodborne agents.

Vaccines are available against hepatitis B.

Exotic infectious agents

Travellers may be exposed to a variety of other exotic infections, such as:

  • rabies from bites or scratches from rabid dogs, bats and other mammals in many countries
  • schistosomiasis from exposure to water infested with the parasites, especially in Africa
  • leptospirosis through activities such as rafting or wading in contaminated streams

Of these diseases, vaccines are available only against rabies.

Recommending travel vaccines

Although recommending appropriate vaccines is important, it is not the only part of a pre-travel medical consultation. Travel vaccines — those relevant for travelling — include all relevant vaccines, not just the ones that prevent diseases that most commonly occur overseas.

Do not recommend a vaccine based only on the destination country, because there is no single ‘correct’ list of vaccines for travel to any particular country.

There are 3 categories of travel vaccines:

  • routinely recommended vaccines (not specific to travelling overseas)
  • selected vaccines based on travel itinerary, activities and likely risk of disease exposure
  • vaccines required by the International Health Regulations 2005 (IHR) or for entry into specific countries

Questions for a pre-travel medical consultation

During a pre-travel medical consultation, ask questions about the traveller’s:

  • personal information, including age and whether they are pregnant or planning pregnancy
  • underlying medical conditions, particularly immunocompromising conditions, and current medicines
  • vaccination history (including adverse events following immunisation) and allergy history
  • purpose of travel and intended activities, especially those associated with various environmental risks and hazards
  • plans for travel insurance

Also ask about their itinerary in detail, including:

  • date of departure and time available for vaccinations
  • specific localities and routes
  • rural versus urban stay
  • duration of stay
  • likely access to health care and other services
  • likelihood of changing the planned itinerary

This information helps to tailor recommendations about preventive vaccination or chemoprophylaxis for exposure risks during the proposed trip. It also allows the clinician to advise about other appropriate preventive health measures (for example, food and water precautions, avoiding bites from mosquitoes or other arthropods) and about managing possible health conditions during travel.

Organisational requirements for vaccination

Some overseas organisations, such as schools, colleges and universities, require evidence of vaccination or immunity against some vaccine-preventable diseases, such as measles and meningococcal disease. Consider these requirements when planning and scheduling vaccines before departure.

Routinely recommended vaccines (not specific to travelling overseas)

Vaccinate all prospective travellers according to the recommended vaccination schedule appropriate for their age, underlying health conditions, occupation and lifestyle. Vaccines might include, for example, pneumococcal polysaccharide vaccine for an older person, or hepatitis B vaccine for a first aid officer. 

Also ensure that all children are vaccinated according to the National Immunisation Program schedule. In exceptional circumstances, give the National Immunisation Program vaccines at the minimum age rather than the recommended age (see Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances ). Children vaccinated using the minimum age rather than the recommended age may need extra vaccine doses to ensure adequate protection. Observe the minimum interval requirements between doses (see Table. Minimum acceptable dose intervals for children <10 years of age ). The chances of being exposed to some diseases, such as measles and mumps, may be greater during overseas travel, even to other developed countries.

For some itineraries, it may be appropriate for the traveller to receive some booster doses earlier than the routine recommended time. An example may be diphtheria-tetanus booster.

Diphtheria, tetanus and pertussis

Vaccinate adult travellers against tetanus before departure, particularly if:

  • their risk of sustaining a tetanus-prone wound is high
  • there could be delays in accessing health services where they can receive tetanus toxoid boosters safely, if required

Offer dTpa vaccine during a pre-travel consultation if the traveller has never received a dose of dTpa . This provides protection against pertussis (see Pertussis ). 

For high-risk travel, consider giving a booster dose of either dTpa or dT vaccine if more than 5 years have passed (see Tetanus ).

Hepatitis B

Most Australian children born since 2000 have been vaccinated against hepatitis B under the National Immunisation Program or state and territory school-based vaccination programs.

Hepatitis B vaccine is recommended for long-term or frequent travellers to regions of intermediate or high endemicity of hepatitis B, including:

  • Central and South America

This is because travellers may be exposed to hepatitis B virus through bloodborne routes (including during emergency medical or dental procedures) or sexual routes. According to 1 survey, about half of Australian travellers who spent at least 3 nights in Southeast or East Asia participated in at least 1 activity that had a risk of hepatitis B transmission. 13

See also Hepatitis B .

Influenza and pneumococcal disease

Older travellers and those with any relevant underlying medical or behavioural risk factors should receive pneumococcal vaccine. See Pneumococcal disease for more details.

Consider influenza vaccine for all travellers, especially if they are travelling to a region during its influenza season. Influenza vaccine is particularly relevant if:

  • there is an influenza epidemic at the traveller’s destination
  • the person is travelling in a large tourist group, especially one that includes older people
  • the person is travelling on cruises, where people are relatively confined for days to weeks

See also Influenza. 

Measles, mumps and rubella

Inadequately vaccinated young adult travellers are responsible for most current measles outbreaks in Australia. This occurs when they acquire the infection overseas and bring it back to Australia. Some countries, regions or communities — including developed countries — have a higher incidence of measles and mumps than Australia. 9

Australians born during or since 1966 who have not received the recommended 2 doses of MMR (measles-mumps-rubella)–containing vaccines are recommended to receive MMR vaccine before travelling. This also applies to infants 6–12 months old travelling to areas with measles outbreaks or where measles is endemic . The exception is for pregnant women, because MMR is a live vaccine and is contraindicated in pregnancy. 

People born before 1966 do not need to receive measles-containing vaccine (unless serological evidence indicates that they are not immune). This is because circulating measles virus and disease were prevalent before 1966, so most people would have acquired immunity from natural infection .

However, confirmed cases of measles have occurred in people born before 1966. 14 If in doubt about a person’s immunity, it may be faster and easier to vaccinate the person than conduct serological testing . See Serological testing for immunity to measles . 

See also Measles . 

Unvaccinated travellers are recommended to receive varicella vaccine if they either:

  • have not had clinical disease, or
  • have an uncertain history of clinical disease and serology shows a lack of immunity 

The exception is for pregnant women, because varicella vaccine is a live vaccine and is contraindicated in pregnancy.

See also Varicella .

Meningococcal disease

Vaccination against meningococcal serogroups A, C, W-135, Y and B is recommended for certain age and population groups who are at increased risk of meningococcal disease.

In addition, MenACWY (quadrivalent meningococcal) vaccine is recommended for people who are:

  • planning travel to, or living in, parts of the world where epidemics of serogroup A, C, W-135 or Y meningococcal disease occur, particularly the ‘meningitis belt’ of sub-Saharan Africa 15
  • planning travel to mass gatherings, such as pilgrims travelling to the Hajj in Saudi Arabia

Seek up-to-date epidemiological information to determine whether a traveller needs meningococcal vaccination. See Accessing up-to-date travel information.

The Saudi Arabian authorities require that all pilgrims travelling to Mecca (for the Hajj or Umra) have evidence of recent vaccination with the quadrivalent meningococcal vaccine. 16  See Requirements for travellers to Mecca and Accessing up-to-date travel information .

See also Meningococcal disease .

Poliomyelitis

Ensure that all travellers are age-appropriately vaccinated against polio (see Poliomyelitis ).

If the person is travelling to a country where wild poliovirus is still circulating, they should receive inactivated poliovirus ( IPV ) vaccine if they have not completed a 3-dose primary course of any polio vaccine. Travellers who have completed the primary course should receive a single booster dose.

The World Health Organization (WHO) Global Polio Eradication Initiative website website has an up-to-date list of polio-affected countries.

Documented evidence of polio vaccination is not routinely required for travellers under the International Health Regulations. However, documented evidence of vaccination may be temporarily required according to WHO recommendations in response to new evidence of the spread of wild poliovirus (see Vaccines required by the International Health Regulations or for entry into specific countries and Documentation and certificates ).

International polio epidemiology and associated travel requirements can change. Check the Australian Government Department of Health website for current recommendations for Australian travellers .

Ensure that all travellers are age-appropriately vaccinated against COVID-19. Foreign governments may require evidence of COVID-19 vaccination before a traveller is allowed to enter. The Australian-issued International COVID-19 Vaccination Certificate is a secure way to prove COVID-19 vaccination history that has been developed to meet agreed international travel standards. Parents and carers of children <14 years of age, adolescents ≥14 years of age and adults can get a copy of their COVID-19 vaccination certificate at any time:

  • using their Medicare online account through myGov
  • through the Medicare Express Plus mobile app
  • by calling 1800 653 809 (free call)

See also COVID-19 .

Vaccines based on travel itinerary, activities and likely risk of disease exposure

Use a risk assessment approach when recommending travel vaccines. Weigh the potential risks of disease exposure and protective benefits from vaccination against potential adverse effects, and the non-financial and financial costs of vaccination.

Prioritise vaccines for diseases that are:

  • common and of significant impact, such as influenza and hepatitis A
  • less common, but have severe potential adverse outcomes, such as Japanese encephalitis and rabies

Consider booster doses, where appropriate (see disease-specific chapters in this Handbook for recommendations). If the person is departing for travel soon, consider an accelerated schedule, if appropriate, such as for hepatitis B vaccine or the combination hepatitis A-hepatitis B vaccine (see Hepatitis A and Hepatitis B ). Although immunity may be established sooner with the accelerated schedule, people who receive an accelerated schedule need another dose about a year later to complete the course and ensure long-term protection.

Most travellers do not need cholera vaccine. 16,17  The risk of a traveller acquiring cholera is very low if they avoid contaminated food and water.

No country requires travellers to have certification of cholera vaccination. No country has official entry requirements for cholera vaccination

See also Cholera .

Hepatitis A

Hepatitis A vaccine is recommended for all travellers ≥1 year of age travelling to moderately or highly endemic countries (including all developing countries). The exceptions are people who have evidence of natural immunity after previous infection .

Normal human immunoglobulin is no longer used to protect travellers against hepatitis A.

See also Hepatitis A .

Japanese encephalitis

While now considered an emerging disease in Australia, Japanese Encephalitis is more likely in travellers to endemic regions overseas. 18 Japanese encephalitis ( JE ) vaccine is recommended for travellers spending a month or more in endemic areas in Asia, Papua New Guinea or the outer islands of Torres Strait during the JE virus transmission season.

Consider JE vaccination for shorter-term travellers, particularly if:

  • travel is during the wet season 
  • travel may be repeated
  • the person will spend a lot of time outdoors 
  • the person’s accommodation has no air-conditioning, screens or bed nets

Check a reputable source before travel for information about JE virus activity — for example, Health Information for International Travel (the ‘Yellow Book’) . 19

A traveller’s overall risk of acquiring JE in these JE - endemic countries is likely to be low (<1 case per 1 million travellers). Determine the specific risk according to the: 17

  • season of travel
  • regions visited 
  • duration of travel
  • extent of outdoor activity
  • extent to which the person avoids mosquito bites 

See also Japanese encephalitis .

Before travel to rabies- endemic regions, advise people about:

  • the risk of rabies infection
  • avoiding close contact with wild, stray and domestic animals — especially dogs, cats, monkeys and bats 
  • the importance of appropriate immediate wound care of all animal bites and scratches 

See also Rabies and other lyssaviruses, including Australian bat lyssavirus .

Recommendations for rabies vaccination as pre-exposure prophylaxis

When deciding whether to give a pre-travel prophylactic rabies vaccination, assess the:

  • likelihood of exposure to potentially rabid animals
  • access to appropriate health care and availability of post-exposure prophylaxis , including rabies immunoglobulin , should there be an at-risk exposure
  • timeliness of access to health care after exposure

Use a lower threshold for recommending rabies pre-exposure prophylaxis for children travelling to endemic areas.

Benefits of vaccination as pre-exposure prophylaxis

Pre-travel rabies vaccination:

  • ensures that the traveller has received a safe and efficacious vaccine
  • simplifies the management of a subsequent exposure because the person will need fewer doses of vaccine
  • means that rabies immunoglobulin — which is often extremely expensive, and difficult or even impossible to obtain in many developing countries — is not needed
  • reduces the urgency of post-exposure prophylaxis

Tick-borne encephalitis

Tick-borne encephalitis (TBE) is caused by a tick-borne RNA flavivirus. The disease may involve the central nervous system. TBE is prevalent in parts of central and northern European temperate regions, and across northern Asia. Travellers are at risk when hiking or camping in forested areas in endemic regions during the summer months.

Safe and effective vaccines are available. Vaccination is recommended only for people with a high risk of exposure.

TBE vaccine is not registered in Australia, but a small stock of vaccine may be available for use under the Special Access Scheme .

Tuberculosis

Vaccination with BCG (bacille Calmette–Guérin) vaccine is generally recommended for tuberculin-negative children <5 years of age who will be staying in high-risk countries for an extended period (3 months or longer).

Vaccinating older children and adults appears to be less beneficial. However, consider vaccinating tuberculin-negative children aged ≥5 years but <16 years who may be living or travelling for long periods in high-risk countries.

A high-risk country is one that has a tuberculosis incidence of >40 per 100,000 population.

For travellers who need BCG vaccine, consider the following precautions when scheduling their vaccination visits:

  • If possible, give BCG vaccine at least 3 months before the person will arrive in an endemic area.
  • Give other live viral vaccines (for example, MMR , varicella, yellow fever) at the same time or with a minimum 4-week interval after BCG vaccination.
  • A tuberculin skin test (TST; Mantoux), performed by trained and accredited healthcare practitioners, is recommended before receiving BCG vaccine for all individuals (except infants aged <6 months).
  • People may suppress reactions to tuberculin for 4–6 weeks after viral infections or live viral vaccines, particularly measles infection and measles-containing vaccines.

State and territory tuberculosis services can provide tuberculin skin tests and BCG vaccine.

See also Tuberculosis .

Typhoid vaccine may be recommended for travellers ≥2 years of age travelling to endemic regions, including: 

  • the Indian subcontinent
  • most Southeast Asian countries 
  • several South Pacific nations, including Papua New Guinea 

This advice is also relevant for those travelling to endemic regions to visit friends and relatives.

Inactivated parenteral and live oral typhoid vaccine formulations are available.

See also Typhoid fever .

Yellow fever

Yellow fever vaccine is recommended for all people ≥9 months of age travelling to, or living in, an area with a risk of yellow fever virus transmission. 20

To minimise the risk of introducing yellow fever, some countries require documented evidence of yellow fever vaccination for entry, in line with the International Health Regulations (see Vaccines required by the International Health Regulations or for entry into specific countries ).

When assessing the need for yellow fever vaccination, consider:

  • the risk of the person being infected with yellow fever virus
  • country entry requirements
  • individual factors such as age, pregnancy and underlying medical conditions 

Vaccination is generally not recommended for travel to areas with a low probability of yellow fever virus exposure — that is: 

  • where human yellow fever cases have never been reported 
  • where evidence suggests only low levels of yellow fever virus transmission in the past 

However, consider vaccination for a small subset of travellers to lower-risk areas who are at increased risk of exposure to mosquitoes or who are unable to avoid mosquito bites. 20

People aged ≥60 years are at increased risk of severe adverse events after primary yellow fever vaccination. Weigh the adverse effects of vaccinating people in this age group against the potential for yellow fever virus exposure and, in turn, the benefits of vaccination. 17

See also Yellow fever .

Booster doses

Most people do not need a booster dose of yellow fever vaccine. A single dose induces protective antibody levels that last for many decades. However, certain people are recommended to receive a booster if their last dose was more than 10 years ago and they are at ongoing risk of yellow fever virus infection . See Yellow fever .

Vaccines required by the International Health Regulations or for entry into specific countries

Yellow fever requirements.

The International Health Regulations require yellow fever vaccination for travelling in certain circumstances. This is to:

  • protect travellers who are likely to be exposed to yellow fever 
  • stop importation of the virus into countries that have the relevant vectors (see Yellow fever ).

Some countries may require documented evidence of yellow fever vaccination as a condition of entry or exit (see Planning and documenting vaccines ). This includes countries that do not currently have yellow fever circulating.

Australia’s yellow fever travel requirements are detailed in the Australian Government Department of Health’s yellow fever fact sheet .

Contact the relevant embassies or consulates in Australia to confirm the entry requirements for yellow fever vaccination for the countries a traveller intends to enter or transit through. 

Requirements for travellers to Mecca

Each year, Saudi Arabia’s Ministry of Health publishes the requirements and recommendations for entry visas for travellers on pilgrimage to Mecca (Hajj and Umra). 16

For pilgrims travelling directly from Australia, only evidence of MenACWY vaccination is currently mandatory. However, check the current requirements when advising prospective Hajj and Umra pilgrims (see Meningococcal disease and Accessing up-to-date travel information ).

Temporary requirements

The International Health Regulations may temporarily introduce requirements for other vaccine-preventable diseases in response to changes in disease epidemiology that are of international health concern. An example is for polio vaccination.

Because country vaccination requirements are subject to change at any time, confirm all current vaccination requirements for the countries a traveller intends to enter or transit through before travel. See Poliomyelitis and Accessing up-to-date travel information .

Planning and documenting vaccines

Ideally, start vaccination courses early enough before departure to allow:

  • monitoring of any possible adverse events 
  • time for adequate immunity to develop

Requirements for multiple vaccines

A traveller may need multiple vaccines before they depart. Apply the standard recommendations and precautions when giving multiple vaccines (see Administration of vaccines ).

A traveller may need more than 1 clinic visit if they need multiple vaccines or doses (for example, rabies pre-exposure prophylaxis or hepatitis B vaccine). Pay special attention to scheduling of these visits, and consider:

  • dose interval precautions (for example, for multiple live vaccines)
  • requirements for pre-vaccination tests (for example, tuberculin skin test)
  • potential interference by some antimalarials, if relevant (for example, rabies vaccine)

Documentation and certificates

It is important to document travel vaccines: 

  • in the clinic’s record
  • in the traveller’s record that they can carry with them 
  • on the Australian Immunisation Register

The record should also include all the other routinely recommended vaccines that the traveller has ever received. 

For yellow fever vaccination, a traveller needs to have an International Certificate of Vaccination or Prophylaxis (ICVP), which only Yellow Fever Vaccination Centres can provide under the International Health Regulations (see Yellow fever ). 

Travellers may also need an ICVP for other vaccine-preventable diseases, such as polio, based on temporary recommendations.

See also Accessing up-to-date travel information .

Vaccinating travellers with special risk factors

See Vaccination for women who are planning pregnancy, pregnant or breastfeeding , Vaccination for people who are immunocompromised and the disease-specific chapters in this Handbook for recommendations for travellers who are pregnant or immunocompromised.

Accessing up-to-date travel information

International travellers’ health risks constantly change. Up-to-date information, and knowledge of the changing epidemiology and current outbreaks of infectious and emerging diseases are essential. Reliable online information sources include:

  • World Health Organization (WHO) for disease outbreak news, and its Travel and health section for specific advice on travel and health, including travel vaccination recommendations
  • Travelers’ health , United States Centers for Disease Control and Prevention (CDC)
  • Travel health information , Australian Government Department of Health
  • Smartraveller , the Australian Government’s travel advisory and consular information service, which provides up-to-date advice about health, safety and other risks of specific destinations for Australian travellers

The following resources have comprehensive technical advice on international travel and health, including vaccination:

  • the latest edition of WHO’s International travel and health
  • the CDC’s Health Information for International Travel (the ‘Yellow Book’)
  • Australian Bureau of Statistics. 3401.0 – Overseas arrivals and departures, Australia, Mar 2018 (accessed May 2018). 
  • Paudel P, Raina C, Zwar N, et al. Risk activities and pre-travel health seeking practices of notified cases of imported infectious diseases in Australia. Journal of Travel Medicine 2017;24(5):tax044.
  • Heywood AE, Watkins RE, Iamsirithaworn S, Nilvarangkul K, MacIntyre CR. A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports. BMC Public Health 2012;12:321.
  • Chen LH, Leder K, Barbre KA, et al. Business travel-associated illness: a GeoSentinel analysis. Journal of Travel Medicine 2018;25.
  • Angelo KM, Kozarsky PE, Ryan ET, Chen LH, Sotir MJ. What proportion of international travellers acquire a travel-related illness? A review of the literature. Journal of Travel Medicine 2017;24.
  • Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. New England Journal of Medicine 2006;354:119-30.
  • Halstead SB, Hills SL, Dubischar K. Japanese encephalitis vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
  • Staples JE , Monath TP, Gershman MD, Barrett AD. Yellow fever vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
  • World Health Organization (WHO). Chapter 6: Vaccine-preventable diseases and vaccines . In: International travel and health. Geneva: WHO; 2017. 
  • Steffen R. Travel vaccine preventable diseases-updated logarithmic scale with monthly incidence rates. Journal of Travel Medicine 2018;25.
  • Denholm JT, Thevarajan I. Tuberculosis and the traveller: evaluating and reducing risk through travel consultation. Journal of Travel Medicine 2016;23.
  • Lachish T, Tenenboim S, Schwartz E. 35 - Humanitarian Aid Workers. In: Keystone JS, Kozarsky PE, Connor BA, et al., eds. Travel Medicine (Fourth Edition). London: Elsevier; 2019. (Accessed 6 July 2023). https://www.sciencedirect.com/science/article/pii/B9780323546966000355
  • Leggat PA, Zwar NA, Hudson BJ. Hepatitis B risks and immunisation coverage amongst Australians travelling to Southeast Asia and East Asia. Travel Medicine and Infectious Disease 2009;7:344-9.
  • Winkler NE, Dey A, Quinn HE, et al. Australian vaccine preventable disease epidemiological review series: measles, 2012-2019. Commun Dis Intell (2018) 2022;46.
  • World Health Organization (WHO). Epidemic meningitis control in countries of the African meningitis belt, 2017. Weekly Epidemiological Record 2018;93:173-84.
  • World Health Organization (WHO). International travel and health: health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj) . 2017 (accessed May 2018). 
  • Freedman DO, Chen LH. Vaccines for International Travel. Mayo Clinic Proceedings 2019;94:2314-39.
  • Furuya-Kanamori L, Gyawali N, Mills DJ, et al. The Emergence of Japanese Encephalitis in Australia and the Implications for a Vaccination Strategy. Trop Med Infect Dis 2022;7.
  • Hills SL, Rabe IB, Fischer M. Infectious diseases related to travel: Japanese encephalitis . In: CDC yellow book 2018: health information for international travel. New York: Oxford University Press; 2017. 
  • World Health Organization (WHO). International travel and health (accessed Apr 2018). 

Page history

Minor updates to clinical guidance around routinely recommended vaccines (not specific to travelling overseas), including the addition of advice regarding COVID-19.

Editorial update to reflect changes to pneumococcal vaccine recommendations for older adults and people with medical risk factors.

Guidance on vaccination of travellers against measles, mumps and rubella updated to reflect advice in the Measles chapter.

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What to know about the measles vaccine — from who should get one, to how long immunity lasts

Measles vaccine is one of the most effective, offers long-lasting protection, medical experts say.

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Demand for measles vaccine leading to shortages

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This story is part of CBC Health's Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by  clicking here .

In Canada, measles was once a disease of the past. But it's increasingly becoming a health threat of the present, after backsliding vaccination rates allowed the virus to creep back into circulation.

Canada officially eliminated measles nearly three decades ago, but for years, medical experts warned it was poised to make a comeback — and disruptions to routine childhood immunization efforts throughout the COVID-19 pandemic may have sped that up.

Now, after tens of thousands of cases in Europe, and close to 100 recent infections across Canada and the U.S., health officials are on high alert.

There are warnings about travel abroad, calls for people to ensure their families are up-to-date on the measles vaccine, and fresh reminders that the virus is highly contagious and capable of causing pneumonia, brain inflammation, and even death.

"A lot of people are worried," said Dr. Alykhan Abdulla, a family physician in Ottawa. "Measles hasn't really been around in our society for a long time."

So how should Canadians navigate the latest guidance around measles vaccination, and who's actually protected? And if you've already had at least one measles shot, are you now set for life?

Who should get the measles vaccine?

If you or your child has never had a combined measles, mumps and rubella (MMR) vaccine — and never had a prior measles infection — the official guidance is simple: Get vaccinated.

But after that, it gets a little more complicated.

For Canadian children, the typical schedule is now two doses, both administered before they enter school. The first MMR dose should be given when a child is 12 to 15 months of age and the second dose at 18 months, or any time after that, but no later than around school entry, notes the Canadian immunization guide. 

  • Second Opinion Canada heading toward major measles outbreak without vaccine boost, new modelling suggests

As for adults, if you were born after the two-dose MMR vaccine became routine, you probably had both rounds as a child. 

Some adults might've only had one dose, however. That includes people born before 1970, who were likely exposed to the virus, given how widely measles used to circulate — and federal guidance assumes those individuals have natural immunity.

However, the same guidance suggests anyone who's at a higher risk of being exposed — like health-care workers, military personnel and international travellers — should get an MMR vaccine, regardless of their year of birth. 

Confused yet? 

  • Canada faces shortage of measles vaccines amid rise in cases, demand

What if you don't have your immunization record, or can't remember if you had a measles infection in childhood? Experts suggest simply getting an MMR dose, to be safe.

"If there's any concern about whether you've been vaccinated, it's actually cheaper and easier just to get vaccinated again," said McMaster University associate professor and immunologist Dawn Bowdish.

What do I need to know if I'm travelling outside of Canada?

More than 50 countries are reporting "large and disruptive" measles outbreaks, World Health Organization officials warned this week.

So if you or a family member hasn't been vaccinated against measles before travelling, there's a higher risk of catching it, medical experts warn, making it even more important to be up-to-date on your shots.

  • Measles vaccine in limited supply at Nova Scotia pharmacies

That's because measles is capable of lingering in the air for up to two hours (yes, hours ) after someone infected enters a space.

Infants under the age of one are "particularly vulnerable" to a measles infection, according to the Public Health Agency of Canada (PHAC), since their routine shots typically start at 12 months of age.

In a statement, PHAC told CBC News the current advice for people travelling internationally is as follows:

  • Infants between six months and less than 12 months of age: One dose if they're travelling to a high-risk area. (However, that shot will be considered "dose zero" on their record, as children who get an early dose will still require two more doses later.)
  • Children and adolescents: Two doses.
  • Adults born in 1970 or later: Two doses.
  • Adults born before 1970: At least one dose.

a travel vaccines

How to protect yourself against measles

If people need a shot, how can they get one.

If you need an MMR shot, medical experts suggest speaking to your primary care provider such as a family doctor or nurse practitioner — if you have one — or reaching out to your local community health centre or public health team.

Travel clinics are also an option to quickly get a shot before a trip, though private businesses can charge $75 or more for a dose.

Still, it's not always easy.

  • Toronto Public Health warns of potential measles exposure at new location linked to 2nd case

Despite the guidance around staying up-to-date on measles vaccinations, multiple Canadians told CBC News that some doctors and pharmacies are either short on supply , or simply discouraging patients from getting another round because they're either deemed too young or too old to need one. 

"I think we're all adjusting to this reality of measles resurgence from abroad," said Shelly Bolotin, director of the Centre for Vaccine Preventable Diseases at the University of Toronto. "And perhaps that is why different people are in different places."

Is there enough supply of the MMR vaccine available in Canada?

If you do need a dose, there are two MMR vaccines being used in Canada right now, from drug makers Merck and GSK. 

Shortage notices have also been posted for both brands' shots, but Health Canada said the companies have assured they'll be able to "fully meet demand" for public immunization programs, including routine childhood vaccines. 

GSK told CBC News the "temporary" shortage for its Priorix vaccine is linked to an increase in demand in the Canadian private market, adding it continues to meet the demand in the public sector. Merck Canada said it is working with provincial and federal health authorities to provide a consistent supply "in a timely manner."

  • Children in Peel Region risk catching measles due to low vaccination rates, warns doctor

What's unclear to Canadian health-care teams is whether an ongoing spike in demand will further complicate vaccination efforts.

"We have to be judicious, we have a resource that is limited," said Abdulla, in Ottawa. "And we have to be thoughtful in the way that we use [the available supply]." 

Family physician Dr. Allan Grill, in Markham, Ont., said his team is currently distributing measles vaccines on an as-needed basis.

"You can imagine how overwhelmed family medicine would get if we decided all of a sudden to just focus all of our attention on everybody's measles vaccine status."

Meanwhile, Andrew Sisnett, president of Summit Health, a travel vaccine provider, said the company rarely doled out MMR shots before this year. Yet demand recently shot up, and he's having issues ordering more. 

"There are concerns that, from a private-sector perspective, that we're not going to be able to procure enough."

a travel vaccines

Measles may be spreading in some communities, health officials warn

How protective is prior infection or vaccination against measles.

If you've had a prior measles infection, there's a silver lining.

Peer-reviewed research from a team including Bolotin stressed that immunity from measles is thought to be life-long.

The study cited evidence from Denmark's remote Faroe Islands, located in the North Atlantic, which experienced a measles outbreak in 1781. The next outbreak in 1846 spared all those older than 65 — as in, all the people who would have been infected exactly 65 years earlier.

"This early observation remains some of the best evidence of life-long immunity to measles," the team wrote.

  • Hamilton child isolating at home after catching measles overseas: public health

That's because of how the measles virus operates, Bowdish said.

"Unlike RSV, or influenza or other respiratory infections ... it actually infects our immune cells," she said. "And then it hijacks those immune cells to travel to our lymph nodes, where there's millions and millions more immune cells to infect." 

A serious infection like that requires a serious immune response, Bowdish said. It's a bit like your body fighting a major war, giving it deep, lasting memories of how to fend off that attacker if it ever invades again.

So, is the same thing true for getting a full set of MMR shots?

To some extent, yes.

The measles vaccine contains small amounts of live virus, making it one of the most protective shots available, Bolotin said, with two doses showing 97 per cent efficacy (how well it does in an ideal and controlled environment) in studies, and 94 per cent effectiveness (real-world performance) in field estimates. 

"It's actually a mini infection in your body. And so it creates something very, very similar to what you would see if you're infected."

  • Measles may be spreading in some Canadian communities, officials warn

There can be instances where immunity after the shots does wane over time, both Bowdish and Bolotin agreed, and various global studies have documented occasional breakthrough infections. Even so, evidence suggests the shots still protect against serious illness and help curb transmission. 

"For most vaccines, what we do is we modify or minimize the severity of infections as opposed to preventing them 100 per cent," said Bowdish.

"But the measles vaccine is a different case, where it really does seem to prevent infections from getting started in most people, most of the time."

Corrections

  • A previous version of this story described the Faroe Islands as being located off the coast of Denmark. In fact, they are located farther out in the Atlantic Ocean, halfway between the U.K. and Iceland. Mar 23, 2024 9:28 AM ET

ABOUT THE AUTHOR

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Senior Health & Medical Reporter

Lauren Pelley covers health and medical science for CBC News, including the global spread of infectious diseases, Canadian health policy, pandemic preparedness, and the crucial intersection between human health and climate change. Two-time RNAO Media Award winner for in-depth health reporting in 2020 and 2022. Contact her at: [email protected]

  • @LaurenPelley

Related Stories

  • Measles cases in Canada spark call for pop-up vaccine clinics in Winnipeg's inner city
  • Vaccines key to addressing uptick in measles cases, doctors say
  • Canada heading toward major measles outbreak without vaccine boost, new modelling suggests
  • Even people born before 1970 are encouraged to get measles shot for international travel

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Routine Vaccines

family showing vaccine band-aids

What are "routine vaccines"?

Routine vaccines are those recommended for everyone in the United States, depending on age and vaccine history. Most people think of these as childhood vaccines that you get before starting school, but but there are also routine vaccines for adolescents and adults .

Why are routine vaccines important for travelers?

Because most U.S. children get routine vaccines, many vaccine-preventable diseases, such as measles, mumps, or chickenpox, are not common in the United States. If you are not vaccinated, international travel increases your chances of getting and spreading diseases that are not common in the United Sates. Popular destinations, including Europe, still have outbreaks of measles and other vaccine-preventable diseases. 

Make sure you are up-to-date on all of your routine vaccines . Routine vaccinations protect you from infectious diseases such as measles that can spread quickly in groups of unvaccinated people. Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries.

Check CDC’s destination pages for travel health information . Check CDC’s webpage for your destination to see what vaccines or medicines you may need and what diseases or health risks are a concern at your destination.

Make an appointment with your healthcare provider or a travel health specialist  that takes place at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing your health concerns, itinerary, and planned activities with your provider allows them to give more specific advice and recommendations.

What routine vaccines do I need?

The routine vaccines you need before travel may depend on your age, health, and vaccine history. You may need to get an accelerated dose of a vaccine or a booster dose before traveling.

Routine vaccinations related to travel may include the following:

  • Chickenpox (Varicella)
  • Hepatitis A
  • Hepatitis B
  • Human Papilloma Virus (HPV)
  • Measles, mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus, diphtheria, pertussis
  • Shingles (Zoster)

The following are CDC immunization schedules for by age group:

  • Recommended Vaccinations or Infants and Children (birth through 6 years)
  • Recommended Vaccinations for Children (7-18 years old)
  • Recommended Adult Immunization Schedule for ages 19 years or older

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  • Travel Vaccines

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Following Measles Outbreaks, Officials Grow Wary of Renewed Threat

Cases this year have already topped the total in 2023. Unvaccinated travelers account for most infections.

A close-up view of an MMR vaccine dose on a tray in a clinic.

By Apoorva Mandavilli

Measles, a highly contagious but preventable disease, is resurging in pockets of the United States, a warning of the dangers of the strengthening anti-vaccine movement.

Listen to this article with reporter commentary

Open this article in the New York Times Audio app on iOS.

The Centers for Disease Control and Prevention has recorded more cases this year than the 58 tallied in all of 2023, although the agency is not expected to release exact numbers until Friday. On Monday, the agency advised health care providers to ensure that unvaccinated patients, especially those traveling internationally, stay updated on their immunizations.

The number of cases is likely to keep rising because of a sharp spike in measles worldwide, along with spring travel to some regions with outbreaks, including Britain, said Dr. Manisha Patel, chief medical officer at the C.D.C.’s respiratory disease division.

Nearly all the cases in the United States so far are related to unvaccinated travelers. “We’re not going to see widespread measles cases going throughout the country,” Dr. Patel said. “But we do expect additional cases and outbreaks to happen.”

Measles is among the most contagious of diseases; each infected person can spread the virus to as many as 18 others. The virus is airborne and can stay aloft up to two hours after an infected person has left the room, spreading rapidly through homes, schools and child care facilities.

In Chicago, one case of measles at a migrant shelter has grown to 13 , prompting the C.D.C. to send a team to help contain the outbreak. (Two additional cases in the city appear to be unrelated.)

In Florida, seven students at an elementary school contracted measles even as the state’s surgeon general, Dr. Joseph Ladapo, left it to parents to decide whether unvaccinated children should attend school.

In southwest Washington, officials identified measles in six unvaccinated adult members of a family living in two counties. And in Arizona, an international traveler infected with measles dined at a restaurant and transmitted the virus to at least two others .

Measles was eliminated in the United States in 2000, and American children generally must be immunized to attend school. Yet sporadic cases lead to larger outbreaks every few years. But now a drop in vaccination rates, exacerbated by the coronavirus pandemic, has experts worried about a resurgence.

When vaccinations lag, “the first disease to appear is measles, because it’s highly infectious,” said Dr. Saad Omer, dean of the O’Donnell School of Public Health at U.T. Southwestern in Dallas.

Nine of 10 unvaccinated people in close contact with a measles patient will become infected, according to the C.D.C.

Measles is far less deadly in countries with high immunization rates and good medical care. Fewer than three of every 1,000 American children with measles will die as a result of severe complications like pneumonia or encephalitis, the swelling of the brain.

Still, about one in five people with measles may end up in a hospital.

Because widespread measles outbreaks have been rare, most Americans, including doctors, may not recognize the vibrant red rash that accompanies respiratory symptoms in a measles infection. They may have forgotten the impact of the disease on individuals and communities.

“Most of our local health department folks have never seen a measles outbreak,” said Dr. Christine Hahn, state epidemiologist of Idaho, which contained a small cluster of cases last year.

“It’s going to be a big challenge to us to respond if and when we get our next outbreak,” she said.

Before the first measles vaccine was introduced in the 1960s, the disease killed an estimated 2.6 million people worldwide each year. But its full impact may have been much greater.

Measles cripples the immune system, allowing other pathogens easier entry into the body. A 2015 study estimated that measles may have accounted for as many as half of all infectious disease deaths in children.

For about a month after the acute illness, measles can stun the body’s first response to other bacteria and viruses, said Dr. Michael Mina, chief science officer of the digital health company eMed and formerly an epidemiologist at the Harvard T.H. Chan School of Public Health.

That leaves patients “massively susceptible to bacterial pneumonias and other things,” said Dr. Mina, who was the lead author on the 2015 study.

“It’s very risky for people in those first few weeks post measles,” he added.

The virus also induces a sort of immune-system amnesia. Normally the body “remembers” the bacteria and viruses it has fought before. Dr. Mina and his colleagues showed in 2019 that people who have measles lose between 11 and 73 percent of their hard-won immune repertoire, a loss that can last for years.

That does not mean the body no longer recognizes those pathogens at all, but it does shrink the arsenal of weapons available to fight them.

“People should be aware that if they’re choosing not to vaccinate, that’s the position they’re putting themselves and their family in,” Dr. Mina said.

The C.D.C. recommends receiving the first dose of the measles vaccine after 12 months of age, and a second between ages 4 and 6. Even a single dose of the vaccine is 93 percent effective. Measles vaccination averted 56 million deaths between 2000 and 2021, according to the World Health Organization.

Vaccination rates in the United States have shown a distinct, if small, dip to 93 percent in the 2022-23 school year from 95 percent in 2019-20 — the level required to protect everyone in the community. Rates of vaccination exemptions increased in 40 states and the District of Columbia.

In a survey last year , just over half of Republicans said that public schools should require measles vaccinations, compared with about 80 percent before the pandemic. (Support for vaccines among Democrats held steady.)

While national or state-level vaccination rates may be high, there may be pockets of low immunization that provide tinder for the measles virus, Dr. Omer said.

If there are enough unvaccinated cases to sustain an outbreak, even those who are vaccinated but whose immunity may have waned are vulnerable, he said.

In Idaho, 12 percent of kindergarten-age children do not have a record of vaccination. Some of the gap results from parents unable or unwilling to share records with the schools, and not because their children are not immunized, Dr. Hahn said.

Still, online schools, which proliferated through the pandemic and remain popular in the state, have some of the highest rates of vaccine exemptions, she said.

In September, a young Idaho man brought measles back after international travel and became ill enough to be hospitalized . Along the way, he exposed fellow passengers on two flights, dozens of health care workers and patients, and nine unvaccinated family members. All nine developed measles.

Idaho got “very lucky” with the outbreak because the family lived in a remote area, Dr. Hahn said. But there are most likely many other areas in the state where an outbreak would be difficult to contain.

“We’ve got plenty of tinder, if you will,” she added.

Some large outbreaks in recent years exploded among huge clusters of unvaccinated people, including the Amish in Ohio and the Orthodox Jewish community in New York City.

In September 2018, one unvaccinated child returned to New York City from Israel, ferrying measles virus picked up during an outbreak in that country.

Even though the city maintains high vaccination rates, that single case set off an outbreak that raged for nearly 10 months, the largest in the country in decades. The city declared a public health emergency for the first time in more than 100 years.

“We had more than 100 chains of transmission,” said Dr. Oxiris Barbot, the city’s health commissioner at the time, and now the president and chief executive of United Hospital Fund.

“Keeping all of that straight was a challenge,” she recalled. “And to have to investigate over 20,000 exposures like that, that was huge.”

Working with community leaders, city officials hurriedly administered about 200,000 doses of vaccine. More than 550 city staff members were involved in the response, and the final cost to the city’s health department topped $8 million.

The C.D.C. is working with state and local health departments to identify pockets of low vaccination and prepare them for outbreaks, Dr. Patel said. The agency is also training health care providers to recognize measles symptoms, particularly in patients with a history of international travel.

Measles is a slippery adversary, but public health is intimately familiar with the tools needed to contain it: screening, tracing contacts and vaccinating the susceptible.

“We’re not helpless bystanders,” Dr. Omer said. “The focus needs to be on meat-and-potatoes public health.”

Audio produced by Tally Abecassis .

Apoorva Mandavilli is a reporter focused on science and global health. She was a part of the team that won the 2021 Pulitzer Prize for Public Service for coverage of the pandemic. More about Apoorva Mandavilli

Puerto Rico reports dengue fever epidemic. How likely is the disease in Ohio?

Dengue fever is on the rise in Puerto Rico, and island officials have declared it an epidemic .

At least 549 cases have been reported so far and more than 340 people have been hospitalized, according to  the island’s health department .

"As of March 21, 2024, the Department of Health's epidemiological surveillance of diseases has observed a 140% increase in dengue cases for Puerto Rico compared to the same period last year," the department said in a press release on Monday.

So, what is the disease? What are its symptoms? And what's the likelihood of it coming to Ohio? Here's what you need to know.

What is dengue fever?

Dengue fever is a viral infection transmitted to humans through the bite of infected mosquitoes, according to the World Health Organization . It is found in tropical and subtropical climates worldwide, mostly in urban and semi-urban areas.

Mosquitoes: What animal kills the most humans per year? Protect yourself from this unexpected predator.

What are the symptoms of dengue fever?

According to Johns Hopkins Medicine , symptoms include:

  • Sudden high fever
  • Severe headaches
  • Pain behind the eyes
  • Joint and muscle pain
  • Swollen glands
  • Rash that appears 3 to 4 days after the fever starts

Is dengue fever a risk in Ohio?

Although the two types of mosquitoes that transmit dengue are found in some counties, the virus is not endemic in the state, according to the Ohio Department of Health .

So far in 2024, there are seven reported cases of dengue fever in Ohio, according to the CDC . But all were contracted while travelling, not in the state.

Is there a vaccine for dengue fever?

A vaccine is available, according to the Centers for Disease Control and Prevention . It is recommended for children ages 9 through 16, but only when they have been previously infected with dengue and living in areas where dengue is common.

Is dengue fever deadly? What is its mortality rate?

While most infections show no symptoms or only cause mild illnesses, dengue fever can be severe or fatal, according to the WHO.

The CDC reports that fewer than 1% of dengue patients died from 2010 to 2018. However, the mortality rate can be as high as 13% in untreated patients.

Where else has dengue fever been reported?

Rio de Janeiro  declared a public health emergency  in February, just before Carnival , amid a surge of dengue fever in Brazil.

In the first few weeks of 2024, Rio documented more than 10,000 cases of dengue fever, nearly half of the total cases reported in the entirety of 2023, which amounted to 23,000, according to officials from the Health Ministry.

Peru and Florida also dealt with dengue fever in 2023.

CDC issues a travel warning following dengue outbreaks

Dengue is an ongoing risk in many parts of Central and South America, Mexico and the Caribbean, according to the CDC. Travelers to areas of risk should protect themselves by preventing mosquito bites. Also, the CDC says travelers might be at increased risk for dengue fever in these countries, which are reporting higher-than-usual cases:

  • French Guiana
  • Saint Barthélemy
  • Saint Martin
  • Turks and Caicos Islands
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Old immune systems revitalized in mouse study, may improve vaccine response in the elderly

by Stanford University Medical Center

immune system

Planes, trains, boats, automobiles and even feet. During the past decades and centuries, global travel and human migration have made all of us more worldly—from our broadening awareness of the world beyond our birthplaces, to our more sophisticated palates, to our immune systems that are increasingly challenged by unfamiliar bacteria and viruses.

In the elderly, these newly imported pathogens can gain the upper hand frighteningly quickly. Unfortunately, however, vaccination in this age group isn't as effective as it is in younger people.

Now a study conducted in mice by Stanford Medicine and the National Institute of Health's Rocky Mountain Laboratories provides tantalizing evidence that it may one day be possible to rev up an elderly immune system with a one-time treatment that modulates the composition of a type of immune cell.

The treatment significantly improved the ability of geriatric animals' immune systems to tackle a new virus head on, as well as to respond vigorously to vaccination—enabling them to fight off a new threat months later.

"This is a real paradigm shift—researchers and clinicians should think in a new way about the immune system and aging," said postdoctoral scholar Jason Ross, MD, Ph.D. "The idea that it's possible to tune the entire immune system of millions of cells simply by affecting the function of such a rare population is surprising and exciting."

Ross and Lara Myers, Ph.D., a research fellow at Rocky Mountain Laboratories, are the lead authors of the study, which is published in Nature . Irving Weissman, MD, professor of pathology and of developmental biology, and Kim Hasenkrug, Ph.D., the chief of Rocky Mountain Laboratories' Retroviral Immunology Section, are the senior authors of the research.

A shift in the immune system

The targeted cells are a subset of what's known as hematopoietic stem cells , or HSCs. HSCs are the granddaddies of the immune system, giving rise to all the other types of blood and immune cells including B and T cells, which are collectively known as lymphocytes . As we age, our HSCs begin to favor the production of other immune cells called myeloid cells over lymphocytes. This shift hampers our ability to fully react to new viral or bacterial threats and makes our response to vaccination much less robust than that of younger people.

"Older people just don't make many new B and T cell lymphocytes," said Weissman, who is the Virginia and D.K. Ludwig Professor in Clinical Investigation in Cancer Research.

"During the start of the COVID-19 pandemic, it quickly became clear that older people were dying in larger numbers than younger people. This trend continued even after vaccinations became available. If we can revitalize the aging human immune system like we did in mice, it could be lifesaving when the next global pathogen arises."

Weissman was the first to isolate HSCs in mice and humans in the late 1980s. In the years since, he and his colleagues have investigated the molecular minutiae of these cells, painstakingly tracing the complicated relationships among the scores of cell types that arise in their wake.

Some of these descendants make up what's known as the adaptive immune system: highly specialized B and T lymphocytes that each recognize just one particular three-dimensional structure—perhaps a pointy bit here or a telltale knobby clump there—that betrays an invading virus or bacteria.

Like trained assassins once they spot their mark, B lymphocytes churn out antibodies that latch onto the telltale structures and target infected or foreign cells for destruction, while various subtypes of T lymphocytes either demolish infected cells or raise a hue and cry to summon other immune cells to finish off the enemy.

The specificity of the B and T lymphocytes allows the immune system to have memory; once you've been exposed to a specific invader, the body reacts swiftly and decisively if that same pathogen is seen again. This is the basic concept behind vaccination—trigger an initial response to a harmless mimic of a dangerous bacteria or virus.

In response, the lymphocytes that recognize the invader not only give rise to cells that eliminate the infection but also generate long-lived memory B and T cells that, in some cases, can last a lifetime. Thus, the system is primed when the threat becomes real.

Another key part of our immune system is called innate immunity, and it's much less discriminating. In the blood, it's run by a class of cells called myeloid cells. Like school janitors, these cells scour the body, gobbling up any unfamiliar cells or bits of detritus. They also trigger inflammatory responses , which recruit other cells and chemicals to infected sites. Inflammation helps the body protect itself against invaders, but it can be a major problem when triggered inappropriately or over-enthusiastically, and aging has been linked to chronic inflammation in humans.

An evolutionary disadvantage

Ross and Weissman knew from previous research that during aging, the number of HSCs that make balanced proportions of lymphocytes and myeloid cells decline, while those that are myeloid-biased increase their numbers. This favors the production of myeloid cells .

Early in human history, when people rarely left their birthplace and lived shorter lives, this gradual change probably had no consequences (it may even have been favorable) because people were likely to encounter all their surrounding pathogens by young adulthood and be protected by their memory lymphocytes. But now it's distinctly disadvantageous.

The researchers wondered if they could tilt the balance back toward a younger immune system by depleting myeloid-leaning HSCs and allowing the more balanced HSCs to replace them.

Their hunch was correct. Mice between 18 and 24 months old (doddering in the mouse world) that were treated with an antibody targeting the myeloid-leaning HSCs for destruction had more of the balanced HSCs—and more new, naïve B and T lymphocytes—than their untreated peers even several weeks later.

"These new, naïve lymphocytes provide better immune coverage for novel infections like those humans increasingly encounter as our world becomes more global," Weissman said. "Without this renewal, these new infectious agents would not be recognized by the existing pool of memory lymphocytes."

The treatment also reduced some negative outcomes like inflammation that can arise when an elderly immune system grapples with a new pathogen.

"Not only did we see a shift toward cells involved in adaptive immunity, but we also observed a dampening in the levels of inflammatory proteins in the treated animals," Ross said. "We were surprised that a single course of treatment had such a long-lasting effect. The difference between the treated and untreated animals remained dramatic even two months later."

When the treated animals were vaccinated eight weeks later against a virus they hadn't encountered before, their immune systems responded more vigorously than untreated animals, and they were significantly better able to resist infection by that virus. (In contrast, young mice used as controls passed all the challenges with flying colors.)

"Every feature of an aging immune system —functional markers on the cells, the prevalence of inflammatory proteins, the response to vaccination and the ability to resist a lethal infection—was impacted by this single course of treatment targeting just one cell type," Ross said.

Finally, the researchers showed that mouse and human myeloid-biased HSCs are similar enough that it may one day be possible to use a similar technique to revitalize aging human immune systems, perhaps making a person less vulnerable to novel infections and improving their response to vaccination.

"We believe that this study represents the first steps in applying this strategy in humans," Ross said.

The study also has interesting implications for stem cell biology and the way HSCs rely on biological niches, or specific neighborhoods of cells, for their longevity and function throughout our lives.

"Most people in immunology have believed that you lose these kinds of tissue-specific stem cells as you grow older," Weissman said. "But that is completely wrong. The problems arise when you start to favor one type of HSC over another. And we've shown in mice that this can be reversed. This finding changes how we think about stem cells during every stage of aging."

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COMMENTS

  1. Need travel vaccines? Plan ahead.

    If yellow fever vaccine is recommended or required for your destination, you'll need to go to a vaccine center authorized to give yellow fever vaccinations. Many yellow fever vaccine centers also provide other pre-travel health care services. Find an authorized US yellow fever vaccine center. Examples of Vaccines

  2. Think Travel Vaccine Guide

    Vaccination (2-dose vaccine): Recommended for most travelers. --Administer 2 doses, at least 6 months apart. --At least 1 dose should be given before travel. Consultation: Advise patient to wash hands frequently and avoid unsafe food and water. Hepatitis B. Sexual contact, contaminated needles, & blood products, vertical transmission.

  3. Travel Vaccines to Protect Your Family

    Many travel vaccines require multiple shots or take time to become fully effective. But some multiple-dose vaccines (like hepatitis A) can still give you partial protection after just one dose. Some can also be given on an "accelerated schedule," meaning doses are given in a shorter period of time.

  4. Travel Vaccines: When to Get Them, Side Effects, and Cost

    Some travel vaccines are given more often than others. For instance, the yellow fever vaccine offers lifelong protection for most people. But typhoid vaccine boosters are recommended every 2 to 5 years. The typical yellow fever vaccine cost is around $170 — but this can vary by clinic and location. GoodRx can help make your travel vaccines ...

  5. Your Travel Vaccine Checklist

    Below is a list of vaccine-preventable travel-related diseases that are not covered by routine adult vaccinations: Hepatitis A. Hepatitis B. Typhoid and paratyphoid fever. Meningococcal disease ...

  6. What Vaccines Do I Need for Travel?

    Non-routine vaccinations required for travel to some countries Staying up to date on typical vaccines like those for COVID-19, flu, tetanus and hepatitis A and B is a smart choice for everyone.

  7. Travelers' Health

    CDC Travelers' Health Branch provides updated travel information, notices, and vaccine requirements to inform international travelers and provide guidance to the clinicians who serve them. ... Routine Vaccines. It's important to be up to date on recommended routine vaccines prior to travel, including Flu, RSV and COVID-19. Learn more .

  8. Vaccines for Travelers

    Vaccines for Travelers. Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places. Getting vaccinated will help keep you safe and healthy while you're ...

  9. Which Vaccinations Are Required for Travel?

    Whether you have travel on the horizon or want to be prepared for 2023 trips and beyond, this guide will get you up to speed on the vaccinations required for travel depending on your destination ...

  10. 9 common questions about vaccines and travel

    Pneumococcal. Measles, mumps and rubella (MMR) Polio. Shingles. Additional vaccines may be recommended depending on your travel itinerary. For example, hepatitis A vaccination is recommended if you are traveling to Southeast Asia. During your appointment, we can discuss which vaccines are appropriate for your itinerary. 3.

  11. Vaccines

    Vaccines. Vaccination is the administration of agent-specific, but safe, antigenic components that in vaccinated individuals can induce protective immunity against the corresponding infectious agent. Before departure, travelers should have a medical consultation to learn about the risk of disease in the country or countries they plan to visit ...

  12. Travel Immunizations & Resources

    Travel vaccines Walgreens offers include: Yellow Fever, Meningitis, Polio, Typhoid, Japanese Encephalitis, Tick-Borne Encephalitis, Hepatitis A, Hepatitis B and Rabies*. *Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability. What other vaccines should I have before traveling? ...

  13. Travel Vaccinations

    In this series: Hepatitis A Vaccine Hepatitis B Vaccine Rabies Vaccine Tick-borne Encephalitis Vaccine Typhoid Vaccine Yellow Fever Vaccine. Travel vaccinations are an essential part of holiday and travel planning, particularly if your journey takes you to an exotic destination or 'off the beaten track'. The risks are not restricted to tropical ...

  14. Common Travel Vaccines

    The three most commonly recommended travel vaccines are: Hepatitis A vaccine for travel to most other countries in the world. Hepatitis A is a common viral infection that you can get from contaminated water or food. Yellow fever vaccine for travel to some parts of Africa and South America. Yellow fever is a virus that spreads through mosquito ...

  15. Recommended Vaccines for Adults

    Get vaccinated before you travel The vaccines recommended or required for an international traveler depend on several factors, including age, health, and itinerary. Take these steps to make sure you are prepared for your trip: Make sure you are up-to-date with all recommended vaccines. Talk with your healthcare provider and get any vaccines ...

  16. Travel vaccination advice

    Travel vaccination advice. If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world. Vaccinations are available to protect you against infections such as yellow fever, typhoid and hepatitis A. In the UK, the NHS routine immunisation (vaccination) schedule ...

  17. Travelers' Health Most Frequently Asked Questions

    If you need to contact a US embassy or consulate, call 1-888-407-4747 (from the US or Canada) OR 00-1-202-501-4444 (from other countries). Travel healthy, from CDC's Travelers' Health! CDC Travelers' Health Branch provides health advice to international travelers, including advice about medications and vaccines.

  18. Travel vaccinations

    Travel vaccinations. When travelling outside Canada, you may be at risk for a number of vaccine preventable illnesses. You should consult a health care provider or visit a travel health clinic preferably six weeks before you travel. This is an opportunity to: review your immunization history. make sure your provincial/territorial vaccination ...

  19. Available travel vaccines

    If travelling to a high-risk area, you should be vaccinated against meningococcal meningitis with a MenACWY vaccine, also known as the quadrivalent meningococcal meningitis vaccine. This is a single injection that should be given 2 to 3 weeks before you travel. Babies under a year old need 2 injections.

  20. Vaccination for international travellers

    Travel vaccines — those relevant for travelling — include all relevant vaccines, not just the ones that prevent diseases that most commonly occur overseas. Do not recommend a vaccine based only on the destination country, because there is no single 'correct' list of vaccines for travel to any particular country.

  21. MOAA

    Active duty family members required to get vaccinated for travel can find their closest military hospital or clinic and inquire about getting the vaccines there. [MOAA MEMBER BENEFIT: Travel Safe With Emergency Assistance Plus] For those not on orders, the CDC website has a directory of clinics where you can get vaccines and travel medications ...

  22. Measles: CDC urges vaccination amid rise in cases in the US and ...

    The warning comes ahead of the busy spring and summer travel season. Many countries, including Austria, Philippines, Romania and the United Kingdom-destinations frequented by American tourists ...

  23. What to know about the measles vaccine

    There are warnings about travel abroad, calls for people to ensure their families are up-to-date on the measles vaccine, and fresh reminders that the virus is highly contagious and capable of ...

  24. Routine Vaccines

    The routine vaccines you need before travel may depend on your age, health, and vaccine history. You may need to get an accelerated dose of a vaccine or a booster dose before traveling. Routine vaccinations related to travel may include the following: COVID-19; Chickenpox (Varicella) Hepatitis A;

  25. Following Measles Outbreaks, Officials Grow Wary of Renewed Threat

    Before the first measles vaccine was introduced in the 1960s, the disease killed an estimated 2.6 million people worldwide each year. But its full impact may have been much greater. But its full ...

  26. Spring Measles Outbreak: Is It Safe to Travel to Florida?

    The vaccine is highly effective and safe, with just one dose providing 93% lifetime protection and two doses providing 97% protection. People considering Florida travel who are unvaccinated may ...

  27. Dengue fever epidemic in Puerto Rico. What to know about the disease

    A vaccine is available, ... CDC issues a travel warning following dengue outbreaks. Dengue is an ongoing risk in many parts of Central and South America, Mexico and the Caribbean, according to the ...

  28. Old immune systems revitalized in mouse study, may improve vaccine

    Planes, trains, boats, automobiles and even feet. During the past decades and centuries, global travel and human migration have made all of us more worldly—from our broadening awareness of the ...