Written by Pamela Prindle, R.N., BSN, CNOR
Co-Author Linda Yau, M.D., F.A.C.P.
June 15, 2016
As the days get longer and schools let out, the summer travel season is heating up. If you are traveling internationally, be sure to get all the appropriate shots to protect yourself from preventable infections. As a first step, everyone should be up to date on the routine vaccines. The following should be up to date if you are traveling:
Tetanus:
Tetanus/Diphtheria/Pertussis: also called Tdap, Adacel, or Boostrix. Most physicians should be writing for this vaccine for their adult patients. Pertussis outbreaks are now worldwide. Protection is 10years. For those families expecting a newborn, all should receive a booster.
Tetanus/Diphtheria: Td is also for adults who have already received a Tdap in the last 10years and are due for another vaccination. Protection is 10years.
Influenza:
The flu vaccine is offered yearly in the fall and is encouraged for all adults to receive one dose.
The type of flu vaccine delivery varies from nasal mist, IM injections, and intradermal injections. The flu mist can be used for adults up age 49, and there is a special vaccine for adults 65yo and up who may need additional protection based on their health status. Since it is finally past flu season, this does not apply so much as during the winter season.
Measles, Mumps, Rubella:
The MMR vaccine is usually given to those adults who were born in 1957-1970 whose immune status is unknown. All adults should have had 2 doses of each or have documented history of disease and/or a blood test to show protection. A single booster dose is all that is needed for adults. Measles outbreaks are on the rise and protection should be evaluated.
Polio
Polio vaccination is usually completed in childhood (3-4 does) and booster doses are needed to endemic areas only. The unvaccinated adult should receive 3 doses, 0, 30, 6mon.
Widespread of Hepatitis B vaccination started in the U.S. in 1991, so adults born before this did not routinely receive this shot through childhood. Hepatitis A vaccines became standard in 2006. Adults born before 1991 need to check their immunization cards to see if they received any of the Hepatitis vaccines as they are usually good for life. Hepatitis A can be contracted through contaminated food or water, so it is very important for travel to Africa, Asia, or South America.
Hepatitis A and Hepatitis B
Most adults are not offered Hepatitis A or B protection unless they are traveling to a risk area. This vaccine is available to all adults who desire protection or have medical conditions that put them at high risk of disease.
Havrix: Hepatitis A is available in a 2-dose series, 6months or more apart. Protection will last a lifetime. It is acquired through contaminated food or water and is generally recommended for travelers to risk areas.
HBV: Hepatitis B is available in a 3-dose series over 6-12 months. Protection is for lifetime.
Twinrix: This vaccine is a combination vaccine of Hepatitis A and Hepatitis B in a 3-dose series over 6-12months. This vaccine is the preferred for adults over 50 who are interested in Hepatitis B vaccination because it has been shown to have a high antibody response in older adults.
Special Travel Vaccinations
Yellow Fever
Yellow Fever vaccination is for international travelers who visit parts of Africa and South America where yellow fever still occurs. It is a live vaccination given to children as young as 9 months to adults. In the past the vaccination has been protective for 10years. Newer research has shown that the YF vaccine is protective for life. CDC and the WHO are in the process of removing the 10 year restriction for entry into YF countries to a lifetime declaration.
Typhoid
Typhoid vaccination is available as an IM injection or as an oral vaccine. Both are formulated for the strain salmonella typhi, a food and water bacterium. The injection protection is for 2 years and the oral is protective for 5 years. The oral dose however takes one week to complete 4 pills. It is given every other day and one must take it on an empty stomach or it is not absorbed properly.
Meningitis:
This is either Meningitis ACYW-135 or it is Meningitis B. These are two very different vaccines.
Menactra or MenACWY is what most adolescents or adults receive, before college or before traveling to an infected area, or for post splenectomy patients. Protection is for 5 years.
The Meningitis B vaccine is new and can be ordered as Bexsero or as Trumenba. The Bexsero is Norvartis and is 2 doses. The Trumenba is Pfizer and is 2 or 3 doses. Both are indicated for ages groups 10-25 years old. This is for young adults at increased risk of meningitis B. Many pediatricians are offering this to students going to college. The need for booster doses is still unclear.
Japanese Encephalitis
The Japanese Encephalitis vaccine is a series of 2 IM injections separated by 30 days. The brand available in the US is Ixiaro. It is recommended for long term visitors to South East Asia. A booster vaccination is recommended in one year if continued exposure exists.
Rabies
The Rabies vaccine is given to travelers as a pre-exposure series. The schedule is 0, 7, 28 days prior to a trip. It is usually recommended for the long stay traveler to remote parts of the world where health care is absent who may be exposed to animals, such as with a camping trip. The rabies vaccine is also used for post-exposure treatment from a suspected rabid animal. That series is 0, 3,7,14 days. A fifth dose is needed for those who are immunocomprised. Rabies Immune Globulin (RIG) is also given on day one of the treatment.
The CDC (Center For Disease Control) writes a terrific and comprehensive website for traveler’s health. You can type in your destination country, and all of the recommended vaccines as well as lists of health related items to bring will pop up on the screen. This is a trusted and reliable source of information for both vaccination and travel tips and warnings.
It is always a great idea to contact your doctor’s office if you will be taking a trip overseas. You will be ensuring your best chance for good health while enjoying new adventures and experiences. Enjoy the summer!
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