Travel vaccinations

If you are planning an overseas trip, you should always check whether there are any diseases you should be immunised against before you depart. Travel vaccinations can protect you against a number of infectious diseases, and are recommended before travelling to certain countries where there is a high risk for that disease.

Talk to your doctor or a travel medicine specialist well in advance of your trip so you know what vaccinations are needed and when they should be administered. It’s important to make sure you have enough time to complete the vaccination course or have any booster doses required. Depending on the vaccine, a full course could take several months.

Where can you get travel vaccinations?

It’s best to have your vaccines before you leave Australia so that you are protected before setting off and you can be assured of safe needle and sterilisation techniques. (If you do need a vaccination overseas, make sure that it is administered with a single-use sterile needle under hygienic conditions, if possible.)

Your general practitioner (GP) can give many of the vaccines, or you may want to see a travel health specialist or visit a travel medicine clinic.

Be sure to make an appointment well in advance of your trip so you know what vaccinations are needed and when they should be given. Some vaccinations require more than one dose and are given at set intervals, so you should seek advice early so you have time to fit them in before you go. Generally it takes at least 2 weeks following a vaccination for your body to produce enough antibodies to protect you against the disease. So for the first week or so after having a new vaccination you will have no protection at all.

Do I need to pay for travel vaccinations?

Some vaccinations are available for free as part of the National Immunisation Program Schedule. Influenza vaccination is free of charge for people who are at increased risk of complications from influenza.

You will usually have to pay for other travel vaccinations - the cost varies depending on the vaccine. If you require several vaccinations, you may be looking at a cost of several hundred dollars. Your doctor should discuss the cost of each vaccination before you are immunised.

Some private health funds give some money back for travel vaccines, depending on your level of cover. If you are charged for seeing the doctor, you should be able to claim at least part of the cost of the consultation through Medicare if you are an Australian resident.

Which vaccines should I have?

The vaccines that are recommended will depend on several factors, including where you are travelling, whether you will be spending a lot of time outdoors and your age.

Some countries require proof of vaccination against certain diseases before they will allow you entry. These requirements can change according to the status of outbreaks. You can check the smarttraveller.gov.au website for vaccination advice for your destination. The World Health Organization also provides a country by country list of vaccination requirements, including certificate requirements, on its website.

I’m just staying at a hotel - do I need vaccinations?

If you are not spending much time outdoors in rural or remote areas and are staying in an air-conditioned hotel or accommodation with mosquito nets and insect screens, your risk of some infections is reduced. However, even if you are going to a major tourist destination, you should still be vaccinated against illnesses that are known to be prevalent at your destination. Hepatitis A and typhoid vaccination is recommended when travelling to any country where bottled water is recommended over tap water for drinking.

What about visiting relatives overseas?

People visiting friends or relatives overseas, particularly immigrants to Australia who are visiting their country of origin, often mistakenly believe that they do not need to be vaccinated or take any precautions. But in fact these people are at still at risk, and because they are often visiting non-tourist areas their risk may be even higher than that of other travellers.

How many vaccinations can you have at once?

It is possible to have some vaccines together - in fact there are some combination vaccines available, such as typhoid plus hepatitis A. However, some vaccines should not be given together. It’s best to consult your GP or a travel vaccination clinic well before your trip so that there is plenty of time to complete any recommended vaccination courses without overlap if necessary. Often, several appointments for vaccinations at various intervals will be needed.

Will I need to be re-vaccinated the next time I travel?

Vaccinations against some infections give long-lasting protection, while others do not. You may need to be re-vaccinated or have a booster dose after several years to have ongoing protection for subsequent trips.

Is vaccination safe?

While there are side effects that can occur following some vaccinations, most are mild and short-lived. See below for the most common side effects associated with travel vaccinations. Doctors usually recommend that you stay at the clinic for about 10 minutes after being vaccinated in case you have an allergic reaction to the vaccine.

Also, some vaccinations are not recommended for certain groups of people, such as pregnant or breast feeding women, children, people with a history of severe allergic reactions to vaccines or eggs, or people with problems with their immune system. Your doctor can advise you on whether it is safe for you to be vaccinated.

Common vaccinations required by travellers

Travellers should be up-to-date with the standard vaccines recommended for all Australians. Before you travel overseas, you should make sure that you have been completely vaccinated against measles, rubella, mumps, tetanus, diphtheria, whooping cough and polio. This means you may need some vaccinations against these illnesses, as well as vaccinations recommended or specifically required for international travel to certain countries, such as yellow fever, meningococcal disease or Japanese encephalitis.

It’s also important to mention whether you’ll be attending a mass gathering while overseas. Any event that involves a large number of people, such as a social, sporting, cultural or religious event, can increase your risk of catching certain infections.

Vaccinations that are often needed or should be considered before international travel include the following.

Tetanus, diphtheria and whooping cough

Make sure to check if you are due for a tetanus booster before travelling. Depending on whether you’ve recently had a booster, your doctor may recommend vaccination. This may be with a combination vaccine to protect you against whooping cough, diphtheria and sometimes polio as well.

Combination vaccines may include tetanus, diphtheria and pertussis (whooping cough) (e.g. Adacel, Boostrix) or tetanus, diphtheria, pertussis and also polio (Adacel Polio, Boostrix IPV).

Children

Diphtheria, tetanus and pertussis vaccinations are routine childhood vaccinations Australia. They are available for free as part of the National Immunisation Program Schedule and given at 2,4 and 6 months, and again at 18 months and 4 years. Booster doses are given between the ages of 10 and 15 years. So, some children may have adequate coverage already.

Adults

Tetanus, diphtheria and pertussis (whooping cough) boosters should be given at age 50 years regardless of travel and again at 65 years, unless a booster has been given in the previous 10 years.

You should have a tetanus booster (with either a tetanus plus diphtheria vaccine or tetanus, diphtheria plus whooping cough vaccine) before travelling if you haven’t had one in the last 10 years. People who will be in high risk areas or situations, such as those going on jungle expeditions, working with animals, or undertaking active or outdoor travel may need a booster dose after just 5 years.

Mild pain or tenderness at the area where you had a tetanus/diphtheria/pertussis injection is common. Uncommon side effects of tetanus plus diphtheria vaccination include tiredness, headache, muscle pains and fever. Allergic reactions are rare.

Poliomyelitis

Poliomyelitis (polio) is now rare, and most countries have been declared free of polio. Polio in young children is often mild, but in older children it can cause paralysis which most often affects the legs, but can also paralyse the muscles needed for breathing or swallowing.

Polio vaccine is a routine childhood immunisation, given as 3 doses at 2, 4 and 6 months of age, then a booster at 4 years. Any person who has never been vaccinated against polio should be vaccinated regardless of travel plans.

Booster doses are recommended for those who have been vaccinated in the past if they are travelling to areas or countries where poliomyelitis still occurs (including Afghanistan, Nigeria and Pakistan). For those exposed to a continuing risk of infection, booster doses are recommended every 10 years. If you only require a booster it may be given as part of a combined booster for tetanus, diphtheria, pertussis and polio (e.g. brand names Adacel Polio, Boostrix IPV).

Documented evidence of polio vaccination (an International Certificate of Vaccination or Prophylaxis - ICVP) is not routinely needed, but this may change so check with your travel medicine specialist before travelling.

Side effects from polio vaccine can include pain and redness at the injection site and fever.

Measles, mumps, rubella and chickenpox

Measles is caused by a virus and is spread by droplets when an infected person breathes, coughs or sneezes and is highly infectious. Most outbreaks of measles in Australia are caused by inadequately immunised young travellers bringing it into the country.

In Australia, routine childhood immunisation against measles, mumps and rubella is usually given as a triple vaccine called MMR (measles, mumps, rubella) at 12 months. An additional dose called MMRV that also includes varicella (chickenpox vaccine) is given at 18 months.

Vaccination against measles, mumps and rubella is recommended before travelling overseas for people born during or since 1966 who have not had 2 doses of MMR previously. Two doses of measles-containing vaccine should be given at least 4 weeks apart.

Varicella (chickenpox) vaccine is also usually offered to unvaccinated travellers who have not had chickenpox. Combination MMRV vaccines are not recommended for people 14 years and older.

Side effects are more common after the first dose of MMR. The most common side effects include fever, tiredness and rash.

Pain, redness and swelling where you had your injection are the most common side effects from varicella vaccine. Rash or fever can also occur.

Hepatitis A

Hepatitis A is a liver disease caused by the hepatitis A virus. It is extremely contagious and can be caught by eating contaminated food. Hepatitis A vaccination is generally recommended before travelling to all developing countries.

A single dose of hepatitis A vaccine (e.g. Avaxim, Havrix, VAQTA) is usually given as primary vaccination and then a booster dose can be given 6-18 months after the first vaccination to prolong its effect. Ideally, the vaccination should be given 4 weeks before travel.

Combination vaccines

A combined hepatitis A and hepatitis B vaccine (called Twinrix) is available in Australia. For adults, it is given as a course of 3 doses of vaccine: one vaccination is given immediately, the second is given one month later, and the third is given 5 months after that. (This is sometimes described as being given at zero, one and 6 months.) There is also an accelerated schedule of injections for adults needing fast protection due to limited time before departure. This comprises 3 doses given on days 0, 7 and 21 with a booster given at 12 months.

There is also a combined hepatitis A and typhoid vaccine (called Vivaxim). Long-term protection requires a booster dose of hepatitis A vaccine 6 to 36 months later.

Side effects may include tenderness at the site of the injection. Some people have also reported tiredness, fever or headaches.

Hepatitis B

Hepatitis B is caused by the hepatitis B virus and is one of the most serious forms of viral hepatitis. It can lead to chronic liver disease, cirrhosis or liver cancer. Hepatitis B can be spread by exposure to blood or sexual contact with an infected person.

Most Australians born since 2000 have been vaccinated against hepatitis B as part of their routine childhood vaccinations. If you have not been vaccinated or are not immune to hepatitis B, vaccination before travelling may be recommended if you are travelling to certain areas, including Central and South America, Africa or Asia. Vaccination is usually recommended if you are staying long term in one of these areas, or have frequent visits. It’s also recommended if you are likely to participate in activities that put you at increased risk.

You will need to discuss with your doctor your risks and when you should start the immunisation programme.

  • The standard schedule for hepatitis B vaccination (e.g. Engerix-B, H-B-Vax II) involves a series of 3 injections over 6 months.
  • A 2-dose schedule of hepatitis B vaccine (e.g. Engerix-B, H-B-Vax II) is also available for adolescents aged 11 to 15 years. This takes 4-6 months to complete.

Accelerated schedules can be given if there is a limited time before you set off. This comprises 3 doses given over 2 months, with a booster given at 12 months. In exceptional circumstances, 3 doses can be given over 3 weeks, with a booster at 12 months. A rapid schedule for a combined hepatitis A and B vaccine called Twinrix (3 doses given over 3 weeks and a 4th dose at 12 months) is also available.

Possible side effects related to the hepatitis B vaccine include pain where you had the injection, fever, tiredness, aches and pain and nausea. Allergic reactions are rare.

Typhoid

Typhoid is an infection caused by a bacterium called Salmonella typhi and is usually caused when contaminated food, milk or water is eaten or drunk. Symptoms of typhoid may include fever, headache, muscle aches, tiredness, reduce appetite and cough. It can also lead to abdominal pain, constipation or diarrhoea, and complications such as bleeding from the gastrointestinal tract. Symptoms of the condition do not usually appear for 7-14 days.

Typhoid is still a problem in many countries so you should discuss with your doctor the areas you will be travelling through and if this vaccination is required. Typhoid vaccination is usually recommended for travellers older than 2 years to countries with high levels of the disease in the population (including the Indian subcontinent and countries in Southeast Asia and the South Pacific). The risk of typhoid fever seems to be higher among travelers who are visiting friends and relatives in at-risk areas.

There is an oral typhoid vaccine (Vivotif) and also vaccines given by injection (Typherix, Typhim Vi), including a combined hepatitis A and typhoid vaccine (Vivaxim). Your doctor or travel health consultant will advise which is the right one for you.

The oral vaccine requires 3 doses taken over a week (sometimes 4 are given); the injected vaccine is a single dose vaccine. You will need to start the doses before you leave and, if you require other vaccinations, these will need to be timed to make sure there are no adverse reactions.

Side effects are rare with typhoid vaccines. If side effects do happen, they are usually mild and may include pain at the injection site (for the injected vaccine), fever and nausea.

Influenza

Influenza - the flu - is a common viral infection that can be spread from person to person very easily, and can be passed on very quickly in crowded areas or areas of close contact (such as on your plane flight). As such, this is an important vaccination for all travellers, especially if they will be travelling to an area during influenza season. Flu vaccination is recommended for children and adults wanting to avoid getting sick with influenza.

People over the age of 65 and those with underlying health problems are especially at risk, as are those travelling in large tourist groups or on cruises.

Fever, tiredness and muscle aches are common side effects of flu vaccination. Tenderness, pain, swelling and redness at the site where you had the injection is also common. Influenza-like symptoms can occur after vaccination (but this does not mean you have flu, as vaccines do not contain live virus and so cannot cause flu). Allergic reactions are rare.

Meningococcal disease

Meningococcal disease is caused by the bacterium Neisseria meningitidis, more commonly known as meningococcus. Meningococcal infections usually cause meningitis (inflammation of the meninges — the lining of the brain and spinal cord), septicaemia (blood poisoning), or a combination of both.

Neisseria meningitidis can live in the external environment and, surprisingly, in the nasal passages, throat and windpipe of a proportion of the population without causing any problems. The meningococcus bacterium is transmitted through respiratory droplets when an infected person coughs or sneezes. Meningococcal disease is one of the most serious bacterial diseases and can cause death or may result in serious long-term health problems. Fortunately, there is normally a very low risk of contracting meningococcal disease except if you are travelling in areas where epidemics are currently occurring.

Outbreaks and epidemics of meningococcal disease are commonly seen in the dry season in sub-Saharan Africa, particularly in areas extending from Senegal to Ethiopia, which has been referred to as the ‘meningitis belt’.

You should check with your doctor or a travel health centre for information about major epidemic sites. If you are travelling in identified high-risk areas, especially in the dry season, you should have a suitable meningococcal vaccine for protection.

Meningococcal vaccination is currently not required for entry into most countries. However, proof of recent vaccination is required by Saudi Arabia for pilgrims travelling to Mecca for the annual Hajj or for the Umrah.

Strains of meningococcus

Of the 13 different strains (or serogroups) of meningococcus, the ones that commonly cause disease globally include strains A, B, C, W135 and Y.

Meningococcal vaccinations recommended for travellers

Travellers should be aware that there is no single meningococcal vaccine that protects against all strains of meningococcal disease. However, quadrivalent meningococcal vaccine (e.g. Menactra, Menveo, Mencevax, Nimenrix) offers protection against 4 strains of meningococci — A, C, W135 and Y, and is recommended if you are travelling to current meningococcal epidemic areas or staying in regions that have been known to be at risk of epidemics. Proof of immunisation with quadrivalent vaccine is required by Saudi Arabia for pilgrims visiting Mecca for the Hajj or Umrah.

Note that the meningococcal vaccine currently given as part of the Australian National Immunisation Program only protects against meningococcal C and is not suitable for travel to meningococcal risk areas. There is also a vaccine against meningococcal type B (Bexsero) which is currently available on private prescription only, but again this only protects against one strain and is not suitable protection for travel to meningococcal epidemic areas.

The recommended quadrivalent vaccination for adult travellers is a single dose and immunity generally lasts for 3 to 5 years. Booster doses may be needed after 5 years for further travel to at-risk areas. The number of doses needed for child travellers varies according to their age and the vaccine brand given - check with your doctor or travel clinic about doses in children.

Possible side effects associated with quadrivalent meningococcal vaccination include mild redness and soreness at the injection site and mild fever.

Rabies

Rabies virus is a Lyssavirus and is closely related to the Australian bat lyssavirus. Rabies is a serious viral infection that is almost always fatal. It is usually transmitted by the bite, scratch or saliva of an infected animal, such as a dog, cat, bat, fox, raccoon, skunk or monkey. It is seen in Africa, Asia, the Americas and Europe. Rabies is present in many popular holiday destinations for Australians, such as Indonesia (including Bali) and Thailand.

All travellers to affected areas are generally advised to avoid close contact with animals and to know how to give first aid if they are bitten by an animal. Avoid feeding or patting animals, even where tourists are encouraged to do so.

Vaccinations for rabies and lyssavirus infection can be given before travelling (called pre-exposure prophylaxis) or after a bite from an animal to prevent infection (called post-exposure prophylaxis). Post-exposure prophylaxis involves a combination of rabies vaccination (e.g. Merieux Inactivated Rabies Vaccine or Rabipur) and immunoglobulin (Imogam) given as soon as possible after the bite or scratch. Be aware that post-exposure prophylaxis may not be easily available at some destinations.

Vaccination before travelling may be advisable for some people, especially those who are likely to be interacting with animals, and consists of 3 injections. Vaccination after a bite or exposure to a rabid animal consists of 2-5 injections given at set intervals starting as soon as possible after exposure, and again may not be available at the destination. Every year there are cases of travellers returning to Australia requiring post-exposure prophylaxis.

Possible side effects relating to rabies vaccination include pain at the injection site, headaches, tiredness and nausea. Severe allergic reactions are rare, but mild to moderate reactions can occur after a booster dose of rabies vaccine. Allergic reactions may cause generalised itching, swelling, fever, tiredness, nausea, vomiting and joint pain.

Japanese encephalitis

Japanese encephalitis is a viral infection that results from the bite of an infected mosquito and is commonly seen in areas of Asia including India and Bali in Indonesia. Japanese encephalitis vaccination (e.g. Imogev, JEspect) may be recommended if you are travelling to Asia in the wet season, for a month or more or making repeated visits. Vaccination may also be recommended if you intend to visit rural areas, spend a lot of time outdoors or travel to places that do not have mosquito nets, insect screens or air-conditioning.

Vaccination involves one dose or 2 doses 28 days apart, depending on your age and the brand of vaccine given. In some cases, a booster is needed after 1-2 years.

Common side effects include injection site pain and swelling, headache, fever, muscle aches, fatigue and tiredness.

Yellow fever

Yellow fever can occur after being bitten by a mosquito infected with the yellow fever virus. The name comes from some of the symptoms - fever and jaundice (yellowing of the skin and eyes). Yellow fever can be life-threatening.

Yellow fever vaccination is recommended for travellers older than 9 months of age who will be travelling to an area with a risk of yellow fever virus transmission, e.g. some areas of Africa and South America.

Vaccination can only be carried out by approved Yellow Fever Vaccination Centres. Many GP surgeries are approved yellow fever vaccination providers. Details of centres can be obtained from your state or territory health department and are widely available on the internet. The vaccine (Stamaril) is very effective and usually offers protection for decades after a single dose. Some people may need a booster after 10 years if they are still at risk of infection. Babies younger than 9 months and those with allergy to eggs that causes anaphylaxis cannot be vaccinated.

An International Certificate of Vaccination or Prophylaxis (ICVP) against yellow fever is needed to travel to many countries if you are arriving there from a country with a risk of yellow fever transmission. If you cannot be vaccinated, you will need a letter of exemption to be allowed entry to these countries.

Most people who experience side effects have only mild symptoms, including mild fever, headache and muscle pains. Rarely, significant side effects are associated with the yellow fever vaccine. The risk of side effects is higher in older people and include disorders of the nervous system and multi-organ system failure, which are similar to yellow fever itself.

Cholera

Cholera is a type of gastroenteritis that is commonly contracted through eating or drinking contaminated food or water. Cholera occurs regularly in Africa, Asia, South America and Central America, and epidemics can occur after natural disasters. Cholera produces profuse watery diarrhoea of sudden onset that leads to dehydration. Severe dehydration can lead to death.

There is an oral cholera vaccine (Dukoral) available in Australia, but it is not given routinely. Its effect is relatively short lasting and for most people the risk of catching cholera is low. Vaccination is needed only if you will be in high-risk situations in high-risk areas. Discuss this with your doctor or travel medicine professional.

The Dukoral vaccine is given as a drink, in 2 doses at least one week apart for adults and children older than 6 years. Younger children require 3 doses. For those who continue to travel to high risk areas, booster doses should be given at 6 months for children aged 6 years and younger; and 2 years for adults and children older than 6 years.

Side effects are uncommon. Some people have mild abdominal (tummy) pain and diarrhoea after taking the cholera vaccine.

Tuberculosis

Tuberculosis is a bacterial infection, and most cases in Australia occur in people who were born in Asia, southern and eastern Europe, the Pacific Islands and north and sub-Saharan Africa.

Tuberculosis usually only occurs in healthy people after long term contact with an infected person. Vaccination against tuberculosis (TB) may be recommended for some young children travelling to overseas countries for an extended period where there is an increased risk of infection, but is not normally recommended for healthy adults. Vaccination may be recommended based on your child’s age and where are how long they will be travelling for. If vaccination is needed, it is best given at least 3 months before departure. Vaccination is available from state and territory tuberculosis services. The vaccine used for tuberculosis immunisation is called BCG vaccine and is in short supply worldwide. The current version used in Australia (BCG 10) is not registered by the Therapeutic Goods Association (TGA).

A local skin reaction is expected at the injection site following tuberculosis vaccination. Swelling and tenderness of the local lymph nodes may also occur, and in rare cases an abscess may form at the injection site.

References

1. Australian Government Department of Health. The Australian Immunisation Handbook 10th edition. 3.2 Vaccination for international travel (updated 1 August 2017). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part3~handbook10-3-2 (accessed Nov 2017).
2. Australian Government Department of Health. The Australian Immunisation Handbook 10th edition. Part 4 Vaccine-preventable diseases (updated 1 August 2017). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home~handbook10part4 (accessed Dec 2017).
3. Immunise Australia Program. National Immunisation Program Schedule (from November 2016). http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule (accessed Dec 2017).
2. World Health Organization. International travel and health. Traveller vaccinations. http://www.who.int/ith/updates/20110427/en/ (accessed Dec 2017).
3. Australian Government. Department of Foreign Affairs and Trade. Smartraveller.gov.au. Health checks and vaccinations. http://smartraveller.gov.au/guide/all-travellers/health/Pages/health-checks-and-vaccinations.aspx (accessed Dec 2017).
myDr