Malaria tablets are recommended for travel to Malaria-Endemic Areas.
Cholera Vaccine is often used to help prevent traveller’s diarrhoea.
The art of travel medicine is put risk into context. The Travel Doctor will help you to find a compromise between unwanted risk and over-doing it.
What’s the bottom-line for a 1-2 week holiday to a Country like Bali or Thailand?
Routinely recommended are Hepatitis A, Seasonal Flu Vaccine and/or Typhoid. Measles is recommended for those not already covered. Recommended for at-risk or longer trips are Rabies and/or Japanese Encephalitis. Hepatitis B depends on past vaccinations history and risk factors.
The Travel Vaccines
Hepatitis A Vaccine
When is Hepatitis A Vaccine Recommended?
Hepatitis A Virus is transmitted via contaminated food or drink. Hepatitis A Vaccine is recommended for travel to countries with medium to high prevalence of Hepatitis A which includes most developing countries.
How long does it take to work?
It’s best to get it done at least 1 month prior to departure when by which time almost 100% of people will be immune.
What is the Hepatitis A Vaccine Schedule?
Hepatitis A may either be given on its own or may be given as a combined vaccine with Typhoid or Hepatitis B.
The single Hepatitis A vaccine or the combined Hepatitis A / Typhoid Vaccine is given into the muscle..
A second Hep A vaccine 6 to 12 months later give long term cover.
How long does The Hepatitis A vaccine last?
After the two Hep A injections, the official Australian advice is that “the duration of immunity is not certain” but “probably persists for many years”. “There is no current evidence that booster doses are required; in healthy individuals it is quite possible that they will never be required” (Australian immunisation handbook updated 2014).
In other words, get the booster dose and you probably won’t ever need another Hep A Vaccine.
What are the pros and cons of Hepatitis A Vaccination?
The Hepatitis A vaccine is relatively cheap, very safe, and very effective. Hepatitis A is an unpleasant illness in most adults with a week or so of flu-type symptoms followed by Jaundice, loss of appetite and weakness that lasts a few weeks. Rarely the condition is fatal.
Side effects of the vaccine might be a local reaction at the injection site. Headache is reported, and fever is not common.
Hepatitis B Vaccine
What is Hepatitis B?
The virus is endemic in many developing countries around the world. For the Traveller, The main sources of exposure to Hepatitis B are sex and being exposed a contaminated needle.
When is the Hepatitis B Vaccine Recommended?
Hepatitis B Vaccination has been part of the routine Australian childhood immunisation programme in infants since around 2000. There was also a catchup program for older children from around 1997.
What this means is that most children and young adults have been vaccinated against Hepatitis B.
When doubt remains as to whether there has been previous Hepatitis B Vaccination then a blood test can be arranged.
The Hepatitis B vaccine is recommended for travel in medium to high-risk countries in people who have not been previously immunised against Hepatitis B and:
are staying in the country long term, or
are frequent short term travellers to countries at-risk, or
have Sexual Contact with locals, or
are engaged in other activities likely to increase risk of exposure to the Hep B Virus.
Let’s summarise this in a simple way. Young Australians will generally have previously been immunised against Hepatitis B. Otherwise, adults need to consider immunisation when they are travelling frequently, or for a longer time, to countries-at-risk.
What is the Hepatitis B Vaccine Schedule?
Hepatitis B vaccine in adults is ideally given in the following way:
First Vaccine, then
Second Vaccine after 28 days, then
Third & Final Vaccine after 6 months
Most people come to the travel clinic with much less time available than six months. The following schedule allows immunity within a few weeks – but requires an extra dose at 12 months. This “accelerated” schedule is as follows:
Second Vaccine after 7 days
Third Vaccine after 21 days
Fourth (Booster) Vaccine after 12 months
In Summary, most people coming to the travel clinic requiring Hepatitis B will need the accelerated 4 vaccine schedule which allows immunity to develop within a few weeks. However, the degree of immunity is not as great as the standard 3 vaccine schedule over 6 months.
A final option is to have the 3-vaccine schedule over 4 months rather than 6 months.
How long does a Hepatitis B vaccine last?
Following a full course of Hepatitis B Vaccine, the vaccine for travel purposes is regarded as life-long for healthy people.
What are the pros and cons of Hepatitis B Vaccination?
The Hepatitis B vaccine is relatively cheap, very safe, and very effective. It is part of the routine Australian childhood immunisation programme.
Hepatitis B is a common cause of chronic viral hepatitis with important long term health issues.
Chronic Hepatitis B infection accounts for around a quarter of Cirrhosis and liver cancer.
Side effects of the vaccine might be a local reaction at the injection site. Fever occurs in 2-3%. Other adverse effects reported infrequently are nausea, dizziness, tiredness, achy joints and achyy muscles.
When is Typhoid Vaccine recommended?
For travel to endemic regions where food hygiene & drinking water may be suboptimal
When visiting relatives overseas
There are over 100 cases of Typhoid each year in Australia.
What is the Typhoid Vaccine Schedule?
The Injectable Typhoid vaccine is given into the muscle as a one-off injection.
Typhoid Vaccine may may be combined with Hepatitis A as a single injection over the age of 16. This is a common scenario because Hepatitis A is found in countries where Typhoid is present.
Under the age of 16, the combined vaccine is not licensed and therefore requires separate Hepatitis A and Typhoid Vaccines.
There is also an Oral Typhoid Vaccine. 1 capsule is taken on each of day 1, day 3 and day 5. The tablet is swallowed whole with water 1 hr before food. It has been shown that a 4th tablet on day 7 increases is the immunity. However, the oral typhoid vaccine only comes in packets of 3.
How quickly does it take to work?
Is a booster needed?
Re-vaccinate every 3 years.
What are the side effects of The Typhoid Vaccine?
Side effects of The Typhoid Vaccine are unusual – it is one of the best tolerated vaccines. Local soreness, swelling or redness occurs in around 1 in 8 recipients of the vaccine. Short term Fever, nausea and/or malaise occur in around 1 in 30.
When is The Rabies Vaccine Recommended?
Consider Rabies vaccine for travel to a rabies-endemic region, particularly when travel is prolonged, or there are risks of coming into contact with animals.
What is The Rabies A Vaccine Schedule?
Three doses of Vaccines are given over 1 month. The second Vaccine is given 7 days after the first vaccine. The third vaccine is given 21 to 28 days after the first vaccine.The standard intramuscular injection is given in the upper outer arm.
How Long dose the Rabies Vaccine last?
The Rabies Vaccine lasts at least 10 years. On the whole, A booster injection is not generally indicated for normal travel. In other words, most people only ever get one course of rabies vaccination – unless the person is doing very high risk travel such as working with animals in a rabies endemic country.
What are the pros and cons of Rabies Vaccination?
Rabies Vaccination is very effective.
One course provides long term protection – boosters are not normally required.
Rabies is almost always fatal.
Even a light scratch from an animal or licking the mouth needs to be taken seriously with post exposure vaccination started without delay.
Greater degrees of exposure require the Rabies immunoglobulin injection that may well require an urgent journey back to Australia to obtain.
Side effects of the live vaccine: sore arm in 20%, headache 7%, nausea and/or malaise in 3-4%.
It is more expensive than other travel immunisations – though the long term protection should be taken into account
There’s another reason for needing the Yellow Fever Vaccine: To allow entry into certain countries. Immigration will check the traveller carries the certificate. Check out the World Health Organisation’s list of country requirements for Yellow Fever Certificate. This list will indicate separately whether vaccination is recommended, and whether vaccination is a requirement.
What is the Yellow Fever Vaccine Schedule?
Just a Single Dose of Vaccine (usually in the arm)
How effective is the Yellow Fever Vaccine?
Around 90% of adults are immune by day 14, and almost all by day 28.
How long does the Yellow Fever Vaccine last?
Immunity after vaccination is thought to be is life-long.
Some countries require a valid International Certificate of Vaccination against Yellow Fever. The yellow fever certificates used to expire every 10 years. However, from June 2016, the certificates are lifelong. So good news – no need for boosters!
What are the Pros and Cons of yellow fever vaccination?
There’s no choice for entry to those countries requiring mandatory vaccination.
Yellow fever may be fatal.
It is a very effective vaccine with around 99% of people protected perhaps life-long.
There has been an increase in reported outbreaks around the world in recent decades.
It’s a relatively expensive vaccine compared to the cheaper ones such as Hepatitis A.
Minor side effects include achy muscles, headaches and/or fever for 5-10 days. Around 1 in 100 vaccine recipients report that they need to reduce their activities due to side effects.
Serious Side effects: Thankfully very rare – but more common in those age over 60 years. There are two types of serious side effects. Around 25 cases of encephalitis have been reported (most before the 1950’s), and 27 case reports of multiple organ failure.
There are circumstances when the yellow fever vaccine should not be administered. When travelling through a country where yellow fever vaccinate is mandated, you would need a letter from your travel doctor. Examples of a “medical waiver” include:
Having a reduced immune status – for example, caused by leukaemia or AIDS.
Being on medication that reduces immunity – for example, corticosteroids, or some drugs used for Rheumatoid Arthritis or cancer.
Allergy to eggs.
Infants under 9 months of age.
Thymus disease or Thymectomy
Japanese Encephalitis Vaccine
When is The Japanese Encephalitis Vaccine Recommended?
Japanese Encephalitis is present in PNG & many parts of Asia including The Indian Subcontinent, South East Asia and China.
In the more northern part of Asia, the disease occurs during the summer or wet season: That’s between April and October.
In the tropical parts of Asia, the disease can occur throughout the year but is more common during the wet season.
Australian guidelines suggest Japanese Encephalitis Vaccination:
For travel 1 month or more in rural areas of high risk countries.
Consider for travel under 1 month in high risk areas particularly in the wet season or where there is considerable outdoor activity (eg. camping without mosquito-proofing).
What is the Japanese Encephalitis Vaccine Schedule?
There are two vaccines available in Australia:
The inactive vaccine is given as two doses given 1 month apart. It takes around 5 weeks to kick-in. A booster is required after 1-2 years.
The live vaccine is given as a one-off dose and kicks-in at around 2 weeks. Adults may consider a booster after 5 years.
The Live Vaccine is a one-off, works quicker, and lasts longer than the inactive vaccine.
Not everyone can have a live vaccine – for example, being on immunosuppressant medication and so on.
How long does Japanese Encephalitis Vaccine last for?
When the live vaccine is used, immunity is usually long term. A booster is therefore not routinely recommended. However, a booster may be recommended for particularly high risk activities, especially if many years have passed since the original vaccination.
When the inactive vaccine is used, a booster is usually recommended 1-2 years afterwards for long term protection.
What are the Pros & Cons of Japanese Encephalitis Vaccination?
Most cases of exposure lead to no symptoms at all. However, Japanese Encephalitis itself is a severe disease with a high death rate. In those who survive, around half have long term neurological effects.
The vaccine is effective (around 95% of recipients produce protective antibodies).
Protection is long term.
It is a relatively expensive vaccine.
Side Effects: Local reactions are common. Other reactions include headache, achey muscles, & malaise – these symptoms usually resolve within 3 days.
When is The Cholera Vaccine Recommended?
There are approximately 5 notified cases of cholera per year from travellers who return to Australia. The vaccine is around 80% effective at preventing cholera.
The National Australian guideline recommend cholera vaccine “in those at increased risk of severe or complicated diarrhoeal disease, such as those with poorly controlled or otherwise complicated diabetes, inflammatory bowel disease, HIV/AIDS or other conditions resulting in immunocompromise, or significant cardiovascular disease.”
Can The cholera vaccine prevent traveller’s diarrhoea?
There’s quite good evidence that cholera vaccine may help prevent a type of traveller’s diarrhoea caused by “heat-labile forms of ETEC.” ETEC stands for Enterotoxigenic Escherichia coli and is a common cause of traveller’s diarrhoea. This indication is outside of the product license but is the main reason why cholera vaccination is given in Australia.
What is the Cholera Vaccine Schedule?
Cholera Vaccine is an oral vaccine (®Dukoral). Two doses are given between 1 and 6 weeks apart (one week is fine). The second dose should be taken at least 2 weeks before departure.
Follow the manufacturer’s instructions. To make up the vaccine for adults and children over 6 years of age, the granules are dissolved in 150mls of water after which the content of the vial is added. You then swallow the made-up vaccine at least 1 hour before or 1 hour after food and drink.
For children age 2 to 6 years, the granules are dissolved in 150mls of water and then 75mls is discarded. The full contents of the vial are added to the remaining 75mls.
How long does The Cholera Vaccine last for?
Vaccination should be repeated if more than 2 years has elapsed since the previous course.
Travel Vaccination FAQs
How Soon before Travel should I attend
There are two issues around the timing of your travel vaccinations:
Some Vaccinations are given as a course of vaccines over 21 to 28 days.
Most single Vaccines start to work at 2 weeks.
Let’s say you come to the clinic one week before your departure. You can still get the single vaccines against Hepatitis A, Typhoid, Japanese Encephalitis or Yellow Fever. However, you won’t be actually “covered” against these conditions until around the second week of your travel.
Coming 2 weeks before allows the above single vaccine to start working. However, Rabies and Hepatitis B require multiple vaccines over a minimum of 21 days.
Therefore, coming at least 1 month before departure is ideal. Two weeks is OK for the simple stuff. Hepatitis B is ideally given over 6 months.
I don‘t know which Vaccines I’ve had before!
This can be considered a normal but unsatisfactory situation!
These are your options:
Try to get hold of your previous vaccination record – or at least for the most recent trip.
Assume that you’re not covered – generally speaking there is no increased risk for having additional vaccines.
Get a blood test to see if you’re immune – this is an option for Hepatitis B or Measles, but not Hepatitis A or Typhoid.
In practice, the travel doctor will ask relevant questions to establish your likely vaccination history. For example, a previous course of 3 vaccines over 1 month will likely have been Rabies or Hepatitis B. The Doctor may also contact the national immunisation register and/or arrange a blood test. The clinic may also offer to contact the practice where you had the previous immunisations.
What age can kids be vaccinated?
Note that different brands of vaccine are licensed at different minimum ages. The following minimum ages are derived from the vaccines with the lowest minimum age:
Hepatitis A: From 12 months
Typhoid: From 2 Years
Rabies: From 12 months
Japanese Encephalitis: From 2 months for the two-dose vaccine (9 months for the one-dose vaccine)
Yellow Fever: From 9 months
Malaria Prevention in kids is important and all kids should take preventative measures. Antimalarial medication in kids is a specialist area of travel medicine.
Which Vaccines are safe in pregnancy?
There is no simple answer to this question and you will need detailed advice from the travel doctor.
Hepatitis A: Consider for Higher-risk travel, or travel to areas of medium to high risk, but not routinely recommended.
Typhoid: Consider for Higher-risk travel, but not routinely recommended.
Rabies: Consider for higher-risk travel.
Japanese Encephalitis: Consider the inactivated vaccine (JEspect) for higher-risk travel, but not routinely recommended.
Yellow Fever: Not Recommended. However, may vaccinate if travel to an at-risk country is unavoidable.