Vaccinations - travel

About travel vaccinations

Depending on where you go, you may need to have vaccinations before you travel. It’s best to see your GP about six to eight weeks before you go. If there are less than six to eight weeks before you plan to travel, still go to your GP or travel clinic as it may be possible to get vaccinated.

If you need to have a course of vaccinations, this can be at different times over a number of weeks. The time between injections will allow your body to respond to the vaccine, so you develop immunity ready for when you arrive. Generally you will have vaccine injections in your upper arm or on the outside of your upper thigh.

You’re unlikely to need any vaccinations if you’re going to the United States, Western Europe, and most parts of Australia or New Zealand. But it’s important to make sure that your booster immunisations for tetanus, diphtheria and polio are up-to-date.

You will need to pay for most travel vaccinations – only some are available for free on the NHS.

Cholera

Cholera is an infection of the small bowel caused by the bacterium Vibrio cholerae. It’s usually spread through water contaminated with infected faeces. Cholera is mainly found in places of poor hygiene and sanitation, such as Africa, Asia, the Middle East, Peru and some parts of Central America.

If you’re travelling to an area that has a cholera epidemic (a widespread occurrence of an infectious disease in a community at a particular time), you may need to have a cholera vaccine. The Department of Health advises that people who are relief or disaster aid workers, or who are in places where there is limited access to medical care, should also have the vaccine.

The cholera vaccine is given orally (you take it by mouth), and comes in sachets that you dissolve in water. Don’t eat or drink anything one hour before or after you take the vaccine. You will need to have two doses between one and six weeks apart. Make sure you have the second dose at least a week before you travel.

The cholera vaccine doesn't give you lifelong immunity and you will need to have a booster to keep you protected. Adults and children over six need the booster two years after the initial dose and children aged two to six need it six months after.

Hepatitis A

Hepatitis A is a liver disease caused by an infection with the hepatitis A virus. People usually become infected by eating contaminated food or drinking contaminated water.

If you’re travelling to an area with a high risk of hepatitis A infection, such as Africa, the Middle and Far East and southern and eastern Europe, it’s advisable to have a course of vaccines.

You will need to have two hepatitis A injections – the second is a booster dose that is usually given six to 12 months after the first. It’s best to have the first injection about two weeks before you travel, but it’s possible to have it the day before you leave. The vaccine (including the booster) can give you up to 20 years of protection.

You can have a combined vaccine, which protects against hepatitis A and B, or one which jointly protects against hepatitis A and typhoid. However, you will need to have separate boosters for each disease for more long-term protection.

Hepatitis B

Hepatitis B is a liver disease caused by infection with the hepatitis B virus. You can get it by having contact with an infected person’s blood or other body fluids, for example semen or vaginal fluid.

The disease occurs worldwide but is more common in South Asia, Africa, the Middle East, the Far East and southern and eastern Europe.

You’re more at risk of getting hepatitis B if you have unsafe sex, use contaminated needles and syringes to inject drugs, are doing relief work or are participating in contact sports in an area with hepatitis B. Also, If you’re planning to stay for a long time, are visiting friends or relatives with chronic hepatitis B infection, or are adopting a child from a country with widespread hepatitis B, you should consider having the vaccine.

There are different immunisation schedules, but generally you have three doses. After the first dose, you will need the second a month later and the third five months after the second dose. If you need to be vaccinated quickly, you can ask for a rapid schedule and have a full course over two months or even three weeks.

Japanese encephalitis

Japanese encephalitis is a viral infection that is passed on through mosquito bites. It’s common in areas such as South-East Asia, India, the Far East or tropical North-East Australia.

You may need a vaccine if you’re travelling to an endemic area (a place where a particular disease is regularly found) for a month or longer, especially if you’re going to rural areas. Ideally, you should get vaccinated a month before you travel.

There are two vaccines, but only one (Ixiaro) is licensed in the UK. For this you need to have two doses 28 days apart. The vaccine is not licensed for children under the age of 18. You will need to have a booster about 12 to 18 months after the initial vaccination if you’re still at risk of the disease.

Meningococcal meningitis

Meningococcal meningitis is an infection that affects the thin lining that surrounds the brain and spinal cord. It’s caused by the bacterium Neisseria meningitidis and is common in parts of Africa and Saudi Arabia.

If you're staying in a country with a high risk of meningitis for a month or more, or you're backpacking or living in a rural area, you will need to have a combined vaccine against the A, C, W and Y strains of meningitis. Saudi Arabia requires proof of this before you can enter the country.

You should have the combined vaccine two weeks before you travel. Adults need just a single dose. Children (over one) will need to have the vaccine two months before travel and will need to have two doses, one month apart.

The timing of a booster vaccine will depend on the specific type of vaccine you have. If you have the ACWY Vax for example, you (and children over five) will need a booster every five years if you’re at continued risk. Children under five need a booster every two to three years.

Rabies

Rabies is a viral infection that can be spread from animals to people. People usually catch it after being bitten by an infected animal, often a dog. Rabies is common in developing countries, and especially in Africa, Asia and South America.

You may need a rabies vaccine if you’re travelling for a month or more to an area where the risk of rabies is high and medical care isn't easily accessible. Or, if you’re travelling for less than a month but may be exposed to rabies due to your activities – for example working with animals that may be infected.

If you need the rabies vaccine, you will be given three injections. You will have the second a week after the first, and the third after a further three weeks (or after a further two weeks if there isn't enough time before you travel). After this, you will need a reinforcing dose a year later and a top-up every two to five years, depending on your risk of getting rabies.

Having the rabies vaccine doesn't mean you're immune to the disease. However, if you get bitten, it may give you more time to seek medical treatment before the symptoms develop.

Tetanus, diphtheria and polio

In the UK, you will usually have had the tetanus/diphtheria/polio vaccines (Td/IPV) during childhood – unless you were born before 1958 when the vaccine programmes were introduced.

Tetanus is common in Asia, Africa, and South America in agricultural regions and in areas where contact with animal waste is more likely.

If you're travelling to a country with tetanus, diphtheria or polio, you will need a booster if you haven't had one for 10 or more years, or if you haven't been immunised before. Adults and children aged 10 or over who haven’t been vaccinated will need to have three doses one month apart, and two boosters. The first booster is given five to 10 years after the initial dose and the second 10 years after.

Tick-borne encephalitis

Tick-borne encephalitis is a viral infection that is passed on through tick bites. There are different types of the disease, which are linked to the area they are found in – Europe, the Far East and Siberia. It’s mainly found in forested locations.

The vaccine is given in three doses. After the first dose you have the second between one and three months later, then the third dose five to 12 months after the second. If you need more immediate protection, you can have two doses, two weeks apart.

Typhoid

Typhoid is caused by the Salmonella enterica serovar typhi bacterium. Paratyphoid fever is a similar illness caused by strains of Salmonella paratyphi. You can get typhoid by eating contaminated food or drinking contaminated water. Typhoid outbreaks are common in Asia, Africa and Latin America.

Getting vaccinated against typhoid is important if you're planning to stay in areas where sanitation and food hygiene are poor. There are two licensed vaccines in the UK – the typhoid Vi polysaccharide injection, and an oral typhoid vaccine. Both give some, but not complete, protection against typhoid. You may be able to have a combined typhoid and hepatitis A vaccine, if available – check with your GP or travel clinic. After you’ve had the vaccine you won't need another one for three years.

Yellow fever

Yellow fever is a disease caused by a virus and is passed on by mosquito bites. It mainly occurs in tropical areas of Africa and South America.

You will need to have the yellow fever vaccine if you're going to or travelling through a country affected by the disease. Some countries require you and any children travelling with you to show certificates to prove you have been vaccinated before you can enter. If you have a child of less than nine months travelling with you, ask a health professional for advice.

You will need to have the yellow fever vaccine at least 10 days before you travel. A certificate will be issued that lasts for 10 years. You can have a booster after 10 years if you’re still at risk.

Getting vaccinated

As part of your travel plans, you should organise a visit to your GP or a travel clinic to have any vaccinations you may need. This should be about six weeks before you travel. You may need a course of vaccinations which will involve two or three injections at different times over a few weeks. This time between injections lets your body respond to the vaccine so you develop immunity to protect you against infection. Vaccine injections are generally given in the upper arm or on the outside of the upper thigh.

If there are less than six weeks before you plan to travel, you should still go to your GP to ask for advice before you set off. You may still be able to be vaccinated. There may be an option to have a course of injections over a shorter period.

You will have to pay for travel vaccinations.

Is there a travel vaccination for malaria?

Answer

No, there isn't a vaccine available for malaria, but there are tablets that you can take to prevent it.

Explanation

Malaria is transmitted by mosquitoes infected with the parasite plasmodium. You will need to take an antimalarial medicine before, during and after travelling to any area where malaria is widespread. This includes Africa, Central and South America, the Indian subcontinent, South-East Asia and the Pacific islands.

There are a range of tablets available – different tablets are more suitable for certain parts of the world. It’s important to check with a health professional to find out which tablets are best for the country you’re travelling to. Malaria distribution around the world and the types of medicine you may need to take can change. Therefore, if you have previously visited a country where malaria is endemic (a disease regularly found among particular people or in a certain area), check to see if the types of medicine you need to take have changed.

You will need to take the malaria tablets at certain times of the day and for most tablets you start the course one week before you travel. However, if you take mefloquine, you will need to start two to three weeks before. If this isn’t possible, take them as soon as you can even if this is just one or two days before you travel. For most tablets you will need to carry on taking them for four weeks after you have left the area.

Some antimalarials are more appropriate for long-term use. If you're staying in one place for more than six months and malaria is prevalent, it's important to continue taking your antimalarial tablets on your return, as you will continue to be at risk of the disease. However, if you plan to permanently move to an area where malaria is endemic, seek advice from your GP or travel clinic.

If you have come to the UK from a country where malaria occurs, it’s very important to take antimalarial tablets if you return to your country of origin. This is because any immunity you have built up against malaria will be rapidly lost after living in the UK and you will therefore be at risk.

Antimalarial medicines may not fully prevent malaria. It’s also important to prevent getting mosquito bites by doing the following.

  • Use an insect repellent that contains DEET on exposed skin or clothing.
  • Use a mosquito net when you sleep; nets treated with an insecticide such as permethrin are much more effective than untreated nets. Also spray your sleeping area with an insecticide; you can combine this with mosquito coils or vaporisers. However, if you’re staying in a hotel with air conditioning and insect netting over the windows, this may not be necessary.
  • Wear long trousers, long-sleeved tops and appropriate footwear after dusk to ensure your skin isn’t exposed.

What’s the difference between a live and an inactive vaccine?

Answer

A live vaccine is a weakened version of a virus or bacterium and an inactive vaccine is a dead version.

Explanation

There are different types of vaccine – live and inactivated. Live vaccines contain a weakened, live virus that’s designed to help your body develop an immune response without you developing symptoms of the disease itself. Inactivated vaccines use a dead or killed virus or bacteria to help your body develop an immune response – they can't cause the diseases they are used to prevent.

Live vaccines include:

  • yellow fever
  • oral typhoid vaccine
  • BCG (tuberculosis vaccine)
  • some childhood vaccines

Inactivated vaccines include:

  • tetanus
  • polio
  • typhoid Vi
  • hepatitis A
  • hepatitis B
  • quadrivalent meningococcal meningitis
  • rabies
  • Japanese encephalitis
  • tick-borne encephalitis

For most people with healthy immune systems, live virus vaccines are effective and safe. However, because live vaccines contain a small amount of a weakened live virus, people with weakened immune systems (from having HIV/AIDS or chemotherapy treatment for example) shouldn’t have them.

Live vaccines should be given on the same day. If not, you will need to wait at least four weeks until you can have your next live vaccine. If you need more than one inactivated vaccine, you can have them at the same time. However, you will need to be injected with separate syringes for each vaccine and into different areas of your body.

Can I have travel vaccinations if I am pregnant?

Answer

If possible, you should try to not have vaccinations if you're pregnant. But you need to weigh up the risk of getting the disease against the risk of potential harm to your unborn child.

Explanation

If possible, it’s best not to travel to an area with a high risk of disease when you’re pregnant. But if you need to, you will need to be given a vaccine.

At present there is limited scientific research to say that vaccines can harm an unborn child. However, live vaccines, such as yellow fever, are thought to be particularly harmful, but the exact risk isn't known.

Ask your GP or travel clinic for information if you’re travelling and are pregnant.

Can I still take other medicines on the day I have a travel vaccination?

Answer

Some medicines can interact with certain travel vaccinations. It’s important to let your GP or travel clinic know if you’re taking any medicines before you have your vaccine.

Explanation

You must let your GP or travel clinic know if you’re taking any medicines and where you plan to travel to. Only some vaccines interact with medicines. These include the following.

  • The oral typhoid vaccine may interact with antibiotics or antimalarials, so they shouldn’t be taken at the same time. This is because antibiotics and antimalarials may act against the vaccine and prevent it working properly. If you’re taking antibiotics, your GP or travel clinic may offer you a typhoid injection instead. If you need to take antimalarials for your trip, have the oral typhoid vaccine before you start taking them, ideally at least three days before.
  • The rabies vaccine may be affected if you’re taking a type of antimalarial drug called chloroquine as this can reduce your body’s response to it. If you’re taking this type of antimalarial, your GP will need to give you the rabies injection deep into your muscle rather than just into your skin. If you have time, complete both your rabies vaccine doses before you start taking chloroquine.
  • Antimalarial medicines can interact with other medicines, such as those for heart disease, HIV/AIDS, epilepsy and depression. Other medicines may also affect how your body absorbs the antimalarial. You must wait at least four hours after taking an antacid medicine before having chloroquine, for example.

Ask your GP or travel clinic if the vaccines you need may interfere with any medicines you take.