Travel Vaccinations

Vaccination is probably the most important preventative therapy available for a range of diseases that can be encountered while travelling.

• Hepatitis A - Single injection from 2 years of age. Booster within 2 years provides lifetime protection.
• Hepatitis B - Either a course of 3 injections at 0, 1 and 6 months or accelerated course of 4 injections at 0,7,21 days and booster after 6-12 months. Most children and young adults are protected because of the childhood vaccination program. But immunity can wane over time and a blood test can confirm immunity.
• Typhoid - Single injection from 2 years of age, protective for 3 years. Thereafter booster required for another 3 years protection..
• Yellow Fever - Single injection from 9 months of age for travel to WHO declared yellow fever countries. Live vaccine with relative high rate of side effects and complications. Not recommended for those aged over 80. Revaccination is not required (prior to 2015 vaccination was valid for 10 years).
• Meningococcal ACWY - Single injection for 3 years protection. From 2018 standard on immunisation program for children aged 1. Also given to teens as part of the school vaccination program.
• Cholera - oral two dose course taken 1 week apart or single live vaccination. Protection for 2-3 years. Also some cross protection against traveller's diarrhea due to ETEC E.Coli.
• Japanese Encephalitis - Single live vaccination for 2 years protection. Usually only given for countryside stays in endemic areas for stays over 1 month (eg. voluntary work).
• Rabies - Pre-exposure course of 3 injections at 0, 7, 21 or 28 days (WHO has approved a 2 dose schedule in 2019). May last up to 3 years. In the event of an animal bite/scratch/lick further 2 injections, so-called post exposure vaccination, are required. Those without pre-exposure vaccinations will need immediate (within 24 hours) access to difficult to obtain rabies immunoglobulin which needs to be injected at the site of the animal contact.

Childhood and other Vaccinations

Many vaccinations are given as part of routine childhood, school or age programs. It is worth checking your vaccination history and if in doubt performing immunity checks or revaccination.

• Measles/mumps/rubella - Given in childhood as 2 doses. Live vaccine. For those born between 1966 and 1994 often only 1 dose was given resulting in low or no long term immunity. Please check and revaccination is free. First dose for babies under the childhood vaccination program is at 1 year of age. If travelling with a younger baby a dose of MMR vaccine can be given as early as 6 months of age.
• Tetanus - A course of injections in childhood usually together with diphtheria and pertussis. To maintain immunity boosters are required. Often given after an injury or animal bite. Revaccinate if last booster was over 5 years prior.
• Pertussis - A course of injections in childhood usually together with diphtheria and tetanus. To maintain immunity boosters are required. Revaccinate if last booster was over 10 years prior.
• Polio - A course of injections in childhood. To maintain immunity single booster as an adult is required.
• Chickenpox - Single injection at 18 months of age. Live vaccine. If no immunity as an adult requires 2 injections 6 weeks apart.
• Meningococcal ACWY - single injection for children aged 1. Also given to teens as part of school vaccination program. Essential for travel to Saudi Arabia for Hajj and recommended in parts of Eastern and Subsaharan Africa and South Asia.
• Influenza - Single yearly inection for those over 9 years of age. If between 6 months of age and 9 years of age 2 injections 1 month apart are required in the year when first vaccinated and yearly thereafter. Easily contracted and guaranteed to spoil any trip and can have serious complications for those with certain medical conditions. Free for children up to age 5, those 65 and over, those with chronic medical conditions.
• Pneumococcal - A course of 3 injections in childhood or 1 to 2 doses over the age of 65. Protects against invasive pneumococcal disease such as pneumonia, meningitis. Free for those over age 65.
• Shingles - Single live vaccination from age 60 but free for those between 70-79. Protects against shingles = reactivation of chickenpox virus varicella-zoster.

Local food and drinks risks

Many illnesses can be contracted from contaminated food and drinks, eg. Typhoid fever, Hepatitis A, Cholera, Traveller's Diarrhea. It is important to be wary about the safety of food, drinks and water.

• Consume thoroughly boiled or cooked food
• Use bottled water for drinking and brushing teeth - ensure the seal has not been broken before use.
• Use water purification if bootled water is not available
• Avoid ice in drinks - ice may be made from contaminated water
• Avoid uncooked foods, eg. salads, fruit that may have been washed with contaminated water
• Avoid raw or poorly cooked foods such as seafood from waters that may be contaminated

Animal bite risk

Rabies is a very serious condition that can lead to paralysis and death. Avoid patting animals, direct hand feeding, and other forms of contact. The rabies vaccination course is complicated requiring multiple injections and in case of a bite/scratch/lick difficult to obtain rabies immunoglobulin may be required. Often an animal bite/scratch/lick can necessitate immediate evacuation and return to Australia to administer immunoglobulin which is not available in many countries. If travelling in remote areas rabies pre-exposure vaccination is recommended.

Mosquito bite prevention

It is thought that mosquito borne disease such as Malaria, Yellow Fever, Dengue Fever has killed more people than any other cause of mortality. The best prevention is to avoid being bitten. In at risk areas use insect repellant, best traveller strength such as Bushman's with a high content of DEET. Wear long sleeves, pants, and tops with collars to avoid bites on limbs and neck. Wear lighter colour clothing. If sleeping in accommodation with open windows or areas use mosquito netting. In high risk areas special chemically impregnated clothing can be worn (bought ready or usual clothing impregnated with a special solution.

Malaria prevention

Malaria can be largely prevented by using mosquito bite prevention methods described above but also using prophylactic medication. Medications available are:

• Atovaquone/Proguanil (Malarone) - taken daily, starting 1 day before entering malaria area until 7 days after leaving the area. Most effective of all the anti-malarial medications. Acts on 2 stages of the parasites life cycle. Protects up to 95%. Relatively expensive.
• Doxycycline - an antibiotiv taken daily starting 2 days before entering area until 28 days after leaving area. Many side effects related to prolonged antibiotic use such as thrush, sensitivity to sunburn (and malaria is usually present in tropical sunny areas) and abdominal upset. Most people do not finish the full course and are vulnerable. Protection is quoted at around 70%. Cheap.
• Mefloquine (Lariam) - taken weekly starting 1 week before entering area until 2 weeks after leaving area. Significant side effects including nightmares and anxiety/depression.

Altitude sickness

Altitude sickness is a physiological response of the body when exposed to the effects of lowered atmospheric pressure and thus reduced oxygen. It can occur even at altitudes as low as 2500m but more commonly occur at altitudes above 3500m. Common problem destinations include: Himalayas, Tibet, Andes, even Colorado. Manifests as headaches, swelling, difficulty breathing. If not treated brain and pulmonary oedema can be fatal. The general rule to avoid this condition is to acclimatise slowly: go up slow and stay or descend if symptoms occur. Hydration is important. For some reasons younger and often fitter people tend to be affected more. A medication called Acetazolamide (Diamox) is available to reduce risk of altitude sickness - taken 3 times a day starting 1 day before arriving at an at risk altitude and continued for 3 days. These 3 day courses can be taken multiple times if altitudes while travelling change. Some medical conditions preclude taking this medication.

Viral illnesses

It is reported that up to 40% of passengers will get sick following a long haul flight of 8 hours or more. The best protection is to board the plane rested and keeping well hydrated. Viral illnesses can manifest most commonly as respiratory or gastrointestinal conditions. These can be contracted via air droplets from someone coughing/sneezing but also from touch (nose/eyes) and either ingestion (via food or via touching the mouth). Wash hands before eating. Use an alcohol based gel to keep hands clean especially after touching rails and other surfaces (especially important on cruises where outbreaks of norovirus can be common). If coughing cover the mouth so not to infect others including your travel companions. Use honey or cough lozenges to reduce the cough. Vaccination against influenza is also recommended.

Traveller's diarrhea = Gastroenteritis

Gastroenteritis can range from mild tummy upset, diarrhea, diarrhea and vomiting to bloody diarrhea and severe dehydration. The causes can vary from viral to bacterial. To prevent occurrence use preventative methods described above. Bloody diarrhea or severe dehydration warrant a doctor or hospital visit. Otherwise the key is to maintain hydration - an excellent rehydration fluid is 50% safe water (boiled or bottled) mixed with 50% clear apple juice. You can also buy hydrolyte or gastrolyte for rehydration. Do not drink mainly plain water. Try to eat light and avoid dairy products and sweet fruit. If you have protracted vomiting some medications can help. If travelling to high risk regions such as South and Southeast Asia you can take GP prescribed antibiotics when traveller's diarrhea occurs. Some forms of traveller's diarrhea can be prevented by vaccination for Cholera prior to travel.

Seasickness and Motion sickness

If you suffer from these conditions see your GP to discuss appropriate medications. These are some over-the-counter solutions such as Kwells, but also prescription medication such as Prochlorperazine (Stemetil) that can be helpful. Scopolamine in the form of patches can be bought overseas (not available in Asutralia). Overview of management of motion sickness in children can be found at NPS. Ginger may be helpful for some.

Sunburn

Do not forget sunscreen. In many countries sunscreen products are very expensive and often difficult to obtain.

For more information see

The Centers for Disease Control and Prevention