Vacation Time! Time for Travel Vaccines

As the summer break approaches for most school-aged children and teens, families may be more eager to travel internationally this year, now that the worst of the COVID-19 pandemic seems to be behind us. An important aspect to staying safe and healthy during international travel is to ensure that all appropriate travel vaccines have been given. General tips for clinicians include asking at appointments about any planned international travel, as some vaccines need to be given with advanced planning. Clinicians should make sure that patients are current on routine vaccinations prior to travel, and should assess the need for specific travel vaccines based on their destinations. Clinicians and families can both go to www.cdc.gov/travel¹ to learn about health and safety information prior to travel, including the need for vaccinations. 

Vaccines that may be needed include: 

Hepatitis A: Hepatitis A can be transmitted through contaminated food and water. This vaccine is recommended for most travelers and is a two-vaccine series, given at least six months apart. At least one dose should be given prior to international travel. Minimum age for vaccination is 6 months for doses prior to travel, but doses prior to 12 months of age do not count toward the two doses needed to be fully vaccinated. 

Hepatitis B: Hepatitis B can be transmitted through sexual contact, contaminated needles and contaminated blood products. This vaccine is recommended for all unvaccinated or non-immune travelers. This vaccination is especially important for people traveling to an area with hepatitis B prevalence that is >2% (e.g., countries in Africa, countries in western and northern South America, Asian and Caribbean countries). The routine series is given at birth, 1-2 months and 6-18 months of age. Unvaccinated persons should complete a three-dose series spaced at zero, one to two, and six months apart. Adolescents aged 11-15 may use a two-dose schedule with four months between doses.  

Typhoid: Typhoid fever is transmitted through contaminated food and water. Oral and injectable vaccines are available. Typhoid vaccine is recommended for any traveler going to an area that is endemic for typhoid. The injectable vaccine should be given at least two weeks prior to travel and is a single dose for those >2 years of age. If exposure is ongoing, repeat every two years. The oral vaccine is for anyone >6 years of age who is able to swallow the capsule whole. This is a live attenuated vaccine that is contraindicated in those that are immunocompromised. Vaccination should be avoided during GI illness, and antibiotics must be avoided from three days before the first dose through seven days after the last dose. The vaccine is given as one capsule every two days for four doses. If exposure is ongoing, repeat every five years. 

Rabies: Rabies is transmitted by the saliva of infected animals. Consider rabies vaccination for patients traveling to high-risk areas (see information for specific country of travel), particularly for those who will be exposed to high-risk environments such as caves, those who plan to have contact with animals, and those who will have significant outdoor exposure in a rural area. A rabies vaccine series should begin at least 21 days prior to travel. Protection lasts for three years. Clinicians should administer doses at zero and seven days. It is important to educate patients and families that even if they are vaccinated, an exposure from an animal bite or scratch will require them to get two booster doses of the vaccine, though rabies immune globulin will not be needed. 

Yellow fever: Yellow fever is transmitted via mosquito bites. A single-dose vaccine is recommended for travelers going to certain countries within South America and Africa. The vaccine should be given at least 10 days prior to arrival. The minimum age for vaccination is 9 months. Certain countries require proof of vaccine prior to entry. This is a live virus vaccine and must be given on the same day as other live virus vaccines or must be delayed by one month. 

Japanese encephalitis: Japanese encephalitis is also transmitted via mosquitos. This vaccine is recommended for travelers >2 months of age going to endemic areas who will be present during the rainy season for one month or longer and for shorter-term travelers if they will be in rural areas where mosquito exposure is anticipated. This vaccine is a two-dose series given 28 days apart. A booster in one year is recommended for those with ongoing or repeated exposure. 

Cholera: Cholera is acquired via contaminated food and water sources. The cholera vaccine is recommended for those older than 2 years of age who are traveling to areas with active cholera transmission; travelers should be vaccinated at least 10 days prior to travel. This is a live oral vaccine. Since 2020, due to changes in manufacturing of this vaccine, this vaccine has not been available in the United States but is anticipated to have available supply on May 1, 2023. 

Meningococcal vaccine: Meningococcal disease is transmitted from person-to-person via oral and respiratory secretions. Meningococcal A, C, W and Y vaccine/MCV4 is recommended for travelers >2 months of age to areas in sub-Saharan Africa, particularly December-June. It is required for travelers to Saudi Arabia for the Hajj pilgrimage. There are several MCV4 vaccine products. The entire vaccine series should be completed at least 10 days prior to travel. Booster doses are recommended in some circumstances if exposure is repetitive or ongoing. 

Malaria: Malaria is transmitted via mosquito bites. Although there is currently no vaccine available, clinicians should consider malaria chemoprophylaxis for travelers going to Africa, Latin America, the Caribbean, South Asia, East Asia, the Middle East, Eastern Europe and the South Pacific if mosquito exposure is anticipated.^2,3 

International travel can be an important time for families and an invaluable learning experience. Ensuring children and teens are prepared for travel with appropriate vaccinations, anticipatory guidance and any needed medications is important. Local health departments and Children’s Mercy Kansas City Travel Medicine Clinic are available to assist with vaccines and pre-travel evaluation and education.

1. Traveler’s health. Centers for Disease Control and Prevention. Accessed April 6, 2023. www.cdc.gov/travel
2. Think Travel Vaccine Guide. Centers for Disease Control and Prevention. Page last reviewed December 4, 2019. Accessed April 6, 2023. https://wwwnc.cdc.gov/travel/page/vaccine-guide
3. American Academy of Pediatrics Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.