Mystified by array of immunisations and the maze of sometimes contradictory information available for travellers? This basic guide can help you sort through the confusion get you to the basic info you need to know before you go.
Immunisations help protect you from some of the diseases you may be at risk of getting on your travels. Unfortunately, there are many more diseases you may encounter while travelling in Asia that can’t be prevented by vaccination (for example diarrhoea, malaria and dengue fever).
Many countries require you to have a certificate showing you’ve been vaccinated against yellow fever (and sometimes cholera, although this is contrary to international law) before they will let you into the country. Wherever you’re going, it’s a good idea to make sure your immunisations are recorded on an official certificate – your doctor or travel health centre will usually issue you with a record. This is useful for your own information; as well as knowing what you’re protected against (and when you’re due for a top-up); you will also be able to show it to any doctor treating you.
Be wary of advice on immunisations and other health issues given to you by embassies or travel agents, especially if they say that ‘no immunisations are needed’. What they mean is that you won’t be asked for any vaccination certificates when you roll up at the border, not that you don’t need the jabs for your own protection.
The first step? See your doctor or local health centre before you go for the most up to date information and treatment options. Ideally, you’ll need to make the first appointment for your immunisations and other travel health advice about six to eight weeks before you travel. This is because you usually need to wait one to two weeks after a booster or the last dose of an immunisation course before you’re fully protected, and some courses may need to be given over a period of several weeks. Although there’s no medical reason why you can’t have all your injections together, it’s a bit masochistic and it may make side effects like fever or sore arm worse. Generally, if you’ve had a full course of an immunisation before, you will only need a booster injection.
Don’t panic if you have left it to the last minute. Immunisation schedules can be rushed if necessary, and many vaccinations can be given together two weeks, or even one week, before you leave. Just bear in mind that you won’t be as well protected for the first week or two of your trip. Note that a full course of rabies vaccine takes a month, as does Japanese B encephalitis.
Which ones do you need?
Working out which immunisations you need doesn’t just depend on your destination, your doctor will also take the following into account: the length of your trip; whether you’re going to be travelling in rural areas or sticking to the resorts; whether you’re planning to work; which vaccinations you’ve had in the past; any medications you’re on; and any allergies you have. So while we can give you some idea of the immunisations you’re likely to need, for the definitive list you’ll need to discuss your requirements with your doctor.
Whatever your travel plans, make sure you’re up to date with routine immunisations, including:
- tetanus (often given together with diphtheria)
- ‘childhood’ illnesses: measles, mumps and rubella
In addition, world travellers will probably need some of the following travel-related immunisations:
Note that immunisation against cholera is no longer generally recommended, except in special circumstances. However, some border officials in Latin America and Africa have been known to demand to see a certificate of immunisation before allowing travellers across the border, even though this contravenes international law.
Your best bet is to discuss this issue with your travel health clinic or doctor before you go. You may be able to get a certificate of exemption or some other form of relevant documentation to carry with you just in case.
All world travellers should be protected against this common disease. You should have the hepatitis A vaccine, which gives good protection for several years (probably forever if you have a booster). A combined hepatitis A and typhoid vaccine has recently become available, which will help cut down on the number of injections you need to put up with.
This immunisation is recommended for long term travellers to hepatitis B hot spots (e.g. Africa, China, Southeast Asia and the Indian subcontinent). You might also need it if you’re going to be working as a medic or nurse, or if needle sharing or sexual contact is a possibility at your destination. This immunisation is given routinely to children in some countries, including Australia and the USA. A combined hepatitis A and B vaccine is available if you need to have both.
Japanese B Encephalitis
You may need this if you’re planning to spend more than a month in rural areas of the Indian subcontinent, China, Japan, Southeast Asia, the Philippines, or Pacific Islands.
Check with your doctor or travel health clinic for the latest information on outbreaks, but this immunisation is currently recommended for Nepal and long term travel in northern Pakistan, northern India, Mongolia and a few areas of Vietnam. Outbreaks of this disease occur periodically in some parts of Latin America, such as the São Paulo area of Brazil. In Africa, epidemics of this occur periodically, mainly in the Sahel area in the hot dry season, although the so-called ‘meningitis belt’ extends as far south as Zambia and Malawi. Be aware that there have been reports of travellers being required to be immunised at borders into Burkina Faso and possibly other countries in the region.
With rabies, you have the choice of either having the immunisation before you go (called preexposure) or if you get bitten (postexposure).
Preexposure vaccination involves receiving a course of three injections over a month before you leave. If you then get bitten by a suspect animal, you will need to have two boosters to prevent rabies developing. If you didn’t have preexposure vaccination, you will need the full course of rabies vaccination (five injections over a month) as well as an immediate injection of rabies antibodies (expensive and often not readily available).
Consider having preexposure rabies vaccination if you’re going to be travelling for more than three months or if you’re going to be handling animals. Children are at particular risk of being bitten, so may need to be vaccinated even if you’re going for only a short time – discuss with your doctor or a travel health clinic.
This infection is widespread in Latin America, but generally poses a small risk to travellers. You may have been immunised against this as a child, but even if you weren’t, you probably won’t need this unless you’re going to be living with local people for three months or more in most parts of Asia (except Japan).
You’ll need this if you’re going for more than a couple of weeks to Africa, Latin America, the Pacific, and most parts of Asia (except Japan), especially the Indian subcontinent. The oral typhoid vaccine can sometimes give you a tummy upset. The new injectable vaccine causes very few effects.
There are two things you need to be aware of with this immunisation. First, proof of immunisation against yellow fever is a statutory requirement for entry into all African countries, and most Latin American countries if you are coming from a yellow-fever infected country in Africa or South America. Second, regardless of whether you need a certificate as an entry requirement, you need the vaccination to protect yourself from the disease if you are planning to visit rural areas of infected countries.
Yellow fever does not exist in all parts of Africa and Latin America, but mosquitoes capable of transmitting it do. In theory, this means it could exist if travellers from infected areas bring the disease with them. Yellow fever-free countries protect themselves from this risk by requiring you to be immunised if you are coming from an infected area. Countries differ in how they define ‘infected’ – discuss this with your doctor before you go, or check any of the information sources listed earlier in this chapter.
Bear in mind that immunisations are not suitable for everyone. If you’re pregnant, for example, there are some immunisations that are best avoided; babies and children are also a special case and require consultation with your doctor.
Other special considerations include any serious reactions you may have had to immunisations in the past, or if you are immunocompromised for some reason (eg you’re taking steroids or you’re HIV-positive). In this situation, some immunisations are best avoided – you should discuss this with your doctor well in advance of travelling.
Immunisations are like any other medication in that they can have unwanted effects. These are generally unpleasant rather than dangerous, although very occasionally serious allergic reactions can occur. There’s no evidence that they damage your immune system in any way.
The most common reactions are soreness around the injection site, sometimes with redness and swelling, and maybe a slight fever or a general feeling of being unwell. Tetanus, for example, commonly gives you a sore arm, while the hepatitis A vaccine can occasionally give you a fever in the evening. These reactions generally settle quickly with painkillers and rest, and an ice pack on your arm can help soothe any soreness. If you get more serious reactions that don’t settle overnight, you should contact the doctor or clinic where you got your injections.
Very occasionally immunisations can provoke allergic reactions due to substances they may contain, like albumin from eggs, which is why you sometimes have to stay at the clinic for half an hour after the injection. Allergic reactions are a possibility with any immunisation, but some immunisations are more likely to cause this than others (eg Japanese B encephalitis). These reactions are more likely if you know you are allergic to eggs or if you have multiple allergies, especially to bee stings; discuss this with your doctor.