Traveling?

Think ahead to protect yourself against local infections!

June 17, 2023

This is the time of year I often see people right before travel, not because they’re traveling, but because they have their regularly scheduled well visit or the child has an infection or injury. Unfortunately, it is often too late to appropriately protect international travelers when it’s days before they leave. No one wants to get sick when traveling!

Depending on where you travel, you may come into contact with infections that are rare in the United States, like malaria or typhoid. Some medications or vaccines may be available, but they should be done with sufficient time to build immunity.

Getting vaccinated or taking recommended preventative medications will help keep you safe and healthy while you’re traveling. It will also help prevent you from bringing germs back to your family, friends, and community.

I covered some general safety tips for families traveling in this older post:

What precautions should you take before traveling?

The vaccines and preventative medications that are recommended depend on

Destination. Some countries require proof of vaccination for certain diseases, like yellow fever or polio. Many countries have vaccine preventable infections that are not common in the US and it is best to protect against them.
Age. The US vaccine schedule recommends vaccination against measles and hepatitis A after the first birthday, but travelers to some areas who are over 6 months of age should get these earlier. There are different types of vaccines against typhoid and have different age requirements.

What is the ideal time to do a travel visit?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Insurance and travel

Health insurance usually does not cover travel related medical expenses.

Consider coupons to help purchase medications and oral vaccines.

Infections to consider - in alphabetical order.

Dengue Fever

Dengue is a mosquito-borne viral illness. It is seen in parts of the Caribbean, Central and South America, Western Pacific Islands, Australia, Southeast Asia, and Africa.

There is no vaccine or specific treatment. Mosquito bite prevention measures are important.

General Respiratory Infections

Respiratory illnesses like influenza, COVID-19, and the common cold can ruin your trip, but there are many things you can do to avoid catching these.

Get your annual flu shot and get up to date on your COVID-19 vaccines.

Wash your hands frequently or use hand sanitizer.

Wear a high quality mask or respirator (KN95, KF94, or N95) when in indoor public areas - especially during peak times of illness. It can be difficult to know if respiratory infections are common in any given location, so if unsure, put one on. The minimal annoyance of a mask is much better than getting sick on a trip!

Hepatitis

Both hepatitis A and hepatitis B vaccines are now on the routine schedule for children in the US, but many adults did not get these vaccines as children. These vaccines are recommended for travel to many locations. Verify if your family has had both hepatitis A and hepatitis B vaccines before you travel.

It is recommended that infants start hepatitis B vaccines at birth. The series is completed at 6-9 months of age. There are catch up schedules for those who haven't completed the series on time.

Children do not get the hepatitis A vaccine until 12 months of age on the standard US schedule, but they can get it as early as 6 months if they will be travelling internationally. If they have not yet started the series and they are over a year, they can start at any time. The booster is given 6-12 months later.

It takes at least 6 months to complete each of these series, so plan early!

Influenza

Remember that influenza hits various parts of the world at different times of the year. The southern hemisphere tends to finish their flu season just as ours is starting. Check to see when it's flu season and vaccinate as needed.

Malaria

Malaria transmission occurs in large areas of Africa, Latin America, parts of the Caribbean, Asia (including South Asia, Southeast Asia, and the Middle East), Eastern Europe, and the South Pacific. Depending on the level of risk (location, time of year, availability of air conditioning, etc) no specific interventions, mosquito avoidance measures only, or mosquito avoidance measures plus prescription medication for prophylaxis might be recommended.

Prevention medications might be recommended, depending on when and where you will be traveling. The medicines must begin before travel starts, continue during the duration of the travel, and continue once you return home. There is a lot of resistance to various drugs, so area resistance patterns will need to be evaluated before choosing a medication. Review the area-specific travel recommendations with your doctor.

Measles

The news routinely reports outbreaks of measles these days. Many of the US outbreaks are related to an unvaccinated person returning from abroad. The MMR protects against measles, mumps, and rubella.

While our standard vaccine schedule does not recommend the MMR until 12 months of age, the vaccine can be used in infants as young as 6 months. It is considered safe to use in infants, but we don't know when their immunity from their mother goes down. If the maternal immunity is still active, the vaccine won't work. This immunity typically falls between 6 and 12 months. After 12 months the vaccine is more likely to be effective, so when the risk is lower, it is recommended to wait until that age for the vaccine.

Between 6 and 12 months of age the MMR is recommended for infants considered high risk for being exposed to measles. This is because if their immunity has fallen, we don't want them to be unprotected. International travel is considered to be high risk. If your baby's maternal immunity is still high, the vaccine won't provide protection, but he or she is still protected until that maternal immunity falls.

Because we don't trust that the vaccine is effective before a year of age, babies who get an early MMR will still need two after their first birthday.

Talk to your baby's pediatrician about getting the MMR if your child is over 6 months of age. Ideally it will be given at least 2 weeks prior to travel to give the body time to develop immunity.

Meningitis

Meningococcal disease can refer to any illness that is caused by the type of bacteria called Neisseria meningitidis. Within this family, there are several serotypes, such as A, B, C, W, X, and Y. These bacteria cause serious illness and often death, even in the United States.

In the US there is a vaccine against meningitis types A, C, W, and Y recommended at 11 and 16 years of age but it can be given as young as 9 months of age. MenACWY-CRM is approved for children 2 months and older.

There is a vaccine for meningitis B prevention recommended for high risks groups in the US but is not specifically recommended for travel unless you’re going to the meningitis belt of Africa.

Meningitis vaccines should be given at least 7-10 days prior to potential exposure.

Travelers to the meningitis belt in Africa or the Hajj pilgrimage in Saudi Arabia are considered high risk and should be vaccinated. Serogroup A predominates in the meningitis belt, although serogroups C, X, and W are also found. There is no vaccine against meningitis X, but if one gets the standard one that protects against ACWY, they will be protected against the majority of exposures. Boosters for people traveling to these areas are recommended every 5 years.

Norovirus

Symptoms of vomiting and diarrhea, primarily caused by outbreaks of norovirus, are common in many places, including the US. Fever and abdominal pain are also common symptoms with this and other viruses that cause vomiting and diarrhea.

To prevent norovirus, wash your hands with soap and water before eating and after using the bathroom, changing diapers, or touching things that other people have touched, such as stair railings. Hand sanitizer does not protect against norovirus very well, but it can be used in addition to hand washing.

There are no vaccines or medications to prevent or treat norovirus.

If you have vomiting or diarrhea, drink plenty of water to replace fluid lost to help prevent dehydration. Pedialyte for little ones and sports drinks for older children and adults can help with mild dehydration. Broths are also helpful due to their high salt and water content. If signs of dehydration (no tears, decrease in urine output, feeling light headed or dizzy) appear, seek medical attention.

Typhoid

Typhoid is not a vaccine routinely given in the US but it is recommended for travel to many parts of the world. There are two main types of typhoid vaccine, injectable and oral.

Children 2 years and older can get an injectable typhoid vaccine, ideally at least 2 weeks prior to travel. It is only one dose and lasts 2 years.

The oral vaccine is only for people 6 years and older. It is given in 4 doses over a week’s time and should be completed at least a week prior to travel. It must be given on an empty stomach (1 hour before eating and 2 hours after eating). Antibiotic treatment can make this vaccine ineffective, so discuss any current medicine you are taking with your doctor. The oral vaccine lasts 5 years.

Neither vaccine is 100 % effective so even immunized people must be careful what they eat and drink in areas of risk.

Yellow Fever

Yellow fever is a mosquito-borne infection that is found in sub-Saharan Africa and tropical South America. There is no treatment for the illness, but there is a vaccine to help prevent infection. Some areas of the world require vaccination against yellow fever prior to admittance. Yellow fever vaccine is recommended for people over 9 months who are traveling to or living in areas with risk for YFV transmission in South America and Africa.

Most physician offices do not offer this vaccine. A special license is required to be able to provide it. Check with your local health department or a travel clinic in your area. This vaccine should be given at least 10 days prior to travel.

After you return...

If you've been in an area of the world that has increased risk for tuberculosis (TB) or if you have suspected exposure to TB, testing for exposure is recommended.

Tuberculosis occurs worldwide, but travelers who go to most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia are at greatest risk.

Travelers should avoid exposure to TB in crowded and enclosed environments. We should all avoid eating or drinking unpasteurized dairy products.

The vaccine against TB (bacillus Calmette-Guérin (BCG) vaccine) is given at birth in most developing countries but has variable effectiveness and is not routinely recommended for use in the United States. Those who receive BCG vaccination must still follow all recommended TB infection control precautions and participate in post-travel testing for TB exposure.

It is recommended to test for exposure in healthy appearing people after travel. It is possible to have a positive test but no symptoms. This is called latent disease. One can remain in this stage for decades without any symptoms. If TB remains untreated in the body, it may activate at any time. Appropriately treating the TB before it causes active disease is beneficial for the long term.

Talk to your primary care provider after international travel to discuss testing.

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