My clients are planning a
trip to several countries in Asia. I have advised that no
immunizations are required, but their doctor has recommended
several vaccinations, including shots against hepatitis A and
typhoid fever. The clients wonder if I know what I am talking
about. What do I tell them?
A: The concept of "required" vs. "recommended"
vaccinations is often a source of confusion, not only to travelers
and travel agents, but also to the medical community at large.
Required immunizations are those legally required by the
destination country to protect its citizens from the importation of
disease, even if in some cases these requirements may incidentally
protect the traveler as well.
The only immunization currently required is the yellow fever
vaccine. Some countries require this vaccine for travelers coming
from anywhere.
In some instances, it is required for travelers transiting a
country where yellow fever is present.
It is important to know the country's requirement in advance
because if travelers arrive without proof of yellow fever
vaccination, they may be turned away at the border, quarantined for
10 days or given the shot on arrival at the airport.
Suffice it to say, the needle used to give the shot may be a
"reusable" needle -- not clean and sterile -- and hence pose an
even greater risk to travelers' health.
The yellow fever vaccine must be received at least 10 days prior
to arrival at the destination. It must be received at a certified
Yellow Fever Vaccination Center (most travel medicine clinics in
the U.S. are certified to give the vaccine).
Proof of yellow fever vaccination is entered onto an
International Certificate of Vaccination which is carried with the
passport. This certificate is good for 10 years.
The only travelers for whom there might be a risk in receiving
the yellow fever vaccine are those who are pregnant or
immunosuppressed. The decision to receive the vaccine in these
cases should be made with a knowledgeable travel health
provider.
It is important to mention that the cholera vaccine no longer is
required.
According to the World Health Organization, no country should
require proof of a cholera immunization. However, sometimes when
crossing between certain countries' borders, guards may request
proof of a cholera shot.
This sometimes reflects lack of current information or, in some
instances, is a thinly veiled request for a bribe.
Border crossings where this commonly occurs are well known to
practitioners of travel medicine and should be discussed with a
travel health provider, where appropriate precautions can be taken
to prevent this problem.
Vaccinations are not required to protect against many diseases
that are of great risk to the traveler.
In fact, the more important immunizations are those that are
recommended.
Recommended immunizations protect travelers from diseases for
which they could be at risk. They include such vaccines as
hepatitis A, hepatitis B, typhoid and, in certain instances,
tetanus/diphtheria, polio, measles and meningitis.
In other instances, vaccines against Japanese encephalitis,
rabies, influenza and pneumococcal pneumonia may be recommended as
well.
The best place to get information on vaccines that are
recommended for a given trip is the Web site of the Centers for
Disease Control and Prevention, at www.cdc.gov.
A list of travel medicine clinics can be obtained through the
International Society of Travel Medicine's Web site. at www.istm.org.
This column is designed to answer agent questions of general
interest to the trade. Please address your questions to Dr. Connor
at [email protected].