Travel Related Diseases
& Prevention

It is important to prepare for the risks of travel related illnesses which may arise on your journey. Chat with Elle to learn what diseases may be prevalent at your destination and to receive tips on prevention.

Travel Vaccines

Cholera

Cholera is a disease caused as a result of the bacteria Vibrio cholerae. It thrives in areas with poor sanitation and lack of access to safe drinking water. Any consumption of food or drink contaminated by the cholera bacteria can lead to the contraction of the disease. In a few cases, cholera can lead to death if the victim is dehydrated due to loss of fluids and electrolytes. Most international travelers do not get cholera because they do not visit areas with active cholera transmission and usually have good access to safe food and water. Cholera is found in countries around the world but is extremely rare in the United States and other industrialized nations.

Prevention:

A licensed cholera vaccine is available in the United States for adults 18-64 years old. It prevents severe diarrhea caused by the most common types of cholera-causing bacteria and should be administered at least 10 days prior to any potential cholera exposure. The vaccine is not 100% effective. In addition to vaccination, travelers should take steps to reduce their risk by:

  • Choosing food and drinks carefully
    • Only eat foods that are cooked and served hot
    • Avoid food that has been sitting on a buffet
    • Eat raw fruits and vegetables only if you have washed them in clean water or peeled them
    • Only drink beverages from factory-sealed containers
    • Avoid ice because it may have been made from unclean water
    • Drink pasteurized milk
  • Wash hands carefully
    • Wash hands often with soap and water for 20 seconds, especially after using the bathroom and before eating
    • If soap and water aren’t available, use an alcohol-based hand sanitizer that contains at least 60% alcohol
    • Keep your hands away from your face and mouth

Centers for Disease Control and Prevention. Cholera Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/cholera.html. Reviewed October 30 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Cholera. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/cholera. Reviewed December 1 2020. Accessed April 20 2021.

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Hepatitis A

Hepatitis A is a virus that often results in liver disease. Hepatitis A virus is found in the stool and the blood of infected individuals. It is a highly communicable disease. Symptoms appear quickly and could include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, diarrhea, clay-colored bowel movements, joint pain and jaundice (yellowing of the skin and eyes). You could be infected with hepatitis A if you engage in any of the following:

  • Consumption of food or drink contaminated with hepatitis A
  • Contact with objects contaminated by the virus followed by direct contact to mouth
  • Direct and personal contact with infected individuals
  • Sexual intercourse with infected individuals

Hepatitis A is a common disease in countries throughout the world. Anyone who has not been vaccinated or had hepatitis A infection before can get infected. Travelers are more likely to get infected with hepatitis A if they visit rural areas, trek in backcountry areas, or frequently eat or drink in settings of poor sanitation. However, even travelers who stay in urban areas, resorts, or luxury hotels, who wash their hands regularly, and who choose food and drinks carefully have been infected when visiting countries where hepatitis A is common.

Prevention:

The best way to prevent exposure and infection of the virus is to get vaccinated. The vaccine for hepatitis A is extremely effective and has been a routine childhood vaccine since 1996. It is recommended for travelers above the age of 6 months to countries where hepatitis A is prevalent. It is administered in 2 or 3 doses; with a minimum of 1 as soon as possible before you travel. Travelers allergic to a component or are below 6 months of age should be administered a single dosage of immune globulin which provides sufficient protection for up to 2 months depending on the dosage.


Centers for Disease Control and Prevention. Hepatitis A Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html. Reviewed July 28 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Hepatitis A. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/hepatitis-a. Reviewed April 27 2020. Accessed April 20 2021.

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Hepatitis B

Hepatitis B is a virus that causes liver disease. Hepatitis B virus is found in the blood and body fluids of infected people. People infected with hepatitis B can spread it to others. Early symptoms of hepatitis B can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellow color in the skin or the eyes). Some infected individuals develop lifelong hepatitis B. The long-term health effects caused by chronic hepatitis B infection can cause people to die early from liver disease and liver cancer. You can be infected with hepatitis B virus if you:

  • Have sexual intercourse with an infected partner
  • Use of needles, syringes, or drug preparation equipment that are shared with an infected person
  • Sharing of personal care items such as razors, toothbrushes, or medical equipment with an infected individual
  • Acquire a wound with a sharp instrument or have a needlestick injury in a health care setting
  • Direct contact the blood or open sores of an infected individual

Hepatitis B occurs in nearly every part of the world but is more common in some countries in Asia, Africa, South America and the Caribbean. This map shows the worldwide prevalence of hepatitis B virus infection. Although the risk to most travelers is low, medical tourists (people who travel for medical purposes) or people who need emergency medical care while traveling may be more likely to get infected.

Prevention:

Getting vaccinated is the best way to protect against hepatitis B. Hepatitis B is a routine vaccination that most people undergo during infancy in the US at birth. The vaccine has proved to be 90% effective at preventing contraction and has been recommended for infants since 1991. The vaccine is recommended for travelers of all ages with plans to travel to countries where hepatitis B is common.


Centers for Disease Control and Prevention. Hepatitis B – Chapter 4 – 2020 Yellow Book. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hepatitis-b#5514. Reviewed July 1 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Medical Tourism – Chapter 9 – 2020 Yellow Book. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-for-work-other-reasons/medical-tourism. Reviewed June 24 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Hepatitis B Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html. Reviewed April 5 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Hepatitis B. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/hepatitis-b. Reviewed April 28 2020. Accessed April 20 2021.

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Japanese Encephalitis

Japanese encephalitis (JE) is a sickness spread through mosquito bites. Its symptoms usually take around 5-15 days to develop and could include fever, headache, vomiting, confusion, and difficulty moving. Symptoms that develop later include swelling around the brain and coma. JE is a serious disease that could be fatal. Travelers who go to Asia are at risk for getting Japanese encephalitis (See map). For most travelers the risk is extremely low but depends on where you are going, the time of year, your planned activities, and the length of the trip. You are at higher risk if you are traveling to rural areas, will be outside frequently, or will be traveling for a long period of time.  In mild climates in northern Asia the risk for JE is greater in the summer and fall. In tropical and subtropical areas, there is a risk year-round.

Prevention:

In addition to bug bite prevention, travelers may choose to get vaccinated against JE. There is one JE vaccine available in the US. It is approved for use in individuals older than 2 months of age. The JE vaccine is administered in two doses, spaced 28 days apart. Individuals above the age of 18 can shorten this buffer period to seven days and all must finish the last dose at least a week before travel. A third dose should ideally be taken if the person has taken the 2-dose primary vaccine a year or more as they risk re-exposure.


Centers for Disease Control and Prevention. Geographic Distribution of Japanese Encephalitis Virus.  Centers for Disease Control and Prevention. https://www.cdc.gov/japaneseencephalitis/maps/index.html. Reviewed February 8 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Avoid Bug Bites. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/avoid-bug-bites. Reviewed January 3 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Japanese Encephalitis Vaccine Information Statement.  Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/je-ixiaro.html. Reviewed August 15 2019. Accessed April 20 2021.

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Malaria

Malaria results from a parasite that is spread by mosquitoes. Symptoms appear between 7 to 3 days but in a few cases can take up to a year to display fully. These could include high fevers, chills and flu. If not treated, Malaria can result in severe illness or even death. The mosquitoes that spread malaria are found in Africa, Central and South America, parts of the Caribbean, Asia, Eastern Europe, and the South Pacific (See maps: Eastern Hemisphere and Western Hemisphere). Travelers going to these countries may get bit by mosquitoes and get infected. About 2,000 cases of malaria are diagnosed in the United States annually, mostly among returned travelers.

Prevention:

There is no vaccine for malaria. Travelers can safeguard themselves by preventing mosquito bites and taking medication to protect against malaria. There are six different malaria medications available. The one that’s right for you depends on your trip and other factors. Depending on the medicine, individuals will have to start taking it several days before the trip as well as during and after. Consultation with a doctor is a must. If bitten by mosquitoes, avoid itching the bites and apply hydrocortisone cream to reduce irritation.


Centers for Disease Control and Prevention. Malaria – Chapter 4 – 2020 Yellow Book. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/malaria#5544. Reviewed July 1 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Avoid Bug Bites. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/avoid-bug-bites. Reviewed January 3 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Choosing a Drug to Prevent Malaria. Centers for Disease Control and Prevention. https://www.cdc.gov/malaria/travelers/drugs.html. Reviewed November 15 2018. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Malaria. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/malaria. Reviewed May 4 2020. Accessed April 20 2021.

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Meningococcal Disease (Meningitis)

Meningococcal disease is a result of bacteria called Neisseria meningitidis. This disease is communicable through direct personal contact like kissing, sharing living spaces etc. Individuals with this disease require immediate medical attention and symptoms vary depending on the type of illness. Some common symptoms of meningococcal meningitis include headaches, sudden fever and a stiff neck as well as nausea, vomiting, confusion and heightened sensitivity to light. Symptoms may present differently in children and infants. The bacteria that cause this disease may also infect the blood and cause septicemia. The symptoms of this include chills, fatigue, vomiting, severe aches and pains, diarrhea, dark rash, and rushed breathing. This disease can also lead to death in a few cases in as little as a few hours. Anyone can get meningococcal disease, but people who live or travel to certain areas of the world are more likely to get it. The “meningitis belt” of sub-Saharan Africa has the highest rates of meningococcal disease in the world. The disease is more common in this part of Africa during the dry season (December through June). Travelers who spend a lot of time with local populations in the meningitis belt, especially during outbreaks of meningococcal disease, are more likely to get this disease. Participants in the Hajj or Umrah pilgrimages in Saudi Arabia are also more likely to get sick.

Prevention:

A vaccine is the best way to protect yourself from the meningococcal disease. There are two types of meningococcal vaccines available in the United States:

  • Meningococcal ACWY (MenACWY) vaccine
  • Serogroup B meningococcal (MenB) vaccine
  • MenACWY is a routine vaccination administered to 11–12-year-olds followed up by a booster shot at 16. MenB is administered to teens and young adults at 16-18 years old. Depending on the travel plans, younger children and adults may also need a MenACWY and those vaccinated previously might require a booster shot.  It takes a buffer period of 7-10 days after vaccination to enable maximum protection against the disease. Consult with a doctor to get your personalized recommendation.

Centers for Disease Control and Prevention. Signs and Symptoms of Meningococcal Disease. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/malari https://www.cdc.gov/meningococcal/about/symptoms.html#meningitis. Reviewed June 7 2017. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Meningococcal Disease – Chapter 4 – 2020 Yellow Book. Centers for Disease Control and Prevention.  https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/meningococcal-disease#5559. Reviewed June 24 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Meningococcal ACWY Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening.html. Reviewed August 15 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Meningococcal B Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.html. Reviewed August 15 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Meningococcal Disease. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/meningococcal-disease. Reviewed May 1 2020. Accessed April 20 2021.

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Rabies

Rabies is a fatal disease caused by a virus that spreads through the saliva of infected animals. All mammals are susceptible to rabies. People typically get rabies from licks, bites, or scratches from infected dogs and other animals such as bats, foxes, raccoons, and mongooses. Rabies impacts the central nervous system, ultimately resulting in brain disease and death. Once symptoms of rabies make themselves known, the disease is nearly always fatal, making prevention paramount. Rabid dogs are a problem in many countries around the world, including most of Africa, Asia, and parts of Central and South America. Although any mammal can transmit rabies, dog bites are how most travelers get rabies. Factors that may increase a traveler’s chances of rabies infection include:

  • Camping or exploring caves (spelunkers)
  • Working with animals (veterinarians, animal handlers, field biologists, or laboratory workers handling animal specimens)
  • Long-term travelers and expatriates
  • Children are more likely to get infected because they often play with animals and may not report bites.

Rabies in dogs is rare in the United States, Australia, Canada, Japan, and most European countries.

Prevention:

In addition to practicing good animal safety, some travelers should get vaccinated against rabies. Rabies vaccine is administered to people at high risk of rabies to protect them should they be exposed. People at high risk of exposure to rabies should be offered a pre-exposure rabies vaccination. For pre-exposure protection, 3 doses of rabies vaccine are recommended. People who may be repeatedly susceptible to rabies virus should receive periodic testing for immunity, and booster doses may be necessary. Rabies vaccine can prevent rabies if given to a person after they have had an exposure, before symptoms appear. Anyone who has been bitten by an animal suspected to have rabies or has been exposed to it should clean the wound and visit a medical professional immediately regardless of vaccination status.


Centers for Disease Control and Prevention. Be Safe Around Animals. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/be-safe-around-animals. Reviewed October 31 2017. Accessed April 20 2021.

Centers for Disease Control and Prevention. Rabies Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html. Reviewed January 8 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Rabies. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/rabies. Reviewed January 28 2021. Accessed April 20 2021.

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Typhoid Fever

Typhoid fever and paratyphoid fever are similar diseases caused by the bacteria Salmonella Typhi. Salmonella Paratyphi bacteria cause paratyphoid fever. It is a communicable disease. It can be contracted when an infected person uses the bathroom and does not wash their hands. The bacteria can remain on their hands and subsequently contaminate everything that the person touches, including any food and drinks. In countries with poor sanitation, the water used to rinse and prepare food and beverages can also be contaminated with these bacteria. Travelers who consume foods or drinks contaminated with these bacteria are susceptible to the disease. Typhoid fever and paratyphoid fever cause similar symptoms. People with these diseases usually have a fever that may go as high as 103–104°F (39–40°C). They also may exhibit weakness, stomach pain, headache, diarrhea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-colored spots.  Internal bleeding and death may occur but are rare.

Prevention:

Two typhoid vaccines are available in the US currently:

  • Pill vaccine. People 6 years+ can take the pill vaccine. All four pills (1 pill every other day) must be taken at least a week before travel.
  • Shot vaccine. People 2 years+ can receive the shot vaccine. One shot (or a booster shot) must be taken at least 2 weeks before travel.

Unfortunately, neither the typhoid pills nor shot can offer complete protection against infection (50%-80%) and both lose effectiveness over time. Also, there isn’t a vaccine that prevents paratyphoid fever. For these reasons, it is very important that you also take the following steps to prevent typhoid:

Choose food and drinks carefully

  • Only eat foods that are cooked and served hot
  • Avoid food that has been sitting open on a buffet
  • Eat raw fruits and vegetables only if they have been washed in clean water or peeled
  • Only consume beverages from factory-sealed containers
  • Avoid ice as it may have been made from unclean water
  • Only consume pasteurized milk

Wash your hands

  • Wash hands frequently with soap and water for 20 seconds, especially after using the bathroom and before eating
  • If soap and water aren’t available, use an alcohol-based hand sanitizer that contains a minimum of 60% alcohol
  • Keep your hands away from your face and mouth

Centers for Disease Control and Prevention. Typhoid Fever. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/typhoid. Reviewed December 1 2020. Accessed April 20 2021.

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Yellow Fever

Yellow fever is a disease caused by a type of virus that is spread through mosquito bites. Symptoms take about 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. Around 15% of people who contract yellow fever develop serious illnesses that could lead to bleeding, shock, organ failure, and sometimes even death. Travelers to certain parts of South America and Africa are at risk for yellow fever.

Prevention:

In addition to avoiding mosquito bites, travelers may be required or recommended the yellow fever vaccine. Yellow fever vaccine is a live vaccine containing a weakened, live yellow fever virus. It is administered as a single shot. A single dose provides lifelong protection for most people. Yellow fever vaccine is provided only at designated vaccination centers. After receiving the vaccine, you will be given an “International Certificate of Vaccination or Prophylaxis” (ICVP, also called the “yellow card”). You will need this card as proof of vaccination to be able to enter certain countries. If you don’t have it, you might be required to get yellow fever vaccine upon entering the country or be forced to wait for up to 6 days to ensure that you are not infected. Do not donate blood for 14 days after vaccination as there stands a risk of passing vaccine virus to others during that period.].


Centers for Disease Control and Prevention. Symptoms, Diagnosis, & Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/yellowfever/symptoms/index.html. Reviewed January 15 2019. Accessed April 20 2021.

Centers for Disease Control and Prevention. Yellow Fever – Chapter 4 – 2020 Yellow Book. Centers for Disease Control and Prevention.  https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/yellow-fever#4739. Reviewed April 9 2021. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Avoid Bug Bites. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/avoid-bug-bites. Reviewed January 3 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Yellow Fever Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/yf.html. Reviewed April 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Yellow Fever. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/yellow-fever. Reviewed November 30 2020. Accessed April 20 2021.

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Routine Vaccines

Chickenpox

Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It can cause an itchy, blister-like rash. The rash first appears on the chest, back, and face, and then spreads over the entire body, causing between 250 and 500 itchy blisters. Chickenpox can be serious, especially in babies, adolescents, adults, pregnant women, and people with a weakened immune system. Anyone who has not had chickenpox or gotten the chickenpox vaccine can get the disease. Chickenpox illness usually lasts about 4 to 7 days. The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may first show up on the chest, back, and face, and then spread over the entire body. It usually takes about one week for all of the blisters to become scabs. Other typical symptoms that may begin to appear 1-2 days before rash include:

  • Fever
  • Tiredness
  • Loss of appetite
  • Headache

Prevention:

The best way to prevent chickenpox is to get the chickenpox vaccine. Everyone – including children, adolescents, and adults – should get two doses of chickenpox vaccine if they have never had chickenpox or were never vaccinated. Children are routinely recommended to receive the first dose at age 12 through 15 months and the second dose at age 4 through 6 years. Chickenpox vaccine is very safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, the symptoms are usually milder with fewer or no blisters (they may have just red spots) and mild or no fever. The chickenpox vaccine prevents almost all cases of severe illness. Since the varicella vaccination program began in the United States, there has been over 90% decrease in chickenpox cases, hospitalizations, and deaths.


Centers for Disease Control and Prevention. Chickenpox Vaccination: What Everyone Should Know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/varicella/public/index.html#:~:text=CDC%20recommends%20two%20doses%20of,age%204%20through%206%20years. Reviewed August 7 2019. Accessed May 10 2021.

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Influenza (Flu)

Flu is a contagious respiratory disease caused as a result of influenza viruses that create infections in the nose, throat, and sometimes the lungs. It can bring about mild to severe illnesses, and in a few cases could cause death. The best way to avoid the flu is by getting a flu vaccine annually. The risk for exposure to influenza during travel depends somewhat on the time of year and destination.

  • In the Northern Hemisphere, the flu season can begin as early as October and can last as late as April or May.
  • In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.
  • In the tropics, influenza activity occurs throughout the year.
  • Travelers in the Northern and Southern Hemispheres can be exposed to influenza during months that fall outside of those listed above, especially when traveling as part of large tourist groups (e.g., on cruise ships) that include people from areas of the world where influenza viruses are circulating.

Prevention:

The CDC recommends that everyone 6 months and older get a flu vaccine yearly. There are several flu viruses that constantly change. New flu vaccines are developed annually to protect patients against 3 or 4 viruses most likely to cause diseases in upcoming flu seasons. Even if a vaccine does not match the virus, it still provides some degree of protection. The buffer period for the vaccine’s protection to develop is about 2 weeks. There are two types of flu vaccine:


Centers for Disease Control and Prevention. Key Facts about Seasonal Flu Vaccine. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/prevent/keyfacts.htm. Reviewed December 16 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Inactivated Influenza Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.html. Reviewed August 15 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Live Intranasal Influenza Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.html. Reviewed August 15 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Flu (Influenza). Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/influenza-seasonal-zoonotic-and-pandemic. Reviewed October 21 2019. Accessed April 20 2021.

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Measles-Mumps-Rubella (MMR)

Measles is an illness transmitted through a highly contagious virus. It is spread through air, commonly due to coughs, sneezes or even breathing. Symptoms include fever, rash, coughs, red eyes and a runny nose. Measles can also in a few cases lead to serious lung infections like pneumonia. In more serious cases, although rare, measles can lead to swelling of the brain and can be fatal.  It is severe in infants and those who have weak immune systems or are malnourished.

Mumps is an illness caused by a virus. Individuals with mumps spread the virus when they:

  • Cough, sneeze, or talk
  • Share items that may have saliva and other bodily fluids on them like water bottles or cups
  • Engage in close-contact activities with others such as playing sports, dancing, or kissing

Symptoms may include headache, fever, fatigue, muscle ache, appetite loss and swollen glands under ears or jaw (parotitis). Mumps can be recovered from fully but can create complications such as swelling of the brain, testicles, ovaries or breasts as well as temporary or permanent deafness.

Rubella is a virus that spreads through the air via coughs or sneezes. Symptoms are mild if there at all, a red rash being the first sign. Other symptoms may include headaches, fever, red eyes, coughs, runny nose, general discomfort and swollen and enlarged lymph nodes. It is dangerous in pregnant women as the baby could be born with birth defects or mental disabilities, organ damage, heart defects, deafness and cataracts.

Prevention:

Getting vaccinated is the best way to safeguard yourself against measles, mumps, and rubella. The combination vaccine MMR offers protection these three diseases. MMR is a routine vaccination that children in the US receive at 12-15 months of age. The vaccine is administered in 2 doses, with the second dose given a minimum of 28 days after the first dose. If you were born in or after 1957 and have never had measles, mumps, and rubella and have never been vaccinated against these diseases, you are susceptible. You should receive 2 doses of MMR vaccine before you travel, the second dose 28 days after the first. People born before 1957 are likely to have been exposed to measles, mumps, and rubella naturally, and usually do not require MMR vaccine. Infants 6 to 11 months old traveling internationally should receive 1 dose of the MMR vaccine prior to travel. This dose does not count as the first dose in the routine childhood vaccination series.

Caution

Pregnant women should NOT receive the MMR vaccine. A pregnant woman not vaccinated against rubella should not travel to countries where rubella is prevalent or areas with known rubella outbreaks, especially during the first 20 weeks of her pregnancy. A woman not vaccinated against rubella should be vaccinated against this disease immediately after her baby is born.


Centers for Disease Control and Prevention. Measles. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/measles. Reviewed May 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Mumps. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/mumps. Reviewed April 30 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Rubella. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/rubella. Reviewed May 4 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. MMR (Measles, Mumps, & Rubella) Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html. Reviewed August 15 2019. Accessed April 20 2021.

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Pneumococcal Disease (Pneumonia)

Pneumococcal disease is a result of bacteria called Streptococcus pneumoniae (pneumococcus). This virus is communicable through coughing and sneezing. Pneumococcus bacteria can create infections in many parts of the body depending on which symptoms present. Symptoms may include fever, cough, shortness of breath, chest pain, stiff neck, confusion, increased sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. In more severe cases, pneumococcal disease can lead to hearing loss, brain damage, and death. Pneumococcal disease occurs around the world but is more common in low- and middle-income countries where fewer people get pneumococcal vaccine. In more temperate climates, pneumococcal disease is more common during winter and early spring. In tropical climates with dry and rainy seasons, pneumococcal disease tends to occur more in the dry season. Travelers are more likely to get pneumococcal disease if they spend time in crowded settings or in close contact with children in countries where pneumococcal vaccine is not routinely used.

Prevention:

Getting vaccinated is the best way to protect against pneumococcal disease. Pneumococcal vaccines are routine in the United States. There are two types of pneumococcal vaccine:

  • CDC recommends PPSV23 for:
    • Adults 65 years or older
    • Individuals aged 2 through 64 years old with certain medical conditions
    • Adults aged 19 through 64 years old who are smokers
  • CDC recommends PCV13 for
    • All children below 2 years of age
    • Individuals 2 years or older with certain medical conditions
    • Adults 65 years or older dependent on consultation with medical professional

Some groups may require multiple doses or booster shots. It is important to consult you or your child’s clinician about what is best for your specific situation.


Centers for Disease Control and Prevention. Pneumococcal Polysaccharide Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.html. Reviewed October 30 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Pneumococcal Conjugate (PCV13) Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv13.html. Reviewed October 30 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Pneumococcal Disease (Streptococcus pneumoniae). Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/pneumococcal-disease-streptococcus-pneumoniae. Reviewed May 4 2020. Accessed April 20 2021.

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Polio

Polio is a disease caused by a virus that impacts the nervous system and is mainly spread through person-to-person contact. Polio can also be spread by eating raw or undercooked food or drinking liquids contaminated with the feces of an infected person. Symptoms aren’t usually prevalent and are typically minor, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs. Most individuals impacted recover completely. In rare cases, polio infection can lead to the permanent loss of muscle function (paralysis) in the arms or legs (usually the legs); it can also be fatal if there is loss of function of the muscles used for breathing or infection of the brain. Polio has been eradicated from the United States but is still prevalent in other parts of the world. Travelers going to certain parts of Africa and Asia may be at risk for polio. Everyone should be up to date with their routine polio vaccination series. In addition, a one-time adult polio vaccine booster dose is recommended for previously vaccinated travelers to certain countries.

Prevention:

Children should usually be administered 4 doses of polio vaccine, at 2 months, 4 months, 6–18 months, and 4–6 years of age. Most adults do not need the polio vaccine if they were already vaccinated against polio as children. Some adults are at higher risk and should consider polio vaccination, such as people traveling to certain parts of the world, laboratory workers who might handle poliovirus, and health care workers who handle active cases of polio. The polio vaccine is available as both a stand-alone vaccine and as part of a combination vaccine. Polio vaccine may be given at the same time as other vaccines. In addition to vaccination, travelers can take steps to protect themselves by:

  • Eating safe foods and drink safe beverages:
    • Follow the Food and Water Safety tips to avoid exposure to any food and drinks that could be contaminated by the feces of a person infected with polio.
  • Practicing hygiene and cleanliness:
    • Wash your hands often.
    • If soap and water aren’t available, clean hands with hand sanitizer (containing at least 60% alcohol).
    • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
    • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Try to avoid close contact with other people, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

Centers for Disease Control and Prevention. Polio Vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/polio/index.html. Reviewed May 4 2018. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Polio Vaccine Information Statement. Centers for Disease Control and Prevention https://www.cdc.gov/vaccines/hcp/vis/vis-statements/ipv.html. Reviewed April 5 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Food and Water Safety. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/food-water-safety. Reviewed February 20 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Polio. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/poliomyelitis. Reviewed September 10 2019. Accessed April 20 2021.

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Shingles

Shingles is caused by varicella zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays dormant (inactive) in their body. The virus can reactivate later, causing shingles, a painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and fully clears up within 2 to 4 weeks. Most people who develop shingles have only one episode during their lifetime. However, you can have shingles more than once. If you have shingles, direct contact with the fluid from your rash blisters can spread VZV to people who have never had chickenpox or never received the chickenpox vaccine. If they get infected, they will develop chickenpox, not shingles. They could then develop shingles later in life. In rare cases (usually in people with weakened immune systems), the rash may be more widespread on the body and look similar to a chickenpox rash. Other symptoms of shingles can include:

  • Fever
  • Headache
  • Chills
  • Upset stomach

Prevention:

Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia (PHN), the most common complication from shingles. CDC recommends that healthy adults 50 years and older get two doses of the shingles vaccine ̣recombinant zoster vaccine, separated by 2 to 6 months, to prevent shingles and the complications from the disease. Individuals who already had shingles (or are unsure if they had chickenpox) should still get the shingles vaccine. Your doctor or pharmacist can give you the vaccine as a shot in your upper arm. It provides strong protection against shingles and PHN. A two-dose series of shingles vaccine is more than 90% effective at preventing shingles and PHN. Protection stays above 85% for at least the first four years after you get vaccinated.


Centers for Disease Control and Prevention. Complications of Shingles. Centers for Disease Control and Prevention. https://www.cdc.gov/shingles/about/complications.html. Reviewed July 1 2019. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Shingles (Herpes Zoster). Centers for Disease Control and Prevention. https://www.cdc.gov/shingles/index.html. Reviewed October 5 2020. Accessed April 20 2021.

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Tetanus-Diptheria-Pertussis (Tdap)

Tetanus is a disease caused by a type of bacteria called Clostridium tetani. The bacteria are typically prevalent in soil, dust, and manure. These bacteria usually enter the body through breaks in skin, often cuts or wounds. It is not a communicable disease. A prominent feature of tetanus is when the jaw muscles tighten, preventing a sick person from opening their mouth. This is sometimes referred to as “lockjaw.” Other symptoms of tetanus could include muscle spasms, painful muscle stiffness, trouble swallowing, seizure, headaches, fever, sweating, difficulty breathing, and paralysis. Patients may also exhibit changes in blood pressure and heart rate. Even with intensive care, 10%–20% of individuals with tetanus die. Most people who contract tetanus will display symptoms within 14 days of infection.

Diphtheria is an infection brought about by bacteria called Corynebacterium Diphtheriae. These bacteria cause respiratory and skin contaminations. Individuals with Diphtheria can spread the bacteria to others when they wheeze or cough, or on the off chance that others come into contact with their contaminated injuries. Side effects of respiratory diphtheria incorporate weakness, fever, sore throat, and phlegm in the throat or nose. Swelling of glands in the neck is also possible.

Pertussis, or whooping cough, is a disease caused by bacteria called Bordetella pertussis. Individuals with whooping cough can spread the bacteria to others when they cough, sneeze, or share the same confined breathing spaces. Babies can be transmitted whooping cough from older siblings, parents, or caregivers who might be unaware that they have the disease. Early symptoms are usually mild and can include a cold, runny nose, low fever, and a mild cough. Later symptoms of the illness could include “fits” of many rapid coughs followed by a high-pitched “whoop,” vomiting, and fatigue. The coughing fits can continue for up to 10 weeks or more. In babies, the coughing can be minimal. Instead, babies could experience pauses in breathing also known as apnea. Whooping cough can cause serious and sometimes fatal complications in babies and young children. About half of babies younger than one year old who get the disease require hospitalization.

Prevention:

Staying up to date on Tdap vaccines is the best way to protect against tetanus, diphtheria, and pertussis. These vaccines are often known as DT, DTaP, Td, and Tdap. Babies require 3 shots of DTaP to build up high levels of protection against diphtheria, tetanus, and whooping cough. Then, young children require 2 booster shots to maintain that protection throughout their early childhood. Preteens should receive one shot of Tdap between the ages of 11-12 years to boost their immunity. Pregnant women should be administered Tdap during the early part of the 3rd trimester during every pregnancy. This can help protect her baby from whooping cough in the first few months of life. All adults who have never received one should be administered a shot of Tdap. This can be given at any time, regardless of when they last got Td. This should be followed by either a Td or Tdap shot every 10 years.

Vaccine

The Food and Drug Administration licensed 12 combination vaccines for use in the United States to help protect against diphtheria and tetanus. Nine of these vaccines also help protect against whooping cough. Some of the vaccines include protection against other diseases as well, including polio, Haemophilus influenzae type b disease, and hepatitis B.

  • DT (generic) and Td provide protection against diphtheria and tetanus.
  • DTaP provides protection against diphtheria, tetanus, and whooping cough.
  • Tdap provides protection against tetanus, diphtheria, and whooping cough.
    • Upper-case letters in these abbreviations mean the vaccine has full-strength doses of that part of the vaccine. The lower-case “d” and “p” in Td and Tdap means these vaccines use smaller doses of diphtheria and whooping cough. The “a” in DTaP and Tdap stands for “acellular,” meaning that the whooping cough component contains only parts of the bacteria instead of the whole bacteria.

Centers for Disease Control and Prevention. Tetanus Vaccine Information Statement. Centers for Disease Control and Prevention https://wwwnc.cdc.gov/travel/diseases/tetanus. Reviewed May 4 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Diphtheria Vaccine Information Statement. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/diphtheria. Reviewed May 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Pertussis (Whooping Cough) Vaccine Information Statement. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/pertussis. Reviewed May 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Diphtheria, Tetanus, and Whooping Cough Vaccination: What Everyone Should Know. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/public/index.html. Reviewed January 22 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. TD (Tetanus, Diphtheria) Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/td.html. Reviewed April 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. DTaP (Diphtheria, Tetanus, Pertussis) Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/dtap.html. Reviewed April 1 2020. Accessed April 20 2021. 

Centers for Disease Control and Prevention. Tdap (Tetanus, Diphtheria, Pertussis) Vaccine Information Statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html. Reviewed April 1 2020. Accessed April 20 2021.

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