Travel Vaccinations for Kids and Families

The Author: Laurie Bouck is the co-author (with Michael J. Smith, MD) of The Complete Idiot’s Guide to Vaccinations. She writes about health and medicine on her blog, MedFly.

Travel Vaccines for Children

When we travel, I don’t wipe down restaurant tables or whip out the hand sanitizer every ten minutes. I know that most germs we might encounter can be knocked out quickly by a healthy immune system. But a few viruses and bacteria, those dangerous enough to have warranted the arduous process of vaccine research and development, give me pause.

Japanese encephalitis, for example, kills 25% of the people who catch it. Hepatitis A can make you seriously ill for months. Polio is still lurking in some corners of the world. Fortunately, vaccines are available to help prevent these infections. For me, vaccines are an easy way to make travel with children safer and less worrisome.

How Travel Vaccines are Classified

The Centers for Disease Control and Prevention (CDC) designates travel vaccines as either routine, recommended, or required.

Routine vaccines are the standard vaccines and booster shots that are recommended for children (and adults) in the United States. For children, these vaccines are given on a dosage schedule that begins at birth (with the hepatitis B vaccine) and continues into adulthood. Most of these vaccines are given to children in their first few years of life, to create immunity before they might be exposed to a disease.

Recommended vaccines are the vaccines that a traveler might want to get if they visit certain countries or regions. A Japanese encephalitis vaccine is recommended for certain types of travel to parts of Asia, for example, and a typhoid vaccine might be recommended for a trip to India. Even if you don’t get these recommended vaccines, though, you can still travel in these areas.

Countries that have required vaccines will need to see written proof of vaccination or vaccination exemption before you are allowed to enter the country. Currently only two vaccines, the yellow fever vaccine and the meningococcal vaccine, are required for entry into certain countries. If a vaccine is required, you will need to show either written proof of vaccination, or a doctor’s note exempting you or your child from the vaccine.

The world is not a static place, though, and the vaccines that are recommended or required for travel to certain countries can change. Some diseases are seasonal, with outbreaks more common at certain times of the year. Other diseases increase or decrease in a country when a large population migrates due to civil war, a natural disaster, or even a religious pilgrimage.

Once you know where you plan to travel, check a trusted travel resource, such as the CDC’s Travelers Health website, to find out what vaccines your family might need.

Occasionally, a routine, recommended, or required vaccine is temporarily unavailable in the United States due to a manufacturing problem or other issue. If a vaccine you want is not available, talk to you health care provider about what your options are.

Disclaimer
This article provides information, not medical advice, about the vaccines your child might need to travel more safely to different areas of the world. To find out what vaccines are best for your family’s unique health needs, make sure you talk to a health care provider.

When and Where to Get Travel Vaccines

Vaccines contain a modified form or piece of a bacteria or virus, which your immune system responds to by destroying it with specialized cells. Your body then retains some of these battle-hardened cells so that they can quickly stop any future infections with that germ before it can sicken you. This process creates immunity to a disease.
Depending on the vaccine, it can take weeks to months after the vaccination for your body to create this immunity; meanwhile, you could still catch the disease if you are exposed to it. Some vaccines also require multiple doses over time in order for your body to create adequate immunity to the disease.

For these reasons, if you need travel vaccines, it’s important to plan ahead. Once you know your travel itinerary, it’s best to start any vaccinations your family needs at least four to six weeks before you leave – several months before is best. If you are leaving in less than a month and need travel vaccinations, talk to your health care provider about an accelerated vaccination schedule and other options that can provide some protection against disease.

In many cases, your health care provider can give your family and you the travel vaccinations that you need. If you need a lot of different vaccinations, though, it’s best to find a local travel medicine clinic. These clinics can also give you the paperwork you need for any required vaccinations. To find a travel medicine clinic near you, contact your local health department, visit the CDC’s Vaccines website, or visit the website for the International Society of Travel Medicine (see Resources for links).

Routine Vaccinations for Travel

Infants and young children are normally vaccinated against a wide range of diseases, such as hepatitis B, tetanus, pertussis (whooping cough), seasonal influenza, and measles, with a series of single and combination vaccines given during well-child health care visits. These vaccines often require multiple doses, spaced out over months or years, to create adequate immunity to a disease. By the time a child turns 18, he or she has completed all the doses and booster shots for vaccines against 16 different diseases listed on the current vaccination schedule. The routine vaccination schedule is updated every January on the CDC’s website (see Resources for link).

Parents in any state can opt out of vaccinating a child for medical reasons (for example, if a child has a serious immune system problem that could make certain vaccinations dangerous for them). Most states also allow parents to opt out of recommended vaccines for religious or philosophical reasons.

Opting out of a routine vaccination can be risky when you travel abroad, though. Many vaccine-preventable diseases are more common in other countries than in the United States. Vaccine researchers like to remind people that these diseases are “just a plane ride away” in today’s world.

Before your trip, make sure that your child’s routine vaccinations (and your own) are up to date. Also ask your health care provider whether your child needs to start some routine vaccinations early, or finish some vaccination series on an accelerated schedule, to help protect them from disease when you travel.

Recommended and Required Travel Vaccinations

Six different vaccines are sometimes recommended or required for international travelers. In most cases, these vaccines are not recommended for children under 1 year old. If you’re taking an infant to an area where a vaccine is recommended or required, you will need to take precautions to protect them from exposure to disease, and (if the vaccine is required to enter the area) provide a doctor’s note explaining that the child is too young to receive the vaccine.

The CDC’s online Vaccine Information Statements provide more details on the symptoms of each vaccine-preventable disease, vaccine doses, and potential vaccine side effects and allergic reactions (see Resources for link).

Typhoid Vaccine
You might need a typhoid vaccination if you are traveling to South Asia (where the risk of infection is much higher than other areas), Asia, Central or South America, the Caribbean, or Africa. The bacteria that cause typhoid fever are spread by contact with infected human feces, and travelers often catch typhoid fever through food or drinks contaminated with feces. True to its name, typhoid fever usually causes a high fever, along with stomach pain and other problems. Untreated typhoid fever can be fatal.

The typhoid vaccine is recommended if you’re visiting a smaller town or rural area where typhoid fever is common, or visiting friends or relatives in an area where typhoid fever is common. Children age 2 and older can receive the typhoid vaccine as a one-dose injection, which provides protection for two years (get the vaccine at least two weeks before you leave). Children age 6 and older can receive the vaccine as a series of four pills, each spaced two days apart, which provides protection for five years (finish the series at least one week before you leave).

Japanese Encephalitis Vaccine
Japanese encephalitis, common in rural areas of South and Southeast Asia, is caused by a virus spread by mosquitoes. Infection can cause brain inflammation and other problems; a quarter of people infected with Japanese encephalitis die, and brain damage is common in survivors.

Outbreaks of Japanese encephalitis (sometimes referred to as “JE”) are often seasonal, so check your travel dates against the most updated vaccination recommendations online. You might need to get this vaccine if you’re planning to spend a month or more in South or Southeast Asia, if you plan to spend time in rural areas, or if you plan to spend a lot of time outdoors (such as camping).

The three-dose vaccine is given over 30 days, although that timing can be halved if needed with an accelerated vaccination schedule. You should finish the series of shots at least ten days before you leave. Children should be one year or older to receive the vaccine, which probably provides protection for two years.

Hepatitis A Vaccine
Because hepatitis A is extremely common worldwide, it is both a routine childhood vaccination and an often-recommended travel vaccination for children and adults. Like typhoid, the hepatitis A virus is spread by contact with infected human feces, or food or drink contaminated with infected feces.

Children who catch Hepatitis A often have no symptoms, but they can pass on the infection to adults, who become seriously ill. Hepatitis A affects the liver, causing problems such as nausea and stomach pain. An infection can take months to go away, and in some cases the infection can be fatal.

The routine hepatitis A vaccine is given to children after they turn one year old. They receive two doses at least six months apart. One dose of the vaccine, given at any time before you leave, can also provide protection if you do not have time to get the second dose before your trip. The vaccine is believed to provide protection from hepatitis A for 20 years or longer.

Rabies Vaccine
Rabies is a fatal virus spread by the saliva of an infected animal, usually through a bite. The symptoms of rabies infection include hallucinations and seizures. Rabies is rare in the United States, but it is a concern in Asia, Africa, and Central and South America. In these countries, rabies is most often spread by infected dogs, monkeys, bats, and cats.

Although most people get a series of rabies shots only if they are bitten by a rabid animal, travelers who might encounter rabid animals when they are far from medical care can get a pre-exposure (prophylactic, or preventative) rabies vaccine. Children are at special risk for rabies because they often want to play with animals. A pre-exposure rabies vaccine can provide some protection to a child bitten by a rabid animal until you can find medical help.

The pre-exposure vaccine can be given to infants (under 1 year old) or children, in three doses over three to four weeks. If a vaccinated child or adult is bitten by a rabid animal, clean the wound well. Then get another dose of the vaccine as soon as possible, and a final dose three days later.

This five-dose vaccine series can prevent rabies if it is completed before symptoms of rabies appear. Rabies symptoms usually do not begin until weeks or months after exposure.

Yellow Fever Vaccine (Required)
Like Japanese encephalitis, yellow fever is a virus that can occur in seasonal epidemics and is spread by mosquitoes. The virus, which affects your liver and blood, can cause jaundice, fever, and flu-like symptoms. Yellow fever, which can be fatal, is a concern in tropical South America and sub-Saharan Africa.

The one-dose yellow fever vaccine is approved for children 9 months and older; if necessary, it can be given to children as young as 6 months old. You should get the vaccine at least 10 days before you leave. The vaccine provides immunity for 10 years.

Some countries require an International Certificate of Vaccination or Prophylaxis (ICVP), which proves you have been vaccinated against yellow fever, before you can enter the country. You can get the vaccination and certificate (which is good for ten years) at a yellow fever vaccination clinic (see Resources).

Some of the countries that require an ICVP for entry will waive these vaccination requirements for infants. If you cannot receive the yellow fever vaccination for medical reasons, a doctor’s letter explaining the reason might be accepted.

Meningococcal Vaccine (Recommended or Required)
The meningococcal vaccine is a routine childhood vaccination, usually given to children around age 11 or 12. The meningococcal vaccine prevents infection with bacteria that can cause disabling or fatal meningitis (brain infection), blood infections, or pneumonia. These infections can develop quickly and spread easily among people who are living or working in crowded conditions.

Since meningococcal outbreaks can occur seasonally in sub-Saharan Africa, the vaccine is often recommended for travelers to that region. Outbreaks also occur in Saudi Arabia during the Hajj, or pilgrimage to Mecca. If you travel to Saudi Arabia during the Hajj (the date of each year’s Hajj is based on the Islamic calendar), the meningococcal vaccine is required for entry; you must provide written proof of vaccination.

The one-dose vaccine is licensed for children as young as age 2. It can also be given to children under age 2 if they need the vaccination to enter Saudi Arabia. It should provide protection for three to five years.

Staying Well on Your Trip

It’s important to understand that no vaccine is guaranteed to protect you from a disease. Standard childhood vaccines, for example, are about 75% to 99% effective at preventing disease, depending on the vaccine. The typhoid vaccine for travelers is 50% to 80% effective.
Even if you get the vaccinations you need for your family, you could still catch a disease you were vaccinated against. Following healthy travel trips can help protect you from infectious diseases as well.

Research the health risks for the areas you plan to visit. As a baseline, be sure to keep your children’s pacifiers, toys, and hands clean while you travel. Ask your health care provider whether you need to bring any extra medical supplies to stay healthy on your trip.

When you look at your travel itinerary, ask yourself:
Is it safe to eat raw foods or should I only eat hot, fully-cooked foods?
Is it safe to drink the water and consume ice, or should I stick to bottled water?
Is it safe to consume unpasteurized milk and cheese?
Do I need to protect myself from insect-borne disease with DEET-based insect repellent or mosquito netting for sleeping?
How else can I protect my family on this trip?

The U.S. State department’s website has many healthy travel tips available online (see Resources for link).

Travel Health Resources

The routine vaccination schedules for children, adolescents, and adults are listed on the CDC’s website at http://www.cdc.gov/vaccines/recs/schedules/default.htm

The CDC’s Vaccine Information Statements provide detailed and updated information about routine, recommended, and required vaccines. They are available online at http://www.cdc.gov/vaccines/pubs/vis/default.htm

Look up what vaccines you need to visit certain countries or regions on the CDC’s Traveler’s Health website at http://wwwnc.cdc.gov/travel/destinations/list.aspx

Find links to both private and state-run travel health clinics in your area on the CDC’s website at http://wwwnc.cdc.gov/travel/content/travel-clinics.aspx

Find a local travel health clinic through the search tool of the International Society of Travel Medicine at http://www.istm.org/WebForms/SearchClinics/Default.aspx?SearchType=Advanced

Yellow fever vaccination clinics provide yellow fever vaccinations and ICVP certificates. The CDC lists locations for these clinics at http://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics-search.aspx

The U.S. Department of State’s Tips for Traveling Abroad includes health tips and resources. It is available online at http://travel.state.gov/travel/tips/tips_1232.html

About the author: Laurie Bouck is an award winning writer focused primarily on health and medicine. She has co-authored a book on vaccines and written for a variety of well respected journals and magazines. She blogs at MedFly.