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Vaccine Recommendations for Travelers 2 Years of Age and Older

Date last rev'd: July 12, 1996

The following vaccines should be reviewed with a physician at least 10 weeks before departure to ensure the proper scheduling of the various appropriate vaccines and dosages.

Primary Vaccine Series:
For travelers over 2 years of age the following immunizations normally given during childhood should be up to date.

• Measles, Mumps, and Rubella (MMR) Vaccine
• Diphtheria, Tetanus, and Pertussis (DTP or DTaP) Vaccine until age 7, then Td Vaccine
• Polio (OPV) Vaccine
• Haemophilus Influenza B (HbCV) Vaccine
• Hepatitis B (HB) Vaccine

Children over 2 should be "on schedule" with each vaccine's primary-series schedule, while adults should have completed the primary series. If you are unsure about your vaccine history, consult with your physician.

In addition adult travelers may want to consider:

• Influenza (Flu) Vaccine - (Recommended for adults 65 years or older, or other high risk individuals)
• Pneumococcal Vaccine - (Recommended for adults 65 years or older, or other high risk individuals)

Booster or Additional Doses: Tetanus and diphtheria: A booster dose of adult Tetanus-diphtheria (Td) is recommended every 10 years. Polio: an additional single dose of vaccine should be received by adult travelers going to the developing countries of Africa, Asia, the Middle East, and the Indian Subcontinent, and the majority of the New Independent States of the former Soviet Union.
This additional dose of polio vaccine should be received only once during the adult years. Enhanced Inactivated Polio Vaccine (eIPV) is recommended for this dose. Measles: Persons born in or after 1957 should consider a second dose of measles vaccine before traveling abroad.

Additional Vaccines: Yellow Fever vaccine is recommended if traveling to certain parts of Africa and South America. Hepatitis B vaccine should be considered for those who will live 6 months or more in areas where there are high rates of hepatitis B (Southeast Asia, Africa, the Middle East, the islands of the South and Western Pacific, and the Amazon region of South America), and who will have frequent close contact with the local population. Moreover, children who have not received hepatitis B vaccine by age 11-12, should be given the vaccine. In general, Hepatitis A vaccine and/or Immune Globulin (IG) is recommended for travelers to all areas EXCEPT Japan, Australia, New Zealand, Northern and Western Europe and North America (excluding Mexico). Typhoid vaccine is recommended for travelers spending 6 weeks or more in areas where food and water precautions are recommended - many parts of the world, especially developing countries. Meningococcal vaccine is recommended for travelers to sub-Saharan Africa, especially if close contact with the locals is anticipated, or if travel occurs during the dry season from December through June. Japanese Encephalitis or Tick-borne Encephalitis vaccines should be considered for long-term travelers to geographic areas of risk. The risk of cholera to U.S. travelers is so low that it is questionable whether cholera vaccine is of benefit.

Many vaccines can be safely administered simultaneously without any decrease in effectiveness. Immune Globulin (IG) may be simultaneously administered at different body locations with an inactivated vaccine such as DTP, eIPV, hepatitis A vaccine, etc. However, IG diminishes the effectiveness of certain live virus vaccines, such as MMR, if IG is given simultaneously. IG does not interfere with either OPV or yellow fever vaccine when given simultaneously. For additional information on simultaneous administration of vaccines read, "Spacing of Immunobiologics."

PREGNANCY AND IMMUNIZATIONS
Women who are pregnant or who are likely to become pregnant within 3 months should not receive MMR vaccine. Yellow fever or polio (OPV) should be given to pregnant women only if there is a substantial risk of exposure. If given during pregnancy, waiting until the second or third trimester minimizes theoretical concerns over possible birth defects. For polio, OPV is recommended over eIPV when immediate protection is needed.

No convincing evidence for risk to the unborn baby from inactivated viral or bacterial vaccines or toxoids administered to pregnant women has been documented. These vaccines include: hepatitis A, hepatitis B, rabies, injectable typhoid, meningococcal, pneumococcal, Tetanus-diphtheria toxoid (adult formulated), and injectable polio. Immune globulin can be given to pregnant women. Specific information is not available on the safety of cholera vaccine during pregnancy; therefore, it is prudent on theoretical grounds to avoid vaccinating pregnant women.

All vaccines may be administered safely to children of pregnant women and to breast-feeding mothers.

Division of Quarantine
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA

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