Merck Manual

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Vaccines for International Travel*,†

Vaccines for International Travel*,†

Infection

Regions Where the Vaccine is Recommended

Comments

All low- and middle-income countries

Two doses are given at least 6 months apart.‡

All low- and middle-income countries (hepatitis B is particularly common in China)

This vaccine is recommended for extended-stay travelers and all health care workers.‡

Japanese encephalitis

Rural areas throughout most of Asia and South Asia, particularly in areas with rice and pig farming

Two doses are given 28 days apart. Adults aged 18–65 years can get the second dose as early as 7 days after the first dose. The last dose should be given at least 1 week before travel.

This vaccine is not recommended for pregnant women.

This vaccine is usually not advised for those spending less than one month in an endemic area.

Northern Sub-Saharan Africa from Mali to Ethiopia (the meningitis belt)

Throughout the world, especially in crowded living situations (such as dormitories)

A single dose of quadrivalent vaccine is effective.

Risk of infection in the meningitis belt is higher during the dry season (December through June).

This vaccine is required for entry into Saudi Arabia during Hajj or Umrah.

All countries, including the United States

This vaccine is recommended for travelers at risk of animal bites, including rural campers, veterinarians, people living in remote areas, and field workers.

It does not eliminate the need for additional vaccinations after an animal bite (for added protection).

This vaccine is given during pregnancy only if the risk of infection is high.

See also Rabies Prevention.

All low-income countries, especially in South Asia (including India)

Two forms of the vaccine are available.

Single injection form: It protects for 2 years and is thought to be safer for pregnant women than the pill form of the vaccine.

Pill form: One pill is taken every other day for a total of 4 pills. This form protects for 5 years and is not safe for pregnant women.

Tropical South America and tropical Africa

The disease is rare, but many countries require proof of vaccination for entry.§

This vaccine is not safe for pregnant women.

This vaccine has an increased risk of side effects in older people.§

One dose is protective for life for most travelers.

* In addition to the listed vaccinations, travelers should be up to date on their routine vaccinations, including influenza, measles, mumps, rubella, tetanus, diphtheria, polio, pneumococcal disease, and varicella.

† All recommendations are subject to change. For the latest recommendations, consult the Centers for Disease Control and Prevention (www.cdc.gov or 800-CDC-INFO [800-232-4636]). See also Overview of Immunization.

‡ There is also a combination hepatitis A and hepatitis B vaccine available, which doctors give on either a three-dose or four-dose schedule. (See Hepatitis A Vaccine and Hepatitis B Vaccine.).

§ For travelers over age 60, doctors may consider completing the waiver section of the Yellow Card (International Certificate of Vaccination), instead of administering yellow fever vaccine. Those travelers should then be particularly diligent regarding personal protection measures against insects.