Precise travel vaccination recommendations depend on the geographic destinations, duration of travel, consumption of local food and untreated water, and likelihood of close contact with local populations. Health information for travelers, including updated immunization and prevention recommendations for various regions of the world, can be found on the CDC website (www.cdc.gov/travel) and the WHO website (www.who.int/topics/travel/en).
Routine childhood vaccinations should be reviewed in all travelers and updated as needed. Children older than 6 months should be immunized against measles (MMR) prior to travel abroad. Yellow fever vaccination may be required for anyone going to or through a yellow fever endemic area or, to prevent introduction of the disease, for travelers returning from an endemic area. Immunization against hepatitis B should be considered in travelers who expect to have close contact with local populations known to have high rates of hepatitis B transmission. Emergency and relief workers should consider cholera vaccination. Meningococcus vaccination is required in order to obtain a visa to Saudi Arabia and is recommended for those planning to visit sub-Saharan Africa. Immunization for tick-borne encephalitis is available in Europe and Australia but not in the United States. Japanese encephalitis vaccine should be offered to those whose travel plans include prolonged trips to rural areas in Southeast Asia or the Indian subcontinent during the endemic season. Typhoid fever and hepatitis A immunizations are recommended for travelers who may be exposed to potentially contaminated food and water sources. Pre-exposure rabies vaccination should be considered for travelers whose plans include a prolonged visit in a remote area or for those whose activities might involve working near animals. See the WHO website for emergency treatment recommendations following a bite from a suspected rabid animal.
Travelers planning to visit areas endemic for malaria should consult the CDC or WHO websites to determine appropriate chemoprophylaxis for the region. Plasmodium falciparum is almost always resistant to chloroquine and sulfadoxine/pyrimethamine, so these drugs are no longer recommended. The drugs used for malaria prevention include atovaquone/proguanil, hydroxychloroquine, doxycycline, mefloquine, and primaquine. All these medications may cause serious adverse effects.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.