Many of the recommended immunizations for travel are immunizations one should have just to stay at home. These were covered in the last article. There are others, however, that are important for visitors to particular parts of the world.

Do your research first at the CDC website so you will be prepared to ask good questions when you see your travel medicine professional. Below are a few of the more common immunizations recommended or required for particular destinations.

Typhoid

Typhoid is a risk primarily in tropical countries. It is a disease of sanitation. In some parts of the world, there is antibiotic-resistant typhoid, making the vaccine more important for travelers. The vaccine has a lower effectiveness rate than most other vaccines, about 80-85%, but the risks make it a worthwhile vaccine for most travelers to tropical climes. The vaccine comes in two forms, an injection which is effective for 2 years and an oral vaccine, effective for 5 years.

Yellow Fever

Yellow Fever is currently the only disease for which a vaccination is required for entry into some countries. Countries where Yellow Fever is endemic, all of which are located in South America and Africa, require the vaccine for all travelers entering the country.

Yellow Fever is spread by mosquitoes, so using a good repellant is a wise precaution as well. Many countries require travelers who have been in a Yellow Fever endemic area during the last month to show evidence of having received the Yellow Fever Vaccine. You must have the YF vaccine administered at a certified Yellow Fever Center, and must have the formal documentation of the vaccine. The CDC website lists certified Yellow Fever Vaccine Centers.

Japanese Encephalitis

Japanese Encephalitis is yet another disease spread by mosquitoes. The animal vectors are ducks and pigs, so it primarily a disease of rural farming areas. It occurs seasonally in more northern areas of Asia such as northern China and Korea, but has an extended seasonal risk in the tropical areas of Asia. Most travelers are not at risk for JE. The CDC recommends the vaccine only for those people who will be spending extended periods of time in rural farming areas, at least 4 to 6 weeks.

Rabies

The rabies vaccine is different from other vaccines in that it does not prevent the development of rabies, but rather gives the person exposed to rabies a longer period of time to seek treatment. It also makes the treatment of the exposed person easier. Rabies is essentially 100% fatal once symptoms develop.

There have been only two documented cases of persons who developed rabies and have survived with intensive care. Rabies is transmitted through the saliva of infected animals, often, dogs, bats and monkeys, but any mammal can spread rabies. While animal bites are the most common route of transmission, rabies can be transmitted by an animal licking a person who has a skin break as minor as a scratch.

More on Rabies

Factors to consider in whether or not to have the pre-exposure vaccine include the incidence of rabies in the areas you are visiting, how far you will be from good medical care, and the activities you will be engaged in.

Those travelers who are at greatest risk of exposure, such as those who will have close contact with animals, those who are bicycling or hiking in areas with high incidence of rabies should consider the vaccine. The cdc website has a list of countries with high endemic rates of rabies. Note that India has the highest rate of human rabies in the world.

Pre-exposure vaccine consists of three shots of the rabies vaccine. If one is exposed to rabies and has had the pre-exposure vaccine, treatment consists of a series of two shots.

For anyone who experiences an animal bite, immediate first aid should be thorough washing with soap and water.

If one is exposed to rabies and has not had a previous vaccination, post-exposure treatment include a series of three shots plus human rabies immune globulin. In developing countries, the human rabies immune globulin may not be available, and Equine rabies immune globulin may be administered instead.

This serum has higher rates of serious adverse reactions than the human immune globulin, but given the seriousness of rabies exposure, it is still advised if no human immune globulin is available. In addition, post-exposure treatment for those previously not vaccinated is 5 shots of rabies vaccine.