Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Immunizations for travel

David Freedman, MD
Karin Leder, MBBS, FRACP, PhD, MPH, DTMH
Section Editor
Peter F Weller, MD, MACP
Deputy Editor
Elinor L Baron, MD, DTMH


International travelers are frequently at risk of exposure to infectious pathogens and should seek advice about immunizations and other necessary prophylaxis prior to departure [1]. In preparation for a trip, individuals should arrange a pretravel consultation with either a specialized travel clinic or a primary care practice with expertise in travel medicine [2]. The traveler should come to the visits with a record of prior immunizations and an itinerary.

Immunization needs are based on the traveler's prior immunizations, health conditions, and likely exposures while traveling (table 1). Those exposures depend upon the countries and regions to be visited and on the nature of potential exposures to infectious agents. For example, travelers with short-term tourism itineraries may have different requirements from those with longer-term occupational exposures. A pretravel consultation enables updating of routine immunizations to protect against illness due to infections for which there is an increased risk of exposure during travel (such as diphtheria, measles, and varicella) [3,4].

Information on the indications, dosing, side effects, timing, and contraindications for immunizations in travelers are provided by the Centers for Disease Control and Prevention (CDC) in a second-yearly publication, Health Information for International Travel [5], with ongoing updates in an online version. The World Health Organization (WHO) also has online information [6]. Information may be found on the CDC website and the WHO website. Guidance may also be found via GlobalTravEpiNet (GTEN), which has web-based tools for providers and patients based on CDC recommendations.

Issues related to immunizations for travelers are reviewed here. Other travel-related medical issues and measures to prevent malaria are discussed separately. (See "Travel advice" and "Prevention of malaria infection in travelers".)


A standard immunization form should be part of the patient's medical record. Details to be recorded include vaccine type, dose, date of administration, manufacturer, lot number, and site of administration [7]. It is also important to document if a patient declines to receive any recommended vaccine.


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: May 2017. | This topic last updated: May 23, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Freedman DO, Chen LH, Kozarsky PE. Medical Considerations before International Travel. N Engl J Med 2016; 375:247.
  2. International Society of Travel Medicine http://www.istm.org/ (Accessed on March 30, 2011).
  3. General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). 2011. http://www.cdc.gov/mmwr/PDF/rr/rr6002.pdf?source=govdelivery (Accessed on January 27, 2011).
  4. Kroger AT, Duchin J, Vázquez M. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html (Accessed on April 27, 2017).
  5. Centers for Disease Control and Prevention. Health Information for International Travel 2018: The Yellow Book. https://wwwnc.cdc.gov/travel/page/yellowbook-home (Accessed on June 20, 2017).
  6. World Health Organization: International Travel and Health www.who.int/ith (Accessed on January 26, 2011).
  7. Hill DR, Ericsson CD, Pearson RD, et al. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1499.
  8. CDC. Health information for international travel 2011-2012. DHHS, Atlanta, GA 2011.
  9. Staples JE, Gershman M, Fischer M, Centers for Disease Control and Prevention (CDC). Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
  10. Centers for Disease Control and Prevention (CDC). Fatal yellow fever in a traveler returning from Venezuela, 1999. MMWR Morb Mortal Wkly Rep 2000; 49:303.
  11. Centers for Disease Control and Prevention (CDC). Fatal yellow fever in a traveler returning from Amazonas, Brazil, 2002. MMWR Morb Mortal Wkly Rep 2002; 51:324.
  12. Colebunders R, Mariage JL, Coche JC, et al. A Belgian traveler who acquired yellow fever in the Gambia. Clin Infect Dis 2002; 35:e113.
  13. US Government Printing Office (GPO) telephone (866-512-1800); online at http://bookstore.gpo.gov/collections/vaccination.jsp (Accessed March 13, 2008).
  14. World Health Organization. International Health Regulations http://www.who.int/ihr/en/.
  15. Vaccines and vaccination against yellow fever. WHO position paper -- June 2013. Wkly Epidemiol Rec 2013; 88:269.
  16. Gotuzzo E, Yactayo S, Córdova E. Efficacy and duration of immunity after yellow fever vaccination: systematic review on the need for a booster every 10 years. Am J Trop Med Hyg 2013; 89:434.
  17. Patel D, Simons H. Yellow fever vaccination: is one dose always enough? Travel Med Infect Dis 2013; 11:266.
  18. Grobusch MP, Goorhuis A, Wieten RW, et al. Yellow fever revaccination guidelines change - a decision too feverish? Clin Microbiol Infect 2013; 19:885.
  19. Centers for Disease Control and Prevention: Travelers' Health http://wwwnc.cdc.gov/travel/content/diseases.aspx (Accessed on January 06, 2011).
  20. Marfin AA, Eidex RS, Kozarsky PE, Cetron MS. Yellow fever and Japanese encephalitis vaccines: indications and complications. Infect Dis Clin North Am 2005; 19:151.
  21. Lindsey NP, Rabe IB, Miller ER, et al. Adverse event reports following yellow fever vaccination, 2007-13. J Travel Med 2016; 23.
  22. Mosimann B, Stoll B, Francillon C, Pécoud A. Yellow fever vaccine and egg allergy. J Allergy Clin Immunol 1995; 95:1064.
  23. Centers for Disease Control and Prevention. Search for Yellow Fever Vaccination Clinics. https://wwwnc.cdc.gov/travel/yellow-fever-vaccination-clinics/search (Accessed on May 19, 2017).
  24. Jackson BR, Iqbal S, Mahon B, Centers for Disease Control and Prevention (CDC). Updated recommendations for the use of typhoid vaccine--Advisory Committee on Immunization Practices, United States, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:305.
  25. Kaplan DT, Hill DR. Compliance with live, oral Ty21a typhoid vaccine. JAMA 1992; 267:1074.
  26. http://www.bernaproducts.com/v_faq/#6.
  27. Faucher JF, Binder R, Missinou MA, et al. Efficacy of atovaquone/proguanil for malaria prophylaxis in children and its effect on the immunogenicity of live oral typhoid and cholera vaccines. Clin Infect Dis 2002; 35:1147.
  28. Mutsch M, Spicher VM, Gut C, Steffen R. Hepatitis A virus infections in travelers, 1988-2004. Clin Infect Dis 2006; 42:490.
  29. Arslan M, Wiesner RH, Poterucha JJ, Zein NN. Safety and efficacy of hepatitis A vaccination in liver transplantation recipients. Transplantation 2001; 72:272.
  30. Wallace MR, Brandt CJ, Earhart KC, et al. Safety and immunogenicity of an inactivated hepatitis A vaccine among HIV-infected subjects. Clin Infect Dis 2004; 39:1207.
  31. Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2007; 56:1080.
  32. Tayal SC, Sankar KN. Impaired response to recombinant hepatitis B vaccine in asymptomatic HIV-infected individuals. AIDS 1994; 8:558.
  33. Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2008; 57:1.
  34. http://www.tga.gov.au/pmeds/auspar/auspar-imojev.pdf (Accessed on March 21, 2011).
  35. Fischer M, Lindsey N, Staples JE, et al. Japanese encephalitis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1.
  36. Jelinek T, Burchard GD, Dieckmann S, et al. Short-Term Immunogenicity and Safety of an Accelerated Pre-Exposure Prophylaxis Regimen With Japanese Encephalitis Vaccine in Combination With a Rabies Vaccine: A Phase III, Multicenter, Observer-Blind Study. J Travel Med 2015; 22:225.
  37. Centers for Disease Control and Prevention (CDC). Use of Japanese encephalitis vaccine in children: recommendations of the advisory committee on immunization practices, 2013. MMWR Morb Mortal Wkly Rep 2013; 62:898.
  38. Paulke-Korinek M, Kollaritsch H, Kundi M, et al. Persistence of antibodies six years after booster vaccination with inactivated vaccine against Japanese encephalitis. Vaccine 2015; 33:3600.
  39. Erra EO, Askling HH, Rombo L, et al. A single dose of vero cell-derived Japanese encephalitis (JE) vaccine (Ixiaro) effectively boosts immunity in travelers primed with mouse brain-derived JE vaccines. Clin Infect Dis 2012; 55:825.
  40. Mahon BE, Mintz ED, Greene KD, et al. Reported cholera in the United States, 1992-1994: a reflection of global changes in cholera epidemiology. JAMA 1996; 276:307.
  41. Weber JT, Levine WC, Hopkins DP, Tauxe RV. Cholera in the United States, 1965-1991. Risks at home and abroad. Arch Intern Med 1994; 154:551.
  42. Centers for Disease Control and Prevention (CDC). Update on cholera --- Haiti, Dominican Republic, and Florida, 2010. MMWR Morb Mortal Wkly Rep 2010; 59:1637.
  43. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm506305.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Accessed on June 13, 2016).
  44. Wong KK, Burdette E, Mahon BE, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine. MMWR Morb Mortal Wkly Rep 2017; 66:482.
  45. Centers for Disease Control and Prevention (CDC). Tick-borne encephalitis among U.S. travelers to Europe and Asia - 2000-2009. MMWR Morb Mortal Wkly Rep 2010; 59:335.
  46. Leder K, Sundararajan V, Weld L, et al. Respiratory tract infections in travelers: a review of the GeoSentinel surveillance network. Clin Infect Dis 2003; 36:399.
  47. Fiore AE, Fry A, Shay D, et al. Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
  48. Uyeki TM, Zane SB, Bodnar UR, et al. Large summertime influenza A outbreak among tourists in Alaska and the Yukon Territory. Clin Infect Dis 2003; 36:1095.
  49. Miller JM, Tam TW, Maloney S, et al. Cruise ships: high-risk passengers and the global spread of new influenza viruses. Clin Infect Dis 2000; 31:433.
  50. Ferson M, Paraskevopoulos P, Hatzi S, et al. Presumptive summer influenza A: an outbreak on a trans-Tasman cruise. Commun Dis Intell 2000; 24:45.
  51. Centers for Disease Control and Prevention (CDC). Influenza B virus outbreak on a cruise ship--Northern Europe, 2000. MMWR Morb Mortal Wkly Rep 2001; 50:137.
  52. Christenson B, Lidin-Janson G, Kallings I. Outbreak of respiratory illness on board a ship cruising to ports in southern Europe and northern Africa. J Infect 1987; 14:247.
  53. Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009; 58:1.
  54. Hyle EP, Rao SR, Jentes ES, et al. Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations. Ann Intern Med 2017.
  55. Vitek CR, Redd SC, Redd SB, Hadler SC. Trends in importation of measles to the United States, 1986-1994. JAMA 1997; 277:1952.
  56. Amornkul PN, Takahashi H, Bogard AK, et al. Low risk of measles transmission after exposure on an international airline flight. J Infect Dis 2004; 189 Suppl 1:S81.