Planning a move abroad? Dr Sneh Khemka, Medical Director for Bupa International, gives us a brief guide to some of the most commonly required travel vaccinations and medicines for destinations around the world.
If you’re moving outside Western Europe, the United States or Australasia, you should consult a travel medicine clinic or medical practitioner at least four to eight weeks before you go, and preferably earlier if you’re planning long-term travel or overseas work.
If you need to travel at short notice, it’s still worth booking a travel medical consultation even as late as the day before you travel – some vaccinations can still be effective if given at this time.
If you regularly need to travel at short notice, consider booking a general check up with a medical practitioner or clinic, where you can have a review, discuss any possible future travel plans and have any necessary vaccinations.
Vaccines don’t offer total protection against diseases. You should still take the usual precautions to avoid disease – for example, taking measures to prevent mosquito bites in areas with malaria, and avoiding areas of poor sanitation.
Tetanus/ diphtheria/ polio
Tetanus, diphtheria and polio vaccines are given in most countries during childhood. However, you should check whether you are fully immunised and if you need to have a booster before you travel anywhere new. The vaccines can be given in combination or separately if needed as a booster.
Tetanus develops from infected wounds; you can get it in anywhere in the world if you don’t have adequate vaccination. You need to have boosters every 10 years to maintain immunity. If you’re moving to an area where access to medical treatment will be limited, it’s particularly important to check that your booster is up to date.
You should also have booster vaccines of diphtheria and polio if you’re moving to or working in an area where these diseases are prevalent. This includes some parts of Asia, Africa, South America, and Russia for diphtheria, and Africa, South Asia, Southeast Asia, and the Middle East for polio.
Malaria is transmitted by mosquitoes infected with the parasite, Plasmodium. You will need to take an antimalarial medicine before moving to any area where malaria is prevalent. This includes Sub-Saharan Africa, Central and South America, South East Asia and the Pacific islands (see map).
Some antimalarials are more appropriate for long-term use. If you’re staying in one of these areas for more than 6 months, it’s important to continue taking your antimalarial tablets, as you will continue to be at risk of the disease. However, if you have permanently moved to an area where malaria is endemic, you should seek specialist advice. It’s possible you may gradually build up some natural immunity against the disease.
Antimalarial medicines need to be started before travel. Most are best started one week before travel, while mefloquine needs to be started two to three weeks before. However, you can still begin the medicine one or two days before travel so it’s worth seeing a medical practitioner if you’re going at short notice. With most medicines, you will need to carry on taking them for four weeks after you have left the area. Antimalarial medicines aren’t 100 percent effective and you should always take measures to avoid getting bitten in the first place.
- Avoiding mosquito bites
- Use an insect repellent containing DEET on exposed skin or clothing
- Use mosquito nets when sleeping; nets treated with an insecticide such as permethrin are much more effective
- Spray sleeping areas with insecticide before sleeping; this can be combined with mosquito coils or vaporizers
- Wear long trousers, long-sleeved tops and appropriate footwear after dusk, to ensure skin is not exposed
- If staying in a hotel with air-conditioning, the above measures aren’t necessary while indoors
Hepatitis A is caused by infection of the liver with a virus. It can occur anywhere in the world, but is most common in developing countries. You should get a hepatitis A vaccination if you're moving anywhere outside Western Europe, North America or Australia.
You will need to have two doses of the vaccine – the first two weeks before you leave, and the second six to 12 months later.
Meningococcal meningitis is caused by bacteria passed either in droplets in the air or by direct contact with someone who has the illness.
High-risk countries for meningitis include areas around sub-Saharan Africa and Saudi Arabia. If you’re staying in a high risk county for a month or more, or you’re visiting a rural area in one of these countries, you’ll need a combination vaccination against the A, C, W and Y strains of meningitis.
You should have the combined vaccine two to three weeks before you plan to leave. Adults just need a single dose of the vaccine. However, you will need a booster every five years if you are at continued risk.
Typhoid is spread through contaminated water and is common throughout the developing world. You will need a vaccination if you're going to countries in Southern and South-East Asia, Central and South America, the Middle East and Africa. Getting vaccinated is especially important if you’re planning on staying in areas where sanitation and food hygiene is poor.
You can have the vaccine one week before leaving. Tablets to prevent against typhoid are also available.
The flavivirus which causes yellow fever is transmitted via infected mosquitoes.
If you're moving to, or living in a country in sub-Saharan Africa or some areas of South America, you will need to get a yellow fever vaccination. Some countries require you to show a certificate to prove you have been vaccinated before you can enter.
You should get the vaccine at least 10 days before you plan to travel. You will need to have a booster after 10 years if you are still at risk of yellow fever. The World Health Organisation (WHO) lists countries that have yellow fever vaccination requirements at www.who.int/ith/countries.
Hepatitis B is an infection of the liver caused by a virus.
Areas where this disease is most common include parts of Africa, most of Asia and parts of eastern Europe. The risk of getting this infection is usually low for travellers. However, you may need a vaccination if you’re moving to an area where the disease is common and you are carrying out certain activities that place you at higher risk – such as undertaking relief work, participating in contact sports, having unsafe sex and injecting medicines.
You may also need the vaccine if you’re planning to stay in an area with hepatitis B for a long time.
You will need three doses, over a period of five months. If you need to be vaccinated quickly you may be able to have the three doses over a shorter amount of time.
The flavivirus which causes Japanese encephalitis is spread by infected mosquitoes. It’s common in South East Asia and the Far East. You will need this vaccine if you’re going to live in one of these areas, or are planning to stay there during the transmission season.
You should generally have three doses over a period of one month to allow immunity to develop, although they can be given over a shorter time period if necessary. You will then need a booster every two to three years if you are at continued risk of Japanese encephalitis.
You may need to be monitored for 30 minutes after your vaccination as there is a risk of allergic reactions.
Cholera is caused by bacteria and is mainly found in areas where hygiene and sanitation aren’t very good. It is most common in developing countries, especially around India, Africa, the Far East and South America.
If you will be working in relief or disaster areas or are going to a place where there are cholera epidemics and medical care is limited, you may need to have a vaccine.
Two doses of vaccine are given, up to six weeks apart and the second dose must be given at least a week before departure. You will need to have a booster after two years.
The flavivirus which causes tick-borne encephalitis is usually spread by infected ticks. It is found in certain forested areas of Western Europe, Scandinavia, and countries of the former Soviet Union. You may need the vaccine if you’re going to live in one of these areas, but there is generally a low risk to travellers.
You will have three doses of the vaccine over a period of six to 15 months.
If you need more immediate protection you can have two doses, two weeks apart.
But remember, wherever you end up going, taking simple precautions and sensible planning well before you leave will keep you and your family well protected and safe.
Bupa International pioneered expatriate health insurance in 1971 and today is one of the world’s leading international health insurers, with over 800,000 customers in 190 countries. It offers groups and individuals living and working abroad a wide range of high quality and flexible plans, with access to a network of more than 5,500 hospitals and clinics around the world and a 24-hour, 365 days a year, multi-lingual helpline. The company is part of the leading international health and care group, Bupa.
For further information please call +44 (0)1273 322 069 or visit wwww.bupa-intl.com.