Far-Off Adventures – Vaccination and Foreign Travel

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The time has finally arrived for the highly anticipated trip out of the country. The plans began long ago: airplane tickets, hotel reservations, rental car, sightseeing plans. The bags are being pulled from the attic to be packed, and the excitement mounts with each passing day. Everything is a go.

But wait–what about vaccines?

Is this one more preparation that needs to be added to the “To Do” list? Traveling out of the country can feel like a venture to another planet. Pictures of exotic destinations coupled with new, curious foods dance off the pages of the travel brochures. Anticipating the unexpected can be a challenge for even the most seasoned traveler. However, traveling with children adds an extra dimension to the anxiety-the thought of your child becoming ill in a foreign country is extremely frightening. Your doctor is recommending a variety of vaccines. Are they necessary? How do you evaluate the risks?

Hepatitis B is a viral infection that is spread through contact with blood. In the US, Hepatitis B is primarily found in adults, and is spread through intimate contact or through sharing needles used with illicit drugs. Hepatitis B is more common in the general population in East and Southeast Asia and in Sub-Saharan Africa. Still, the risk of long-term complications is much less than we are generally led to believe. More than 95 percent of those who contract Hepatitis B fully recover, and an infection will result in lifetime immunity for that person. Unless you plan to spend extended periods in close contact with infected persons, the risks of contracting Hepatitis B while traveling is extremely small.

Polio is an infectious disease caused by a virus that attacks the nervous system. The disease is seen primarily in children under five years of age; the initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. Paralysis results in approximately 1 to 2 percent of children who contract the viral infection, though the vast majority recovers completely from this paralysis. A few, however, go on to have permanent, lifetime disability.

Polio is nearly eradicated. Once common throughout the undeveloped world, as of February, 2006, only four countries still report isolated outbreaks: Nigeria, India, Pakistan and Afghanistan. In addition, there have been no cases of wild polio in the Western Hemisphere since 1991.

Polio vaccination of children continues in the US, with 5 doses given prior to entering school, (1) reasoning that until polio is completely eradicated entirely, the risk of reintroducing polio into this country is “only a plane ride away.” However, an examination of the data reveals only six cases of imported polio documented between 1980 and 1998, the last in New York City in 1993. (2) The risk for contracting polio at home is negligible; the risks overseas are nearly the same.

Tetanus is an acute, spastic paralytic illness caused by a toxin released from the bacterium Clostridium tetani. The bacterium is found in soils and animal feces throughout the world. Neonatal tetanus is the most deadly and the type most often pictured in textbook cases of tetanus. However, the vast majority of these cases occur following childbirth and the use of unsterile equipment to cut the umbilical cord. While other forms of tetanus are a serious disease, recovery is the norm. In other words, tetanus is not a uniformly fatal disease. If you are traveling to remote areas, such as the backpacking in areas without medical care and without clean water, you may want to give careful consideration to your tetanus status.

However a word of caution: A tetanus shot does not guarantee protection. In a study published by the CDC (Centers for Disease Control) in 1997, 13% of people who contracted tetanus had four or more tetanus shots.(3) Your best protection against tetanus is to thoroughly clean the wound with copious amounts of warm, soapy water, and to encourage the injury to bleed profusely for a few minutes. Apply hydrogen peroxide to clean your wound, followed by a topical antibiotic ointment such as Neosporin.


When traveling overseas, it is possible to encounter some illnesses not generally seen in the US. The Centers for Disease Control lists the following infections as possible concerns for anyone traveling to any destination around the globe:

Typhoid Fever, an acute, febrile illness caused by the bacterium Salmonella typhi, is characterized by fever, headache, and enlargement of the spleen. The greatest risk is for travelers to the Indian subcontinent and to developing countries in Asia, Africa, and Central and South America who will have prolonged exposure to potentially unrefrigerated foods.

Yellow Fever is a mosquito-borne viral illness that can vary in severity from a flu-like syndrome to severe hepatitis and hemorrhagic fever. The disease occurs only in sub-Saharan Africa and rural, tropical South America.

Japanese Encephalitis, another mosquito-borne viral infection, is found throughout Asia, particularly in rural or agricultural areas of the temperate regions of China, Japan, Korea, and eastern Russia. The risk to short-term travelers to cities is very low.

For all of these potential infections, it is important to obtain a natural mosquito repellant, one that is free of DEET, the toxic additive found in most insect repellants. , made by Royal Neem. It is free of chemicals and contains many natural ingredients.

Hepatitis A is a viral disease that has an onset of fever and diarrhea, followed within a few days by jaundice (turning yellow). The disease ranges in clinical severity from no symptoms to a mild illness lasting one to two weeks. Although endemic throughout the world, Hepatitis A can be prevented by carefully following the hygiene and following a few food recommendations :

1. Eat only cooked foods hot to the touch. Avoid eating food from street vendors.

2. Avoid eating raw fruits and vegetables unless you peel them yourself.

3. Drink only “safe” beverages: sealed bottled water, hot tea, coffee, beer, wine, and boiled water; avoid drinking beverages with ice.

5. Avoid eating raw or undercooked meat and seafood (hepatitis risk).

6. Avoid all tap water, and be careful of getting shower water in your mouth. When dining in restaurants, ask whether the salad greens have been washed in boiled, distilled or bottled water.

7. Avoid milk and dairy products of unknown refrigeration standards.


Although the CDC recommends that all travelers obtain vaccines when traveling abroad, it is important to realize that, with one exception, no vaccine is required before you travel anywhere in the world: they are only “recommended.” You will not be required to have a vaccination record to enter a country, nor will you be required to obtain vaccines to return home. The sole exception is the Yellow Fever vaccine, which may be required if you travel to or from a South American or African country infected with Yellow Fever. The recommendations can vary from country to country; if such a destination is part of your travel plans, you should look up the Yellow Fever requirements for that specific country. (4)

I have been a globe-trotter for most of my adult life. In the past 25 years, I have had the good fortune to have traveled to more than 40 countries. I have never been asked for a vaccine record, nor have I ever felt the need for any vaccines, even when traveling to remote, exotic destinations.

Final advice? Remember to pack your passport, sunglasses and favorite book. Have fun and don’t risk getting sick before you go from multiple vaccinations.



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