Wherever your journey takes you, whatever the purpose of your trip, information about the likely health risks at your destination – and how to reduce them – is an essential part of ensuring a successful and enjoyable holiday.
A specialist travel clinic is a good place to start, for a careful assessment of your previous vaccine protection and any additional vaccines you may need. Some destinations require proof of vaccination against dangerous endemic diseases, such as yellow fever, upon entry into the country, and some disease prevention regimens begin well before the day of departure. So it’s important to be aware of sensible precautions as you look ahead to your trip.
Here are the most common diseases travelers may encounter abroad, how and when to get vaccinated against them, and how to limit the risks of illness while on vacation.
In this guide:
Typhus
Risk areas: Africa, the Indian subcontinent, South and Southeast Asia and South America
Method of vaccination: Vaccine (injection or oral medication) every three years
When should you get vaccinated: At least one month before departure
What is typhoid?
Typhoid is caused by the salmonella bacteria, causing fever, diarrhea (or sometimes constipation) and potentially serious complications. Drug resistance can complicate its treatment.
What you need to know about the typhoid vaccine
It must be updated every three years. If you hate needles, an oral typhoid vaccine is available as an alternative.
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Hepatitis A
Risk areas: Africa, Asia, the Middle East and Central and South America
Method of vaccination: Injection
When can you get it: Two weeks before departure
What is hepatitis A?
Hepatitis A is a viral infection of the liver – and complications such as liver failure increase with age. The good news: Hepatitis A is now rare among travelers since vaccines became available in the 1990s.
What you need to know about the hepatitis A vaccine
Your first dose protects for a year; a second dose extends this to more than 20 years.
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Yellow fever
Risk areas: Sub-Saharan Africa, South America, Central America and Trinidad in the Caribbean.
Method of vaccination: Injection
When can you get it: More than 10 days before departure
What is yellow fever?
Yellow fever is a viral infection spread by mosquitoes in Africa and Latin America. Although the virus is named for the yellowing caused by liver failure and jaundice, it attacks every system of the body. It occurs in sudden, unpredictable outbreaks, alternating with inactivity.
What you need to know about the yellow fever vaccine
The vaccine is only given in officially recognized vaccination centers. It contains a live, weakened virus that may cause harmful effects in older age groups or in people with various pre-existing medical conditions. A careful risk assessment is therefore essential. Vaccination certificates against yellow fever are valid for life, but only become valid 10 days after vaccination. Some experts recommend booster doses after 10 years for people at high ongoing risk.
Expert tip: Countries with mosquitoes that can spread yellow fever often require travelers coming from yellow fever areas to show proof of vaccination as a condition of entry – to avoid spreading the disease – so check the requirements carefully.
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Rabies
Risk areas: Asia, Africa and Central and South America
Method of vaccination: Three injections for vaccination before travel
When can you get it: At least eight weeks before departure
What is rabies?
Rabies is a fatal viral infection of the brain and nervous system. All bites, licks and scratches by dogs (or other mammals, including monkeys, cats and bats) should be treated as a potential risk of rabies. Rabies occurs in most countries and animal bites are among the most common reasons travelers need medical care abroad.
What you need to know about the rabies vaccine
Ideally, three doses of vaccines are required, spread over three weeks. Vaccination before travel greatly simplifies the action needed if you are bitten while on vacation: cleaning the wound to prevent infection and promote healing, and booster vaccine doses as soon as possible.
Without prior vaccination, the treatment is more complicated and urgent: an injection of rabies immune globulin (RIG) – a product containing antibodies that neutralize the rabies virus and often unavailable in countries with the highest risk – into the area of the bite. This treatment is followed by an accelerated course of vaccination, which can throw your travel schedule into chaos and revolves around medical appointments.
Expert tip: Never touch animals while traveling. Street dogs pose a particular danger: they are not pets, can be territorial and should not be approached. Docility can be a sign of rabies, and sick or injured animals should not be handled. And infamous ‘monkey temples’ should only be viewed from a distance.
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Malaria
Risk areas: Parts of Africa and Asia, Central and South America, the Dominican Republic and Haiti, parts of the Middle East and some islands in the Pacific Ocean
Method of vaccination: Tablets or capsules
When can you get it: Talk to a doctor four to six weeks before the trip
What is malaria?
Malaria parasites are transmitted by Anopheles mosquitoes. Symptoms include fever, chills, aching muscles and joints, headache, abdominal pain, diarrhea and jaundice. If left untreated, it can lead to decreased consciousness, coma and possibly death. The onset of symptoms can be delayed for weeks, causing the connection to travel to be forgotten. (Read more about rising cases of malaria in our guide to preventing the disease abroad.)
What you need to know about antimalarial treatments
Antimalarial tablets or capsules, of which Malarone and doxycycline are the most common, are usually taken once a day before, during and after travel.
Expert tip: If you feel unwell when you return home, always tell your doctor that you have been away so that he/she can perform appropriate tests for malaria.
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Dengue fever
Risk areas: Parts of Africa and Asia, Central and South America, the Caribbean, the Pacific Islands and some southern areas of North America. (However, dengue’s geographic range is expanding as warmer temperatures create more favorable conditions, with sporadic cases even in southern Europe.)
Method of vaccination: Vaccine injection (for high-risk travelers only)
When can you get it: If you are at high risk of disease, consult your doctor more than three months before your trip
What is dengue?
Dengue is the world’s most common mosquito-borne viral infection. Symptoms, also known as ‘bone fracture fever’, include rashes and pain in the muscles, joints and behind the eyes. There are four different tribes; infection with one strain provides only partial protection against future infection with another strain. Subsequent infections may be more serious.
What you need to know about the dengue vaccine
A dengue vaccine, administered in two doses, three months apart, has recently been approved in Britain; if this is impracticable, a starting dose provides 80 percent protection. Some experts are concerned about the possibility of an increased risk of future severe dengue and therefore recommend only vaccinating travelers with a previous dengue infection. So it’s best to talk to your GP or a travel health specialist if you have any concerns.
Expert tip: The best way to prevent dengue infection is to avoid mosquito bites.
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How to protect yourself during your travels
We all want our trips to be relaxing and worry-free: a proactive approach to health, prevention and your own safety is crucial to their success. Follow these tips to go on holiday safely.
Bite prevention
Protecting yourself from insect bites is a good way to prevent some of the diseases described above – as well as the nuisance of the bites themselves. In fact, careful insect precautions can reduce the number of bites by 90 percent or more: When used together, bite prevention measures, vaccines, and antimalarial drugs make a powerful combination.
When outdoors at times when mosquitoes bite, cover up and use repellents containing 50 percent DEET on clothing and exposed skin (repellants containing picaridin are also effective). Clothing can be sprayed with permethrin, which is safe for humans but a contact killer for insects. If you are sitting outside, burn mosquito coils to keep mosquitoes at bay. Indoors, in screened or air-conditioned rooms, use spray insecticides in combination with plug-in insect killers. If mosquitoes can enter your accommodation at night, sleep under a mosquito net provided with insecticide.
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Food and water hygiene
There is no polite way to say this: food, water and hands contaminated directly or indirectly with feces spread diarrheal diseases, viruses, parasites, bacteria and their toxins. The risk increases with high temperatures and poor hygiene, and it can be especially difficult to avoid if you’re not on your guard (on a recent trip to the United States, my pride was seriously damaged by a bout of Shigella dysentery, back on an outbreak caused by contaminated guacamole – although tested and treated quickly).
Fresh, thoroughly cooked food, served hot, is safest. Remember to wash your hands regularly and use hand sanitizers or wipes. Buffets are – especially at warm temperatures and where flies are present – very risky; choose freshly cooked foods instead. Where hygiene is poor, avoid salads and raw foods.
A harsh but effective call for a warm climate: avoid ice in drinks and stick to bottled water. And to be prepared for the worst-case scenarios, it’s best to travel with a medical kit that includes diarrhea treatment, oral rehydration tablets, and antibiotics.
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Information to tell your doctor
The best way to ensure you are protected before traveling abroad is to talk to a doctor and share your upcoming itinerary and planned high-risk activities, such as animal encounters or wilderness excursions. Your GP can also help you identify any routine vaccinations that are required, such as measles, diphtheria, whooping cough, tetanus, polio and more everyday diseases such as Covid and flu.
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Where you can learn more
For more information, visit Travel Health Pro and Fit For Travel.
Dr. Richard Dawood is a travel medicine specialist at the Fleet Street Clinic