Growing up in North America, we have access to standard childhood vaccinations. They include diphtheria, tetanus, polio, pertussis (whooping cough), measles, mumps, rubella (German measles), Hib (Haemophilus influenza type B), varicella (chickenpox), and hepatitis B (for those born after 1982).
If you plan to take your children to countries with high risks of certain diseases, have them assessed by a travel doctor or nurse. Additional vaccinations may be needed, especially if children have not finished the routine series. Be aware that diseases like tetanus, polio and measles, common in less developed countries, can cause severe disability and deaths.
Meningitis: This specific travel vaccine protects against four different strains of bacteria. Those who plan to travel to Saudi Arabia for the Hajj and Umra, or to visit, will not be issued a visa without proof of this vaccination from a travel clinic. This vaccination must be repeated every three years.
Yellow fever: Mosquitoes can carry the virus for this disease. It causes illness in many countries in Africa and South America. The disease attacks the liver, causing severe jaundice (yellowing of the skin and whites of the eyes, hence the name yellow fever). The death rate from yellow fever is very high.
Some countries require proof of vaccination (a special certificate) in order to enter the country. Many countries free of yellow fever will refuse entry to an unvaccinated traveller coming from a country that has yellow fever. The vaccine and the official certificate are valid for ten years, after which the shot must be repeated and a new certificate issued. Yellow fever vaccine can be given to adults and children over nine months of age. However, in certain situations this vaccine should not be given. Yellow fever is a 'live' vaccine. It contains minute amounts of weakened virus that stimulate the blood to form protective antibodies. These antibodies will destroy any new yellow fever viruses a nasty little mosquito might inject.
The virus is made in cultures (or growing environments) that include egg protein. Those with a severe egg allergy cannot have it. It is not given to pregnant women, or to anyone with severe problems of the immune (defence) system, such as cancer patients. Rare but serious side effects from the vaccine have also been reported in people over the age of 60.
Some who are unable to take the vaccine must travel to countries requiring the certificate. In this case, an exemption letter can be given by a travel clinic designated as a yellow fever centre. The unvaccinated traveller must be aware, however, of the risk of getting the disease. Also note that customs officers at the country's border may choose not to accept the exemption letter and so refuse entry to the traveller.
Discuss your risks and options with a doctor or travel nurse at a yellow fever centre. Remember that to provide protection and for the certificate to be valid, this vaccine must be given at least ten days before entering the country at risk.
Where you go, for how long, and whether you plan to backpack through the jungle or stay in a five-star all-inclusive resort can all affect the length of this list. Since none of the vaccines (except oral typhoid) in this category are 'live,' they can generally be used in pregnancy and in children over the age of one or two.
Hepatitis A: From Calgary to Timbuktu, this is an extremely common virus even in all-inclusive resorts. Healthy carriers transmit the virus by handling food, water and ice cubes consumed by others. The illness can vary from mild and flu-like to severe with prolonged symptoms due to liver inflammation. Infected children often are not ill, but frequently spread the disease to others. This vaccine is a series of two shots - the first shot gives excellent protection for a year or more, while the additional shot gives lifelong immunity.
Hepatitis B: This serious disease can lead to death from liver failure or cancer. It is transmitted by contact with contaminated needles or body fluids. Transmission is similar to that of hepatitis C and HIV (AIDS), neither of which can be prevented by vaccinations. Once infected with hepatitis B, you may carry the virus forever.
Since many people consider hepatitis B a lifestyle disease, they do not feel they are at risk. However, you can become ill or injured and require medical or dental treatment in a place where no clean needles are available (yes, that happens). Physical or sexual assault in areas of the world where hepatitis B is common can also expose you to the disease. This vaccine is a series of three shots, with protection after the first two shots, and lifelong immunity after the third.
Twinrix: This is a combination of hepatitis A and B in one vaccine. It requires two shots for initial protection, and three for lifetime immunity.
Tetanus/diphtheria: This vaccine comes combined with protection for both diseases. Public Health routine immunizations keep children up to date with their last shot at age 14. This is the shot you receive if you step on a nail or have a dirty wound. This vaccine should be repeated every five to ten years, depending on the location and type of travel you are doing.
Typhoid: Salmonella bacteria cause this nasty disease. Like hepatitis A, it can be transmitted to food and water by a healthy carrier. Raw or inadequately cooked shellfish or water contaminated by sewage can also transmit the disease. The shot, which can be given to those over the age of two, provides protection for about three years. An oral 'live' vaccine is also available for those over age six, and provides protection for five years.
Polio: Protection from childhood polio vaccinations gradually lessens with age. This is not a concern in North America, since we no longer have the disease. However, polio is still a serious problem in some parts of Africa and Asia. For people travelling in these areas, a polio booster (by needle) is recommended. One booster, for people over the age of 18 years, is felt to provide lifetime immunity. A new requirement for travel to Saudi Arabia is proof of polio vaccination for all travellers ages 15 years and under.
Meningitis: Besides the requirement for travellers to Saudi Arabia (see Required Vaccines), the meningitis vaccine may be recommended in certain situations. In many African countries, meningitis outbreaks occur regularly during the dry season (December to June). It also breaks out periodically in other countries around the world. Vaccine protection lasts about three years.
Different bacteria cause disease in different areas. So, the meningitis shot you had as a teenager during an outbreak in Alberta will not protect you in Africa. A travel vaccine, which covers four different types of bacteria, is necessary if you are travelling to a risk area.
Influenza: Don't forget your flu shot! Flu season is November to May in the northern hemisphere, April to September in the southern hemisphere, and year round in the tropics. Remember, your biggest risk of getting the flu is while you spend hours in the airport and on planes. Since vaccines change every year, they must be taken annually for protection. No vaccine currently exists for avian influenza (bird flu). If you are travelling to risk areas you should consult a travel clinic for advice on personal protection.
Rabies: Any mammal, from bats to camels, can carry rabies. Most transmission in developing countries is from dogs - often wild, aggressive and running in packs. Untreated rabies is 100 per cent fatal. Anyone (including children) at high risk can get a series of three shots of pre-exposure vaccine. If an animal bite or scratch breaks the skin, seek immediate medical treatment. Those who have had pre-exposure vaccine will need two shots. Someone who has not had pre-exposure vaccine requires the full series of post-exposure treatment.
Japanese encephalitis: That pesky mosquito again! This virus causes severe inflammation of the brain, with a high risk of brain damage or death. It is not very common, but does occur seasonally in various parts of Asia. It is very rare in Japan, in spite of the name. The offending mosquito likes to breed in rice paddies and fish ponds in rural areas. The vaccine requires three shots, with boosters every three years for those at risk.
Dukoralª: Hooray - this one is not a needle! It is a two-dose oral vaccine that helps protect against cholera. Cholera is mainly an issue for aid workers in refugee camps. Dukoralª also provides three months of protection from traveller's diarrhea caused by E-coli bacteria. Since other bacteria can also cause traveller's diarrhea, the need for Dukoralª is assessed on an individual basis.
Malaria: This is mentioned here only because many people think there is a shot for malaria. Sorry, not yet. Protection from malaria requires pills. A travel health professional should be consulted to determine your risk and discuss the best medication.
Remember, you need to allow time to get immunizations done. Some vaccines require more than one shot and some require a specific period of time before travel to become effective. If you can, consult a travel clinic six to eight weeks before your trip. Some vaccine schedules can be accelerated if time is short. Still, 'better late than never' applies in this case. The travel clinic can advise you on how to stay safe if there is not enough time for the vaccine. No two trips are alike and no two travellers are alike. Protecting yourself is a vital part of planning your trip.