Travel Vaccinations: The Complete Guide to Staying Healthy Abroad

Introduction

Whether you're planning a relaxing beach holiday, a backpacking adventure through Asia, a safari in Africa or travelling for business, preparing for your trip involves more than booking flights and packing your suitcase.

Many destinations around the world have health risks that are uncommon in the UK. Diseases such as hepatitis A, typhoid, rabies and yellow fever remain common in some countries, while malaria continues to affect travellers every year.

Fortunately, many travel-related illnesses are preventable through a combination of travel vaccinations, malaria prevention, insect bite avoidance and personalised travel health advice.

At Wallis Jones Pharmacy, our pharmacist-led travel clinic provides tailored travel health consultations based on your destination, medical history, planned activities and previous vaccination history.

Why Travel Health Matters

There is no single set of travel vaccinations that suits everybody. The advice appropriate for one traveller may be very different from the advice appropriate for another travelling to the same country.

Travel health recommendations usually depend on a combination of factors:

• The country you are visiting
• The specific regions within that country
• How long you are staying
• The season and time of year
• The type of accommodation you are using
• Your planned activities
• Any medical conditions you have
• Whether you are pregnant or breastfeeding
• Your previous vaccination history

When to Book

Ideally, travellers should arrange a travel health consultation approximately four to six weeks before departure. This allows time for vaccines to become effective and for multi-dose courses to be completed where necessary.

Some vaccines are given as a course of two or more doses over several weeks, and antimalarial tablets may need to be started before you travel, so earlier appointments give the most flexibility.

Your Travel Consultation

A travel health consultation is a structured conversation about your trip and your health. It helps the pharmacist build an accurate picture of your individual risk before making any recommendations.

We'll then carry out an individual travel health risk assessment and recommend appropriate vaccinations, malaria prevention and other precautions for your trip.

Travel Vaccine Overview

The vaccines below are among those most commonly discussed in UK travel clinics. Which of them, if any, are appropriate for you is decided during your consultation. Select a vaccine to jump to the relevant section.

Hepatitis A

What is hepatitis A?

Hepatitis A is a highly infectious viral infection that affects the liver. It is usually spread through contaminated food or water, or through close contact with someone who is already infected.

Where is it found?

Hepatitis A occurs worldwide, but risk is generally higher in areas where sanitation and food hygiene standards may be poor, including:

• The Indian subcontinent
• Sub-Saharan Africa
• North Africa
• Parts of the Far East
• South and Central America
• The Middle East

Who may be at greater risk?

• Travellers staying with local populations, or visiting friends and relatives
• Frequent travellers
• Long-stay travellers
• Travellers going where sanitation and food hygiene may be poor
• Certain people with existing liver disease
• People who may be exposed through their occupation
• Travellers to outbreak areas with limited access to safe water and healthcare

Symptoms

• Fever
• Loss of appetite
• Nausea
• Malaise (a general feeling of being unwell)
• Jaundice (yellowing of the skin and eyes)

Illness tends to become more serious with increasing age, and recovery may take weeks or months.

Prevention

Careful food and water hygiene remains important for all travellers. Vaccination is often discussed alongside these precautions rather than instead of them.

How long does protection last?

A completed hepatitis A vaccination course can be expected to provide protection for at least 25 years, and probably longer. Current UK guidance may recommend a booster at 25 years for people with ongoing risk.

Hepatitis B

Hepatitis B is a viral infection of the liver that is transmitted through infected blood and body fluids.

Prevention

• Practising safer sex, including using condoms
• Ensuring sterile equipment is used for any medical, dental, tattooing or piercing procedure
• Avoiding sharing needles, syringes or other injecting equipment
• Avoiding sharing razors, toothbrushes or other items that may be contaminated with blood
• Taking appropriate precautions around any exposure to blood or body fluids

Hepatitis B vaccines can be given alone, or in certain combination vaccines, depending on what is clinically appropriate for you.

Typhoid

Typhoid fever is caused by the bacterium Salmonella Typhi and is usually acquired through contaminated food or water. Globally, disease occurs particularly in areas where sanitation and access to clean drinking water are limited.

Many travel-associated cases reported in the UK occur among people visiting friends and relatives in India, Pakistan and Bangladesh.

Symptoms

• Fever
• Headache
• Muscle and joint pain
• Constipation or diarrhoea
• Rash

Complications can include intestinal bleeding and perforation, so medical assessment is important if you become unwell during or after travel.

Rabies

Rabies is a viral infection transmitted through the saliva of an infected animal. Exposure usually happens through:

• A bite
• A scratch
• Saliva contacting broken skin
• Saliva contacting the eyes, nose or mouth

Pre-exposure vaccination

Pre-exposure rabies vaccination usually involves 3 doses given on days 0, 7 and 21 or 28. Alternative licensed schedules may apply depending on the vaccine, your age and your circumstances.

Protection is long-lasting, but the need for further vaccination or monitoring depends on your ongoing exposure risk.

Who should particularly consider pre-travel vaccination?

• Long-stay travellers
• Travellers to remote areas
• People with limited access to medical care while away
• Animal workers
• Cyclists
• Runners
• Travellers undertaking activities that increase animal exposure

Yellow Fever

Yellow fever is a viral infection transmitted predominantly by certain day-biting mosquitoes. Risk exists in parts of Africa, South America, Central America and Trinidad.

Whether there is a meaningful risk for you depends on:

• Your destination
• The intensity of transmission in that area
• The season
• The duration of your stay
• Your planned activities
• Your vaccination status

International Certificate of Vaccination or Prophylaxis (ICVP)

Important yellow fever safety information

Yellow fever vaccine is a live vaccine and requires an individual clinical risk assessment. It is not the case that everyone travelling to a country with yellow fever risk should be vaccinated.

Yellow fever vaccination is given using a live vaccine such as Stamaril®. Before vaccination, the healthcare professional will carry out an individual risk assessment, because the vaccine is not suitable for everyone.

Special consideration, additional precautions or contraindications can apply to:

• People who are immunocompromised
• Very young infants
• Pregnancy
• Breastfeeding
• People aged 60 and over
• People with certain thymus disorders
• People who have had a previous severe vaccine reaction

Your pharmacist will assess suitability individually and discuss the options available for your itinerary, including certificate requirements and, where appropriate, referral.

Japanese Encephalitis

Japanese encephalitis (JE) is transmitted by mosquitoes in parts of Asia and the Western Pacific. For most short-term urban travellers, the risk is very low.

When can risk increase?

• Long stays
• Rural travel
• Rice-growing and irrigated farming areas
• Outdoor activities
• Camping
• Fieldwork
• Significant evening and night-time exposure

Although infection is uncommon in travellers, symptomatic encephalitis can be severe. IXIARO® is the vaccine licensed in the UK, and whether it is recommended depends on your individual exposure risk.

The standard adult schedule is generally 2 doses given on day 0 and day 28. An accelerated schedule of day 0 and day 7 may be available for eligible adults when travel is imminent, but it is not the standard schedule for everyone. Booster requirements depend on your ongoing exposure risk.

Tetanus

Tetanus bacteria are present in soil around the world, and infection can occur when contaminated material enters a wound.

Higher-risk wounds

• Animal bites
• Burns
• Puncture wounds
• Wounds contaminated with soil
• Wounds containing foreign bodies
• Open fractures

All travellers should make sure their routine UK vaccination schedule is up to date before departure.

For travel to areas where medical facilities may be limited, a booster may sometimes be recommended when the last tetanus-containing vaccine was given more than 10 years ago.

Tick-Borne Encephalitis

Tick-borne encephalitis (TBE) is transmitted mainly by infected ticks and occurs in parts of central, northern and eastern Europe, Siberia and parts of Asia.

Tick prevention

• Cover exposed skin with long sleeves and trousers
• Use an effective insect repellent
• Check yourself, children and clothing for ticks regularly
• Remove ticks promptly using appropriate tweezers or a tick remover
• Avoid unpasteurised dairy products in risk areas

Where vaccination is appropriate, TBE vaccines are given as a 3-dose primary course; the timing of doses, and whether an accelerated schedule can be used, depend on the vaccine used. Booster timing depends on your age, the vaccine given and your ongoing risk. Vaccination is considered as part of your individual risk assessment.

Malaria

Malaria prevention: remember ABCD

Malaria is a potentially serious parasitic infection transmitted through the bites of infected mosquitoes. It occurs in parts of Africa, Asia, Central and South America, the Caribbean, the Middle East and some Pacific islands.

Chemoprophylaxis: choosing the right malaria tablet

There is no single malaria tablet that suits every traveller. The most appropriate option is decided during a consultation, and depends on a combination of factors:

• The country you are travelling to
• The exact area or region within that country, and whether it is urban or rural
• How long you will be in the malaria-risk area
• Your medical history, including any liver, kidney, mental health or heart conditions
• Your current medicines, because some interact with antimalarials
• Pregnancy, planned pregnancy or breastfeeding where relevant
• Any previous side effects or difficulty tolerating a particular antimalarial
• Known drug-resistance patterns and current UK travel health guidance

Tablets also differ in when they must be started, how often they are taken and how long they must be continued after leaving the risk area — so the practicalities of your trip matter too.

Common Malaria Prevention Tablets

• Atovaquone/proguanil is generally well tolerated; possible effects include stomach upset, nausea, headache or mouth ulcers, and suitability depends on factors such as kidney function.
• Doxycycline may cause gastrointestinal irritation and increased sensitivity to sunlight; take with plenty of water and not immediately before lying down.
• Mefloquine may cause dizziness, sleep disturbance or vivid dreams, and has important neuropsychiatric contraindications and precautions.

Antimalarial tablets are prescription-only medicines. No single antimalarial is "best" for everyone, and this page is not intended to help you choose a medicine yourself. Choice depends on your destination and the specific area, season, length of stay, accommodation, activities, medical history, current medicines, pregnancy or breastfeeding where relevant, and any contraindications or interactions. This information is for general guidance only and is not a substitute for an individual travel-health assessment.

Altitude Sickness

Altitude illness usually becomes a concern when travelling above approximately 2,500 metres (8,200 feet). It can affect fit, healthy people and is related to how quickly you ascend rather than how fit you are.

Acute Mountain Sickness (AMS)

• Headache
• Nausea
• Loss of appetite
• Dizziness
• Fatigue
• Sleep disturbance

High Altitude Cerebral Oedema (HACE)

• Confusion
• Altered consciousness
• Poor coordination

High Altitude Pulmonary Oedema (HAPE)

• Increasing breathlessness
• Cough
• Chest tightness
• Difficulty breathing when lying flat
• Blood-tinged sputum

Golden rules of altitude

• Ascend gradually
• Allow time to acclimatise
• Never ascend to sleep higher when experiencing symptoms
• Descend if symptoms worsen
• Never leave someone with altitude illness alone
• Ensure travel insurance covers your maximum planned altitude and emergency evacuation

Above approximately 3,000 metres, sleeping elevation should generally not increase by more than around 500 metres per day, with appropriate acclimatisation days built into your itinerary.

Acetazolamide may be considered for prevention or treatment in appropriate travellers following individual clinical assessment. It is not suitable for everyone, and medication does not replace a sensible, gradual ascent profile.

Food & Water Safety

Food and water precautions remain important even after vaccination, because vaccines do not cover every food and water-borne infection. Diseases such as hepatitis A and typhoid can be transmitted through contaminated food and water.

• Wash your hands regularly, especially before eating
• Use safe drinking water — bottled, boiled or appropriately treated
• Be cautious with ice where water safety is uncertain
• Choose food that is freshly prepared and thoroughly cooked
• Be cautious with raw or undercooked food, including shellfish
• Peel fruit yourself where appropriate
• Maintain good general food hygiene

Insect Bite Prevention

Insects can transmit a number of infections, including malaria, yellow fever, Japanese encephalitis, tick-borne encephalitis and other vector-borne diseases such as dengue for which no vaccine may be routinely available to travellers.

• Use an effective insect repellent and reapply as directed
• Wear loose-fitting clothing that covers exposed skin
• Use mosquito nets, ideally insecticide-treated, where appropriate
• Take appropriate accommodation precautions such as screens and air conditioning
• Carry out regular tick checks after outdoor activity
• Remove ticks promptly and correctly

Insect repellents: DEET

DEET-containing repellents are widely recommended for travellers, and a 50% product is commonly used. Always follow the individual product's instructions, including age restrictions, use in pregnancy or breastfeeding, and how the product should be applied and reapplied. If you're also using sunscreen, apply sunscreen first and the repellent afterwards.

• A 50% DEET-based repellent is commonly recommended for travellers to higher-risk areas
• Increasing the concentration above 50% does not meaningfully increase the duration of protection
• Age suitability varies between products — check the label before use in infants and young children
• Many DEET products can be used during pregnancy and breastfeeding when used as directed; when breastfeeding, wash your hands and breast tissue before feeding or handling your baby so the infant does not ingest it. Check the individual product's instructions
• DEET can be applied to clothing as well as exposed skin, but it may damage some synthetic materials or fibres
• Reapply according to the manufacturer's instructions, particularly after swimming, heavy sweating or washing

Take care around plastics and synthetic materials — DEET can damage items such as sunglasses, watch straps, camera equipment and some synthetic fabrics.

Alternatives to DEET

If DEET is not tolerated or preferred, a repellent containing approximately 20% picaridin (also known as icaridin) can be considered as an effective alternative. DEET is usually the first choice for higher-risk areas, with picaridin/icaridin a well-regarded alternative. Follow the instructions for the specific product you use.

Insect Repellent Comparison

Clothing and other bite-prevention measures

Repellent works best alongside a few simple habits. These measures reduce bites overall, but clothing choices alone should not be relied on for protection.

• Wear loose-fitting clothing
• Cover your arms and legs where practical, especially at dawn and dusk
• Consider lighter-coloured clothing, as darker colours can be more attractive to some mosquitoes
• Apply repellent to any exposed skin, and reapply as directed
• Use mosquito nets, ideally insecticide-treated, where appropriate

Travellers' Diarrhoea

Travellers' diarrhoea is one of the most common illnesses affecting travellers and is usually associated with contaminated food or water. It most often occurs in the first week of a trip and is generally short-lived.

Traveller's Diarrhoea – Risk Areas

Traveller's diarrhoea can occur worldwide, but the risk is generally higher in countries where food hygiene standards are lower, sanitation facilities are inadequate and access to clean water is limited.

Risk varies between countries and regions, and can also vary depending on accommodation, activities, season and local food and water hygiene. Individual travel plans should therefore be considered when assessing the risk of traveller's diarrhoea.

Most episodes are self-limiting and settle without specific treatment, but maintaining hydration is particularly important — especially in hot climates, and for young children and older travellers. Food and water precautions should be tailored to your destination.

What About Travel Probiotics?

Some travellers choose to use probiotic products before or during travel. The evidence for preventing travellers' diarrhoea is mixed, so probiotics are best viewed as an optional extra rather than a reliable preventive measure.

They should never replace food hygiene, safe drinking water, hand washing or appropriate medical advice. If you would like to discuss whether a probiotic is suitable for you, our pharmacy team is happy to talk it through as part of your travel consultation.

Do I Need Standby Antibiotics?

Antibiotics are not routinely required for every traveller, and most episodes of travellers' diarrhoea resolve with fluids alone. In selected circumstances, however, a clinician may consider supplying a standby antibiotic course for self-treatment.

Whether this is appropriate depends on your destination, how remote your travel is, your access to medical care, the length of your trip, your individual medical risk, previous history and your planned activities. The choice of antibiotic and the instructions for using it should be determined following an appropriate clinical assessment.

If a standby course is supplied, you should receive clear advice about when to start treatment, when not to take it, how to maintain hydration, the red-flag symptoms to watch for and when urgent medical assessment is needed.

Frequently Asked Questions