Additional vaccinations – may be recommended depending on your destination and travel plans

• Hepatitis A – Often recommended
• Hepatitis B – Particularly for longer stays
• Dengue – Vaccination may be considered for travel to risk areas
• Chikungunya – Vaccination may be considered for travel to risk areas
• Cholera – May be considered where hygiene and sanitation are poor
• Typhoid – May be considered where hygiene and sanitation are poor
• Japanese encephalitis – May be considered for longer stays in certain risk areas
• Meningococcal disease – May be relevant for certain types of travel involving close or crowded living conditions
• Influenza – Particularly important for people at increased risk of severe illness
• TBE – Risk in areas where infected ticks occur
• Tuberculosis – Mainly for longer stays or certain risk groups

Hepatitis A

is caused by a virus transmitted mainly through contaminated food or drink and causes inflammation of the liver. The risk is greatest in countries where water, food hygiene and sanitation standards are poorer. Vaccination is often recommended for travel to large parts of Africa, Asia, the Middle East, South America and Central America.
One dose of hepatitis A vaccine provides very good protection for at least one year. A further dose approximately one year later can be expected to provide protection for at least 40 years.
Young children rarely become seriously ill but can transmit the infection to others after returning home. Vaccination may therefore still be considered, particularly for children attending preschool or nursery.
If you are pregnant, it is particularly important to consider protection against hepatitis A when travelling to areas with a high risk of infection.

Hepatitis B

is transmitted through blood and sexual contact, but infection can also occur in connection with tattooing, piercing, ear piercing, surgical and dental procedures, blood transfusions and inadequately sterilised needles.
Vaccination is recommended particularly for longer stays or repeated travel to areas where hepatitis B is common. Healthcare workers should also be vaccinated.

Good protection is usually achieved after three doses, preferably given over a period of six months. If there is not enough time to give the first two doses well before departure, an accelerated schedule of three doses over 2–3 weeks may be used instead. In this case, a fourth dose should be given after one year. This additional dose also provides protection for future travel.

Dengue fever

is sometimes known as "breakbone fever" and is caused by a virus transmitted by mosquitoes that mainly bite during the daytime. Dengue has increased dramatically worldwide in recent years, and major outbreaks occur regularly in tropical and subtropical regions, including Southeast Asia, South America and the Caribbean.
Dengue is relatively common among travellers to tropical regions, although symptoms may also first appear shortly after returning home. Common symptoms include fever, headache, back, muscle and joint pain, rash and pain behind the eyes. The illness is usually self-limiting, with symptoms generally lasting a little over a week. In some cases, however, severe disease requiring hospital treatment can occur. The risk of severe disease may be greater with a subsequent dengue infection. Deaths occur in rare cases.
Protection against mosquito bites is therefore very important. Vaccination may be considered in some cases following an individual risk assessment.

Chikungunya

is a mosquito-borne viral disease that has caused major outbreaks in recent years in parts of Asia, Africa, the Indian Ocean region and South America.
The virus is transmitted by mosquitoes that often bite during the daytime, from early morning until late evening. Symptoms resemble those of dengue fever, with sudden onset of high fever, headache, muscle pain and joint pain. Some people also develop itching, skin rashes and minor bleeding. The disease is generally not life-threatening, but troublesome and persistent joint pain can affect around 30% of those infected, particularly older people. Complications such as inflammation of the brain or the membranes surrounding the brain can occur.
Important preventive measures include protection against insect bites and, in some cases, vaccination.

 

Cholera

is a bacterial infection that can cause severe diarrhoea and rapid dehydration. Infection occurs mainly through contaminated water and food in areas with poor sanitation and inadequate access to safe drinking water.
Large outbreaks occur repeatedly in parts of Africa and, periodically, in Asia, the Middle East, South America and Central America. The risk for most tourists is generally low but increases with basic accommodation, longer stays or travel to areas experiencing an ongoing outbreak.

Vaccination may be particularly considered for people who:

• have chronic intestinal disease
• have heart disease, kidney disease or diabetes
• have reduced stomach acidity or use acid-suppressing medication
• are planning a longer stay in areas with poor hygiene and sanitation
• are travelling to areas with an ongoing cholera outbreak

Even shorter trips to high-risk areas may sometimes justify vaccination, as an episode of diarrhoea can significantly affect a trip.
The vaccine is usually given as two doses at least one week apart. For the best protection, the final dose should be taken no later than one week before departure. Protection against cholera is good and can last for up to two years in adults, but only six months in children.
Good hand hygiene and care with food and drinking water remain the most important preventive measures.

Typhoid fever

is a serious intestinal infection caused by bacteria. It occurs mainly in Asia, Africa, South America and Central America, particularly where water and food hygiene may be inadequate.
The risk for most tourists is generally low, especially during shorter stays in hotels with good hygiene standards. Vaccination may, however, be considered for:

• longer stays
• backpacking
• work or voluntary work
• staying with local residents
• travel involving basic accommodation or uncertain hygiene conditions.

Two types of vaccine are available: capsules taken by mouth and an injectable vaccine. Protection lasts for approximately 1–3 years.
Vaccination does not provide complete protection, so care with food and drinking water remains very important.

Japanese encephalitis

is a serious viral disease that can cause inflammation of the brain. It occurs in parts of Asia and the western Pacific, as well as in some parts of Australia.
The virus is transmitted by mosquitoes, particularly in areas where pigs and water birds live close to people. The risk is generally greatest in rural and agricultural areas, especially near rice fields and standing water, although transmission can also occur on the outskirts of larger cities.

For most ordinary tourists the risk is low, but vaccination may be considered for:

• longer stays in risk areas
• backpacking or basic accommodation
• stays in rural areas
• repeated travel to endemic areas
• uncertain itineraries or travel involving a variety of environments
• travel during an ongoing outbreak

Vaccination may also be appropriate for people planning to live temporarily or permanently in countries where the disease occurs. The primary vaccination course usually consists of two doses and provides good protection for several years. A booster dose may be recommended if the risk continues.
As the disease is spread by mosquitoes, effective protection against mosquito bites is always important, even for vaccinated travellers.

Meningococcal disease (meningitis)

is a serious bacterial infection that can cause meningitis and sepsis. The disease often develops rapidly and can be life-threatening. Infection is spread through close contact between people via coughing, sneezing or saliva. The risk of transmission increases with prolonged close contact and crowded living conditions. Major outbreaks occur particularly in parts of sub-Saharan Africa, in the area known as the "meningitis belt", although the disease also occurs elsewhere in the world, including Asia, South America and periodically in Europe.

Vaccination may be particularly considered for:

• longer stays in areas with an increased risk of infection
• close contact with local residents
• studying abroad or living in shared accommodation
• healthcare or humanitarian work
• travel during the dry season in the African meningitis belt

Meningococcal vaccination is also mandatory for pilgrims travelling to Mecca and Medina in Saudi Arabia for Hajj and Umrah. Several different groups of meningococcal bacteria can cause disease. The vaccine recommended depends on the destination, age and individual risk assessment. In some situations a vaccine against groups A, C, W and Y is used, while vaccination against group B may be appropriate in others.
Protection is usually achieved after one or two doses depending on the type of vaccine and the traveller's age. The duration of protection varies, and a booster dose may sometimes be required if the risk continues.

Influenza

is a viral infection spread mainly through respiratory droplets and close contact between people. Influenza circulates worldwide throughout the year, although in temperate parts of Europe larger outbreaks occur mainly during the winter months.

When travelling between different parts of the world, travellers may be exposed to influenza during the local influenza season, particularly during air travel, cruises, group travel, and stays in larger cities or tourist areas.

Vaccination is particularly important for people at increased risk of severe illness. Recommendations regarding which groups should be vaccinated vary between countries, and travellers should follow the current recommendations in their country of residence.

Vaccination may also be considered before travelling abroad, both to reduce the risk of becoming ill during the trip and to avoid placing additional demands on healthcare services at the destination.
Influenza viruses change continuously, which means that vaccines are updated regularly. Protection is therefore primarily intended for the relevant influenza season.
Good hand hygiene and avoiding close contact with people who are ill can also reduce the risk of infection.

Tick-borne encephalitis (TBE)

is a viral disease that can cause inflammation of the brain. The virus is present in the tick's salivary glands and can be transmitted soon after a tick attaches. Ticks become active when temperatures rise, and the risk of infection is generally greatest from spring to autumn.
TBE occurs in parts of northern, central and eastern Europe and in parts of Asia. The geographical distribution of risk areas continues to change.
People who are likely to be exposed to tick bites in risk areas should consider vaccination.

Vaccination schedules and booster recommendations vary between countries and may also depend on age, the vaccine used and individual health factors. Follow the recommendations in your country of residence or seek advice from a vaccination clinic.

Tuberculosis

is a bacterial disease that primarily affects the lungs and is spread through the air by people with infectious pulmonary tuberculosis.
Tuberculosis is relatively uncommon in many European countries, but globally it remains one of the world's most common serious infectious diseases. The risk of infection is considerably higher in many parts of Africa and Asia and in some other regions of the world.
BCG vaccination policies vary considerably between countries. In some countries routine BCG vaccination is still part of the childhood vaccination programme, while in others it is offered mainly to people at increased risk of tuberculosis.

Vaccination may be considered particularly for:

• children and adolescents who will be staying for an extended period in areas with a high incidence of tuberculosis
• people who will be living in close contact with local communities for an extended period
• healthcare workers or others at increased risk of close contact with people with infectious tuberculosis

BCG vaccination primarily protects young children against severe forms of tuberculosis.
If you have previously received BCG vaccination, revaccination is rarely recommended. In some cases, however, an individual assessment may be appropriate before a prolonged stay in a high-risk area.

Travelling with young children

Travel with young children often requires special consideration. This is particularly important when travelling to countries with a higher risk of infectious diseases, poor hygiene and sanitation, malaria risk, or when the child has not yet received all routine childhood vaccinations.

• Make sure the child's routine vaccinations are up to date.
• MMR vaccination may sometimes need to be given earlier than usual before travel.
• Hepatitis A vaccination may be recommended for travel to many countries.
• Travel to malaria-risk areas should be planned particularly carefully.

Contact a vaccination clinic well in advance of departure for an individual assessment.