Which shots do you really need? It depends not only on where you're going, but also what you'll be doing there. Part two of a two-part series.

Did you know that not all travellers receive the same vaccination recommendations? Depending on your travel plans, your health practitioner may advise you to get one or more vaccinations in addition to any routine or required vaccinations. (See Part 1 of this series for a quick primer!)

What are selective vaccinations?

When it comes to travel, there are different vaccination categories: routine, recommended, required, and selective. Routine vaccinations (or childhood vaccinations) like measles, mumps, rubella, tetanus, and polio are available for free from your health practitioner. Travel is a good reminder to make sure they’re up to date—adults need booster doses of some routine vaccinations!

Recommended vaccinations are advised for all travellers. Hepatitis A vaccination is often recommended if it wasn’t part of your routine vaccinations. Required vaccinations like Yellow Fever are a legal requirement to enter some countries. Selective vaccinations are recommended in addition to the vaccinations above if your trip puts you at greater risk of certain illnesses. You’re more likely to need selective vaccinations if you:

• Are planning a long-term trip
• Are planning adventure travel
• Are visiting rural or remote areas
• Are visiting areas with poor sanitation
• Might be in close contact with animals

Selective vaccines can reduce the severity of an illness common at your destination (such as typhoid fever), prevent an illness that can be severe (such as Japanese encephalitis), or simplify treatment in case you’re exposed to a serious illness (such as rabies).

Do I need any selective vaccinations?

It’s important to tell your health practitioner about the activities you’re planning, how long you’re travelling, and whether you’re visiting any rural or remote areas. The more information you provide, the easier it is to determine which risks are the most significant on your trip.

Typhoid Fever

Typhoid is a bacterial infection transmitted through contaminated food and water, so it’s important to be extra cautious about what you eat and drink if you’re visiting an area with risk of typhoid fever. The vaccine comes in an oral live version and inactivated injectable version. The oral version typically protects you five to seven years and the injectable for two to three years. The typhoid vaccine costs about $50 per dose (one injection or four pills) and reduces the severity of the illness if you do get sick. It’s often recommended for travellers visiting areas with poor sanitation, humanitarian workers, long-term travellers, and adventure travellers to Southeast Asia, sub-Saharan Africa and parts of South America.

Japanese Encephalitis

Japanese encephalitis is transmitted by Culex mosquitoes in rural areas of Southeast Asia. Most people who are infected don’t have any symptoms, but among those who do get sick, Japanese encephalitis can be severe and sometimes fatal. The vaccine available in North America typically lasts one year and comes in a series of two shots. At an average cost of $220 per dose, this is the most expensive vaccine out there. It’s recommended if you’re taking a long-term trip to rural areas of Southeast Asia—especially if you’re living or working near agricultural areas like rice paddies.

Rabies

Rabies is a viral infection transmitted through the saliva of infected mammals and is almost always fatal if left untreated. Most rabies infections in people come from untreated dog bites, which is a significant public health concern in many countries. The three-dose pre-exposure vaccine buys you more time to seek medical care if you’re bitten and the treatment includes two additional doses of vaccine. The vaccine can be very expensive, at an average cost of $200 per dose.

If you get bitten and have not had the three pre-exposure shots, you’ll need four doses of the rabies vaccine (five if you have a compromised immune system) and Human Rabies Immune Globuline (HRIG). Be aware that HRIG is in very short supply worldwide, so if you’re planning an extended stay in a rural area of Africa, Asia, Central America, or South America, the rabies vaccine is a good investment. Rabies is also an important vaccine to consider if you’ll be in close contact with animals—for example, if you’re doing a veterinary course, visiting farms, or exploring bat caves.

Meningococcal Meningitis

If you’re visiting countries in the "Meningitis Belt"—the semi-arid area of sub-Saharan Africa that extends from the Atlantic Ocean to the Red Sea—or an area with a current outbreak, you may be at higher risk for this illness.
Vaccination against serotypes A, C, Y, and W135 is recommended for travellers. One dose of this vaccine protects you from these four types of meningococcus bacteria for three to five years.

Meningococcal meningitis is transmitted through close or long-term contact with an infected person’s saliva or respiratory secretions, so you may be at higher risk if you’re on a long-term trip, on a work or volunteer assignment in healthcare or education, staying in dormitories, or attending major sporting or cultural events.

Travel health teamwork: You and your health practitioner

Discuss your travel plans with your healthcare practitioner and work together to determine which vaccinations will provide the best protection based on your health status and budget. If you’ve received vaccinations for  a previous trip, you may already have the protection you need! On the other hand, you may need to get re-vaccinated or you may need additional vaccinations that you haven’t had before. A good rule of thumb is to book an appointment with your health practitioner six weeks before your trip to give yourself time to get vaccinations that are delivered in multiple doses over several weeks.

Vaccination is not only about protecting yourself, it’s about protecting others around you who may be more susceptible to getting sick, who can’t get vaccinated, or who don’t have access to vaccinations in the countries you visit.

In part one of this series where we look at the routine vaccines you'll need as a traveller.

Daphne Hendsbee, IAMAT’s Communications and Marketing Specialist, strives to present complex health information in a way that is concise, accurate, and easy to understand. She is especially interested in global health and the social determinants of health.

Tullia Marcolongo is the Executive Director of IAMAT. Her goal is to communicate travel health issues in a relatable manner, giving travellers all the options available to them to make an informed choice. She is a member of the International Society of Travel Medicine (ISTM), the American Society of Tropical Medicine and Hygiene (ASTMH), and holds a Certificate in Travel Health.

IAMAT’s mission is to make the world a healthier place to travel by providing travellers with impartial health information and access to an international network of English-speaking doctors.