Travel vaccines: what to get and why

Now that summer is upon us and families are busy planning holidays, the importance of protecting children and family members against preventable diseases should be at the forefront of everyone’s mind. Vaccines play an essential role in preventing common illnesses. Vaccination, after clean water, is the most effective public health intervention in the world for saving lives and promoting good health.

Protecting the health of travellers of any age can be complex and varied. There can be much to consider when attending a travel health consultation, during which time a comprehensive travel health risk assessment is completed, enabling the travel health practitioner to understand the health needs of the traveller, whatever their age and wherever the destination of travel.

Some vaccines are recommended for specific destinations while others transcend borders and can be recommended for almost any destination.

Travel vaccines should be administered at least four weeks prior to departure, but it is never too late to attend a travel clinic for vaccination – some protection is better than none.

Vaccines such as tetanus, diphtheria and polio, measles, mumps and rubella are administered routinely as part of the UK national childhood immunisation programme. For children of any age who did not receive the measles, mumps and rubella vaccination during childhood, it is important that they should receive a course of the vaccine at least a month before travel.

The reason for this is that there are on-going outbreaks of these illnesses in Europe with the largest outbreaks being seen in Italy and Romania. Other countries affected include Austria, Belgium, Denmark, Finland, France, Germany, Ireland, the Netherlands, Portugal, Spain, Sweden and the UK.

Hepatitis A is generally present in parts of the world where standards of sanitation and food hygiene are poor. This includes parts of Africa, the Indian subcontinent, the Far East, the Middle East, and Central and South America.

The hepatitis A vaccine can be given on its own or combined with the hepatitis B or typhoid vaccine, the latter meaning that a child, teenager or adult could receive dual protection against both diseases by a single injection.

Once a course of hepatitis A vaccine is completed, the person will be protected against hepatitis A for up to 25 years.

The value of protecting a child with the hepatitis A vaccine is because children with hepatitis A often do not have symptoms, but they can pass the disease onto others, including their unvaccinated parents. Another benefit is that it prevents a child from being unwell from hepatitis A as he or she gets older, when the disease can be more serious.

Both children and adults can get the infection from.

• eating food prepared by someone with the infection who has not washed their hands properly
• drinking contaminated water (including ice cubes)
• eating raw or undercooked shellfish from contaminated water
• close contact with someone who has hepatitis A.

Typhoid is found throughout the world, but it is also more likely to occur in areas where there is poor sanitation and hygiene. High-risk areas include the Indian subcontinent, Africa, South and South East Asia, Central and South America.

In the UK, most people who get typhoid fever develop it whilst visiting India, Pakistan or Bangladesh. It is therefore particularly important that children and family members are vaccinated if visiting any of these countries.

Hepatitis B is widespread in many parts of the world with high-prevalence regions including sub-Saharan Africa, most of Asia and the Pacific islands; intermediate-prevalence regions include the Amazon, southern parts of Eastern and Central Europe, the Middle East and the Indian sub-continent and low-prevalence regions include most of Western Europe and North America.

Hepatitis B can be spread through medical treatment (blood transfusions and injections)

or dental treatment in an unhygienic environment with unsterilised equipment.

Vaccination against hepatitis B protects a child against a potentially serious disease and also prevents liver disease and cancer from hepatitis B in later years. The vaccination also protects other people from the disease because children with hepatitis B usually do not have symptoms, they can pass the disease to others without anyone knowing they were infected.

Rabies is a rare but serious disease which is usually caught from the bite or scratch of an infected animal, most often a dog but also cats and monkeys, indeed any mammal including bats. Rabies is found throughout the world, particularly in Asia, Africa and Central and South America. Children are often curious and like to play with and stroke animals.

It is difficult to tell a child to keep away from animals so vaccinating a child against rabies is often something to consider, depending upon the holiday. If you are travelling with a child, make sure they are aware of the dangers and that they should tell you if they have been bitten, scratched or licked by an animal. It is advisable to check them for any wounds if they come into contact with an animal.

Although vaccines are an important way to prevent illnesses whilst travelling, it is essential to remember that there are other causes of travel-related illnesses in all age groups, including those diseases transmitted by insects e.g. malaria, dengue fever and Zika. Travelling with a basic first aid kit, including oral rehydration sachets, an anti-histamine cream and insect repellent is strongly advised. Lastly, vigilance and precautions against accidents should remain paramount for travellers of all ages, but in particular when travelling with children.

The Royal Free London Travel Health and Immunisation Clinic is well placed to meet the travel health and immunisation needs of the public. A highly experienced team of clinical specialist travel medicine nurses provide a comprehensive one stop service at the Royal Free London NHS Foundation Trust.