Travel vaccinations are an essential part of holiday and travel planning, particularly if your journey takes you to an exotic destination or 'off the beaten track'. The risks are not restricted to tropical travel, although most travel vaccines are targeted at diseases which are more common in the tropics.
This leaflet discusses the vaccinations that are available and gives some idea of the time you need to allow to complete a full protective course of vaccination. Further information specific to your destination can be obtained from your surgery, from specialist travel clinics and from a number of websites. You will find a selection of these listed at the bottom of this leaflet and under references.
Why are up-to-date vaccinations important before travelling abroad?
The rise in worldwide and adventurous tourism has seen a massive increase in people travelling to exotic destinations. This leads to exposure to diseases that are less likely to occur at home. These are diseases against which we have no natural immunity and against which we are not routinely immunised in the UK. They include:
- Insect-borne conditions such as malaria, dengue, yellow fever and Zika virus.
- Diseases acquired from eating and drinking, such as hepatitis A and traveller's diarrhoea.
- Diseases acquired from others or conditions of poor hygiene, such as hepatitis B and Ebola virus.
- Diseases acquired directly from animals, such as rabies.
These are illnesses which might not only spoil your holiday but might also pose a risk to your life. For specific advice on travelling to more remote places: see separate leaflet called Advice for Travelling to Remote Locations.
What travel vaccinations do I need?
Before travelling outside the UK it is important to check whether there are any vaccinations available which could protect you. You can do this by making a travel planning appointment at your GP surgery. There are also several websites which aim to offer up-to-date, country-specific advice on vaccinations and on disease patterns.
Vaccination courses need to be planned well in advance. Some vaccinations involve a course of injections at specified intervals and it can take up to six months to complete a course. Some vaccinations can't be given together.
The protection offered by vaccination is not always 100%. Vaccination will greatly reduce your chances of acquiring the disease and in many cases the protection level offered is extremely high. The protection will also not be lifelong. However, there isn't a vaccine available for every disease - for example, there is none at present against malaria. Even where a vaccine is available, vaccination should not be the only thing you rely on for protection against illness. It is important to know the risks; taking sensible steps to avoid exposing yourself to disease is by far the most useful thing you can do.
The following table lists the travel vaccinations which are available and in common use in the UK. Always check with your surgery or online before travelling, particularly to unusual destinations, for local outbreaks of disease which mean other specific vaccinations are advised.
|Cholera (oral) notes: a booster can be given 2 years after the primary course. If more than 2 years have elapsed since cholera vaccination the primary course must be repeated.|
|DIPHTHERIA||Part of UK schedule|
|Diphtheria notes: 5 doses of the combined diphtheria, tetanus and polio vaccine are enough to provide long-term protection through adulthood.|
|Encephalitis (Japanese) notes: usually only recommended for travellers to affected rural areas for over 30 days, or during outbreaks. Boost at 2-5 years if needed.|
|Encephalitis (tick-borne) notes: dose 2 on Day 14 if travelling immediately. Risk is generally low unless walking, camping or working in heavily forested regions of affected countries between April and October when the ticks are most active.|
|Hepatitis A notes: if late with the second dose, 20-year protection can still be relied upon.|
Hepatitis B notes:
Booster at 5 years or when antibody levels fall.
Fast course: Day 0, then 1 month, 2 months, 12 months.
Accelerated course: Day 0, 7, 21, then 12 months.
|HEPATITIS A/B COMBINED||
|Hepatitis A/B combined notes: as for hepatitis B, fast or accelerated courses available.|
|Meningitis ACWY notes: a certificate of vaccination is required from all visitors arriving in Saudi Arabia for the purpose of Umrah or Hajj.|
|POLIO||Part of UK schedule|
|Polio notes: almost eradicated worldwide. 5 doses of the combined diphtheria, tetanus and polio vaccine are enough to provide long-term protection through adulthood.|
|Rabies notes: boost at 2-5 years if needed.|
|TETANUS||Part of UK schedule|
|Tetanus notes: total of 5 doses needed for lifelong immunity but boosted in the case of high-risk injuries.|
|TUBERCULOSIS||May be given at birth|
|Tuberculosis notes: offered at birth to higher-risk children. Also offered to close contacts of cases and to health workers under the age of 35 years. Poorly effective in adults over the age of 35 years. Negative Mantoux test is needed prior to vaccination.|
|Typhoid notes: every 3 years if needed.|
|Yellow fever notes: every 10 years if needed. Only available from accredited centres. Some countries require a certificate of vaccination before allowing entry (in some cases, if travelling from an affected area; in other cases, for entry from anywhere).|
It is important that pregnant women also receive the necessary vaccinations before travelling. Some vaccines, however, are not safe to use in pregnancy - see table below. In some cases your doctor or nurse may ask you to consider whether the journey could wait until after the birth of your baby, as the risks of disease may be very real and you may be unable to fully protect yourself and your baby. There is currently no vaccine or medicine to prevent Zika virus, which is transmitted by Aedes mosquitoes and which is of particular concern to pregnant women due to its link to birth defects. The recent outbreak of the virus is currently considered a Public Health Emergency of International Concern. See separate leaflet called Zika Virus.
|Anthrax||Recommended ONLY IF there is a high risk of exposure|
|DTaP||Recommended if indicated|
|Hepatitis A||Recommended if indicated|
|Hepatitis B||Recommended in some circumstances|
|Influenza (inactivated)||Recommended if indicated|
|Japanese encephalitis||Inadequate data for specific recommendation|
|Meningococcal ACWY||May be used if indicated|
|Polio||May be used if indicated|
|Rabies||May be used if indicated|
|Typhoid||Inadequate data for specific recommendation|
|Yellow fever||May be used if exposure risk is high|
No vaccination is available against malaria. People who live permanently in malarial zones have partial protection but they lose this swiftly when they move away. Protection against malaria is through a combination of avoidance of mosquito bites and the use of anti-malarial tablets. Tablets have to be started before entering the malarial zone and continued for some days or weeks after leaving it. The recommended tablet regime varies by area. Your practice nurse will have access to up-to-date advice on recommendations for your journey. See separate leaflet called Malaria Prevention for more details.
Diseases for which no vaccine is yet available
There are many tropical diseases for which no vaccination is yet available. These include:
- Insect (arthropod)-borne viruses such as dengue, Zika and chikungunya.
- Infections carried by water-dwelling organisms such as bilharzia and flukes
- Parasitic diseases such as leishmaniasis, onchocerciasis, trypanosomiasis and hydatid disease. Parasites are living things (organisms) that live within, or on, another organism.
Most of these conditions can be avoided by travellers taking reasonable precautions around:
- Food and drink.
- Swimming in water known to be infested with parasitic organisms.
- Exposure to biting insects.
- Unprotected sexual encounters.
People often at greatest risk when travelling are those visiting a country which they think of as their place of origin, where members of their family live and roots may be. People often believe - falsely - that as one-time residents who may have been born and raised there, they have a natural immunity. They feel that they are not on holiday but visiting home and that vaccinations aren't needed.
Unfortunately this is not true. We acquire natural immunity by living in a place and being constantly exposed to the diseases that are present. When we leave the area for distant shores that protection is rapidly lost and we need the protection of vaccination, together with the other precautions listed above.
This is particularly true of malaria, where visitors 'going back home' may find their relatives puzzled and even amused that they are taking anti-malarial medication. Even so, it's very important to do so. It's only by living there all the time that you acquire your resident relatives' level of immunity. Your immune system has a short memory for this sort of partial immunity.
Where can I get travel vaccinations?
Many NHS surgeries offer a full range of travel vaccinations. Alternatively, you can visit specialist travel clinics.
Free travel vaccinations
The NHS does not usually cover travellers for vaccinations relating to exotic travel, although some vaccinations such as hepatitis A are usually free. Aid workers and healthcare workers are often offered free vaccinations against occupational risks but others have to pay. Anti-malarial tablets are never free and can add a substantial sum to the cost of your trip. Whilst this may seem expensive, it is usually a small sum relative to the costs of your travel. Safeguarding your health should be considered an essential part of any trip.
If a vaccination certificate is issued keep it and update it over the years so that you have a full record. Your NHS surgery will have a record of vaccines they have administered to you and can often issue a copy. However, the yellow fever vaccination certificate needs to be saved, as this cannot be re-issued.
There are many excellent websites offering detailed advice for travellers by country and region. You will find a selection under 'Further Reading and References', below.
You can prevent getting cholera and other water-borne infections by avoiding contaminated water and having good personal and food hygiene.
What is cholera?
Cholera is an illness cased by a germ (bacterium) called Vibrio cholerae. The illness can be mild and may even not lead to any symptoms in some people. However, in many cases it causes severe diarrhoea, sometimes with being sick (vomiting). This can quickly lead to serious lack of fluid in the body (dehydration) and can even be fatal.
Cholera is usually caught from drinking infected water or eating infected shellfish and other foods. Person-to person spread can occur though.
The worst affected areas are the Indian subcontinent, the Far East, Africa and South America. The risk to travellers even in infected areas is still quite small.
The most important part of prevention is to be very careful about personal, food and water hygiene. This is most important in areas where sanitation is poor and where there is a risk of catching cholera. You should not drink any water that is untreated and be very careful what you eat. This not only applies to cholera but also to all sorts of other water-borne infections found in areas of poor sanitation.
An oral vaccine (Dukoral®) became available in the UK in 2004. This is now the only vaccine for cholera available in the UK. It is not advised for most travellers. It may be advised for certain people travelling to places where cholera may occur. Your doctor or nurse will advise if you should consider having this vaccine.
Examples of people who are likely to be advised to have this vaccine include:
- People going to work in an area of a known cholera outbreak. For example, aid workers, health workers, etc, who will be working in emergency relief camps where cholera has broken out.
- People planing to stay for a long time in an area where there is high risk of cholera - especially any area where there is limited access to medical care.
Clinical Editor's comment (October 2017)
Dr Hayley Willacy advises that in the USA a new single-dose cholera vaccine is available. The vaccine is approved for adults aged 18-64 years who are travelling to an area with an active cholera outbreak. The vaccine - Vaxchora® - has been reported to reduce the chance of severe diarrhoea in 9 people out of 10 at ten days after vaccination and in 8 people out of 10 at three months after vaccination. The safety and effectiveness of Vaxchora® in pregnant or breast-feeding women is not yet known. It is also not known how long protection lasts beyond 3-6 months after getting the vaccine. Side-effects are uncommon but may include tiredness, headache, abdominal pain, nausea and vomiting, lack of appetite, and diarrhoea.
The oral vaccine comes in sachets which are dissolved in a drink. It can be used by adults and children aged two years and over. You should not eat or drink anything for an hour before and an hour after taking a dose of the vaccine. This is to make sure it is absorbed fully from your gut.
The course of vaccination is two doses for people over 6 years old and three doses for children 2-6 years old. Each dose is given at least one week apart but no later than six weeks apart. The course of vaccinations should be finished at least one week before potentially coming into contact with cholera. Typically, this is one week before travel.
A booster dose is needed to maintain protection. This is after two years for people over 6 years old, and after six months for children 2-6 years old. The cholera vaccine can be given at the same time as other injected vaccines.
Note: the vaccine does not provide complete protection. For example, it does not protect against all strains of cholera. Therefore, it is still important that you should be careful with regard to what you eat and drink in the usual way.
Who should not receive the vaccine?
There are very few people who cannot have the oral cholera vaccine. It should not be given if:
- You have had a severe reaction to a previous dose of the oral cholera vaccine.
- You have had a severe (anaphylactic) reaction to formaldehyde or to any of the ingredients of the vaccine.
There are currently no data on the safety of this vaccine in pregnant or breast-feeding women. Therefore, if you are pregnant or breast-feeding, the vaccine should only be considered if the risk of cholera is high.
Side-effects from this vaccine are uncommon. Less than 1 person in 100 develops some tummy (abdominal) pains, diarrhoea or a feeling of sickness (nausea) for a short time after taking the vaccine.
Check with your practice nurse at least two weeks before you travel to see if you should have this vaccination.
What is hepatitis A?
Hepatitis A is an illness caused by the hepatitis A virus. The virus mainly causes inflammation of the liver. Symptoms include:
- Generally feeling unwell.
- Yellowing of your skin or the whites of your eyes (jaundice).
- Sometimes, being sick (vomiting).
- A raised temperature (fever).
However, some people who are infected do not develop any symptoms (a subclinical illness). The illness is not usually serious and full recovery is usual but the symptoms can be quite unpleasant for a while. The hepatitis A virus is passed out in the stools (faeces) of infected people and infection is usually spread by eating dirty (contaminated) food or drink.
Hepatitis A infection can occur in the UK but it is more common in countries where there is poor sanitation or where disposal of sewage is poor. In the UK, most cases of hepatitis A are seen in people who have recently returned after travelling to such countries. If you catch hepatitis A, the illness is not usually serious but it may ruin a holiday or business trip. See separate leaflet called Hepatitis A for more details.
This leaflet is just about vaccination to help prevent hepatitis A infection.
Who should be immunised against hepatitis A?
Travellers to countries outside Western Europe, North America and Australasia should consider being immunised. The highest-risk areas include the Indian subcontinent (in particular India, Pakistan, Bangladesh and Nepal), Africa, parts of the Far East (except Japan), South and Central America and the Middle East. Vaccination is generally recommended for anyone over the age of 1 year. Your doctor or practice nurse can advise if you should be immunised against hepatitis A for your travel destination.
Close contacts of someone with hepatitis A. Occasional outbreaks of hepatitis A occur in the UK within families or in institutions. Close contacts of someone found to have hepatitis A infection (for example, family members or other members of the institution) may be offered vaccination. This only happens rarely. The most important measure for anybody with hepatitis A is good personal hygiene. In particular, washing hands after going to the toilet or before eating.
People with chronic liver disease. If you have a persistent (chronic) liver disease (for example, cirrhosis) it is suggested that you have the hepatitis A vaccine. Hepatitis A infection is not more common in those with chronic liver disease but, if infection does occur, it can cause a more serious illness.
People exposed to hepatitis A at work. For example, laboratory workers who are exposed to hepatitis A during their work and sewage workers are advised to be immunised against hepatitis A.
Staff of some large residential institutions. Outbreaks of hepatitis A have been associated with large residential institutions for people with learning difficulties, where standards of personal hygiene among clients or patients may be poor. Therefore, vaccination of staff and residents of some institutions may be recommended.
Injecting drug users who share drug injecting equipment are also thought to have an increased risk of hepatitis A infection and so should consider vaccination.
People with certain blood clotting problems (such as haemophilia) who need to receive blood clotting factors, may have an increased risk of hepatitis A infection. This is because the hepatitis A virus may not be completely destroyed during the preparation of these blood products. Vaccination is therefore suggested for these people.
Men who have sex with men, and other people whose sexual practices involve oral-anal contact, may also like to consider vaccination against hepatitis A.
Note: if you have been infected with hepatitis A in the past, you should be immune to further infection and therefore not need vaccination. A blood test can detect antibodies to check if you are already immune. This may be worthwhile doing if you have had a history of yellowing of your skin or the whites of your eyes (jaundice) or come from an area where hepatitis A is common.
Hepatitis A vaccine
There are a number of different hepatitis A vaccines available. There are also some combined vaccines for both hepatitis A and hepatitis B and also hepatitis A and typhoid fever. A combined vaccine may be useful if you require protection against both diseases.
The hepatitis A single vaccine is given as two doses. The first dose of the vaccine protects against hepatitis A for about one year. The vaccine causes your body to make antibodies against the virus. These antibodies protect you from illness should you become infected with this virus. Ideally, you should have an injection at least two weeks before travel to allow immunity to develop. However, the vaccine may still be advised even if there is less than two weeks before you travel.
A second dose of the vaccine 6-12 months after the first gives protection for about 20 years. If you are late with this second dose, you should have it as soon as possible but you don't need to start with the first dose again. Another booster dose of hepatitis A vaccine after 20 years can be given to those people still at risk of infection.
The doses of the combined vaccines against both hepatitis A and hepatitis B or hepatitis A and typhoid may need to be given at slightly different time intervals. Your doctor or practice nurse will be able to advise you in detail.
Are there any side-effects from the vaccine?
Some people develop a temporary soreness and redness at the injection site. Much less common are:
- A mild raised temperature (fever).
- Feeling sick (nauseated).
- Feeling off your food for a few days.
Severe reactions are extremely rare.
Who should not receive hepatitis A vaccine?
There are a very few situations where the hepatitis A vaccine is not recommended. They include:
- If you have an illness causing a high temperature. In this situation, it is best to postpone vaccination until after you have fully recovered from the illness.
- If you have had an allergic reaction to the vaccine or to any of its components in the past.
- One type of vaccine (Epaxal®) should not be given to anyone who is known to be allergic to eggs.
- Children under the age of 1 year. However, the risk of hepatitis A in children under the age of 1 year is very low. The hepatitis A vaccine is not licensed for this age group.
The vaccine may be given if you are pregnant or breast-feeding and vaccination against hepatitis A is thought to be necessary.
Remember - vaccination for travellers is only one aspect of preventing illness. No vaccination is 100% effective. So when travelling to at-risk areas, you should have very good personal hygiene and also be careful about what you eat and drink.
You should avoid eating and drinking the following when travelling to areas where the risk of hepatitis A is higher:
- Raw or inadequately cooked shellfish.
- Raw salads and vegetables that may have been washed in unclean (contaminated) water. (Wash fruit and vegetables in safe water and peel them yourself.)
- Other foods that may have been grown close to the ground, such as strawberries.
- Untreated drinking water, including ice cubes made from untreated water. (Remember also to use only treated or bottled water when brushing your teeth.)
- Unpasteurised milk, cheese, ice cream and other dairy products.
Also, be careful when buying food from street traders. Make sure that food has been recently prepared and that it is served hot and on clean serving plates. Food that has been left out at room temperature (for example, for a buffet) or food that may have been exposed to flies could also pose a risk.
The hepatitis B vaccine can also be used to prevent infection if, for example, you have had a needlestick injury and you are not immunised. Some people need blood tests to check if they are immune. See your practice nurse if you think you need this vaccine.
What is hepatitis B?
Hepatitis B is an infection caused by the hepatitis B virus. The infection mainly affects the liver. However, if you are infected, the virus is present in body fluids such as blood, saliva, semen and vaginal fluid. In the UK it is estimated that about 1 person in 200 to 1,000 is infected with the hepatitis B virus. It varies widely depending on the part of the UK studied. It is much more common in other countries. It is most common in sub-Saharan Africa and East Asia.
If you are infected with the hepatitis B virus, the initial symptoms can range from no symptoms at all to a severe illness. After this initial phase, in a number of cases the virus remains in the body long-term. These people are called carriers. Some carriers do not have any symptoms but can still pass on the virus to other people. About 1 in 4 carriers eventually develop a serious liver disease such as cirrhosis. In some cases liver cancer develops after a number of years. See separate leaflet called See separate leaflet called Hepatitis B for more details of the disease.
If you are pregnant and are infected with the hepatitis B virus, you can pass it on to your baby as the baby is being born. Vaccinations for the baby can prevent this happening. So all pregnant women in the UK are offered testing for hepatitis B during each pregnancy. If the test is positive, the baby can be protected.
How is hepatitis B passed on?
The hepatitis B virus is passed from person to person in one of these ways:
- Blood-to-blood contact. For example, drug users sharing needles or other equipment which may be contaminated with infected blood. (Blood used for transfusion is now screened for hepatitis B virus.) Healthcare workers can be infected through accidental needlestick injuries.
- Having unprotected sex with an infected person.
- An infected mother passing it to her baby.
- A human bite from an infected person. This is very rare.
Who needs hepatitis B vaccination?
Clinical Editor's comment (September 2017)
Dr Hayley Willacy has recently read guidelines from Public Health England affecting vaccination against hepatitis B - see 'Further Reading and References', below. Temporary recommendations have been developed because worldwide shortages of hepatitis B vaccine have severely impacted the UK supply. The recommendations include advice on who should have priority to receive the vaccine based on the highest, immediate need. It also says that giving post-exposure vaccine should not be put off.
Anyone who is at increased risk of being infected with the hepatitis B virus should consider being immunised. This includes:
- Workers who are likely to come into contact with blood products, or are at increased risk of needlestick injuries, assault, etc. For example:
- Medical laboratory workers.
- Cleaners in healthcare settings.
- Prison wardens.
- Police officers and fire and rescue workers.
- Staff at daycare or residential centres for people with learning disabilities where there is a risk of scratching or biting by residents.
- People who inject street drugs. Also:
- Their sexual partners.
- The people they live with.
- Their children.
- People who change sexual partners frequently (in particular, sex workers).
- People who live in close contact with someone infected with hepatitis B. (You cannot catch hepatitis B from touching people or normal social contact. However, close regular contacts are best immunised.)
- People who regularly receive blood transfusions (for example, people with haemophilia).
- People with certain kidney or liver diseases.
- People who live in residential accommodation for those with learning difficulties. People who attend day centres for people with learning difficulties may also be offered vaccination.
- Families adopting children from countries with a higher risk of hepatitis B, when the hepatitis B status of the child is unknown. (It is, however, advisable for the child to be tested for hepatitis B.)
- Foster carers or if you live with foster children.
- Prison inmates. Vaccination against hepatitis B is now recommended for all prisoners in the UK.
- Travellers to countries where hepatitis B is common. In particular, those who place themselves at risk when abroad. The risk behaviour includes sexual activity, injecting drug use, undertaking relief work and/or participating in contact sports. Also, if you may need a medical or dental procedure in these countries and the procedure may not be done with sterile equipment.
- Babies who are born to infected mothers.
Clinical Editor's notes (July 2017)
Dr Hayley Willacy draws your attention to the introduction of a new routine vaccine for all infants born in the UK from August 1st 2017. They will be offered a six component vaccine (Hib-DTaP-hepatitis B-poliovirus). The new vaccine will replace the existing five component vaccine to also give protection against hepatitis B virus (HBV) in addition to diphtheria, tetanus, pertussis, poliomyelitis, and Haemophilus influenzae type b disease. There will not be any change to the timing of the routine childhood vaccination schedule, with the hexavalent vaccine replacing the vaccine previously given at 8, 12, and 16 weeks of age. Note: the restricted supply of vaccine mentioned above does not affect the new vaccine due to be used in the routine childhood vaccination programme.
The vaccination schedule
You need three doses of the vaccine for full protection. The second dose is usually given one month after the first dose. The third dose is given five months after the second dose.
One to four months after the third dose you may need to have a blood test. You may need one if you are at risk of infection at work, especially as a healthcare or laboratory worker or if you have certain kidney diseases. Your doctor will be able to advise you if you need a blood test. This checks if your body has made proteins to protect you (antibodies) against the hepatitis B virus. If you have, you will not be able to get it (ie you are immune.)
You may then need a booster dose five years later. There is no need for a blood test before or after this.
The schedule is the same for the combined hepatitis A and B vaccine which is also available.
Rapid vaccination schedule
A schedule of giving three doses more quickly than usual may be used in some situations. That is, three doses with each dose a month apart. An even quicker schedule is also sometimes used. That is, the second dose given seven days after the first and the third dose given 21 days after the first.
These rapid schedules may be used if you are at very high risk of infection and need to be immune as soon as possible. For example, if you are soon to travel abroad, are new to prison or are sharing needles to inject drugs. However, a more rapid schedule may not be as effective for long-term immunity unless a fourth dose is given 12 months after the first dose. Your doctor will advise on the best schedule for your circumstances.
Are there any side-effects from hepatitis B vaccination?
Side-effects are uncommon. Occasionally, some people develop soreness and redness at the injection site. Rarely, some people develop a mild high temperature (fever) and a flu-like illness for a few days after the injection.
What if I come into contact with hepatitis B and am not immunised?
Seek medical attention as soon as possible if you have been at risk from a possible source of infection and you are not immunised. For example, if you have a needlestick injury or have been bitten by someone who may have hepatitis B.
You should have an injection of immunoglobulin as soon as possible. This is an injection which contains antibodies against the virus. It gives short-term protection. You should also start a course of vaccination. The hepatitis B vaccine is very effective at preventing infection if given shortly after contact with hepatitis B. Even if you have had the hepatitis B vaccine and are at risk of infection (for example, by having unprotected sex or sharing contaminated needles), you should ask your doctor for advice. You may be advised to have a booster vaccine or even an injection of immunoglobulin.
Babies who are born to infected mothers should have an injection of immunoglobulin as soon as possible after they are born. They should also be immunised. The first dose of vaccine is given within the first day after birth. This is followed by three further doses at 1 month, 2 months and 12 months of age. At 12 months, immunised babies have a blood test to check that the vaccine has worked.
Who should not receive the hepatitis B vaccine?
- If you have an illness causing a high temperature, it is best to postpone vaccination until after the illness.
- You should not have a booster if you have had a severe reaction to this vaccine in the past.
- The vaccine may be given if you are pregnant or breast-feeding and vaccination against hepatitis B is necessary.
Japanese encephalitis can be a serious illness causing inflammation of the brain. The risk of developing Japanese encephalitis is very low. However, you may need the vaccine if you are staying longer than a month. Check with your practice nurse 6-8 weeks before you travel to see if you should have this vaccination.
What is Japanese encephalitis?
Japanese encephalitis is caused by a virus. It used to be called Japanese B encephalitis. It is passed to humans by the bite of an infected mosquito. It cannot be transmitted by other humans. These mosquitoes often feed on pigs and wading birds (such as herons). So Japanese encephalitis is more common in areas where pigs and wading birds are found. In particular it is common in areas of rice fields (paddy fields) and pig farms.
Japanese encephalitis is usually a mild illness. In many cases there are no symptoms. However, in a small number of cases (about 1 in 250 infected people) the illness is much more serious. In these people, the infection may start with high temperature (fever), tiredness, headache, being sick (vomiting) and sometimes confusion and agitation. This may progress to inflammation of the brain (encephalitis). This can cause permanent brain damage and is fatal in some cases.
Japanese encephalitis occurs throughout Southeast Asia and the Far East. It is mainly a problem in rural farming areas. It occurs more commonly in the rainy season when the mosquitoes are most active. This season (known as the transmission season) varies between countries. For example:
In China, Korea and Japan, it is most common between May and September.
In Thailand, Cambodia and Vietnam, it is most common between March and October.
In Nepal and North India, it is most common between September and December.
In Malaysia, Indonesia and the Philippines, it is common all year round as the rains can come throughout the year.
Who should be immunised against Japanese encephalitis?
Your doctor or practice nurse can advise if you should have this vaccination for your travel destination.
- Generally, it is advised for travellers who stay for a month or longer during the transmission season in rural areas of certain countries in Southeast Asia and the Far East.
- It may be advised for shorter trips to these countries if you are at particular high risk. For example, if you travel to areas where rice and pig farming co-exist or if you do a lot of outdoor activities.
The vaccine is also recommended for laboratory workers who may be exposed to the virus with their work.
This vaccine is not currently available on the NHS. You will have to pay for it at your surgery, pharmacy or travel clinic.
The vaccine schedule
The vaccine stimulates your body to make protective proteins called antibodies against the virus. These antibodies protect you from illness should you become infected with this virus.
In the UK, there is only one Japanese encephalitis vaccine recommended. It is called IXIARO®. It is licensed for use from the age of 2 months. This is usually given as two injections; the second injection is given 28 days after the first. Children between the ages of 2 and 36 months are given half the dose.
Full immunity takes up to a week to develop. The course of injections should be completed at least one week before departure. So, you should see your practice nurse well in advance of your travel date.
A booster dose may be needed if you are still in an at-risk area after 1-2 years.
Who should not receive the Japanese encephalitis vaccine?
If you are ill with a fever you should postpone the injection until you are better.
You should not have an injection of this vaccine if you have had an allergic reaction to a previous dose of this vaccine.
There is no evidence of risk with this vaccine if you are pregnant or breast-feeding. However, if you are pregnant or breast-feeding, it is usually only given if the risk of Japanese encephalitis is very high and cannot be avoided.
Are there any possible side-effects from the vaccine?
Mild pain and redness occur at the site of injection in some people. The most common side-effects are headache and muscle aches. Other less common reactions include a flu-like illness, fever and feeling tired.
You should also try to prevent mosquito bites
Vaccination is only one aspect of preventing illness whilst abroad. Vaccination is not completely reliable and you should also try to avoid mosquito bites when in 'at-risk' areas.
Mosquito bites can be avoided by the following:
- Sleep in rooms that are properly screened. For example, rooms with close-fitting gauze over windows and doors.
- Spray the bedroom with insecticide just before evening. This kills mosquitoes that may have come into the room during the day.
- If you sleep outdoors or in an unscreened room, use mosquito nets impregnated with an insecticide (such as permethrin). The net should be long enough to fall to the floor all around your bed and be tucked under the mattress. Check the net regularly for holes. Treat the net with fresh insecticide every six months.
- Use an electric mat to vaporise insecticide overnight. Burning a mosquito coil is an alternative.
- Mosquitoes that carry the Japanese encephalitis virus are most active at dusk and in the evening. If possible, avoid going out after sunset. If you do go out after sunset then wear long-sleeved clothing, trousers and socks. Light colours are better, as they are less attractive to mosquitoes.
- Apply insect repellent to clothing or exposed skin. Diethyltoluamide (DEET) is safe and effective but take advice on the best repellent in the area you visit.
There is no cure for rabies but there is a vaccine to prevent it. This can be given to people who are at risk of rabies.
People who should be immunised against rabies include those who work with animals, and people who travel to remote areas where medical help is not available. The vaccine can also prevent rabies infection after a high-risk bite. Treatment with an anti-serum and vaccine works well if you receive them soon after being bitten.
What is rabies?
Rabies is a disease caused by a virus. Almost everyone who develops rabies will die from it. Fortunately there is a vaccine to prevent it which is very effective.
Symptoms usually start 3-12 weeks after being bitten or scratched by an animal (usually a dog) carrying the rabies virus. However, symptoms may occur months or even years after a bite from an infected animal. The virus passes through the cut skin and travels (gradually) into the nervous system. After symptoms develop, most people die in less than two weeks.
Symptoms of rabies include:
- Initially mild symptoms of infection with a virus - headache, a raised temperature, and feeling sick (nausea) and generally unwell.
- A numb feeling in the skin around the area where the bite or scratch was.
- Being very agitated and not being able to sleep.
- Being very confused.
- Frothing at the mouth and having difficulty swallowing.
- Being afraid of water.
- Fits (convulsions).
- Muscle spasms.
- Not being able to move certain muscles (paralysis). This eventually includes not being able to use breathing muscles.
At present, the UK is virtually free of rabies. The strict regulations for imported animals help to keep rabies out of the UK. Animals coming into the UK must have proof they are clear of and immune to rabies. In the UK in recent years a very few people have died from rabies which they contracted from animal bites whilst abroad. There is a small risk from rabies in bats in the UK but not from other animals.
However, rabies is present in most of the rest of the world. Worldwide, there are more than 60,000 human cases each year. India has the highest number of cases of rabies. Dogs are the main carriers of rabies. Foxes, cats, bats, monkeys, raccoons and skunks can also be affected. A bite from any of these animals from any country outside the UK should be taken very seriously.
Who should be immunised against rabies?
People who are at risk of infection with rabies are advised to have the rabies vaccine as a precaution. In the UK, people whose work puts them at risk of rabies are entitled to vaccination on the NHS:
- People working with the rabies virus in laboratories.
- People who work with imported animals.
- People who regularly handle species of bats in the UK.
- People whose work might bring them into contact with rabid animals. (Most staff in veterinary practices do not need rabies vaccination, unless they are handling bats or imported animals.)
- Healthcare workers who come into contact with patients with rabies.
- People working abroad in high-risk countries who may be in contact with animals with rabies. (For example, veterinary staff or zoologists)
In addition, people travelling to areas where there is a high risk of rabies may be advised to have the vaccine. This is not available on the NHS and must be paid for. This includes:
Travellers to parts of the world at risk of rabies where medical treatment may not be available. For example:
- People trekking who may be many days walk away from medical help.
- People visiting parts of the world which may not have enough supply of rabies vaccines to give if they are bitten.
- People travelling to parts of the world where rabies is common and who are likely to be involved in activities which put them at greater risk. For example, running, cycling, working with animals.
- People travelling to parts of the world where rabies is common, who will be there for over a month.
Vaccines for travellers are available through GP surgeries, some pharmacies, and travel clinics. Information on the risk of rabies in the country you are travelling to is available from a number of organisations. For example, the National Travel Health Network and Centre, and Public Health England (see 'Further Reading and References', below). Whether you need rabies vaccination will depend on:
- Which country you are visiting, and in some cases which part of the country.
- What you will be doing while you are there.
- How long you are staying.
- How old you are. (Children may be at higher risk, as they are more likely to pet stray animals.)
The rabies vaccine can be given:
- As a precaution, to people who have not been bitten but who are at risk of a bite from an animal with rabies. This is called pre-exposure prophylaxis.
- To people who have had a bite or scratch from an animal which might have rabies, to prevent them getting the rabies infection. This is called post-exposure prophylaxis.
- Both. Even if you have had the rabies vaccine as a precaution, if you are then bitten, you need further doses to make sure you do not develop the disease. However, if you have had the vaccine beforehand, you will not need so many injections after a bite. If you have had the vaccine beforehand, you also have better protection against the rabies virus.
The injection is usually given in the muscle at the top of your arm.
Three doses of vaccine are usually given. The first injection, a second injection seven days later and a third injection 21-28 days after the first injection. The vaccine is very effective - almost 100%. That is, it will stop nearly everybody who has had it getting rabies if they are bitten by an animal with rabies. The vaccine stimulates your body to make proteins called antibodies against the rabies virus. These antibodies protect you from rabies should you become infected with this virus.
Booster doses may be required after one year and then every 3-5 years for people whose work gives them a risk of contact with the rabies virus. People who are at a smaller risk by travelling again into areas with rabies may need a booster after ten years.
If your work puts you at risk of rabies, you may need a blood test to confirm you are immune from rabies. This may need to be checked regularly and a booster dose of the vaccine given if the blood test shows you are not immune.
If you have a bite or scratch from an animal thought to be at risk of rabies (or an animal known to have rabies), you will need a course of the rabies vaccine. This may be two or five further doses of the injection. How many doses you need depends on how high a risk of rabies you have. This will in turn depend on:
- Which country you were in when you were bitten and how high the risk is there.
- What is known about the animal which gave you the injury (for example, which species of animal, if it is known to have rabies, if it has had rabies vaccinations).
- How bad the injury is and where it is.
- Whether you have had the pre-exposure injections or not.
These injections are available on the NHS. You will have them over a week (2-injection course) or a month (5-injection course). If you have not previously had the pre-exposure rabies vaccines, you will also have an injection of a substance called human rabies-specific immunoglobulin (HRIG). This will protect you from rabies for a short time, while you wait for your vaccine to start to work. HRIG is injected either into your wound, or into the muscle in your upper leg.
Who should not be immunised against rabies?
- If you have an illness causing a high temperature (fever) it is best to postpone vaccination until after the illness.
- You should not have a booster if you have had a severe allergic reaction to this vaccine in the past.
- You should not have a rabies vaccination if you have had a severe allergic reaction to one of the components in the vaccine in the past. (For example, it contains traces of an antibiotic called neomycin, so you should not have it if you are severely allergic to neomycin.)
If you are pregnant or breast-feeding you may still be advised to have the vaccine if the risk of exposure to rabies is high.
Are there any side-effects from the vaccine?
There may be slight redness and swelling in the arm for 1-2 days, where the injection was given. Occasionally there are other side-effects such as a mild raised temperature, muscle aches or feeling sick (nausea). These soon pass without leaving any problems. Severe reactions are extremely rare.
What if I am bitten by a suspect animal?
You should avoid any contact with wild or domestic animals when travelling abroad. If you are bitten by an animal in an at-risk country then:
Wash the wound immediately with running water (and soap if possible) for at least five minutes. Disinfectant and a simple dressing may be applied to the wound.
Seek medical attention as soon as possible even if you have been previously immunised, as further treatment may be given to reduce the risk of infection. You may need to have more doses of the vaccine. You may also need to have an injection of HRIG mentioned above. This will not be needed if you have already had a course of the vaccine.
Check with your practice nurse at least 6-8 weeks before you travel to see if you should have this vaccination. Ideally, for complete protection, start the course of injections six months before travelling.
What is tick-borne encephalitis?
TBE is caused by a virus. It is usually spread by bites from ticks which are infected with the virus. Unpasteurised milk from infected animals, especially goats, is a less common source of the infection.
Affected people often develop a flu-like illness that lasts about a week. This may progress to inflammation of the brain (encephalitis) or inflammation of the tissues around the brain (meningitis). These are serious conditions which can cause headache, high temperature (fever), sickness (vomiting), agitation and confusion. In severe cases they can lead to a coma or even, less commonly, death.
People who recover from the illness may have long-term problems as a result. These include weakness of arms or legs, or problems with co-ordination or walking.
There are three different types of TBE virus:
- European TBE virus.
- Far Eastern TBE virus.
- Siberian TBE virus.
European TBE occurs mainly in western and central European countries and is particularly common in forest and mountainous regions. Far Eastern TBE occurs in eastern Russia and some countries in East Asia, particularly in forested regions of China and Japan. Siberian TBE occurs in Siberia and some parts of Russia.
Who should be immunised against tick-borne encephalitis?
Your doctor or practice nurse can advise if you should have this vaccination for your travel destination. Maps and information on the travel health advice websites listed below will also show you if you need vaccination.
Generally, the risk to the average traveller to affected countries is small. Vaccination is recommended for people who intend to walk, camp or work in heavily forested regions of affected countries between April and October when the ticks are most active. In particular, if you stay in areas where there is heavy undergrowth. It is also recommended for people who handle material that may be infected by the virus (for example, laboratory workers).
There is currently no risk from TBE in the UK. There have been a few cases of it in the UK but those people contracted it abroad. The virus does not pass between people.
The vaccine schedule
The usual schedule is to have three injections of vaccine. The second vaccine is given 1-3 months after the first and the third is given 5-12 months after the second. You should have booster doses every three years if you continue to be at risk of infection. If immunity is required more quickly, a second dose can be given two weeks after the first dose, which gives slightly less protection than the other schedule.
The dose for children over the age of 1 year but younger than 16 years is half the adult dose. There is a special vaccine preparation for children. In the UK, the adult vaccine is called TicoVac® and the children's vaccine is called TicoVac Junior®.
The vaccine stimulates your body to make antibodies against the virus. These antibodies are proteins which protect you from this illness should you come into contact with this virus.
Ideally, vaccination should be completed at least a month before travel. It is considered to be effective against all strains of the disease.
Who should not receive the tick-borne encephalitis vaccine?
- If you are ill with a high temperature (fever) you should postpone the injection until you are better.
- You should not have a booster if you have had a severe reaction to this vaccine in the past.
- You should not have this vaccine if you have a severe allergy to egg. (This is because the vaccine contains small amounts of egg protein. Allergy to egg is rare and it does not mean an upset stomach when you eat eggs, or disliking eggs.)
- The vaccine is not licensed for children under the age of 1 year.
- This vaccine is safe if you are pregnant or breast-feeding.
Are there any possible side-effects from the vaccine?
- Mild pain and redness occur at the site of injection in some people.
- Some people develop a high temperature (fever), particularly after the first dose. This is most common within twelve hours of having the vaccine. This usually settles within 24-48 hours.
- Severe reactions are extremely rare.
You should also try to prevent tick bites and infection
Vaccination is extremely effective. However, if you are travelling to affected areas, whether you have been immunised or not, it is also important to:
- Cover arms, legs and ankles.
- Use insect repellent on exposed skin, socks and outer clothing.
- Not drink unpasteurised milk, especially goat's milk.
Ticks should be removed as soon as possible with tweezers as close to the skin attachment as possible. They should be removed by steady pulling without jerking or twisting. Other ways of removing ticks are with tick removal tools, or with loops of cotton or floss. Do not pull a tick out with your fingers.
You should be immunised against typhoid before you travel to certain countries where the risk of typhoid is high - in particular, countries in the Indian subcontinent. There are two typhoid vaccines available in the UK - an oral and an injectable vaccine.
What is typhoid?
Typhoid fever is caused by a germ (bacterium) called Salmonella typhi (S. typhi). This bacterium may contaminate food or drink in areas of poor sanitation. Typhoid ranges from being a mild illness to a fatal one. Symptoms include sudden onset of:
- High temperature (fever).
- Severe headache.
- Feeling sick (nausea).
- Tummy (abdominal) pain.
- Loss of appetite.
- Constipation or diarrhoea.
These symptoms can be very severe.
(Note: there are many types of salmonella bacteria which can infect people. Most remain in the gut and cause diarrhoea. S. typhi is more invasive - it can get from the gut into other parts of the body and it causes the more serious illness of typhoid fever.)
People with typhoid fever pass out the bacteria with their stools (faeces), and sometimes in their urine. Even when symptoms have gone, about 1 in 10 people who have had typhoid fever remain carriers for some time. This means that some bacteria continue to live inside the gut and you continue to pass out bacteria with your stools. If hygiene is not good then the bacteria can be passed to others who may then get typhoid fever. About half of carriers become free of the typhoid bacteria within three months. However, others continue to pass out typhoid bacteria with their stools long-term.
The incubation period for the disease is usually 1-3 weeks. This means that you do not get symptoms for 1-3 weeks after becoming infected. Around 200 cases are notified in the UK each year. About 8 in 10 of these cases are in people who caught the infection abroad, and most of these were visiting friends or relatives in South Asia. Typhoid infection can be successfully treated with antibiotic medicines, which reduce the chances of serious illness.
Who should be immunised against typhoid?
Travellers to areas where typhoid is a problem should be immunised, particularly where hygiene and sanitation are poor. The worst affected areas are Asia, Africa and Central and South America, so you should be immunised if visiting these countries, especially if you are visiting friends and relatives. Vaccination may not be needed for short stays if you stay in good accommodation (including most package holidays). Your GP or practice nurse can advise if you should be immunised against typhoid for your travel destination.
People who handle specimens which may contain typhoid bacteria should also be immunised.
There are two vaccines available in the UK - an oral vaccine and an injectable vaccine. Both vaccines stimulate your body to make antibodies against typhoid germs (bacteria). These antibodies protect you from illness should you become infected with typhoid bacteria. It is important to remember that not everyone who is vaccinated will be totally protected against typhoid fever. No vaccine is 100% effective.
The oral vaccine
The oral vaccine is given as three capsules, one taken every other day. The capsules should be kept refrigerated. Each capsule should be taken with cold or lukewarm liquid (no warmer than 37°C), approximately one hour before a meal. It should be swallowed whole as soon as possible after being placed in the mouth, and not chewed. The oral vaccine should be completed one week before you travel, as protection takes at least seven days to begin. This oral vaccine should only be given to children over 6 years of age. Antibiotics and some malaria tablets can stop the oral vaccine working. Most malaria tablets should not be taken for at least three days after receiving the oral vaccine. Your nurse will be able to advise you further about this.
The injectable vaccine
The injectable vaccine is given as a single injection into your upper arm or thigh. It should be given at least two weeks before you travel, ideally one month before.
Re-vaccination is needed eventually as the protective effect of the vaccines fades over time. A booster dose is recommended every three years for the injection and every year for the oral vaccine (with three capsules) for those still at risk. It is important to keep a record of which vaccinations you have, and when and where you have them.
A combined vaccine against typhoid fever and hepatitis A is also available. This may be useful if you require protection against both illnesses. The hepatitis A component gives protection for one year and the typhoid component gives protection for three years.
Are there any possible side-effects?
Mild local soreness and redness may occur after the injection for a few days. High temperature (fever) can occur in about 1 in 100 people. Following oral vaccine, the most common side-effects are feeling sick (nausea), diarrhoea, fever and headache. Serious reactions are very rare for both vaccines.
Who should not receive typhoid vaccines?
Very few people cannot be given the injectable typhoid vaccine. It should not be given to:
- People with an illness with high temperature (fever). It is best to wait until the illness has subsided before being immunised.
- People who have had a severe (anaphylactic) reaction to the vaccine in the past.
- Young children - when children are too young to be vaccinated, very careful attention to food and water hygiene is essential if taking children to an at-risk area.
There are currently no data on the safety of these vaccines in pregnant or breast-feeding women. However, if the risk of typhoid is high then you may be advised to have the vaccine if you are breast-feeding or pregnant.
There are some additional restrictions that apply differently to the oral vaccine and to the injectable vaccine.
The oral vaccine should not be given to:
- People who have had an allergy to gelatin.
- Children under the age of 6 years.
- People who have reduced immunity (people with HIV, those taking high-dose long-term steroids, those receiving chemotherapy, etc).
The injectable vaccine should not be given to:
- Children under 2 years of age, as it is not licensed for them. This means that the manufacturer cannot offer guarantees about its effects or effectiveness in that age group.
- Children under the age of 2 years, who may not acquire the same level of immunity from the vaccine, due to the immaturity of their immune systems.
Note: doctors may occasionally recommend injectable vaccine use in children aged 12-24 months if the risk of typhoid is very high.
Remember - vaccination for travellers is only one aspect of preventing illness. Both typhoid vaccines are only about 75% effective, particularly if you are exposed to large numbers of typhoid germs (bacteria).
Safety in pregnancy is not known but there is no reason to believe the vaccine risks harm to the mother or baby, so it is used if travel is essential and the risk of typhoid is high.
So, when you travel to at-risk areas you should:
- Have good personal hygiene.
- Only drink water or other drinks that are known to be safe (bottled water, sterilised water, etc).
- Only eat foods that have been cleaned and/or prepared properly.
You may need an International Certificate of Vaccination to prove you have been immunised, as some countries will not allow you entry unless you can produce one. Check with your practice nurse at least two weeks before you travel to see if you need this vaccination.
What is yellow fever?
Yellow fever is a serious disease caused by the yellow fever virus which is carried by mosquitoes and which infects humans and other primates (for example, monkeys).
For some people it can cause a flu-like illness from which they recover completely. However, for other people it causes symptoms of high temperature (fever), being sick (vomiting), yellowing of the skin or the whites of the eyes (jaundice) and bleeding. This is fatal in about 1 in 12 cases. There is no medicine that can destroy the virus, so treatment is to support the person medically whilst they fight the infection themself.
Yellow fever is passed to humans and other primates such as monkeys by bites from infected mosquitoes of a type which tend to bite during daylight hours. (These are different to the type of mosquitoes which carry malaria, which tend to bite from dusk to dawn.)
Yellow fever occurs in certain countries of Africa and South America. In the distant past it has been present in Europe and Asia but these parts of the world are currently free of yellow fever.
Yellow fever is not transmitted directly from person to person; the mosquito is needed to carry the infection from one human to another. Therefore, whilst vaccination offers high protection against yellow fever infection, taking steps to avoid being bitten is also an important part of avoiding the disease.
Who should be immunised against yellow fever?
- Travellers over the age of 9 months to countries where yellow fever is a risk. Some countries require an International Certificate of Vaccination against yellow fever before they will let you into the country. Yellow fever is the only disease which routinely requires proof of vaccination:
- In some countries, vaccination is compulsory for all incoming visitors.
- In some countries, vaccination is compulsory for those who have travelled from a 'yellow fever' area or country.
- Your doctor or practice nurse can advise if you should be immunised for your travel destination and whether you need this certificate of vaccination.
- Workers who handle material that may be infected by the yellow fever virus - for example, laboratory workers.
- People who are resident in areas where yellow fever is present.
The purpose of vaccination for travellers is two-fold:
- Firstly it is to protect you from catching yellow fever.
- Secondly it is to protect local populations from catching yellow fever from you, leading to an epidemic. Some countries are theoretically in danger of epidemics, as they have the right mosquitoes to transmit the virus, and have the kinds of monkeys who could become infected and act as a store or reservoir for the virus. They therefore require visitors to be immunised.
The vaccine and where it can be obtained
You should have an injection of vaccine at least ten days before the date of travel to allow immunity to develop.
A single dose of vaccine was previously considered to provide immunity for at least 10 years. In 2013 the World Health Organization (WHO) declared that a single injection can be considered to give lifelong immunity. The International Health Regulations have not yet been altered to reflect this and so the certificate is only valid for 10 years, after which a booster is needed. Some countries now accept it as being valid for life, so it is important to check the regulations for the countries you are visiting. You can do this on the WHO or National Travel Health Network and Centre (NatHNaC) websites or at your GP surgery.
Yellow fever vaccine can only be given at accredited centres. Many GP practices are accredited. If your local GP practice is not accredited you can find a list of the nearest available centres from NaTHNaC (see 'Further Reading and References', below). You will then be issued with a vaccination certificate which gives the date your vaccine will become effective.
The vaccine stimulates your body to make antibodies against the yellow fever virus. These antibodies protect you from illness should you become infected with this virus. The yellow fever vaccine is a live vaccine which can be given at the same time as other vaccines.
What are the side-effects of yellow fever vaccine?
Severe reactions after a yellow fever vaccine are very rare but mild reactions can last for up to 14 days. These include feeling generally unwell, headache, muscle aches, joint pain, mild fever or soreness at the injection site. Always contact a doctor if you have any concerns.
Who should not receive the yellow fever vaccine?
The yellow fever vaccine is not usually given under the following circumstances, although advice should be taken from your doctor or practice nurse:
- If you have reduced immunity (immunosuppression) - for example, people with HIV, people taking high-dose long-term steroids, people receiving chemotherapy, etc.
- If you are ill with a fever you should ideally postpone the injection until you are better.
- As a rule, pregnant women should not be immunised with this vaccine. It is sometimes given after the sixth month of pregnancy if there is a high risk of catching yellow fever.
- This vaccine may be given if you are breast-feeding and cannot avoid being at high risk of catching yellow fever.
- You should not have the yellow fever vaccine if you have had a severe (anaphylactic) reaction in the past to egg. (This is because the vaccine contains small amounts of egg. A severe reaction to egg is very rare and it does not mean an upset stomach eating eggs or disliking eggs.)
- Children under 9 months old should not receive the yellow fever vaccine. (Babies aged 6-9 months may occasionally receive the vaccine if the risk of yellow fever during travel is unavoidable.)
- Older travellers (those aged over 60 years) who have not previously been vaccinated against yellow fever are at a higher risk of side-effects with the yellow fever vaccine.
- If you have had a severe reaction to the yellow fever vaccine in the past.
- If you have a thymus disorder.
Further reading & references
- Immunisation against infectious disease - the Green Book (latest edition); Public Health England
- Travellers Health; US Centers for Disease Control and Prevention
- Travel Health Pro; National Travel Health Network and Centre (NaTHNaC)
- Travelling if you have a medical condition; British Airways (includes downloadable MEDIF forms)
- Travel Health Advisor
- Travel and Diabetes; Diabetes UK
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Colin Tidy
Dr Adrian Bonsall