MD Travel Health

Frequently asked questions by travelers

Where can I get these vaccinations?

You can go to either an infectious diseases specialist, a travel medicine clinic, or your family physician. (Your family doctor will have many of these vaccines in stock, but probably not rabies, Japanese encephalitis, or yellow fever.) Yellow fever vaccine can only be given at a registered yellow fever vaccination center. For extended trips abroad, especially in rural areas, it’s generally advisable to go to an infectious diseases specialist or a travel medicine center. For a partial list of travel clinics, go to the websites of the International Society of Travel Medicine and the American Society of Tropical Medicine and Hygiene.

When should I make an appointment for these vaccinations?

Preferably one month or more before departure.

I’ve received some of these vaccines in the past. How do I know if I need a booster?

This is how long the vaccines are effective (i.e. if it’s been longer than this since you were immunized, you need a booster):

Hepatitis A — 10 years (after second dose; relatively new vaccine; recommendations not finalized)
Typhoid VI (injectable typhoid) — 2 years
Vivotif (oral typhoid) — 5 years
Hepatitis B — obtain a blood test to determine if still protected
Rabies - either revaccinate after 2 years or obtain a blood test to determine if still protected
Yellow fever — 10 years
Meningococcal — 3 years
Japanese encephalitis — 3 years
Tetanus-diphtheria — 10 years
Measles — lifetime (after second dose)
Varicella — lifetime (after second dose)
Polio — lifetime (after a single adult booster)
Influenza — 4-6 months

What is the basis for these recommendations?

The recommendations are largely derived from the publications and websites of the Centers for Disease Control and the World Health Organization. The statements of Health Canada and other governmental agencies have also been considered. For certain diseases, such as typhoid fever, data are limited and official recommendations are somewhat broad. If there is uncertainty in any given situation, we tend to be cautious and recommend giving the vaccine.

What do you do of there is a discrepancy between the advice of the Centers for Disease Control (CDC) and the World Health Organization (WHO)?

We err on the side of caution; i.e. in any given situation, if one organization recommends giving a vaccine and the other doesn’t, we generally advise giving the vaccine. On most points, the CDC and WHO are in close agreement. The chief area of discrepancy is yellow fever vaccine. In countries where yellow fever occurs, the WHO usually recommends yellow fever vaccine only for travel to those parts of the country where yellow fever has actually been reported, whereas the CDC generally recommends the vaccine for all travel outside urban areas. We have adopted the latter set of recommendations. Regarding malaria, the CDC recently revised its recommendations to include atovaquone/proguanil (Malarone), which was recently approved by the FDA. The WHO has not yet stated its position on the appropriate use of this drug. Pending comment by WHO, we are following the CDC recommendations.