Travel vaccines help keep trips on track

Who should get the chikungunya vaccine?

Chikungunya vaccine is approved in the United States for people 12 years of age and older. It is administered in a single dose and recommended for adolescents and adults traveling to a country or territory where a chikungunya outbreak is currently occurring. It may be considered for adolescents and adults traveling or relocating to an area with elevated risk, particularly those planning to stay for an extended period such as six months or more.

• Pregnant women should discuss the vaccine with a health care provider before receiving it because there is limited data on safety during pregnancy.
• People with certain underlying health conditions should also consult their provider to determine whether vaccination is appropriate for their situation.

How is chikungunya spread?

Chikungunya is a viral disease spread primarily through the bite of an infected mosquito. The transmission cycle begins when a mosquito feeds on a person infected with chikungunya virus. After roughly a week, that mosquito is able to pass the virus on to the next person it bites. Chikungunya does not spread directly between people through casual contact.

What are the symptoms of chikungunya?

Symptoms of chikungunya typically appear four to eight days after a bite from an infected mosquito, though the onset can range from 2 to 12 days. Most people who are infected will develop noticeable symptoms. Common symptoms include:

• Fever: often high, typically above 39°C (102°F), with a sudden onset
• Joint pain: can be severe and affecting multiple joints at once, in a pattern where both sides of the body are affected

Other symptoms may include:

• Headache
• Muscle pain
• Joint pain
• Skin rash
• Nausea or vomiting
• Eye inflammation

Acute symptoms typically resolve within 7 to 10 days. However, joint pain can persist for weeks, months or even years in some individuals, making chikungunya a potentially long-lasting condition even after the initial illness has passed. Serious complications are uncommon but can occur, particularly in very young infants, older adults and adults with certain underlying conditions.

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Who should consider getting the cholera vaccine?

Cholera vaccine is approved in the United States for people 2 to 64 years of age and is administered in a single dose. It is not routinely recommended for all travelers because the risk of infection among travelers who follow food and water safety precautions is generally very low. However, vaccination should be considered for travelers who are:

• Visiting or relocating to an area where cholera is currently present or where an outbreak is occurring
• Traveling to regions where access to safe drinking water and adequate sanitation is limited
• Traveling to areas experiencing a humanitarian crisis with elevated cholera risk

How is cholera transmitted?

Cholera is a bacterial disease spread primarily through the consumption of water or food that has been contaminated. Cholera is not easily spread through casual person-to-person contact. However, people who are infected but not yet showing symptoms can still shed the bacteria, meaning the disease can continue circulating in a community even when illness is not visible.

What does having cholera look like?

Symptoms typically appear two to three days after consuming contaminated food or water, though they can begin as quickly as a few hours or as late as five days after exposure. Many people infected with cholera experience mild symptoms or none at all. However, roughly 1 in 10 people develops severe symptoms that, without prompt treatment, can become life-threatening. The most recognized symptoms include:

• Profuse watery diarrhea: often described as having a pale, milky appearance similar to water in which rice has been rinsed. This is sometimes called “rice-water stool”
• Vomiting
• Leg cramps
• Restlessness or irritability

The primary danger of cholera is severe dehydration, which can develop very quickly due to the volume of fluid lost through diarrhea and vomiting. If left untreated, severe dehydration from cholera can lead to kidney failure, shock, coma and death. Signs of dehydration to watch for include:

• Rapid heart rate
• Low blood pressure
• Dry mouth and extreme thirst
• Sunken eyes (in infants and young children)
• Reduced or absent urination
• Loss of normal skin elasticity

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Who is the hepatitis A vaccine recommended for?

Hepatitis A vaccination is recommended for a wide range of people, including children as part of routine childhood immunization and adults in certain higher-risk groups.

Vaccination is routinely recommended for:

• All children 12 to 23 months old, as part of the standard childhood vaccine schedule
• All children and adolescents 2 to 18 years old who have not previously been vaccinated against hepatitis A
• Infants 6 through 11 months old who are traveling internationally to areas where hepatitis A is a concern. Note that doses given before 12 months of age do not count toward the standard two-dose series, so additional doses will still be needed at the recommended ages
• Adults who were not vaccinated as children and want protection against hepatitis A

Vaccination is also recommended for those who:

• Are traveling internationally, particularly to countries with higher rates of hepatitis A
• Have chronic liver disease or HIV
• Use injection or non-injection drugs
• Have occupational risk for infection
• Will be having close contact with an international adoptee
• Are experiencing homelessness
• Are men having sexual relations with other men

How is hepatitis A spread?

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus (HAV). It spreads primarily through ingesting the virus, even if it's small amounts. It does not spread through casual contact, such as sitting next to someone, or through coughing and sneezing.

Common ways hepatitis A can spread include:

• Eating food prepared by an infected person who did not wash their hands thoroughly after using the bathroom
• Drinking water or eating food washed in water contaminated with the virus
• Eating raw or undercooked shellfish harvested from sewage-contaminated water
• Close personal or household contact with someone who is infected
• Certain types of sexual contact with an infected person
• Sharing drug use equipment with someone who is infected

One important aspect of hepatitis A is that an infected person can spread the virus to others up to two weeks before any symptoms appear. This means the virus can circulate in a community before anyone is aware an outbreak is occurring.

How many doses of the hepatitis A vaccine do I need?

The number of doses depends on which type of hepatitis A vaccine you receive.

Single-antigen hepatitis A vaccine (protects against hepatitis A only):

• Requires 2 doses, given at least 6 months apart
• This schedule applies to both children and adults

Combination vaccine (protects against both hepatitis A and hepatitis B):

• Requires 3 doses, administered over the course of 6 months
• Available only for adults 18 years and older
• An accelerated 30-day schedule is also available for travelers who need faster protection, followed by a booster dose at 12 months

If you received your first dose but were delayed in getting your second, you do not need to start the series over. Simply get the second dose as soon as possible.

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Who should get the hepatitis B vaccine?

Hepatitis B vaccination is recommended for a broad population, not just people traveling, to prevent infection and reduce the risk of chronic liver disease. It is recommended for all infants at birth, unvaccinated children younger than 19 years of age, adults ages 19 through 59 years, and adults  ages 60 years and older with risk factors for hepatitis B or without identified risk factors but seeking protection.

Can I get the hepatitis A and B vaccines at the same time?

Yes, you can receive both vaccines during the same visit. There are two primary ways to receive both vaccines at once:

Separate injections: You can receive the single-antigen hepatitis A vaccine and the hepatitis B vaccine as two separate shots in different arms during the same appointment.

Combination vaccine: An approved combination vaccine is available for adults ages 18 years and older.

How many doses of hepatitis B vaccine do I need?

The number of doses required for the hepatitis B vaccine depends on the specific vaccine formulation used. Standard adult schedules include:

• 2-dose series: Certain single-antigen vaccines (such as Heplisav-B) require 2 doses given at least 4 weeks apart.
• 3-dose series: Other single-antigen vaccines (such as Engerix-B and Recombivax HB) require 3 doses administered over a 6-month period, typically at 0, 1 and 6 months.

Combination vaccine (hepatitis A and B): The combination vaccine (Twinrix) requires 3 doses given over 6 months. An accelerated 4-dose schedule is also available for rapid protection before travel, consisting of doses at 0, 7, and 21 to 30 days, followed by a booster dose at 12 months.

If your vaccine series is interrupted or delayed, you do not need to restart the series. You should simply receive the next dose as soon as possible to complete the schedule.

Get hepatitis B vaccine information

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Who should consider the Japanese encephalitis vaccine?

Japanese encephalitis vaccine is approved for use in adults and children ages two months and older. It is recommended for travelers who:

• Plan to move to a country where Japanese encephalitis is endemic
• Plan to visit endemic areas for longer periods, such as one month or more
• Travel frequently to areas where the virus is present

Vaccination should also be considered for shorter-term travelers (less than one month) who:

• Plan to visit rural or agricultural areas, especially during the transmission season, and expect to have extensive outdoor or nighttime exposure
• Plan to stay in accommodations without air conditioning, screens or bed nets
• Are uncertain of their specific travel duration, destinations or activities
• If your travel plans are limited to brief visits to major cities, you likely do not need the vaccine.

How is Japanese encephalitis spread?

Japanese encephalitis is a viral infection spread to humans through the bite of an infected mosquito. The virus is maintained in a natural transmission cycle between mosquitoes and animals. Mosquitoes become infected when they feed on these animals, and the mosquitoes can then pass the virus to humans during subsequent bites. However, even when infected, humans do not develop high enough concentrations of the virus in their bloodstream to pass it back to biting mosquitoes. The virus does not spread directly from person to person through casual contact.

How many doses of the Japanese encephalitis vaccine are needed?

The primary vaccination series approved in the United States consists of two doses. The standard schedule is as follows:

• First dose: Administered at a selected start date
• Second dose: Administered 28 days after the first dose. For adults 18 through 65, an accelerated schedule is also approved, allowing the second dose to be given as early as 7 days after the first dose.

Regardless of the schedule used, the primary series should be completed at least one week before potential exposure to the virus to ensure adequate protection. A single booster dose may be considered for individuals who completed the primary series one year or more previously and continue to be at risk of exposure or face potential re-exposure to the virus.

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Who is the rabies vaccine recommended for?

The rabies vaccine is recommended for individuals who are at a higher risk of coming into contact with the rabies virus or potentially rabid animals. It should be considered if you:

• Plan to spend a month or more in countries where rabies is highly prevalent and access to immediate medical care is limited
• Work with animals that could have rabies

How is rabies transmitted?

Rabies is a viral disease that primarily affects the central nervous system and is fatal if medical treatment is not received before symptoms begin. The virus is often transmitted through the saliva of an infected mammal. Rabies is not transmitted through casual contact, such as petting an animal, or through contact with blood, urine or feces. Possible transmission routes include: 

• Bites: The vast majority of rabies cases are transmitted through the bite of an infected animal.
• Scratches: Scratches from an infected animal can also transmit the virus if the claws are contaminated with saliva.
• Mucous membrane exposure: The virus can be transmitted if infected saliva or brain tissue comes into direct contact with open wounds, cuts or mucous membranes such as the eyes, nose or mouth.

What is the difference between pre-exposure and post-exposure rabies vaccination?

Pre-exposure prophylaxis (PrEP rabies vaccine) is administered to individuals at high risk of exposure before any contact with a rabid animal occurs. It consists of a standard two-dose series given on days zero and seven. While it does not eliminate the need for medical evaluation after an exposure, it simplifies the post-exposure treatment plan. It also removes the need for rabies immune globulin, which can be difficult to obtain globally, and reduces the number of post-exposure vaccine doses required.

Post-exposure prophylaxis (PEP rabies vaccine) is an urgent medical intervention administered immediately after a bite, scratch or other potential exposure to a rabid animal.

• For unvaccinated individuals: PEP includes thorough wound cleansing, a dose of human rabies immune globulin (HRIG) on day 0 to provide immediate antibodies, and a 4-dose vaccine series administered on days 0, 3, 7 and 14.
• For previously vaccinated individuals: PEP is much simpler, requiring only wound cleansing and two booster vaccine doses on days 0 and 3, with no immune globulin required.

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Where is tick-borne encephalitis (TBE) most commonly found?

Tick-borne encephalitis is not found in the United States. Instead, it is found in a region stretching from western and northern Europe to northern and eastern Asia. Within these countries, the virus is typically found in forested areas where ticks are active.

Who should get the TBE vaccine?

TBE vaccine is approved for individuals ages one year and older. It is recommended for individuals who:

• Are moving or traveling to an endemic area and expect to have extensive exposure to ticks based on their planned outdoor activities and itinerary
• Will be participating in outdoor activities in or near forested areas, such as hiking, camping, bicycling, fishing or trail running, in regions where the virus is known to circulate

Vaccination may also be considered for those who visit or move to areas where TBE is spreading, even if they're unsure if they will participate in activities that put them at risk for exposure. When deciding on the best approach, it's important to think about personal risk factors that could result in more severe disease, as well as perception of risk and possible activities.

How many doses of the TBE vaccine are required?

The primary vaccination series for the tick-borne encephalitis vaccine approved in the United States consists of three doses given over the course of 5 to 12 months.

To ensure adequate protection, the primary series should ideally be completed at least one week before potential exposure to ticks in endemic areas. A single booster dose, which is a fourth dose, may be given at least 3 years after the completion of the primary series if ongoing exposure or re-exposure to the virus is expected.

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Who should get the typhoid vaccine?

Typhoid vaccine is recommended for individuals who are at an increased risk of contracting typhoid fever, a potentially severe bacterial infection.

• Travelers to endemic areas: Anyone traveling to parts of the world where typhoid is common, particularly South Asia, as well as parts of Africa, East Asia and Latin America. The risk is higher for those visiting friends and relatives, as they may be less cautious with food and water safety and may stay in rural areas with variable sanitation.
• Close contacts of carriers: Individuals who live with or have close personal contact with a documented chronic carrier of the bacteria.
• Laboratory personnel: Workers who routinely handle specimens containing the bacteria in a laboratory setting.

Because the vaccine is not completely effective, all vaccinated individuals should continue to practice strict food and water safety precautions while traveling.

How is Typhoid spread?

Typhoid fever is caused by the bacterium Salmonella Typhi, which infects only humans. The bacteria are shed in the stool and, less commonly, the urine of infected individuals or chronic carriers. Possible transmission routes include:

• Contaminated water: Swallowing water contaminated with sewage is a common source of infection, particularly in areas with inadequate water treatment systems.
• Contaminated food: Eating food that has been handled by an infected person who did not wash their hands thoroughly after using the bathroom can transmit the bacteria. Food rinsed in contaminated water or raw shellfish harvested from polluted waters can also be sources of infection.
• Chronic carriers: Some individuals continue to harbor and shed the bacteria in their stool for more than a year after recovering from the illness. These chronic carriers can unknowingly spread the infection to others.

Is the Typhoid vaccine available as a shot or pill?

Typhoid vaccine is available in both injectable and oral formulations, allowing you to choose the option that best fits your preferences and medical history. Eligibility, number of doses, schedule and duration of protection depends on the formulation.

Get more information about typhoid

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This depends on several factors: where you're going, how long you'll be there, what activities you have planned, and your personal health history. In all cases, speaking with a provider is the best way to help you determine the right protection for your trip.

• Every traveler should be up-to-date on routine vaccines, including measles-mumps-rubella (MMR), tetanus, flu, and COVID-19.
• Government travel health resources offer destination-specific guidance on which vaccines and medications may be recommended or required for your trip.
• Your specific plans, including whether you'll be in rural areas, eating at local restaurants or traveling during certain seasons, can all affect which vaccines are most important for you.
• Some vaccines are required, meaning you must have them to enter the country. Others are recommended, meaning they are not legally required but are strongly advised for your health.

Generally, aim to schedule a pre-travel consultation at least four to six weeks before your departure. It can take weeks for immunity to develop after getting vaccinated, so timing matters considerably depending on the vaccine. Some vaccines require more than one dose, spaced weeks or even months apart.

Starting early enough helps ensure more complete protection, but providers may still offer certain services within days of departure.

Coverage varies, as policies vary by insurer and plan type. Standard health insurance plans often do not cover travel-specific vaccines, viewing them as elective rather than medically necessary, but may cover routine vaccines.

Call your insurer before your appointment and ask specifically which travel vaccines are covered.

Yes, in most cases. Most vaccines can be administered at the same visit, at separate injection sites, without reducing their effectiveness or increasing the risk of side effects. This approach is helpful for international travelers, since the goal may be to build protection against multiple diseases as efficiently as possible before departure.

Both routine and travel vaccines can cause side effects. If they do happen, they are usually mild and resolve within a few days. Vaccine side effects are typically a sign that your immune system is responding as intended.

Serious reactions are rare. Severe allergic reactions (anaphylaxis), with symptoms such as difficulty breathing, rapid heartbeat or facial swelling, can occur but are extremely uncommon. Reach out to a health care provider if you experience:

• A fever that is high or persists beyond a couple of days
• Severe or worsening pain at the injection site
• A rash that spreads or does not improve
• Any difficulty breathing or signs of a severe allergic reaction. Seek emergency care right away.