Travel and immunisation

Background

International travel carries an increased likelihood of exposure to infections, illness or injury that a person may not otherwise be exposed to. This risk varies depending on factors like the country and area of travel, the season/weather conditions, duration of travel and planned activities, as well as a person’s individual circumstances (medical conditions, age, etc).

Visiting friends and relatives (VFR) is one of the most common reasons for international travel. A VFR traveller is defined as a person who currently lives in a high-income country and travels to their lower-income country of birth to visit friends or relatives. VFR travellers have higher rates of some travel-related infections. It is important for VFR travellers to take appropriate precautions to ensure optimum protection.

Whilst an individual may be considered up to date with their vaccines in Australia, the National Immunisation Program (NIP) recommends vaccines for the Australian context only. When travelling overseas it is important to obtain vaccine recommendations from a healthcare professional trained in travel medicine to ensure optimal protection when in another country.

Recommendations

A consultation with a health care professional should be undertaken a minimum of 4 to 6 weeks prior to overseas departure. This allows time to develop immunity following the administration of any vaccines prior to arrival at the travel destination. Depending on which vaccines are recommended, a course of vaccines over time may be indicated before a person is considered fully protected.

It is particularly important for individuals who are immunocompromised to seek travel advice early to maximise protection prior to travel. Similarly, people who are planning pregnancy or are pregnant should seek advice early to ensure optimum protection for both the parent and unborn baby. Individuals planning pregnancy with a high likelihood of travel should consider vaccination prior to pregnancy, noting that live-attenuated vaccines are contraindicated during pregnancy.

Vaccines

Individuals travelling overseas should firstly ensure that they are up to date with the routine NIP. Some NIP vaccines can be given earlier than scheduled, or as additional doses to ensure that an individual is optimally protected prior to travel. Early or additional doses of NIP doses may need to be privately purchased; check your local state or territory’s immunisation program to confirm funding eligibility.

Protection against measles is very important due to the increase in cases occurring internationally and across Australia.

Influenza vaccination is also recommended for anyone travelling overseas (recommended annually for everyone aged over 6 months, funded for certain groups).

Table 1. Minimum age range for NIP and routine vaccinations

shaded boxes indicate live-attenuated vaccines, which are contraindicated for pregnant women and people who are immunocompromised.
*live-attenuated vaccines must be administered on the same day or a minimum of 4 weeks apart.

Other travel-related vaccines that may be recommended – depending on age, risk factors, location and duration of travel – include:

• COVID-19
• cholera
• hepatitis A
• Japanese encephalitis 
• rabies (NB: rabies vaccination can be administered either before potential exposure or after exposure has occurred)
• tuberculosis
• typhoid
• yellow fever (NB: yellow fever vaccine recipients must obtain an International Certificate of Vaccination or Prophylaxis).

Other precautions

Other preparations for travel may include: 

• considering the need for malaria prophylaxis (medication to prevent malaria)
• measures to prevent mosquito-borne disease such as wearing long-sleeved clothing, using window and door screens or mosquito nets, and insect repellent than contains DEET
• food and water safety.

Access

General practitioners, select pharmacies, travel medicine clinics and specialist physicians (infectious disease physicians, paediatricians and immunisation specialists) can provide recommendations for preventative care and offer vaccination.

Most specialists require a GP referral, and may have wait times for an appointment. In addition, certain vaccines (including yellow fever vaccines and tuberculosis vaccines) can only be administered at certain clinics. Wait times can be particularly long for tuberculosis vaccination due to high demand and limited clinics. It is important to factor this into travel planning timelines.

It is important to note that travel vaccines can be expensive.

Resources

• Department of Health Victoria: Yellow fever vaccination centres
• Centres for Disease Control and Prevention (CDC): Travelers’ health
• Travel health pro- travel health website
• Smart Traveller (Australian Department of Foreign Affairs and Trade)
• MVEC: BCG/Tuberculosis
• WHO: Global vaccination schedules
• Australian Immunisation Handbook: Vaccination for international travellers
• Australian Immunisation Handbook: Catch-up vaccination