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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

  • Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
  • Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
  • The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

  • Travel clinic
  • Health department
  • Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

  • Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
  • Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
  • Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
  • Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

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Frequently Asked Questions: Guidance for Travelers to Enter the U.S.

Updated Date: April 21, 2022

Since January 22, 2022, DHS has required non-U.S. individuals seeking to enter the United States via land ports of entry and ferry terminals at the U.S.-Mexico and U.S.-Canada borders to be fully vaccinated for COVID-19 and provide proof of vaccination upon request.  On April 21, 2022, DHS announced that it would extend these requirements. In determining whether and when to rescind this order, DHS anticipates that it will take account of whether the vaccination requirement for non-U.S. air travelers remains in place.

These requirements apply to non-U.S. individuals who are traveling for essential or non-essential reasons. They do not apply to U.S. citizens, Lawful Permanent Residents, or U.S. nationals.

Effective November 8, 2021, new air travel requirements applied to many noncitizens who are visiting the United States temporarily. These travelers are also required to show proof of COVID-19 vaccination. All air travelers, including U.S. persons, must test negative for COVID-19 prior to departure. Limited exceptions apply. See  CDC guidance  for more details regarding air travel requirements.

Below is more information about what to know before you go, and answers to Frequently Asked Questions about cross-border travel.

Entering the U.S. Through a Land Port of Entry or Ferry Terminal

Q. what are the requirements for travelers entering the united states through land poes.

A:  Before embarking on a trip to the United States, non-U.S. travelers should be prepared for the following:

  • Possess proof of an approved COVID-19 vaccination as outlined on the  CDC  website.
  • During border inspection, verbally attest to their COVID-19 vaccination status. 
  • Bring a  Western Hemisphere Travel Initiative  compliant border crossing document, such as a valid passport (and visa if required), Trusted Traveler Program card, a Department of State-issued Border Crossing Card, Enhanced Driver’s License or Enhanced Tribal Card when entering the country. Travelers (including U.S. citizens) should be prepared to present the WHTI-compliant document and any other documents requested by the CBP officer.

 Q. What are the requirements to enter the United States for children under the age of 18 who can't be vaccinated?

A:  Children under 18 years of age are excepted from the vaccination requirement at land and ferry POEs.

Q: Which vaccines/combination of vaccines will be accepted?

A:  Per CDC guidelines, all Food and Drug Administration (FDA) approved and authorized vaccines, as well as all vaccines that have an Emergency Use Listing (EUL) from the World Health Organization (WHO), will be accepted.

Accepted Vaccines:

  • More details are available in CDC guidance  here .
  • 2 weeks (14 days) after your dose of an accepted single-dose COVID-19 vaccine;
  • 2 weeks (14 days) after your second dose of an accepted 2-dose series;
  • 2 weeks (14 days) after you received the full series of an accepted COVID-19 vaccine (not placebo) in a clinical trial;
  • 2 weeks (14 days) after you received 2 doses of any “mix-and-match” combination of accepted COVID-19 vaccines administered at least 17 days apart.

Q. Is the United States requiring travelers to have a booster dose to be considered fully vaccinated for border entry purposes?

A:  No. The CDC guidance for “full vaccination” can be found here.

Q: Do U.S. citizens or lawful permanent residents need proof of vaccination to return to the United States via land POEs and ferry terminals?

A:  No. Vaccination requirements do not apply to U.S. citizens, U.S. nationals, or Lawful Permanent Residents (LPRs). Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation.

Q: Is pre- or at-arrival COVID testing required to enter the United States via land POEs or ferry terminals?

A: No, there is no COVID testing requirement to enter the United States via land POE or ferry terminals. In this respect, the requirement for entering by a land POE or ferry terminal differs from arrival via air, where there is a requirement to have a negative test result before departure.

Processing Changes Announced on January 22, 2022 

Q: new changes were recently announced. what changed on january 22.

A:  Since January 22, 2022, non-citizens who are not U.S. nationals or Lawful Permanent Residents have been required to be vaccinated against COVID-19 to enter the United States at land ports of entry and ferry terminals, whether for essential or nonessential purposes. Previously, DHS required that non-U.S. persons be vaccinated against COVID-19 to enter the United States for nonessential purposes.  Effective January 22, all non-U.S. individuals, to include essential travelers, must be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request. DHS announced an extension of this policy on April 21, 2022.

Q: Who is affected by the changes announced on January 22?

A: This requirement does not apply to U.S. citizens, U.S. nationals, or U.S. Lawful Permanent Residents. It applies to other noncitizens, such as a citizen of Mexico, Canada, or any other country seeking to enter the United States through a land port of entry or ferry terminal.

Q: Do U.S. citizens need proof of vaccination to return to the United States via land port of entry or ferry terminals?

A: Vaccination requirements do not apply to U.S. Citizens, U.S. nationals or U.S. Lawful Permanent Residents. Travelers that exhibit signs or symptoms of illness will be referred to CDC for additional medical evaluation. 

Q: What is essential travel?

A:  Under the prior policy, there was an exception from temporary travel restrictions for “essential travel.” Essential travel included travel to attend educational institutions, travel to work in the United States, travel for emergency response and public health purposes, and travel for lawful cross-border trade (e.g., commercial truckers). Under current policy, there is no exception for essential travel.

Q: Will there be any exemptions? 

A: While most non-U.S. individuals seeking to enter the United States will need to be vaccinated, there is a narrow list of exemptions consistent with the Centers for Disease Control and Prevention (CDC) Order in the air travel context.

  • Certain categories of individuals on diplomatic or official foreign government travel as specified in the CDC Order
  • Children under 18 years of age;
  • Certain participants in certain COVID-19 vaccine trials as specified in the CDC Order;   
  • Individuals with medical contraindications to receiving a COVID-19 vaccine as specified in the CDC Order;
  • Individuals issued a humanitarian or emergency exception by the Secretary of Homeland Security;
  • Individuals with valid nonimmigrant visas (excluding B-1 [business] or B-2 [tourism] visas) who are citizens of a country with limited COVID-19 vaccine availability, as specified in the CDC Order
  • Members of the U.S. Armed Forces or their spouses or children (under 18 years of age) as specified in the CDC Order; and
  • Individuals whose entry would be in the U.S. national interest, as determined by the Secretary of Homeland Security.

Q: What documentation will be required to show vaccination status?

A:  Non-U.S. individuals are required to be prepared to attest to vaccination status and present proof of vaccination to a CBP officer upon request regardless of the purpose of travel.

The current documentation requirement remains the same and is available on the CDC website . Documentation requirements for entry at land ports of entry and ferry terminals mirror those for entry by air.

Q: What happens if someone doesn’t have proof of vaccine status?

A: If non-U.S. individuals cannot present proof of vaccination upon request, they will not be admitted into the United States and will either be subject to removal or be allowed to withdraw their application for entry.

Q: Will incoming travelers be required to present COVID-19 test results?

A: There is no COVID-19 testing requirement for travelers at land border ports of entry, including ferry terminals.

Q: What does this mean for those who can't be vaccinated, either due to age or other health considerations? 

A: See CDC guidance for additional information on this topic. Note that the vaccine requirement does not apply to children under 18 years of age.

Q: Does this requirement apply to amateur and professional athletes?

A: Yes, unless they qualify for one of the narrow CDC exemptions.

Q: Are commercial truckers required to be vaccinated?

A: Yes, unless they qualify for one of the narrow CDC exemptions. These requirements also apply to bus drivers as well as rail and ferry operators.

Q. Do you expect border wait times to increase?

A:  As travelers navigate these new travel requirements, wait times may increase. Travelers should account for the possibility of longer than normal wait times and lines at U.S. land border crossings when planning their trip and are kindly encouraged to exercise patience.

To help reduce wait times and long lines, travelers can take advantage of innovative technology, such as facial biometrics and the CBP OneTM mobile application, which serves as a single portal for individuals to access CBP mobile applications and services.

Q: How is Customs and Border Protection staffing the ports of entry? 

A: CBP’s current staffing levels at ports of entry throughout the United States are commensurate with pre-pandemic levels. CBP has continued to hire and train new employees throughout the pandemic. CBP expects some travelers to be non-compliant with the proof of vaccination requirements, which may at times lead to an increase in border wait times. Although trade and travel facilitation remain a priority, we cannot compromise national security, which is our primary mission. CBP Office of Field Operations will continue to dedicate its finite resources to the processing of arriving traffic with emphasis on trade facilitation to ensure economic recovery.

Q: What happens if a vaccinated individual is traveling with an unvaccinated individual?  

A:  The unvaccinated individual (if 18 or over) would not be eligible for admission.

Q: If I am traveling for an essential reason but am not vaccinated can I still enter?

A:  No, if you are a non-U.S. individual. The policy announced on January 22, 2022 applies to both essential and non-essential travel by non-U.S. individual travelers. Since January 22, DHS has required that all inbound non-U.S. individuals crossing U.S. land or ferry POEs – whether for essential or non-essential reasons – be fully vaccinated for COVID-19 and provide related proof of vaccination upon request.

Q: Are sea crew members on vessels required to have a COVID vaccine to disembark?

A:  Sea crew members traveling pursuant to a C-1 or D nonimmigrant visa are not excepted from COVID-19 vaccine requirements at the land border. This is a difference from the international air transportation context.

Entering the U.S. via Air Travel

Q: what are the covid vaccination requirements for air passengers to the united states  .

A:  According to CDC requirements [www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html | Link no longer valid], most noncitizens who are visiting the United States temporarily must be fully vaccinated prior to boarding a flight to the United States. These travelers are required to show proof of vaccination. A list of covered individuals is available on the CDC website.  

Q: What are the COVID testing requirements for air passengers to the United States?  

A:  Effective Sunday, June 12 at 12:01 a.m. ET, CDC will no longer require pre-departure COVID-19 testing for U.S.-bound air travelers.

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Which Vaccinations Are Required for Travel?

By Cassie Shortsleeve

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A trip abroad requires you to be up-to-date on a whole checklist of things these days: travel insurance, airline policies, visas, passports , and, as far as your health is concerned, vaccines. Yet while the COVID-19 pandemic has made us acutely aware of the importance of staying healthy on the road, travel vaccines have always been a mainstay of safe travel—a crucial tool in avoiding the (often expensive) headaches of getting sick , and treating sicknesses, abroad.

Whether you have travel on the horizon or want to be prepared for 2023 trips and beyond, this guide will get you up to speed on the vaccinations required for travel depending on your destination, itinerary, and health status. Follow the below steps to protect your immune system in another country.

Make sure you’re current with routine vaccines

The Centers for Disease Control and Prevention (CDC) recommends all travelers be up to date on routine vaccines before travel. Routine vaccines include shots like COVID-19; chickenpox; Hepatitis A and B; Influenza; Measles, Mumps, Rubella (MMR); Polio; and more. The CDC has a full list of routine vaccines here .

“‘Routinely recommended vaccines’ are vaccines that have been considered very important to prevent common diseases in the population to start,” says Lin H. Chen , M.D. director of the Travel Medicine Center at Mount Auburn Hospital in Cambridge, Massachusetts, and the former president of the International Society of Travel Medicine (ISTM).

Routine vaccines protect against disease that exists at low levels (chickenpox) or barely exists at all (measles) in the U.S. They also protect against severe disease from diseases that are still present in the United States (influenza or COVID-19). Generally, they’re given in childhood or adolescence—though some are given through adulthood—so it’s always a good idea to double-check your vaccination records.

When traveling, routine shots are especially important because international travel increases your chances of both contracting and spreading diseases that aren’t common in the U.S. A good example of this is measles. While it’s practically non-existent in the U.S., international travel increases your risk of exposure and popular destinations including Europe still have measles outbreaks.

It’s worth double checking your status even if you think you’re up to date: “During the pandemic, some routine vaccination programs may have suffered lapses, so there is concern that diseases may become more common,” says Dr. Chen.

The routine vaccination recommendations have also changed over the years (the addition of the COVID-19 vaccine to the list is an example) and it’s easy to let vaccines like tetanus ( generally needed every 10 years ) lapse.

“It is even recommended at this time that certain adults who are traveling who have not had a polio vaccine for many years and are traveling to a risk area get an additional dose of the polio vaccine,” says Elizabeth D. Barnett , M.D., a professor at Boston University Medical School and a leader in the field of travel and tropical Medicine.

If you’re traveling with a child , talk to your pediatrician: Rules around vaccination can be different for babies traveling internationally. A baby who is not leaving the U.S., for example, gets their first dose of the MMR vaccine at 12 months; if they will be leaving the country, they get the first dose at six months .

Utilize official resources to learn more about vaccination recommendations around the world

“Understanding the epidemiology of where diseases are circulating is really important,” says Dr. Chen.

That’s why, generally, she sends travelers to the CDC’s website , which outlines exactly what additional vaccines you may need for essentially every country in the world. All you have to do is plug in your destination and you’ll find information about vaccines and medications, health travel notices, COVID-19 travel information, and more.

Start a conversation with your primary care doctor—then consider seeing a travel medicine specialist

It’s always good to start a conversation with your primary care doctor about vaccines before you travel, but if your itinerary is complex, involving multiple countries, being in rural areas, areas without good hygiene, or areas where you may not be able to protect yourself from mosquito- or food-borne illnesses, or if you have questions based on what you found on the CDC website or your own personal health history, consider asking your physician for a referral to a travel medicine specialist or travel clinic.

After all, when it comes to vaccinations required for travel, it’s not just about where you travel, but how you travel.

“The art of travel medicine is listening to where the person is going, what they're going to be doing, and making a decision based on the risk-benefit ratio,” says Dr. Barnett. A travel medicine doctor will be able to analyze disease trends and trip details such as how long you’ll be traveling or how well you’ll be able to protect yourself against mosquitoes. “You have to really dig into those things,” she says.

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Take a vaccine called the Japanese encephalitis vaccine, which prevents a type of encephalitis (inflammation of the brain). “We can't just say the risk is present in a specific country, because the risk depends on the time of year, whether the disease is being transmitted at that time, the exact location—rural areas, especially farming regions are associated with much higher risk — whether there's a local outbreak situation going on, and more.”

You may not be able to get every shot you need at your primary care doctor’s office either. The yellow fever vaccine, for example (which you may need if you’re traveling somewhere like Sub-Saharan Africa or specific parts of South America), is only available at special travel clinics or public health settings, says Dr. Barnett. You can find a list of travel medicine clinics on the CDC’s website.

Your health background (what diseases you’ve had in the past, whether or not you’re immune-suppressed, and if you’re more predisposed to a certain condition) also play a role in what vaccines to consider. (A very small subset of people vaccinated against yellow fever, for example, experience severe adverse events, says Dr. Barnett.)

The bottom line

For many people and many trips, discussing travel plans with your primary care doctor and using the CDC’s destination feature for vaccine guidance will suffice. Other, more complex trips require a visit to a travel clinic. If you’re aiming to get into one, start the process at least a month before your departure date—appointments can be hard to get and your body needs time to build up immunity from any additional vaccines you may require.

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COVID-19 international travel advisories

If you plan to visit the U.S., you do not need to be tested or vaccinated for COVID-19. U.S. citizens going abroad, check with the Department of State for travel advisories.

COVID-19 testing and vaccine rules for entering the U.S.

  • As of May 12, 2023, noncitizen nonimmigrant visitors to the U.S.  arriving by air  or  arriving by land or sea  no longer need to show proof of being fully vaccinated against COVID-19. 
  • As of June 12, 2022,  people entering the U.S. no longer need to show proof of a negative COVID-19 test . 

U.S. citizens traveling to a country outside the U.S.

Find country-specific COVID-19 travel rules from the Department of State.

See the  CDC's COVID-19 guidance for safer international travel.

LAST UPDATED: December 6, 2023

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travel vaccinations information

Joel Streed

9 common questions about vaccines and travel

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Travel does more than just transport you to a different place. It can broaden your perspective, increase your happiness, give you a chance to try new things, boost your creativity and help you recharge. Even planning a trip can be an exciting task. The anticipation of mapping an itinerary and scheduling your must-see attractions can bring a lot of joy and happiness.

One of the most important tasks before taking a trip is to make an appointment with a travel medicine specialist. These health care professionals help keep travelers safe and happy before and after their journeys.

Here are answers to common questions about travel medicine:

1. who should make an appointment with a travel medicine specialist.

Anyone planning a trip overseas can benefit from seeing a travel medicine specialist. However, a travel clinic appointment is critical if you are traveling to underdeveloped or developing countries where there's a higher risk of contracting severe communicable illnesses while abroad. It is also important for patients with certain medical conditions that make their immune systems weaker and more vulnerable to infectious diseases.

2. What vaccinations do I need to travel overseas?

All travelers should be vaccinated against the flu and current with COVID-19 vaccines and boosters.

In addition, it's important to complete the adult vaccination schedule that includes vaccinations for:

  • Chickenpox (varicella)
  • Diphtheria, tetanus and pertussis (DTP)
  • Pneumococcal
  • Measles, mumps and rubella (MMR)

Additional vaccines may be recommended depending on your travel itinerary. For example, hepatitis A vaccination is recommended if you are traveling to Southeast Asia. During your appointment, we can discuss which vaccines are appropriate for your itinerary.

3. Are there travel destinations that have different vaccination recommendations?

Yes. Infectious diseases thrive in different climates. If you travel to a new climate, you may be exposed to diseases to which you don't have any immunity.

Some infections are more prevalent in tropical settings compared to temperate climates. For example, typhoid and hepatitis A are more common in Southeast Asia because these communicable diseases can be spread through contaminated water. Some areas of Africa and South America have a higher prevalence of yellow fever and malaria, which are mosquito-borne infections.

The  Centers for Disease Control and Prevention (CDC)  has good information online for travelers for each travel destination.

Recommended vaccines may include:

  • Hepatitis A
  • Hepatitis B
  • Japanese encephalitis
  • Yellow fever

4. Can my primary care provider give me travel vaccinations?

It depends on your travel destinations and vaccine recommendations. I recommend starting the conversation with your primary care provider and reviewing the  CDC recommendations .

If you have a complex itinerary with multiple countries or are traveling to Southeast Asia or Africa, it's better to make an appointment at the travel clinic. I also would recommend patients with organ transplants and immunocompromising conditions seek travel medicine consultation to reduce the risk of illness during travel. During that appointment, we will review your itinerary, provide necessary vaccinations and discuss ways to prevent mosquito-borne or tick-borne diseases.

5. How long before my trip should I go to the travel clinic?

Plan to have an appointment at least four weeks before you travel. Some vaccines require several weeks for immunity to develop, while others require more than one dose of vaccine for full protection.

If your trip is to an underdeveloped or developing country, you may need to schedule an appointment up to two months in advance to receive a complete set of immunizations. This gives your body time to produce the protective antibodies, so you are well protected when you land at your destination.

6. Can I only go to the travel clinic before I travel?

No. The Travel and Tropical Medicine Clinic is available before or after travel. The team can provide consultative services and treatment if you get sick after you return home.

7. I'm going to an all-inclusive resort. Will I have a lower risk of getting sick?

Maybe, but no traveler should take safety for granted. Even in an all-inclusive resort, knowing how food is prepared or the water supply quality is not possible. Mosquitos and other insects could still be a concern. It's important to take all necessary precautions and follow vaccination recommendations when you travel, regardless of your accommodations.

8. How do I lower my risk of malaria when traveling?

Malaria is a disease caused by a parasite. It's spread to humans through the bites of infected mosquitoes. Prophylactic malaria medications are available and are started before the travel, continued during the stay and for a certain duration after returning home. A travel medicine specialist can review the risks and benefits of all prevention and treatment options.

9. How do I stay healthy while traveling?

Nothing can ruin a trip like illness. Make sure all your vaccinations and boosters are up to date, and get any new vaccinations recommended for your destinations.

Food and water safety is important while traveling. Only eat well-cooked food. Avoid eating from roadside stands and uncooked foods, like salad and raw vegetables. Drink bottled beverages only, including bottled water. This is especially important if you travel in resource-limited regions, such as Southeast Asia or Africa.

Hand hygiene is important at home and overseas. Wash your hands often using soap and hot water. Avoid crowded places, follow respiratory etiquette and consider optional masking. Mosquitos and bugs can transmit parasites and diseases, like yellow fever and malaria. Use mosquito repellents. Mosquito nets may be appropriate in some parts of the world, as well.

As you make travel plans, schedule an appointment with a travel medicine specialist to get the vaccinations and information you need to be healthy and safe on your journey.

Raj Palraj, M.D. , is a physician in  Infectious Diseases  and  Travel and Tropical Medicine  in  La Crosse , Wisconsin.

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Overview - Travel vaccinations

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against infections such as yellow fever , typhoid and hepatitis A .

In the UK, the  NHS routine immunisation (vaccination) schedule protects you against a number of diseases, but does not cover all of the infectious diseases found overseas.

When should I start thinking about the vaccines I need?

If possible, see the GP or a private travel clinic at least 6 to 8 weeks before you're due to travel.

Some vaccines need to be given well in advance to allow your body to develop immunity.

And some vaccines involve a number of doses spread over several weeks or months.

You may be more at risk of some diseases, for example, if you're:

  • travelling in rural areas
  • backpacking
  • staying in hostels or camping
  • on a long trip rather than a package holiday

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Which travel vaccines do I need?

You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

  • Travel Health Pro
  • NHS Fit for Travel

Some countries require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages.

Even if an ICVP is not required, it's still a good idea to take a record of the vaccinations you have had with you.

Find out more about the vaccines available for travellers abroad

Where do I get my travel vaccines?

First, phone or visit the GP practice or practice nurse to find out whether your existing UK vaccinations are up-to-date.

If you have any records of your vaccinations, let the GP know what you have had previously.

The GP or practice nurse may be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria.

They can give you any missing doses of your UK vaccines if you need them.

Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area.

If the GP practice can give you the travel vaccines you need but they are not available on the NHS, ask for:

  • written information on what vaccines are needed
  • the cost of each dose or course
  • any other charges you may have to pay, such as for some certificates of vaccination

You can also get travel vaccines from:

  • private travel vaccination clinics
  • pharmacies offering travel healthcare services

Which travel vaccines are free?

The following travel vaccines are available free on the NHS from your GP surgery:

  • polio (given as a combined diphtheria/tetanus/polio jab )
  • hepatitis A

These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were brought into the country.

Which travel vaccines will I have to pay for?

You'll have to pay for travel vaccinations against:

  • hepatitis B
  • Japanese encephalitis
  • tick-borne encephalitis
  • tuberculosis (TB)
  • yellow fever

Yellow fever vaccines are only available from designated centres .

The cost of travel vaccines that are not available on the NHS will vary, depending on the vaccine and number of doses you need.

It's worth considering this when budgeting for your trip.

Other things to consider

There are other things to consider when planning your travel vaccinations, including:

  • your age and health – you may be more vulnerable to infection than others; some vaccines cannot be given to people with certain medical conditions
  • working as an aid worker – you may come into contact with more diseases in a refugee camp or helping after a natural disaster
  • working in a medical setting – a doctor, nurse or another healthcare worker may require additional vaccinations
  • contact with animals – you may be more at risk of getting diseases spread by animals, such as rabies

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations.

But it's important to check that you're up-to-date with routine vaccinations available on the NHS.

Pregnancy and breastfeeding

Speak to a GP before having any vaccinations if:

  • you're pregnant
  • you think you might be pregnant
  • you're breastfeeding

In many cases, it's unlikely a vaccine given while you're pregnant or breastfeeding will cause problems for the baby.

But the GP will be able to give you further advice about this.

People with immune deficiencies

For some people travelling overseas, vaccination against certain diseases may not be advised.

This may be the case if:

  • you have a condition that affects your body's immune system, such as HIV or AIDS
  • you're receiving treatment that affects your immune system, such as chemotherapy
  • you have recently had a bone marrow or organ transplant

A GP can give you further advice about this.

Non-travel vaccines

As well as getting any travel vaccinations you need, it's also a good opportunity to make sure your other UK vaccinations are up-to-date and have booster vaccines if necessary.

People in certain risk groups may be offered extra vaccines.

These include vaccinations against diseases such as:

Read more information on NHS vaccines for adults and children to find out whether you should have any.

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

travel vaccinations information

MSU Extension Vaccine Education

Understanding travel vaccinations.

Alyssa Maturen <[email protected]> - November 11, 2022

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What you need to know to keep yourself and others safe while you travel.

A photo of a map with scrabble letters on it that spell out travel safe.  The photo also includes a smartphone and a passport.

With travel ramping up across the country and world, understanding how to stay safe is essential. Save yourself the headache at the airport by learning what vaccinations are required for entry ahead of time to best enjoy your travels.

What are Travel Vaccines?

Travel vaccines are vaccinations that are given to protect travelers from diseases that may be rare in the country they live in, but a concern for the places they are going. According to the World Health Organization (WHO), “vaccines use your body’s natural defenses to build resistance to specific infections that make your immune system stronger.” The Centers for Disease Control and Prevention (CDC) lists 16 main travel vaccinations that you may need to get for the first time or as boosters before traveling. Example vaccines the CDC identified:

  • Flu (Influenza)
  • Hepatitis A
  • Hepatitis B
  • Japanese encephalitis
  • MMR (Measles, Mumps, Rubella)
  • Meningococcal
  • Pneumococcal
  • Tdap (Tetanus, Diphtheria, Pertussis)
  • Yellow fever

When to Get Travel Vaccines?

The U.S. Department of Health and Human Services recommends getting, “vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines enough time to provide full protection while you’re traveling. It also helps to make sure there’s enough time for you to get vaccines that require more than one dose.”  Plan ahead for your trip and identify an ideal window of dates to get vaccinated. Then, call ahead and schedule vaccinations with your primary care doctor or at a clinic.

To know which vaccines are required and recommended for the location(s) of your trip, use the CDC’s Travel Toolkit to search by location for the complete list of vaccines to ask your doctor about before traveling. The toolkit also discusses non-vaccine preventable diseases that you might encounter at your destination country and ways to avoid them. 

Where to Find Travel Vaccines

It is widely recommended that you talk to your doctor about what travel vaccines you should get. Some primary care offices may offer the vaccinations themselves. You can also often find the vaccines you are looking for at local health departments, yellow fever vaccination clinics, and specific travel clinics. You can go to Vaccines.gov to locate a clinic near you.

If you would like to learn more about vaccines, check out Michigan State University Extension’s partnership with the Michigan Vaccine Project to find links to event schedules, podcasts, publications, webinars, and videos related to vaccine education at https://www.canr.msu.edu/vaccineeducation/ .

This article was published by Michigan State University Extension . For more information, visit https://extension.msu.edu . To have a digest of information delivered straight to your email inbox, visit https://extension.msu.edu/newsletters . To contact an expert in your area, visit https://extension.msu.edu/experts , or call 888-MSUE4MI (888-678-3464).

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Vaccinations and preventative health.

When travelling overseas, you may get sick from infectious diseases or other health conditions. Before you go, find out what vaccinations and other preventative measures are appropriate for your destination .

Explore this page to learn about:

  • the impacts of getting sick overseas
  • how to find out about health risks in your destination
  • where to get medical advice
  • travel vaccinations
  • registering a vaccination you received overseas
  • preventative medication
  • preventative measures you can take while you're there
  • how the Government can help if you get sick overseas

Read this page in tandem with the Department of Health's guidance on Travel Health , and our travel advice for your destination .

The impact of getting sick overseas

Getting sick overseas is a sure way to ruin your trip. It impacts your health and may impact your safety and finances. Medical assistance overseas can be expensive.

Anyone can catch an infectious disease , even if you're usually fit and healthy.

Health risks

You could experience serious illness, injury or even death while travelling overseas. Health risks include:

  • worsening of pre-existing illnesses, such as heart disease or mental health conditions
  • injury, such as wounds, sprains, fractures or head injuries
  • heat or cold related illness, including severe sunburn
  • infectious diseases
  • traffic accidents
  • allergic reactions
  • altitude sickness
  • illnesses that may have occurred at home, such as stroke or heart attack

If you return to Australia with an infectious disease , you put other people at risk, including your family and friends.

Your health is your responsibility.

Financial risks

If you get sick or injured, you could face very high medical costs. You'll need to pay for medical care yourself.

Costs may include loss of prepaid activities, accommodation or flights, as well as emergency food, accommodation or flight changes for your companions.

When you're overseas, you don't have access to Australia's subsidised Medicare and Pharmaceutical Benefits (PBS) Schemes. You, your family or travel insurer will have to pay.

  • Stays in emergency wards overseas often cost thousands of dollars per day.
  • If you have caught an infectious disease, they may need to put you in quarantine, which costs even more than an emergency ward.
  • If you can't pay your bill upfront, you may not get treatment. Even in a medical emergency .
  • If you get treatment and then can't pay your bill, you could be arrested or jailed .

Learn more about money problems while you're away.

Research your destination's health risks

Health risks can vary between destinations. When you know the risks, you know what vaccinations and preventative health measures you can take.

  • Talk to your doctor or travel clinic.
  • Read about key health risks in our travel advice for your destination .
  • See the World Health Organisation (the WHO) advice on infectious disease risks for travellers .
  • Check travel guides and online travel resources for your destination.
  • Subscribe for updates to our travel advice for your destinations, including on changes to health risks, such as disease outbreaks.

You may need to meet certain health requirements to enter and exit your destination. For example, some countries require proof that you've had a yellow fever vaccination . Contact your destination's embassy or consulate in Australia for information.

Get medical advice from your doctor

Your personal situation can affect your health risks overseas. You need medical advice tailored to you, even if you're usually fit and healthy.

Only your GP, travel doctor or other medical specialist can advise what vaccinations and preventative health measures you should take. See your doctor to find out what is right for you.

  • Ask how to protect yourself against infectious diseases , blood clots and destination specific risks such as altitude sickness and temperature related sickness.
  • Consider how your medical conditions may be affected by travelling, such as heart conditions, diabetes or mental health.
  • If you're an older Australian, ask if there are any additional precautions you should take.
  • If you're travelling with babies or children, check their usual and travel vaccinations are up to date. Ask about any health issues that may be particularly relevant to them at your destination.
  • If you're pregnant, ask what vaccinations you can take, what special risks you may face and what destinations you may wish to avoid.
  • Read our general advice on taking care of your health .

Common vaccinations for travel

Vaccinate yourself against diseases that are a risk in your destination. If a travel warning is in place for a vaccine-preventable disease, get vaccinated against it.

You may need proof of certain vaccinations to enter and exit some countries. Some airlines and cruise lines require evidence before you board.

Diseases that the Department of Health suggests travellers can vaccinate against include:

  • hepatitis A and hepatitis B
  • chickenpox (varicella)
  • yellow fever
  • tuberculosis (TB)
  • Japanese encephalitis
  • meningococcal disease
  • influenza (flu)

Depending on your health and destination, there may be other diseases you may need to vaccinate against. Talk to your doctor for advice specific to you.

Learn more about travel vaccinations from the Department of Health's website.

Registering a vaccination received overseas

If you get vaccinated while overseas, you can register your vaccination on the Australian Immunisation Register (AIR) when you return to Australia.

To register your vaccination in the AIR:

  • Obtain proof of vaccination from your provider when you receive the vaccine
  • Bring the proof of vaccination to Australia when you return. The proof must be translated to English if it’s in another language.
  • Make sure your Medicare online account is up to date.
  • Give the proof of vaccination along with your Medicare card to a recognised vaccination provider in Australia. They’ll verify your vaccination status and add the record of vaccination to the AIR.

For more information on registering an overseas vaccination, visit Services Australia .

Medication and medical supplies

You can get some over the counter or prescription medications to help protect you from infectious diseases and other health problems overseas.

Common preventative medications and medical supplies may include:

  • an adequate supply of usual medications
  • a first aid kit
  • anti-malarial tablets
  • altitude sickness tablets
  • insect repellent sprays, creams and gels containing DEET or picaridin
  • antihistamines for allergies or insect bites
  • oral rehydration sachets or tablets
  • anti-diarrhoeal medication
  • motion sickness prevention medication
  • emergency antibiotics
  • water purification tablets

Talk to your doctor or travel clinic about medications you can take to prevent health problems where you're going.

You can get some over the counter or prescription medications overseas to help protect you from infectious diseases and other health problems. However, these may not be the same standard as those bought in Australia.

Be aware of any limitations or risks when travelling with medication .

What you can do to prevent illness while you're away

There's plenty you can do while you're away to reduce the risk of health problems.

  • Practise good hand hygiene.
  • Eat and drink safe food and water.
  • Protect yourself against insect bites.
  • Use sunscreen and other sun protection.
  • Take actions to prevent blood clots due to air or land travel.
  • Take actions to prevent illness related to heat, cold, and altitude.
  • Practice safer sex.
  • Use appropriate safety equipment for your activities.
  • Take appropriate precautions when participating in activities that are unfamiliar or you haven’t done for a while.
  • Take care with drugs and alcohol in unfamiliar environments.
  • Be aware in unfamiliar traffic conditions and only use vehicles that you are licensed to drive.
  • Avoid destinations with higher risks of infectious diseases if you have medical conditions that place you at increased risk.
  • Know how to seek medical assistance in your destination.
  • Seek medical advice if you're unwell overseas or on your return.
  • Follow social media and local news while you're there so you can find out if there's a disease outbreak.

If there is a major disease outbreak in your destination and we raise the advice level to do not travel, then don't go. Wait until the risk has passed. You're putting yourself and others at serious risk.

Consular Services and preventative health

You're responsible for preparing to protect your health while you're away.

Read the Consular Services Charter for what the Australian Government can and can’t do to help you if you have health troubles overseas.

What we can do

  • We can update our travel advice if we learn of a disease outbreak.
  • We can publish some key health risks in each destination.
  • We can provide some consular help in a medical emergency .
  • We can give you a list of local English-speaking doctors and health services.
  • We can help you get in contact with family and friends in Australia.

What we can't do

  • We can't give you medical advice.
  • We can't tell you every vaccination you need.
  • We can't tell you everything to do to protect your health overseas.
  • We can't pay your medical costs if you get sick while you're away.

Final tips before you go

  • Check our travel advice for your destination , look for details on health risks and how to access medical services overseas.
  • Subscribe to updates for your destination in case the situation changes.
  • Do your own research, and know the health risks in your destination.
  • Get medical advice, only a doctor can tell you what vaccinations are right for you.
  • Get the vaccinations and medicines you need well before you go, some take time to work.
  • Stock up on items you'll need overseas to stay safe before you go, such as insect repellent.
  • Look after your health while you're away, make smart decisions to reduce your risks of needing medical assistance or dying .
  • Learn more about infectious diseases overseas.
  • Read about travelling with medication and medical equipment .
  • See our advice on travelling while pregnant .
  • Learn about medical tourism .
  • See our health advice for everyone .
  • Read advice on reducing health and other risks when travelling with children .
  • Read about health risks in all your destinations .
  • See our advice for travellers with a disability .
  • See our advice on taking care of your mental health .
  • Understand how and when consular services can help Australians overseas.
  • Read travel health information and learn about travel vaccinations (Department of Health).
  • Read about travel immunisations (Victorian Government).
  • See advice on immunisation for travel (Department of Health).
  • Know the restrictions on travelling with medication (Therapeutic Goods Administration).
  • What you need to know about travelling overseas with PBS medications (Department of Human Services).
  • Know how to take care of your health when you travel (CHOICE).
  • Learn more about infectious disease risks for travellers (World Health Organisation).

Related content

When you go overseas, you may be exposed to a range of infectious diseases. Before you go, learn about the health risks in your destination and see your doctor.

Read our general advice for Australians planning to travel overseas with medications or medical equipment.

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Yellow Fever Vaccine

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Yellow fever is a serious disease. You should be immunised against yellow fever before you travel to certain countries.

In this article

What is yellow fever, what country requires the yellow fever vaccine, who should have the yellow fever vaccine, where can i get the yellow fever vaccine, how does the yellow fever vaccine work, when should you get the yellow fever vaccine, what are the side-effects of yellow fever vaccine, who should not receive the yellow fever vaccine.

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 several months before you travel to see if you need the yellow fever vaccine. You will only be able to get it from your GP if they are a designated yellow fever centre - if not then you will have to see a private travel clinic. Since 2020 there have been some shortages of this vaccine, so allow plenty of time before you travel to get it sorted out.

Yellow fever is a serious disease caused by the yellow fever virus which is transmitted by infected 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 mosquitoe bites from 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 and Central 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.

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  • 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 may be able to advise if you should be immunised for your travel destination and whether you need this certificate of vaccination. Not all practices have the resources to do this - if yours doesn't then you'll need to go to a private travel clinic.
  • 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.

Yellow fever vaccine can only be given at accredited centres. Many GP practices (but not all) 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.

You should have an injection of vaccine at least ten days before the date of travel to countries with yellow fever 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.

Severe reactions after receiving the yellow fever vaccine are very rare but mild reactions can last for up to 14 days. Common side-effects of the vaccine may include feeling generally unwell, headaches, muscle aches, joint pain, mild fever or soreness at the injection site. Always contact a doctor if you have any concerns. A more serious, but rare, side-effect is encephalitis or infection in the brain. Most people recover fully from this side-effect which presents between 2 and 56 days after the vaccine with a fever or headache which may progress to confusion and a coma. This serious side-effect is more common in those aged over 60, who should therefore only have the vaccine if there is a serious and unavoidable risk of catching yellow fever.

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, although if travel is unavoidable then the woman and her doctor will need to make an assessment of the risks versus the benefits of having the vaccine - a private travel specialist would need to be approached for this, rather than your GP.
  • This vaccine may be given if you are breastfeeding and cannot avoid being at high risk of catching yellow fever, but expert advice should be sought before doing so.
  • 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 and should therefore only have it if there is a serious and unavoidable risk of catching yellow fever. .
  • If you have had a severe reaction to the yellow fever vaccine in the past.
  • If you have a thymus disorder.

Dr Mary Lowth is an author or the original author of this leaflet.

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Further reading and references

Immunisation against infectious disease - the Green Book (latest edition) ; UK Health Security Agency

Travelling if you have a medical condition ; British Airways (includes downloadable MEDIF forms)

Travellers' Health ; US Centers for Disease Control and Prevention

Travel Health Pro ; National Travel Health Network and Centre (NaTHNaC)

MHRA updated guidance on use of yellow fever vaccine in patients with immunosuppression, with thymus dysfunction, and in those aged over 60 ; Medicines and Healthcare products Regulatory Agency, April 2019

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Do you need to worry about side effects from vaccines?

Do you need to worry about side effects from vaccines?

What side effects are associated with the yellow fever vaccine?

What side effects are associated with the yellow fever vaccine?

We ask a GP what to expect after vaccinations

We ask a GP what to expect after vaccinations

How long before you travel should you get vaccinated?

How long before you travel should you get vaccinated?

Hi everyone, would really appreciate some guidance on this.My workplace want me to be fully vaccinated against Hep B with a blood test to confirm immunity. I had the full 3 doses previously but never... john56729

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions .

USA TODAY

Visa or vaccines? How to know your international travel requirements

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Almost all of us have dreamed of going to destinations such as a safari in Africa, the Himalayas in Asia, or the crystal clear beaches of Bora Bora in French Polynesia. However, every time we think about trips to an international destination, many times we give up the idea because it could be very difficult or we do not know what documents or procedures we need to visit them.

However, there are excellent free tools with accurate information that can help you know if you need a visa to travel or if you need any vaccinations or preventive medical treatment.

Start the day smarter. Get all the news you need in your inbox each morning.

How to know if you need a travel visa

Having a passport will not necessarily guarantee you entry to other countries. Although many destinations do not require any permit or visa for U.S. citizens, many others do. How can you check if you need a visa, electronic authorization, or some special permission to enter another country? You must enter the website of the Department of State and choose the destination you plan on visiting. There, you will find a section that tells you the country's entry requirements and if you need any visas.

This is a very useful tool since it connects you directly with the downloads or electronic services of the countries you will visit so that you can start your process and request the required document. It is important that you always use the official pages of government entities to ensure that the information is correct and that you are not paying additional for an ordinary procedure.

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How to know if you need vaccines and preventive treatments

Do I need to be vaccinated to travel to a destination? What vaccines do I need? Which are recommended and which are required? These are very common questions. The answers can be found on the website of the Centers for Disease Control and Prevention . Upon entering, you can select your destination and find information about necessary vaccinations, required vaccinations, recommended preventive medical treatments and general information about the destination.

For example, when we visit tropical countries many times vaccines such as yellow fever are required and many others such as Patitis or Typhoid are also recommended. In places with reported cases of cholera or malaria, it is important to carry preventive medications for emergencies.

A very important fact is that the CDC page tells you where you can get the vaccination centers near your residence so you can schedule an appointment to meet the requirements for your trip.

Two vacations in one: How to add a second destination to your trip (for little or no cost)

These two free information tools from official government entities are very useful whenever you travel to an international destination. In my experience, every time I start organizing a new trip, the first exercise I do is to confirm what I need to be able to enter that destination. Preparing and being informed can save you a lot of last-minute pain.

Wilson "Wil" Santiago Burgos is the founder of  Mochileando.com , one of the largest travel platforms in Puerto Rico and the Latin American market in the U.S.

This article originally appeared on USA TODAY: Visa or vaccines? How to know your international travel requirements

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Yellow Fever Vaccine Boosters Needed for Some Travelers

travel vaccinations information

According to the U.S. CDC Yellow Book 2024, an international traveler's risk for acquiring Yellow Fever virus is determined by their immunization status and destination-specific and travel-associated factors. 

Since about thirty countries require proof of a pre-arrival yellow fever vaccination, many travelers have questions about the vaccine's long-term efficacy.

On January 22, 2024, the Lancet Global Health recently published results from a systematic review aimed at assessing the necessity of a booster vaccination based on the long-term (10+ years) immunogenicity of primary yellow fever vaccination in travelers and in residents of yellow fever-endemic areas, as well as in specific populations, including children and immunocompromised individuals.

The gathered evidence suggested that a single dose of yellow fever vaccine  provides lifelong protection (overall seroprotection rate 94%) in travelers.

However, in people living with HIV and young children (<2 years), booster doses might still be required because lower proportions of vaccinees were seroprotected ten or more years post-vaccination.

The pooled seroprotection rate was 47% in children and 61% in people living with HIV. 

Lower observed seroprotection rates among residents of yellow fever endemic areas were partly explained by the use of a higher cutoff for seroprotection that was applied in Brazil. No conclusions could be drawn for the sub-Saharan Africa region.

The CDC says most people infected with yellow fever do not get sick or have only mild symptoms. People who get sick will start having symptoms 3–6 days after infection.

According to the CDC, about 12% of people with symptoms develop serious illnesses.

The study was registered with PROSPERO, CRD42023384087. No industry conflicts of interest were disclosed.

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Yellow fever cases 2023

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Is it possible to visit Russia as a tourist in 2023?

travel vaccinations information

Yes, traveling to Russia as a tourist in 2023 is possible. Here’s what to look out for if you’re preparing for your dream trip. 

Visa requirements

First things first, it is worth checking if you need a visa to cross the Russian border. In 2023, citizens of some 65 countries can visit Russia without a visa. This includes most of the post-Soviet states like Azerbaijan, Armenia, Belarus, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Uzbekistan, as well as Ukraine.

Additionally, citizens of some countries in South and Central America – including Argentina, Brazil, Bolivia, Chile, Colombia, Nicaragua, Paraguay, Panama, Peru, Venezuela, Guatemala, Honduras, Costa Rica, El Salvador, Uruguay, Ecuador – do not need a visa to travel to Russia.

Citizens of Israel, South Africa, Cuba, Montenegro, Thailand, South Korea, United Arab Emirates, Qatar, Andorra, Serbia, Bosnia and Herzegovina, North Macedonia, Mongolia, Botswana enjoy visa-free regime with Russia, too.

For the full list of countries, click here .

travel vaccinations information

* Data for the infographics is from November 2022 and was obtained from the Russian consular information website.

* The status of a particular country is subject to change. We advise additionally researching the relevant information in each particular case before booking any trip to Russia.

* Visa waivers may apply for holders of diplomatic or military service passports, select businessmen, air crew members, members of a ship or train crew, professional truck drivers, organized tourist groups and people who have official permission to live in some border regions.

Is it safe to travel to Russia right now?

Russia as a travel destination received a fair share of negative PR from various sources in early 2022.

Some official travel accounts run by governments of countries like the U.S. , Australia , Great Britain and others advise their citizens to abstain from non-essential travel to the country.

That said, it is always advisable to evaluate safety risks when traveling to any foreign country. Traveling to Russia is no exception. However, Moscow, St. Petersburg and other major Russian cities have been widely regarded as being safe , especially in comparison to other popular tourist destinations.

Little has changed in major Russian cities from the point of view of tourists or local residents. Consequently, the most extreme and vocal concerns over security may be disregarded as being too alarmist.

That said, logistics pose the greatest challenge for tourists traveling to Russia in 2023. A number of countries closed their national airspace for Russian air companies resulting in more complicated logistics for tourists who intend to visit Russia in 2023.

However, specific changes depend on a particular country from where a tourist departs. In some cases, direct flight routes remain intact. For example, nothing has changed for tourists from China, India, Turkey, Middle Eastern countries and the majority of post-Soviet states. They can book direct flights to Russia’s main airports.

Tourists departing from European capitals will have to book connecting flights via Turkey or countries in the Middle East. This makes tickets more expensive and flights longer. However, it is still possible to travel to Russia from virtually any country in the world.

It should be noted that every country has its own nuances that must be taken into account beforehand. For example, the Indian Embassy in Russia advises Indian nationals against traveling to Russia via third countries. According to the embassy website, Indian travelers should choose only direct flights from Delhi to Moscow, otherwise they risk being denied entry into Russia.

In another instance, the British government prohibited its citizens from purchasing tickets on Russian airlines that were under sanctions. Nonetheless, the British authorities made an exception for those journeys originating in or within Russia: in this case, British nationals may purchase tickets from Russian companies without breaching UK sanctions.

Covid restrictions, vaccination status & quarantine

In 2022, Russian authorities canceled Covid-related restrictions for Russian citizens and foreign tourists, alike.

In 2023, foreign nationals no longer need to provide results of a negative PCR test when entering Russia by any mode of transport. Therefore, foreign travelers no longer need to take a coronavirus test in advance before departure.

Furthermore, Russian authorities lifted Covid-related restrictions that required visitors to provide a specific reason for visiting the country facilitating tourist traveling.

The only remaining Covid-related regulation is a requirement to fill in a questionnaire. Passengers – both Russian and foreign citizens – will be asked to fill out the paper version of the questionnaire on board during their flight to Russia.

Click here to find out who can travel to Russia without a visa in 2023.

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  • Section 2 - Vaccination & Immunoprophylaxis— General Principles
  • Section 2 - Yellow Fever Vaccine & Malaria Prevention Information, by Country

Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

  • Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

  • Fluvoxamine
  • Metoclopromide
  • Tetracycline
  • Calcineurin inhibitors
  • Ciprofloxacin
  • CYP2D6 enzyme substrates 1
  • CYP3A4 enzyme inhibitors 2
  • Methotrexate
  • QT- prolonging agents 3
  • Bismuth subsalicylate
  • Barbiturates
  • Carbamazepine
  • Iron- containing preparations
  • mTOR inhibitors
  • Antiarrhythmic agents
  • Beta blockers
  • Calcium channel receptor antagonists
  • CYP3A4 enzyme inducers 4
  • H1 receptor antagonists
  • Lumefantrine
  • Phenothiazines
  • Protease inhibitors
  • Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

  • HIV medications
  • Antacids containing magnesium or aluminum hydroxide
  • Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

  • Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

  • Acetaminophen
  • Anticholinergics
  • Aspirin, high dose
  • Dextroamphetamine
  • Diclofenac sodium
  • Mecamylamine
  • Anticholinesterases
  • Digitalis preparations
  • Hypoglycemic agents
  • Macrolide antibiotics
  • Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

Bibliography

Frenck RW Jr., Gurtman A, Rubino J, Smith W, van Cleeff M, Jayawardene D, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19(8):1296–303.

Jabeen E, Qureshi R, Shah A. Interaction of antihypertensive acetazolamide with nonsteroidal anti-inflammatory drugs. J Photochem Photobiol B. 2013;125:155–63.

Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine. J Infect Dis. 1997;175(4):871–5.

Nascimento Silva JR, Camacho LA, Siqueira MM, Freire Mde S, Castro YP, Maia Mde L, et al. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella. Vaccine. 2011;29(37):6327–34.

Nielsen US, Jensen-Fangel S, Pedersen G, Lohse N, Pedersen C, Kronborg G, et al. Travelling with HIV: a cross sectional analysis of Danish HIV-infected patients. Travel Med Infect Dis. 2014;12(1):72–8.

Ridtitid W, Wongnawa M, Mahatthanatrakul W, Raungsri N, Sunbhanich M. Ketoconazole increases plasma concentrations of antimalarial mefloquine in healthy human volunteers. J Clin Pharm Ther. 2005;30(3):285–90.

Sbaih N, Buss B, Goyal D, Rao SR, Benefield R, Walker AT, et al. Potentially serious drug interactions resulting from the pre-travel health encounter. Open Forum Infect Dis. 2018;5(11):ofy266.

Stienlauf S, Meltzer E, Kurnik D, Leshem E, Kopel E, Streltsin B, et al. Potential drug interactions in travelers with chronic illnesses: a large retrospective cohort study. Travel Med Infect Dis. 2014;12(5):499–504.

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  22. Vaccinations & Immunizations

    Immunizations available at Rite Aid*. See below for a list of vaccine preventable diseases that Rite Aid can immunize against. Click on specific illnesses for more information. Chickenpox. Diphtheria. Flu. Haemophilus influenzae (Hib) Hepatitis-A. Hepatitis-B.

  23. Americans Will Need This New Document For 2025 European Travel

    The days of jetting off to Paris with just a passport are numbered. Starting in 2024, 1.4 billion people—including Americans—will need a special travel authorization to enter the Schengen area ...

  24. Is it possible to visit Russia as a tourist in 2023?

    Visa requirements. First things first, it is worth checking if you need a visa to cross the Russian border. In 2023, citizens of some 65 countries can visit Russia without a visa. This includes ...

  25. Interactions Between Travel Vaccines & Drugs

    However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine-vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles. Travel Vaccines & Drugs Live Attenuated Oral Typhoid & Cholera Vaccines