Vaccination Advice for the First Trip

Before travelling outside of the UK, it is very important to check if any vaccinations are going to be required. The best way to do this is to book a travel health consultation with a trained professional but you can also visit the NHS's Fit for Travel website for advice and recommendations.

UK Childhood Vaccinations

In the UK we are incredibly lucky to have a robust childhood immunisation schedule and so if you have lived in the UK all of your life, chances are that you will have gone through the vaccination process. The following are all of the illnesses covered by the UK childhood immunisation schedule:

• Diphtheria
• Tetanus
• Whooping cough (pertussis)
• Polio
• Haemophilus influenzae type b
• Rotavirus (This is given at 2 months of age and was only introduced in 2013)
• Pneumococcal
• Meningitis C
• Measles
• Mumps
• Rubella
• BCG for TB (This was given at 14 years of age but was stopped in 2005)
• HPV (This is given at 12-13 years of age but was only introduced in 2008)

Recommendations for Countries we are Visiting

New Zealand

Courses or boosters usually advised: none
Other vaccines to consider: Tetanus
Yellow fever vaccination certificate: not required for this country

Australia

Courses or boosters usually advised: none
Other vaccines to consider: Japanese Encephalitis; Tetanus
Yellow fever vaccination certificate: required for travellers over 1 year of age arriving from countries with risk of yellow fever transmission and for travellers having transited more than 12 hours through the airport of a country with risk of yellow fever transmission, excluding Galapagos islands in Ecuador, the island of Tobago and limited to Misiones province in Argentina

Singapore

Courses or boosters usually advised: none
Other vaccines to consider: Hepatitis B; Japanese Encephalitis; Tetanus
Yellow fever vaccination certificate: required for travellers over 1 year of age who, within the preceding 6 days, have been in or transited more than 12 hours through the airport of a country with risk of yellow fever transmission

Indonesia

Courses or boosters usually advised: Diphtheria; Hepatitis A; Tetanus; Typhoid
Other vaccines to consider: Cholera; Hepatitis B; Japanese Encephalitis; Rabies
Yellow fever vaccination certificate: required for travellers over 9 months of age arriving from countries with risk of yellow fever transmission.

Malaysia

Courses or boosters usually advised: Hepatitis A; Tetanus; Typhoid
Other vaccines to consider: Cholera; Diphtheria; Hepatitis B; Japanese Encephalitis; Rabies
Yellow fever vaccination certificate: required for travellers over 1 year of age arriving from countries with risk of yellow fever transmission and for travellers having transited more than 12 hours through the airport of a country with risk of yellow fever transmission

More Information about Recommended Vaccines

Tetanus

This is a illness which is caused by tetanus spores entering the body through breaks in the skin such as cuts and grazes. The spores are found in soil around the world. 5 doses of tetanus vaccine are included in the UK vaccination programme. Boosters are usually recommended if you are travelling to a country where you will be unlikely to be able to get a booster at the time of sustaining a tetanus-prone wound.

This involves a one off intra-muscular injection (which also contains the diphtheria vaccine). The booster lasts for 10 years.

Japanese Encephalitis

This disease is spread by a type of mosquito which breeds in rice paddies and tends to bite at night. The risk is higher for those who are unable to avoid mosquito bites and for long stay travellers to rural areas.

This involves 2-3 doses (depending on brand) of intra-muscular injections. A booster is required within the second year after vaccination.

Hepatitis B

This illness is a blood-borne infection which means that it spreads through sexual intercourse, contaminated needles and medical instruments, infected blood and blood products. The risk of getting hepatitis B is higher for those who will be working in healthcare, those who are long stay or frequent travellers and those who may need, or request, surgical procedures abroad.

This usually involves 3 intra-muscular injections over 4-6 months. Boosters can be given every 5 years but are not always required.

Diphtheria

This illness is an airborne infection and so spreads through respiratory droplets. The risk of contracting diphtheria will higher if mixing with locals in overcrowded living conditions. 5 doses of diptheria vaccine are included in the UK vaccination schedule and should be enough to provide life-long cover.

This involves a one-off intra-muscular injection (which also contains the tetanus vaccine). The booster lasts for 10 years.

Hepatitis A

This disease spreads through the faecal-oral route and so you can contract the illness through consuming contaminated food and water or person to person contact. Due to this, risk is going to be higher in areas where personal hygiene and sanitation are poor.

There is a brand which contains just the hepatitis A vaccine, another which combines it with typhoid and a third which combines it with hepatitis B.The solely hepatitis A vaccine and the option in combination with typhoid are the most popular and involve a one off intra-muscular injection. You can be given a booster 1-2 years after your first vaccine and this provides protection for 20 years.

Typhoid

This illness also spreads via the faecal - oral route and so infection occurs after consuming contaminated food and drink. Risk is higher where access to adequate sanitation and safe water is limited.

As above, this can be given alone or in combination with the hepatitis A vaccine. The vaccines which contain solely typhoid can be given as a one off intra-muscular injection or 3 doses of oral medication. The one in combination with hepatitis A is a one off intra-muscular injection. The vaccine gives protection for 3 years.

Cholera

Another disease which spreads faecal-orally and so again the consumption of contaminated food or water can cause infection. It is common in areas with poor sanitation and lack of clean drinking water as well as during floods and after natural disasters. By taking simple precautions with food and water and maintaining good personal hygiene it would be unusual for travellers to contract cholera.

This is given as 2 doses of oral medication and gives protection for 2 years.

Rabies

This disease occurs following a bite from an infected animal or if an infected animal were to lick a broken area of skin as the virus is present in the saliva of an infected animal. Risk is higher for those going to remote areas (who may not be able to promptly access appropriate treatment in the event of a bite) and those who may be in contact with animals and bats. Even when pre-exposure vaccine has been received, urgent medical advice should be sought after any animal or bat bite as the vaccine only delays the onset of symptoms, it does not stop it altogether.

This involves 3 intra-muscular injections over the course of 4-5 weeks. Further vaccines are required if you will regularly be in contact with animals (e.g. for work). Travellers do not usually require further vaccines unless you are travelling to a high risk area and it is >10years since your last rabies vaccine.

What We Decided To Do

Tetanus

We felt that our childhood immunisations would suffice as we would not be travelling anywhere so remote that we could not seek medical help at the time of a tetanus-prone wound.

Japanese Encephalitis: Again we felt that we would not be travelling anywhere very remote and if we do, we are packing long sleeved clothes, insect repellent and a mosquito net anyway so should be able to protect against bites.

Hepatitis B

As I normally work as a doctor I am already fully vaccinated against hepatitis B. We felt that Alistair did not fall into a high risk group and so he is not getting the vaccination course.

Diphtheria

We felt that our childhood vaccinations were sufficient protection.

Hepatitis A

From our previous travels we have already both had an initial hepatitis A vaccine and have both also received a booster which now gives us cover for 20 years.

Typhoid

Again, we have both been previously immunised against typhoid on two occasions due to previous travel and the last one was less than 3 years ago.

Cholera

We felt that taking basic precautions with food and cleanliness would be enough to protect against cholera and so opted out of getting this vaccine.

Rabies

As the pre-exposure vaccine only delays onset of symptoms and we hope to not be in contact with animals or visit very rural/remote areas we have decided not to get this vaccine.

In addition, we have both previously had yellow fever vaccines and so will not need to worry about as the yellow fever vaccine lasts for 10 years.

Hopefully the above summary proved a little useful! In the end the most important thing is to seek advice about the requirements and recommendations for the countries you are visiting from someone who is qualified to give you the correct information. Deciding which vaccines to get after this is then about balancing risk and your own personal choice and preference.