Vaccinations for Worldwide Travel
At the Travel Health Clinic, you will be provided with:
- A consultation with the doctor to discuss the details of your trip
- Advice on the kind of vaccines you might require
- Written advice on malaria protection tablets, if they are required, including side-effects, cost and when and how to take them
- A prescription for malaria protection tablets, if they are needed
- A prescription for some 'standby' (or first aid) medicines, in case you need them
- A 'Staying Well While Abroad' advice booklet to take away with you
- A completed vaccine record booklet (that includes a Yellow Fever Certificate, if needed)
- The vaccinations you require
- Our contact details, so that you can e-mail the doctor you saw at our clinic for health advice if you are having health problems while abroad
- Answers to any questions you might have
Where necessary, we can vaccinate you for the following conditions (click on the name for further details):
This is a viral infection, transmitted by one kind of mosquito in some parts of South America and Africa (not Asia).
Evidence (in the form of a certificate) of vaccination for this disease is a requirement for entry to some countries. The issue of whether one needs to be vaccinated against Yellow Fever can cause a lot of confusion. The disease occurs only in Latin America and Africa (not Asia). Do you need to be vaccinated against it? Often, yes, but not always. Two factors will determine if you need to be vaccinated or not:
- do you need to be protected against the disease and
- will you be asked by immigration officials at your destination country to prove that you have been vaccinated?
In some cases, although Yellow Fever occurs in a country, large parts of the country may not be affected. If vaccination is not mandatory from an immigration point of view and you are travelling to a non-infected part of the country and not travelling to a neighbouring country that is infected, you will not need to be vaccinated.
More information on country-specific requirements for Yellow Fever can be found at this website, maintained by our Public Health colleagues in Scotland (there is no equivalent website maintained by the H.S.E. in this juristiction): https://www.fitfortravel.nhs.uk/home
From 11th July 2016, the World Health Organisation declared that the duration of protection provided by the vaccine was changing from 10 years to life-long.
Yellow Fever Vaccination Recommendations in Africa, 2015. Map used courtesy of WHO.
Yellow Fever Vaccination Recommendations in the Americas, 2019. Map used courtesy of WHO.
A bacterial infection present in the soil. It occurs worldwide, including in Ireland. Infection enters the body via cuts to the skin. In persons who are not immunised, the infection has the potential to cause problems affecting the nervous system. Most Irish people received a course of this vaccine during childhood (ages 2 months, 4 months, 6 months, 5 years and age 11 - 14 years). If you have not received a tetanus shot in the past 10 years, you might require a booster shot before travel; this will avoid the need to seek out a clinic overseas that can provide you with this vaccine in the event of a cut or other open wound injury.
In Ireland, the vaccine for this disease is always part of the tetanus vaccine.
Diphtheria is a bacterial infection that causes inflammation in the upper respiratory tract. Transmission is by airborne droplets from person to person.
A viral infection, nearly eradicated worldwide, that is still present in some parts of West Africa, South Asia and South-East Asia. Transmission is by hand to mouth. It affects the nervous system.
In Ireland, this vaccine is not available as a stand-alone shot and comes combined with other vaccines in a single shot e.g. Polio/Tetanus/Diphtheria (combined).
Polio affected countries for which WHO recommends Polio immunisation or boosting to travellers. Map used courtesy of WHO.
This is a virus which is spread by food and/or water that have been contaminated. Travellers to most Developing Countries should be vaccinated for this disease.
Hepatitis A is not such a serious infection in young children (mortality: 0.15%) but becomes much more serious in middle age (mortality: 1%) and older people (mortality: 2%).
Hepatitis A, countries or areas at risk. Map used courtesy of WHO.
This is a viral infection of blood/body fluids. It is found in about 10% of the population in Africa, China and South-East Asia.
It is transmitted sexually, by bites from humans (e.g. from a child with behavioural difficulties in an orphanage setting) and by incompletely sterilised medical/dental equipment. It is also transmitted by incompletely screened blood transfusions.
Hepatitis B vaccine has been part of the standard vaccines given to babies in Ireland since 2008.
The kind of person for whom Hepatitis B vaccine is of particular importance are those:
- engaged in volunteer work with people (e.g. in orphanages, schools, clinics and hospices)
- staying for periods of more than a few weeks in the developing world (longer stay implies higher chance of interacting with the local medical/dental services)
- who might be at risk of unprotected sexual contact while abroad.
Hepatitis B, countries or areas at risk. Map used courtesy of WHO.
(This is not the vaccine that produced dimples in the upper left arm. It is also not the shot that produced a temporary star-shape indentation in the skin of the upper arm in children during school vaccination programmes).
If you were born in Ireland before 1978, you should already be protected for MMR (life-long immunity through having been infected).
If you were born after 1978 and you're not sure that you received the MMR vaccine at age 1 year and again at age 5 years, the simplest thing is to be vaccinated with the MMR vaccine now, with a 2nd dose being done in one to three months from now - this will provide life-long immunity against Measles (and Mumps and Rubella). Vaccination now (even if you are already immune) is safe and a less expensive alternative to doing blood tests to check your immunity.
The proportion of those who fail to develop full immunity follow two childhood shots of MMR vaccine are: Mumps 12%, Measles 5% and Rubella 5%. If you are planning to spend a long time overseas (moving for months/years to a developing country for work reasons) or spend a short time working with children (orphanages/volunteering in schools) or working with young adults (e.g. TEFL), will often recommend a precautionary extra MMR vaccine shot, to try to maximise the chance that you have full Mumps - Measles - Rubella immunity prior to going to environments where these highly contagious infections are circulating more commonly than in Ireland.
A bacterial infection (a member of the salmonella food poisoning family) transmitted by contaminated food and/or water. Vaccination against this disease is recommended for travel to many Developing Countries, particularly in South Asia and Africa.
This vaccine provides five-year protection against four types of bacterial meningitis. It is given to teenagers in the U.S. prior to College entry.
Children living in Ireland have been receiving this vaccine only since Sept. 2019 (one shot in the first year of secondary school). Prior to that, they were vaccinated for Meningitis C (but not for the A, Y and W-135 types, all of which are more common abroad). The four-type (ACY and W-135) vaccine is also known as the 'quadrivalent vaccine'.
This vaccine is particularly important if you are going to volunteer with children in crowded settings (schools, orphanages) in the countries coloured orange in the map below (e.g. Uganda, Kenya, Ethiopia).
Evidence of vaccination (in the form of a vaccination certificate) with a version of the quadrivalent/tetravalent conjugate vaccine (e.g. 'Nimenrix' or 'Menveo') within the previous five years is required by Saudi Arabian authorities for pilgrims visiting Mecca for the Hajj pilgrimage or for the Umrah. Official guidance is available at this link.
Meningococcal meningitis, countries or areas at high risk, 2014. Map used courtesy of WHO.
(As of 1st Nov. 2020 the vaccine against this disease is temporarily unavailable from the Irish supplier).
This is a viral infection (formerly known as 'Japanese B Encephalitis') transmitted by one kind of mosquito in the areas indicated on the map below. The disease is not a significant risk to most travellers. It should however be considered in those who are making repeated visits to, or prolonged stays (e.g. >1 month) in affected regions (see map, below), especially if staying in rural areas.
The vaccine ('Ixiaro') consists of two doses, given at least 7 days apart with the 2nd dose being given ideally 7 days or more prior to travel. It can be administered from the age of 2 months and older. Initial immunity lasts for 1 year. A single booster dose of vaccine will extend immunity for a further 10 (ten) years.
Japanese encephalitis, countries or areas at risk, 2012. Map used courtesy of WHO.
The information which follows is based on the HSE's Immunisation Guidelines for Ireland (March 2019 Rabies chapter update):
Pre-travel, Rabies vaccine can now be given as shots on either:
- Days 0, 3, 7 (providing partial protection for one year, with one top-up shot at one year leaving to life-long partial protection in most patients) or
- Days 0, 7, 21 or more (providing partial protection for life in most patients)
Rabies is a viral infection that can affect warm-blooded animals (dogs, cats, monkeys, bats...). A few countries - mostly island nations - are rabies-free or free of rabies in terrestrial animals (Ireland, UK, New Zealand). Most other countries are affected. The disease is transmitted from infected to non-infected animals via saliva (bites or scratches, typically). An animal can look normal but be in the early stages of infection and be capable of transmitting it to humans.
For an infected animal to transmit the infection to a human, its saliva must penetrate the skin of the human (via a bite, scratch or lick to broken skin of the human or via a lick from the animal to the human's lips or eyes). The vaccine for rabies provides partial protection. No full-protection vaccine exists. In the event of possible exposure to rabies, two scenarios exist:
|Time within which you should present to hospital:||Follow-up treatment required:|
|Person not already vaccinated:||1 - 2 days maximum.||4 visits to hospital over a 28-day period (days 0, 3, 7, 14 - 28) for vaccine and, on day 0, a specialised injection called 'Rabies Immune Globulin' (RIG).|
|Person already vaccinated
(3 shots of vaccine given over a 7 - 21 day period*):
|3 - 4 days maximum.||2 visits to hospital (days 0, 3) for vaccine.|
(*As of March 2019, a change to Ireland's HSE Immunisation Guidelines for Ireland allows for the vaccine to be give pre-travel on days 0, 3, 7 - providing partial protection for one year with a 4th dose being done on day 365 to provide life-long partial protection in most categories of patients).
Doctors usually err on the side of caution when dealing with a patient who may have been exposed to rabies and if in doubt, treat the patient according to the treatment schedule described above.
Is it worth being vaccinated if you are going to have to seek medical attention anyway, regardless of whether you have been already vaccinated or not? Sometimes, yes. A patient who is not already vaccinated and who had been potentially exposed to rabies now needs to:
- be able to access a hospital within 2 days (this could be difficult if they are travelling in a remote location)
- in order to be reliable, the hospital has to have a continuous power supply (to power the fridge in which the vaccine must be stored at a temperature of 2°C - 8°C)
- the hospital must have 'RIG' in stock.
The above three conditions will be difficult to meet in large parts of Africa, and remote parts of Latin America and Asia. On the other hand, it should not be too difficult to meet the criteria in major cities in most of Latin America, Asia and some parts of Africa.
In short, the vaccine is of greatest relevance to those who will be travelling to remote areas or to very poor countries where basic services do not function reliably.
Rabies, countries or areas at risk. Map used courtesy of WHO.
This vaccine is given mainly to Health-Care Workers who do not have a history of having had a Chickenpox infection in childhood and who test negative for the disease on blood testing. Two doses of vaccine given at least one month apart leads to life-long immunity.
More information on who should receive this vaccine is available here in the Immunisation Guidelines for Ireland. Although this vaccine is used from age 1 year and above, in our clinic we feel it is appropriate that patients under the age of 16 years be given this vaccine by their General Practitioner. In our clinic, we restrict ourselves to administering this vaccines to those aged 16 years and above only.
Cholera (oral vaccine)
This bacterial infection is contracted by consuming contaminated food and/or water. It often results in extreme diarrhoea. The infection does not pose a significant risk to the vast majority of travellers.
The vaccine can be worth doing if you are likely to have difficulty in accessing clean water and/or be engaged in hands-on work in basic conditions, surrounded by significant poverty.
The oral Cholera vaccine (Dukoral®) comes as a pleasant-tasting drink, not a traditional injection. Patients should be fasting for at least one hour before receiving the vaccine and remain fasting for at least one hour after drinking it.
Cholera, areas reporting outbreaks, 2011-2012. Map used courtesy of WHO.
Influenza (Seasonal Flu)
The Seasonal Influenza (Flu) vaccine is a vaccine that becomes available in September of each year. It is intended to provide protection against the Flu virus that appears every year in the Autumn/Winter. There are two types of flu vaccine available in Ireland for autumn/winter 2020/2021:
- A nasal spray vaccine for children aged 2 years to 18 years (we are not offering this at our clinic; most GPs will however do it)
- A traditional arm injection vaccine for adults ('quadrivalent inactivated'); we are doing this in our clinic for those aged 18 years and older.
The cost of the vaccine is:
- €45 if it is administered during a regular Travel Vaccination consultation
- €85 if you come in to the Clinic just to have the Seasonal Influenza (Flu) vaccine only.
The Flu virus changes with time. As a result, a different kind of Seasonal Influenza (Flu) vaccine is made each year to protect against that year's flu virus. The Seasonal Influenza (Flu) vaccine for the autumn/winter 2020/2021 season is coming into stock at our clinic during the first half of October 2020. This vaccine will be used until March/April 2021.
You can make an appointment to receive the Seasonal Influenza (Flu) vaccine by e-mailing email@example.com.
This is a viral infection, spread to humans by the bites of some ticks in forested areas of Europe (see map below) from the late Spring to early Autumn each year. The infection is also found across the central steppe of Asia (central Russia, Kazakhstan, parts of Mongolia and China).
The infection does not pose a significant risk to most travellers. Vaccination can be worth doing if you are planning to spend time trekking in forested areas, where you might be at risk of tick bites.
The vaccine can be given to those aged 1 year and older. Two shots, given at least two weeks apart, will provide protection for several months. A third shot given five to 12 months later will provide protection for three years.
More detailed information on the number of cases of the infection recorded in individual countries can be found on the website of the company that manufactures the vaccine, Baxter Ltd.
Whooping Cough (Pertussis)
Although you were vaccinated for Pertussis as a child (if you were born after 1952), your immunity disappeared by age 20 years.
It is now estimated that 30% of adult winter cough cases lasting more than two weeks are due to re-acquisition by the (under-immune) adult of Pertussis virus.
Protection against Pertussis is available as part of a combined Tetanus/Diphtheria/Polio/Whooping cough (Pertussis) single-shot vaccine. 1 shot provides protection against all four diseases for 10 years.
Pertussis immunity should be boosted every 10 years (all information taken from Immunisation Guidelines for Ireland, accessible here).
Malaria is an infection transmitted by one particular kind of mosquito. There is no vaccination shot that protects against malaria. Protection involves measures to minimise the amount of mosquito bites to which you are exposed plus the taking of protection tablets, designed to stop you developing the disease.
Country-specific malaria risk information is available at this link from our colleagues in NHS Scotland https://www.fitfortravel.nhs.uk/home (the H.S.E. does not currently provide country-specific risk advice for malaria).
The following malaria distribution map is used courtesy of the Malaria Atlas Project.
No or minimal malaria risk = white, light grey and dark grey areas. Malaria risk = pink, red and black areas. Darker colours = most intense risk.
Tuberculosis (TB) Screeing
Mantoux (PPD / Heaf) skin test
Tuberculosis (TB) is a bacterial infection usually affecting the lungs. It does not represent a significant risk to most travellers. A vaccine against TB (the BCG vaccine) exists and was administered almost exclusively to infants by the HSE's Public Health service, prior to supply issues since 2015, which have made the vaccine unobtainable in most cases. The vaccine is not normally given to those travelling abroad.
The Mantoux (PPD / Heaf) skin test is a skin test that is sometimes done in order, among other things, to confirm that a patient is free of TB infection. The Mantoux Test is most commonly done in the following situations:
- As part of immigration requirements to some countries (e.g. student visas for the USA)
- To check for or to confirm the absence of TB in healthcare workers
- To check for or to confirm the absence of TB in aid agency staff who have been working in Developing Countries.
The Mantoux test produces a result 2 - 3 days after being done. A more detailed explanation of the Mantoux skin test can be found in the Immunisation Guidelines for Ireland, which can be accessed here.
Quantiferon (IGRA) blood test
An alternative method for confirming the absence of TB is the 'Quantiferon (IGRA/T.B. Spot Gold)' blood test, which produces a result about 10 days after being done.
Tuberculosis, estimated new cases, 2010. Map used courtesy of WHO.
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