If you plan to travel outside the country, you may need immunizations to protect yourself against diseases that aren't common in the United States.

See your healthcare provider at least 4-6 weeks before any international travel.

• Find out what vaccines may be recommended or required based on your travel destination.
• Make sure you are up-to-date on all of your routine vaccines. Routine vaccinations protect you from infectious diseases such as measles that can spread quickly in groups of unvaccinated people. Many diseases prevented by routine vaccination are not common in the United States but are still common in other countries.

Special Considerations

Measles

• Measles is highly contagious, and most measles outbreaks in the United States happen because infected travelers bring it back from other parts of the world. Before international travel, make sure the following people are immunized against measles:
  • Babies 6 months through 11 months of age: 1 dose
  • Children 12 months of age or older: 2 doses separated by at least 28 days
  • Unvaccinated adolescents and adults: 2 doses separated by at least 28 days

Meningitis

• The meningococcal vaccine is required for travelers going on Hajj or Umrah in Saudi Arabia. Additional vaccinations are recommended.

Polio

• Anyone traveling to a polio-affected country needs to be fully vaccinated against polio. Adults need a one-time booster dose of polio vaccine within 4 weeks to 12 months prior to any international travel. This booster should be documented in your yellow International Certificate of Vaccination to avoid delays in transit or over-vaccination in polio-affected countries.
• If you haven't been vaccinated against polio within the previous 4 weeks to 12 months you may be required to get a one-time booster dose of polio vaccine at least by the time of departure.

Yellow Fever

• The Yellow Fever vaccine may be required to enter a country or to return to the United States, depending on your travel destination.

Zika Virus

• Zika virus is spread to people primarily through the bite of an infected mosquito but can also be spread from infected individuals to their sex partners, or from an infected pregnant mother to her baby. No vaccine is available to prevent a Zika virus infection.

Make an appointment with your healthcare provider or a travel health specialist at least one month before you leave. They can help you get destination-specific vaccines, medicines, and information. Discussing health concerns as well as your itinerary and planned activities with your provider allows them to give more specific advice and recommendations.

Share the following information about yourself or your trip with your provider:

• Special conditions such as pregnancy, allergies, or chronic health problems.
• Destinations on your itinerary.
• Type of accommodations (hotels, hostels, short-term rentals).
• Type of travel (cruise, business, adventure travel).
• Timing and length of your trip.
• Planned activities.

Take recommended medicines as directed. If your doctor prescribes medicine for you, take the medicine as directed before, during, and after travel.

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Sometimes unexpected issues occur during travel. Learn what you can do before you leave to protect yourself and your travel companions.

Get travel insurance. Find out if your health insurance covers medical care abroad. Travelers are usually responsible for paying hospital and other medical expenses out of pocket at most destinations. Make sure you have a plan to get care overseas, in case you need it.

Prepare for emergencies. Leave copies of important travel documents (e.g. itinerary, contact information, credit cards, passport, proof of school enrollment) with someone at home, in case you lose them during travel. Make sure someone at home knows how to reach you in an emergency. Carry your emergency contacts with you at all times.

Prepare a travel health kit with items you may need, especially those items that may be difficult to find at your destination. Include your prescriptions and over-the-counter medicines in your travel health kit and take enough to last your entire trip, plus extra in case of travel delays. Depending on your destination you may also want to pack insect repellent, sunscreen (SPF15 or higher), aloe, alcohol-based hand sanitizer, water disinfection tablets, and your health insurance card.

While most after-travel illnesses are mild, some symptoms may warrant a trip to your healthcare provider.

Diarrhea

• Most cases of diarrhea go away in a few days, but see your doctor if you have diarrhea that lasts for two weeks or longer. Persistent diarrhea can make you lose nutrients and is often caused by a parasitic infection that will need to be treated with special drugs.

Fever

• If you have been in a country with malaria and develop a fever within a month after you leave, see a doctor immediately. Most fevers are caused by less serious illnesses, but because malaria is a medical emergency, your doctor must rule it out first. Always tell your doctor about any travel you have done, even if it was months ago.

Skin Problems

• Skin problems (rashes, boils, fungal infections, bug bites) are among the most common illnesses reported by people who have returned from international travel. Most skin problems are not serious, but they may be a sign of a serious illness, especially if you also have a fever.

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Whatever the reason, if you visit your provider after returning from a trip overseas, tell them about your recent travel. Make sure to include all relevant details:

• What you did on your trip
• How long you were gone
• Where you stayed (hotel, tent, etc.)
• What you ate and drank while you were there
• Whether you were bitten by bugs
• Whether you swam in freshwater
• Any other possible exposures (sex, tattoos, piercings, drug use)

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Zika Testing

Zika testing is only recommended in cases where you have symptoms and have either traveled or had sex with someone who traveled to an area with Zika.

Two main types of illnesses that you may be able to spread easily to another person are respiratory illnesses (those that affect your breathing) and foodborne illnesses (those spread by eating, drinking or putting something in your mouth that has been contaminated).

Respiratory Illnesses

Illnesses, such as the flu, spread from person to person when droplets from the cough or sneeze of an infected person move through the air and get into the mouth or nose of people nearby. The germs in these droplets can often also live on surfaces, such as desks or doorknobs, for two hours or longer and can spread when people touch these surfaces and then touch their eyes, mouth, and nose. The most common symptoms are coughing, sneezing, and runny nose.

Prevention

• Wash your hands often with soap and water.
• Wash after you use the bathroom, sneeze or cough, and before preparing food, eating or touching anything that you might put in your mouth.
• Hand sanitizer with alcohol may be used if no running water is available.

Foodborne Illnesses

You will encounter many different foods and food preparations when visiting other countries. Unfortunately, these new foods may also come with a virus, bacteria or parasite. As a result, foodborne illnesses are common among travelers. The most common symptoms are nausea, vomiting, and diarrhea.

Furthermore, hygiene and safety practices for food and water may be different in other countries than what you are used to at home. You can get a foodborne illness from eating or drinking contaminated food and water, even if the food and water looks and tastes fine.

Prevention

• Eat foods that are fully cooked and served hot.
• Eat only fruits and vegetables that you can wash and peel yourself.
• Eat and drink only dairy products that have been pasteurized.
• Do not eat food from street vendors.
• Drink beverages that have been bottled or sealed (water, carbonated drinks or sports drinks).
• Do not put ice in drinks.
• Do not brush your teeth with tap water.
• Check country-specific tips for your destination.

Protect yourself from mosquito bites.

• Even if you do not feel sick, travelers returning to the United States from an area with a risk of Zika should take steps to prevent mosquito bites for 3 weeks so they do not spread Zika to mosquitoes that could spread the virus to other people.
• Protect yourself and your family from mosquito bites by using EPA-registered insect repellants, wearing long-sleeved shirts and long pants, and controlling mosquitoes inside and outside your home.

Protect yourself during sex.

• Use condoms or don’t have sex to avoid getting or spreading Zika during sex if you or your partner has traveled to an area with risk of Zika. The amount of time you need to take these steps depends on whether you or your partner has symptoms and whether you or your partner are pregnant or trying to get pregnant.

Watch for symptoms.

• Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are fever, rash, headache, joint pain, conjunctivitis, and muscle pain.
• Zika is usually mild with symptoms lasting for several days to a week.

See a doctor or healthcare professional if you have symptoms of Zika.

• If you have symptoms of Zika after travel to an area with risk of Zika, talk to your doctor and tell him or her about your travel.
• If you’re pregnant, talk to your doctor after travel to an area with risk of Zika, even if you don’t feel sick.
• If you’re thinking about trying to become pregnant after travel to an area with risk of Zika, talk to your doctor when you return and see specific recommendations for couples trying to become pregnant.

Keep your patients safe by staying up-to-date on the latest health news, information, and vaccination recommendations.

Immunizations

• Routine immunization schedules
• Country-specific travel vaccine recommendations
• Country-specific travel vaccine recommendations for malaria and yellow fever

Resources

• Chart of Vaccine Contraindications and Precautions to Commonly Used Vaccines (does not include all travel vaccines)
• Vaccine Information Statements (VIS) It is federal law to give VISs to your patients before administering the vaccine.
• Vaccine Adverse Event Reporting System (VAERS)

CDC Travel Health Clinical Updates

• Clinician Updates: Visit for the most recent CDC clinical updates on vaccines and other country-specific travel information.
• CDC Clinician Resources

The Centers for Disease Control and Prevention (CDC) Yellow Book is the recommended resource for information specific to illnesses associated with a returned traveler. Visit the Yellow Book (Chapter 5) for general information on how to approach travel-related health problems.

Travel-related health problems have been reported in as many as 22 percent to 64 percent of travelers returning from developing countries. Although most of these illnesses are mild, up to 8 percent of travelers are sick enough to seek treatment from a healthcare provider. Most post-travel infections become apparent soon after travel, but incubation periods vary, and some conditions can appear months to years after the initial infection. Additional resources for evaluating a returned traveler can be found here.

lllnesses associated with fever appearing in the first two weeks after travel

SYNDROME	POSSIBLE CAUSE
Systemic febrile illness with initial nonspecific symptoms	Malaria Dengue Typhoid fever Rickettsial diseases (such as scrub typhus, spotted fevers) East African trypanosomiasis Acute HIV infection Leptospirosis Ebola virus disease Viral hemorrhagic fevers
Fever with central nervous system involvement	Meningococcal meningitis Malaria Arboviral encephalitis (such as Japanese encephalitis virus, West Nile virus) East African trypanosomiasis Angiostrongyliasis Rabies
Fever with respiratory symptoms	Influenza Bacterial pneumonia Acute histoplasmosis or coccidioidomycosis Legionella pneumonia Q fever Malaria Tularemia Pneumonic plague Middle East respiratory syndrome (MERS)
Fever and skin rash	Dengue Chikungunya Zika Measles Varicella Spotted fever or typhus group rickettsiosis Typhoid fever Parvovirus B19 Mononucleosis Acute HIV infection

The Yellow Book covers common travel-related health problems, including fever in returned travelers, persistent travelers’ diarrhea, skin/soft tissue infections, and advice on screening asymptomatic returned travelers.

Clinics must be pre-authorized to administer the yellow fever vaccine. IDOH is registering clinics after the new supply of yellow fever vaccine is available in the United States. Please visit the link below to complete the application to become a YF provider. You will be contacted by IDOH after completing the application.