Travel Vaccinations in New York City, for Safe Overseas Trips

Although not widely available, the anthrax vaccine can help prevent anthrax, a serious infection caused by the spores of Bacillus anthracis bacterium, which can cause severe respiratory disease and skin manifestations. This vaccine is not typically available for the general public. It is only recommended for people who are at an increased risk of coming into contact with anthrax spores or after known exposure to B. anthracis. For additional information, please visit https://www.cdc.gov/anthrax/

The chickenpox vaccine first became available in the United States in 1995. Each year, more than 3.5 million cases of chickenpox, an estimated 9,000 hospitalizations, and 100 deaths are prevented by chickenpox vaccination in the United States (CDC).

The CDC recommends two doses of chickenpox vaccine for children, adolescents, or adults who have never had chickenpox and were never vaccinated. Children are routinely recommended to receive the first dose at 12 through 15 months of age and the second dose at 4 through 6 years of age. For additional information, please visit https://www.cdc.gov/vaccines/vpd/varicella/public/index.html#who_needs

The cholera vaccine used in the United States is an oral (swallowed) vaccine. Only one dose is needed. Booster doses are not recommended at this time. If you are an adult 18 through 64 years old, traveling to an area with high incidence of cholera (especially Asia and Sub-Saharan Africa) , you may need cholera immunization. The cholera vaccine does not protect from other foodborne or waterborne diseases. The cholera vaccine is not a substitute for being careful about what you eat or drink.
For additional information, please visit https://www.cdc.gov/cholera/

Hepatitis A is a potentially fatal liver infection. It is usually spread through close, personal contact with an infected person or when a person unknowingly ingests the virus from for or drinks that are contaminated by small amounts of stool from an infected person. Most adults with hepatitis A experience symptoms that include fatigue, poor appetite, stomach pain, nausea, and jaundice (yellow skin or eyes, dark urine, light-colored bowel movements). Most children less than 6 years of age do not have symptoms. 

A person infected with hepatitis A can transmit the disease to other people even if he or she does not have any symptoms of the disease. Most people who get hepatitis A feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases however, hepatitis A can cause liver failure and death. This is more common in people older than 50 years of age and in people with other liver diseases. 

Hepatitis A vaccine has made this disease much less common in the United States. However, outbreaks of hepatitis A among unvaccinated people and especially in high burden countries, still frequently occur. 

For additional information, please visit https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.html 

Hepatitis B is a devastating disease caused by a virus that attacks the liver. The hepatitis B virus (HBV) can cause lifelong infection leading to cirrhosis (scarring of the liver), liver cancer, liver failure, and death. The hepatitis B vaccine is available for all age groups. The hepatitis B vaccine is recommended for children, adolescents, and adults age 19 through 59 years.  Adults aged 60 years or older with risk factors for hepatitis B infection should also be vaccinated. Hepatitis B vaccine is strongly recommended for travelers to regions with increased rates of hepatitis B (especially Asia and Africa).  

For a complete list of recommendations, please visit https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html 

In 2001, the Food and Drug Administration (FDA) licensed a combined hepatitis A and B vaccine (Twinrix®) for use in persons aged >18 years. Twinrix is manufactured and distributed by GlaxoSmithKline Biologicals (Rixensart, Belgium), and is made of the antigenic components used in Havrix and Engerix-B (GlaxoSmithKline). The antigenic components in Twinrix have been used routinely in separate single antigen vaccines in the United States since 1995 and 1989 as hepatitis A and B vaccines, respectively. For additional information, please visit https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5037a4.htm 

HPV vaccination is key in preventing cancer causing infections of the cervix in women and penis / anus in men. 
HPV infections and cervical precancers (abnormal cells on the cervix that can lead to cancer) have dropped since 2006, when HPV vaccines were first introduced in the United States. 

• Among teen girls, infections with HPV types that cause most HPV cancers and genital warts have dropped 88 percent.
• Among young adult women, infections with HPV types that cause most HPV cancers and genital warts have dropped 81 percent.
• Among vaccinated women, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer has dropped by 40 percent. For additional information, please visit https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html

Japanese encephalitis (JE) is a serious infection of the brain caused by the Japanese encephalitis virus. 

• It occurs mainly in rural parts of Asia. 
• It is spread through the bite of an infected mosquito. It does not spread from person to person. 
• While risk is low for most travelers, it is higher for people living in areas where the disease is common, or for people traveling there for long periods of time. 
• Most people infected with JE virus don’t have any symptoms. Others might have symptoms as mild as a fever and headache, or as serious as encephalitis (brain infection). 
• A person with encephalitis can experience fever, neck stiffness, severe confusion, seizures, and coma. About 1 person in 4 with encephalitis dies. Up to half of those who survive encephalitis will have permanent disability. 
• It is believed that infection in a pregnant woman could harm her unborn baby. 
• JE vaccine can help protect travelers from JE disease. 

For additional information, please visit https://www.cdc.gov/vaccines/vpd/j-enceph/index.html 

Malaria is a mosquito driven parasitic blood infection which can cause severe disease and death if left untreated. It is a major public health issue in many parts of the developing world. Travelers going to malaria-endemic countries are at risk for contracting the disease, and almost all of the approximately 1,700 cases per year of malaria in the United States are due to travel.  Malaria can be treated effectively early in the course of the disease, but delay of therapy can have serious or even fatal consequences.  

Malaria prevention consists of a combination of mosquito avoidance measures and preventive medications. If you plan on traveling to Africa, Southeast Asia, or South America, you will likely need to take malaria preventing medication. 

For additional information, please visit, https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-relatedinfectiousdiseases/malaria#:~:text=Chemoprophylaxis,is%20exposed%20to%20malaria%20parasites. 

According to the Centers for Disease Control and Prevention (CDC), 

MMRV vaccine protects against four diseases: measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children 12 months through 12 years of age.  People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel— 

• Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days). 
• Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days. 
• Teenagers and adults who do not have presumptive evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.  For additional information, please visit https://www.cdc.gov/vaccines/vpd/mmr/public/ 

Meningococcal disease caused by the Neisseria Meningococcal bacteria is a rare but very serious brain infection that can become deadly in a matter of hours. Teenagers, young adults, and college students are at higher risk at developing meningitis than the general population. 

Certain medical conditions (including cancer) and medications (immune modulators) put people at increased risk for meningococcal disease.  Travelers to the “meningitis belt” in sub-Saharan Africa are also at increased risk for acquiring meningococcal disease. In Africa, the disease is most common during the dry season (December through June). Travelers who spend prolonged time interacting with local populations, especially during outbreaks, have the highest risk of getting sick. Vaccinated travelers who continue to be at increased risk should receive booster shots. The CDC recommends meningococcal conjugate (MenACWY) vaccination for  all people traveling in the meningitis belt in sub-Saharan Africa. 

Additionally, Saudi Arabia requires participants in the annual Hajj and Umrah pilgrimages show proof of MenACWY vaccination. For additional information, please visit https://www.cdc.gov/meningococcal/vaccine-info.html 

Pneumococcal infection can range from ear and sinus infections to pneumonia and bloodstream infections. There are vaccines to help prevent pneumococcal disease.

There are 2 types of pneumococcal vaccines available in the United States:

Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)

Pneumococcal polysaccharide vaccine (PPSV23)

High risk travelers, including those with immune-compromising conditions (HIV, cancer, diabetes, ect), or those over 65 years of age are recommended to receive pneumococcal vaccinations.

For additional information, please visit https://www.cdc.gov/vaccines/vpd/pneumo/hcp/who-when-to-vaccinate.html

According to the Centers for Disease Control and Prevention (CDC), Polio, or poliomyelitis, is a disabling and potentially deadly disease, caused by the poliovirus. The virus spreads from person to person and can infect the spinal cord, causing paralysis. There is no cure for polio, but it can be prevented with safe and effective vaccination. Inactivated polio vaccine (IPV) is the only polio vaccine  given in the United States since 2000. Travelers going to countries where polio is endemic and unvaccinated / incompletely vaccinated adults should receive polio immunization. For complete list of recommendations, please visit https://www.cdc.gov/vaccines/vpd/polio/hcp/recommendations.html 

Rabies is a serious illness that almost always results in death. The rabies virus enters the body following a bite from an infected animal, eventually making its way into the central nervous system. Symptoms only begin once the central nervous system has been infiltrated, which may be days to years following initial exposure. Symptoms include delirium (confusion), abnormal behavior, hallucinations, hydrophobia (fear of water), and insomnia (difficulty sleeping), which rapidly proceeds to coma and death. One symptoms begin, death is almost certain, even with highest level of medical care. 

Rabies is still considered universally fatal disease and preventive measures (for example, proper wound care, pre-vaccination and postexposure prophylaxis) are the only way to optimize survival if bitten by a rabid animal. 

Preexposure vaccination (PrEP) is recommended for some international travelers based on the occurrence of animal rabies in the country of destination, the availability of anti-rabies biologics, and the intended activities of the traveler, especially in remote areas. The rabies pre-exposure vaccine increases the time window to receive post exposure treatment if exposed to rabies. This becomes especially important if traveling to a remote area without readily available post exposure treatment. Missing the post exposure window may result in rabies which is nearly ALWAYS fatal. In addition to travelers, preexposure vaccination may be recommended for veterinarians, animal handlers, field biologists, cavers, missionaries, and certain laboratory workers. 

For additional information, please visit 

https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/rabies 

Shingles is a paintful skin rash caused by a reactivation of varicella-zoster virus (VZV). A vesicular eruption of zoster generally occurs unilaterally (on one side of the body) in the distribution of a sensory nerve or dermatome. Zoster can occur in any dermatome but occurs most often in the trunk or face. Two to four days prior to the eruption, there may be pain and paresthesia (numbness) in the involved area. The most common and debilitating complication from zoster is postherpetic neuralgia (PHN). PHN is a severe pain that persists in the area of the initial rash occurrence, even after the lesions have resolved. Treatment of persons with PHN is complex, with varying degrees of success in controlling the chronic pain. 

RZV (Shingrix) vaccine is currently the only zoster vaccine licensed and available for use in the United States. The CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix because it is the only way to protect against shingles and postherpetic neuralgia. For additional information, please visit https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/ 

According to the Centers for Disease Control and Prevention (CDC), TBE virus is transmitted to humans through the bite of an infected tick of the Ixodes species, primarily I. ricinus (European subtype) or I. persulcatus (Siberian and Far Eastern subtypes).  

TBE is endemic to focal areas of Europe and Asia, extending from eastern France to northern Japan and from northern Russia to Albania. Approximately 5,000–13,000 TBE cases are reported each year, with large annual fluctuations. 

Disease severity increases with age. Although TBE tends to be less severe in children, residual symptoms and neurologic deficits have been described. Clinical course and long-term outcome also vary by TBE virus subtype, although some of the reported differences may be due to patient selection, access to medical care, or age-specific exposure. The European subtype is associated with milder disease, a case-fatality ratio of <2%, and neurologic sequelae in up to 30% of patients. The Far Eastern subtype is often associated with a more severe disease course, including a case-fatality ratio of 20%–40% and higher rates of severe neurologic sequelae. The Siberian subtype has a case-fatality ratio of 6%–8%, with rare reports of cases with slow or chronic progression over months. There is no specific antiviral treatment for TBE; therapy consists of supportive care and management of complications. 

No TBE vaccines are licensed or available in the United States. 

Travelers should avoid consuming unpasteurized dairy products and use all measures to avoid tick bites  

Travelers anticipating high-risk exposures, such as working or camping in forested areas or farmland, adventure travel, or living in TBE-endemic countries for extended periods, may wish to be vaccinated in Europe. 

For additional information, please visit https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/tickborne-encephalitis 

According to the Centers for Disease Control and Prevention (CDC), Typhoid fever and paratyphoid fever are life-threatening illnesses caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively. 

Most people in the United States with typhoid fever or paratyphoid fever become infected while traveling abroad, most often to countries where these diseases are common.  Vaccination can help prevent typhoid fever. CDC recommends vaccination for people traveling to places where typhoid fever is common, such as South Asia, especially India, Pakistan, or Bangladesh.   Two typhoid fever vaccines are available in the United States. 

Oral vaccine: Can be given to people at least 6 years old. It consists of four pills taken every other day and should be finished at least 1 week before travel. Injectable vaccine: Can be given to people at least 2 years old and should be given at least 2 weeks before travel. Typhoid vaccines are not 100% effective. Always practice safe eating and drinking habits to help prevent infection. 

For additional information, please visit https://www.cdc.gov/typhoid-fever/typhoid-vaccination.html 

According to the Centers for Disease Control and Prevention (CDC), 

Yellow fever is a serious disease caused by the yellow fever virus. There is no medicine to treat or cure yellow fever. Yellow fever virus is spread by the bite of an infected mosquito. It is found in parts of Africa and South America. They yellow fever vaccine can prevent yellow fever and recommended for people aged 9 months or older who are traveling to or living in areas at risk for yellow fever virus transmission in South America and Africa. Yellow fever vaccine may be required for entry into certain countries. Yellow fever vaccination requirements and recommendations for specific countries are available on the CDC Travelers’ Health page.