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Getting Ready: Pre-travel Inoculation

"What shots do I need?" - This the most frequently asked question in travel clinics. This subject probably creates the most anxiety and confusion in the minds of travellers and medical professionals alike. And the answer, again, is "it depends".

Practicing travel medicine is a bit like being an insurance agent. We do our best to assess the risks to which the traveller will be exposed, and try to recommend the most appropriate forms of protection, whether it be needles, pills, condoms, or common sense. To do so requires knowledge of geography, tropical and many other fields of medicine, epidemiology and human behaviour. It also requires knowledge of each individual traveller.

The most important principle we go by, is:
"Immunize according to risk…. not just the country visited."


In assessing these risks, we consider the following:

  • Duration of travel - someone going away for 4 days is at less risk than a person relocating for 2 years
  • Purpose of travel - certain activities, such as medical work…. present a greater risk than sitting behind a desk or sightseeing
  • Style of travel - the budget-minded backpacker or person returning home to visit their family will have greater exposure than the businessperson who doesn’t leave his 5 star hotel
  • Age - certain age groups might be more susceptible to certain infections, or have riskier behaviour
  • Time of year - certain infections may be seasonal, such as malaria or Japanese encephalitis]
  • Urban vs. rural travel - many infections are only found in rural areas, such as Japanese encephalitis, while others, such as dengue fever, may be in urban settings
  • Other medical problems or medication - HIV infection, diabetes, heart disease and pregnancy are only a few of the conditions that will affect the risk of travel; see section on The Special Traveller
  • Destination - certainly it does make a difference where you are going. The Bahamas are not a great problem, Haiti is!

So clearly, a middle-aged couple taking an eighteen day, fully guided, megabuck tour through the capitals and beaches of Southeast Asia would be at much less risk than a young backpacker spending six months wandering through the remote corners of these same countries. Indiana Jones is a high risk traveller!

The Side Effects

A word about side effects from the vaccines. In general, I feel that vaccines are one of the safest things known to mankind. Yes, they may hurt a bit, but the anticipation is usually much worse than the real thing. There is usually some tenderness and perhaps some swelling at the injection site for a day or two after the shot. Flu like symptoms – fever, aches and pains – may, but don’t usually occur. While an association between some of the vaccines and other conditions such as autism have been made, these claims have been disproven. Sometimes you just have to weight the risk, or the alleged risk of the vaccine versus the risk of the disease itself. Imagine if we had vaccines against HIV/AIDS, malaria and tuberculosis.

People sometimes faint after their inoculation, especially those who have fainted before. If you are having vaccinations, make sure you have eaten in the recent past! Take off your heavy sweaters and scarves before the shot. Ask to lie down after the shot if you are a fainter. Make sure you lie down and get your feet up if you feel a bit woozy after your needle.

We divide the available vaccines into those that are:

ROUTINE - all of us should be up to date with these
REQUIRED - needed to enter a country
RECOMMENDED - depend upon the patient's risk factors and personal preference

"The doctor advises... but the traveller decides!"

Content (c) Mark Wise
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