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Travel Vaccines

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Travel Vaccines

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Travel Vaccines
Note: International travelers should be current for vaccines routinely recommended in the United States (for example MMR, influenza and Tdap). Some vaccines recommended for international travelers are addressed in separate Ask The Expert sections (for example hepatitis A, hepatitis B, rabies and meningococcal ACWY). This section contains information only on vaccines not routinely recommended in the United States.
Vaccination is only one part of preparing for international travel. Before travel occurs please consult the Centers for Disease Control and Prevention travel website at https://wwwnc.cdc.gov/travel for detailed information about staying healthy during travel.
What are the recommendations for use of the new oral cholera vaccine?
CVD 103-HgR (Vaxchora, PaxVax) cholera vaccine was approved by the Food and Drug Administration in June 2016. ACIP has not yet published recommendations for Vaxchora. However, at their June 2016 meeting, ACIP voted to recommend vaccination for adults 18 through 64 years old traveling to areas of active cholera transmission. An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1 and includes areas with cholera activity within the last 1 year that are prone to recurrence of cholera epidemics; it does not include areas where rare sporadic cases have been reported. No country or territory currently requires vaccination against cholera as a condition for entry.
In addition to vaccination, all travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary prevention strategies against cholera infection. Travelers who develop severe diarrhea should promptly seek medical attention for rehydration therapy.
The package insert for VaxChora oral cholera vaccine states that effectiveness and safety have not been established for revaccination or for individuals with previous immunity. Does the CDC have any recommendations on revaccination or is one dose considered lifetime immunity at this time?
At this time, CDC does not have any recommendation related to revaccination with oral cholera vaccine. The duration of immunity following one dose is unknown. As more information becomes available, CDC will update its recommendations accordingly.
Does live oral cholera vaccine need to be administered at an interval from other live oral or injectable vaccines?
In general, no. According to ACIP's General Best Practice Guidelines for Immunization, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. So live oral cholera vaccine may be administered simultaneously or at any interval before or after administration of most other vaccines. One exception is Ty21a oral typhoid vaccine and oral cholera vaccine. Oral cholera vaccine should be administered before Ty21a vaccine, and 8 hours should separate the cholera vaccine and the first dose of Ty21a.
How can I get yellow fever vaccine? Is there a vaccine shortage?
Yes, there is a yellow fever vaccine (YF-Vax) shortage. If you are a healthcare provider who administers yellow fever vaccine, you can no longer place an order for YF- Vax online. You must call Sanofi Pasteur at 1-800-VACCINE (1-800-822-2463), and a customer service representative will work with you to determine how many doses can be shipped and which vial sizes (single dose or 5 dose). YF-Vax doses will be prioritized for patients who are traveling in the next 30 days to an area where yellow fever vaccine is required or recommended.
Healthcare providers should refer to the section titled Yellow Fever and Malaria Information, by Country (https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country) in CDC Health Information for International Travel 2018 ("The Yellow Book”) for information about which countries require yellow fever vaccination for entry and for which countries CDC recommends yellow fever vaccination. In the absence of a country requirement, CDC does not recommend yellow fever vaccination if the traveler’s itinerary does not include travel to a yellow fever–endemic area.
This information can be found at https://wwwnc.cdc.gov/travel/news-announcements/yellow-fever-vaccine-shortage-2016.
When not given on the same day, is the interval between yellow fever and MMR vaccines 4 weeks (28 days) or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways.
The General Recommendations on Immunization makes the generic recommendation that live parenterally or nasally administered vaccines not given on the same day should be separated by at least 28 days. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days if possible.
This page was updated on June 30, 2017.
This page was reviewed on June 30, 2017.
 
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