Immunizations Recommended for Travel Outside of Canada

Source: Health Canada

If you are planning to travel outside of Canada, you may require immunizations, depending on your travel destination, the length of your stay and whether or not your routine immunizations are up-to-date. Since it can take several weeks for an immunization to protect you against a disease, you should consult a travel health clinic or your family physician 2 to 3 months before your trip in order to allow enough time for the vaccines or immunizing agent to take effect.

The actual immunizations you may require will vary according to your age, health, and any pre-existing medical conditions, as well as the nature of your travel, whether you will be staying in city hotels or travelling in remote rural areas. A travel health clinic or family physician should assess your individual circumstances and provide any vaccines that may be required for your trip. This is especially important if you plan to travel with infants or young children. Specific changes to the routine childhood immunization schedule, as well as additional vaccines that may be recommended for infants and young children who travel are outlined in the Canadian Immunization Guide, Fifth Edition, 1998.

A list of diseases for which immunization may be required follows. Those which are recommended as part of the routine immunizations in Canada are marked with an asterisk *.

Diphtheria*

Diphtheria is an acute bacterial infection of the throat, nose and tonsils, resulting in lesions in the infected area. In severe cases, it can cause swelling and fluid build-up in the neck. Diphtheria can also infect the skin, causing lesions similar to impetigo. In Canada, a diphtheria booster shot is recommended every 10 years. All travellers should have up-to-date diphtheria shots prior to travel. This is particularly important because of the resurgence of diphtheria in some Eastern European countries.

European tick borne Encephalitis

European tick borne encephalitis is a viral disease resembling other encephalitides transmitted by mosquito bite. This disease is transmitted by tick bites and has a longer duration of symptoms. Vaccination is recommended for long-term travellers to areas where this disease is widespread, specifically areas of Russia and other countries of the former Soviet Union as well as parts of Europe during April through August. This vaccine is not routinely available in Canada. You should contact a travel health clinic to assess your need for this vaccine and to make arrangements to obtain the vaccine through Health Canada's Special Access Programme.

Hepatitis A

Hepatitis A is a viral disease affecting the liver. The symptoms include abrupt fever, malaise, loss of appetite, nausea and abdominal discomfort, followed by jaundice (yellowing of skin colour). Hepatitis A varies in severity and duration of the illness. In rare cases it can cause fatal liver damage. Protection against Hepatitis A through immunization with Hepatitis A vaccine is recommended for travellers to developing countries, especially rural areas, or areas where the hygenic quality of food and water supply is likely to be poor, or areas where Hepatitis A is widespread. For infants < 1 year and in individuals for whom the vaccine is contraindicated, Immune Serum Globulin (ISG) may be used. ISG provides protection for 4-6 months. Those living for prolonged periods in developing countires may require a booster. A travel health clinic or family physician will recommend which immunization is appropriate for individual circumstances.

Hepatitis B*

Hepatitis B is also a viral disease affecting the liver. Usually more serious than Hepatitis A, its symptoms include gradual development of fever, loss of appetite, abdominal discomfort, nausea and vomiting, joint pain, rash and frequently progresses to jaundice. Its severity also varies, but a greater percentage of cases will involve destruction of the liver cells resulting in liver failure and death. Unlike Hepatitis A, Hepatitis B is transmitted through contact with infected blood and other body fluids. Any traveller who will be staying in an area with widespread Hepatitis B for longer than 6 months, or who is doing medical work, or who is likely to have contact with blood or sexual contact with residents of such areas, should be immunized with Hepatitis B vaccine.

Japanese Encephalitis

Japanese encephalitis (JE) is caused by a virus transmitted by mosquito bite. It causes an acute inflammation of the brain, spinal cord and the membranes surrounding them which can result in high fever, headache, disorientation, tremors, convulsions occasionally and coma. This disease occurs throughout most of East Asia from India east to Korea and Japan during the late summer and early fall. It also occurs sporadically throughout the year in tropical areas of Southeast Asia including Thailand. Vaccination is recommended for travel to any area prone to JE for more than 4 weeks. You should contact a travel health clinic in order to have your specific needs assessed.

Measles*

Measles is an acute highly infectious disease caused by a virus. A fever usually develops before the symptoms which include inflammation of the tissue around the eyes, inflammation of the nasal tissues with severe runny nose, cough and red blotchy rash on the skin. Two doses of measles vaccine are recommended for all unimmunized travellers aged > 1 year who were born after 1970 and who are en route to a measles endemic area, unless there is serologic proof of immunity or physician documentation of prior measles.

Meningococcal meningitis

Meningococcal meningitis is an acute bacterial infection resulting in the sudden development of fever, intense headache, nausea and often vomiting, stiff neck and a distinctive rash. Severe cases can result in delirium and coma and, if untreated, toxic shock and death. Meningococcal disease occurs seasonally in some regions of the world. In Sub-Sahara Africa, epidemics of meningococcal disease occur between December and June. Localized outbreaks have been reported in parts of Brazil, India and Nepal. Short-terms travellers staying in city hotels with high standards, and little contact with the local population are at minimal risk and should not need to be vaccinated for travel in Asia, Africa or Latin America.

Poliomyelitis*

Poliomyelitis, commonly called polio, is a disease caused by a virus. It can vary in severity from a mild illness with fever, to an inflammation of the lining of the brain, to paralysis and sometimes death. Most residents of Canada are already vaccinated against polio; however, if you have not been vaccinated before, or if you have not had a booster shot in the past 10 years, you may require polio vaccine before you travel. Outbreaks of polio can occur in many countries, especially those without national vaccination programs.

Rabies

Rabies is an acute viral infection, causing inflammation of the brain and spinal cord which is invariably fatal. Rabies occurs in many areas of the world. Travellers planning extended visits to countries where rabies control programs for domestic animals are inadequate, or who are planning to live in areas where rabies is widespread should consider pre-exposure immunization with rabies vaccine. A post-exposure vaccine exists for use following a bite by a rabid animal; however, it may not be easily available in all countries. Regardless of whether pre-exposure immunization has been given, any traveller bitten by a rabid animal should be given the post-exposure vaccine immediately.

Rubella*

Rubella, also known as German measles, is usually a mild illness caused by a virus. Its symptoms include fever, headache, malaise, inflammation of the tissues around the eyes and a widespread rash. Rubella can cause serious birth defects in an unborn child should the mother be infected during pregnancy. All children and women of childbearing age who have never had rubella or have not been previously vaccinated, should be given a rubella vaccine prior to travel.

Tetanus*

Tetanus, also known as lockjaw, is caused by a toxin produced by the tetanus bacteria. This bacteria, found usually in the soil, infects an open wound or cut and begins to produce toxin. The toxin causes painful muscle contractions usually in the face and neck muscles. If untreated, the contractions can restrict breathing, causing death. In Canada, a tetanus booster shot is recommended every 10 years. All travellers should have up-to-date tetanus shots prior to travel.

Typhoid

Typhoid fever is caused by a bacterial infection. Its symptoms include a sustained fever, headache, malaise, loss of appetite, slowed heartbeat, enlarged spleen and rose spots developing on the trunk of the body. Typhoid is typically spread through water which has not been adequately treated to remove or kill the bacteria. Typhoid vaccine is recommended for any traveller who will have prolonged exposure to potentially contaminated water and food. Most urban tourist destinations provide water which is adequately treated; however, if you plan to travel in smaller cities and villages in developing countries, or rural areas off the usual tourist routes, you may need to be vaccinated against typhoid before you travel.

Yellow Fever

Yellow fever is an viral disease spread by mosquito bite. The symptoms include the sudden onset of fever, chills, headache, generalized muscle pain, severe fatigue, nausea and vomiting.

International Health Regulations, established by the World Health Organization, require that travellers to regions where yellow fever is found be vaccinated against yellow fever and given an International Certificate of Vaccination. A valid certificate issued within the past 10 years is required for entry into 21 countries in Central Africa and South America. In addition, 102 other countries require proof of vaccination from travellers who have passed through (non-direct flights) an area where yellow fever occurs. Travellers without proper vaccination and certificate can be seriously delayed, depending on the route and destination. Both the vaccine and certificate are only available at certain travel medicine clinics recognized by Health Canada as yellow fever clinics.

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