Do I Need Shots to Visit … ?

When I first started traveling outside the U.S., a stop at a doctor’s office for a few shots was almost routine, as was schlepping my yellow immunization card along with my passport. These days, immunization requirements are rare enough that we often forget about them entirely. Still, a few do exist, and travelers aren’t always sure what they need, especially if they’re heading beyond the familiar grounds of Canada, the Caribbean, or Western Europe. As a reader recently asked:

“What shots are required for a visit to Egypt?”

The short answer to our reader is simple: None unless you enter Egypt from or through a country where yellow fever is prevalent.

But this question suggests a broader look at the overall question of required medical documentation. The information I cite is drawn from two sources: The State Department’s information sheets on individual country entry requirements and the Center For Disease Control and Prevention’s travel website.

Yellow fever

As far as I’ve been able to tell, the only common mandatory vaccination these days is for yellow fever. And that requirement is limited to travelers arriving:

• From any country to Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote D’Ivoire, Democratic Republic of Congo, French Guiana, Gabon, Ghana, Liberia, Mali, Niger, Rwanda, Sao Tome and Principe, Sierra Leone, Tanzania, and Togo.
• From dozens of specifically listed countries or “endemic” zones of those countries&#8212mainly in sub-Saharan Africa, northern South America, plus Trinidad and Tobago&#8212into additional dozens of countries around the world. In some cases, the requirement includes travelers who haven’t actually stayed in the endemic zone but instead have just traveled through (airport stop only) an infected area.

The U.S. currently has no vaccination requirements for returning travelers. Although not always required, however, medical prudence would suggest yellow fever immunization for any American planning to visit or transiting any area on the CDC list of countries where that disease is “endemic.” The CDC site lists clinics around the country that provide this immunization.

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Malaria

The CDC ranks malaria as the world’s other infectious disease of most concern to travelers, noting that travelers to sub-Saharan Africa have the greatest risk of contracting and dying from malaria. But the disease is widespread in large parts of South Asia, South America, the South Pacific, and even a few places in Eastern Europe. Risks are greatest in (1) rural areas, (2) the rainy season, and (3) low-altitude regions; even in some high-risk countries, tourists are generally safe in capital cities. Overall, says CDC, anyone traveling outside the U.S., Canada, and Western Europe runs some risk of malaria.

There is no vaccination for malaria. Clearly, as a traveler, your main focus should be on prevention. That means:

• Avoiding mosquito bites by a combination of screens and insect repellents.
• Taking pre-trip preventive antimalarial drugs.

Although chloroquine was once effective worldwide, many malaria strains have become resistant. The CDC website lists preferred antimalarial drugs for each country.

Other

Beyond yellow fever and malaria, as far as I can tell from the State Department and CDC websites, travelers’ risks from other serious diseases are fairly low in most popular tourist destinations. The CDC recommends only that you keep up with the standard recommendation for all U.S. residents. And that’s more of a bundle than you might think: The list for adults recommends appropriate immunizations against tetanus/diphtheria/pertussis, HPV (females), MMR, varicella, flu, pneumococcal, hepatitis A and B, meningococcal, and zoster (seniors). Recommendations vary somewhat for children and infants; consult CDC for details.

Of course, travelers always face risks of low-level gastrointestinal or mild respiratory problems, but remedies are widely available. Most travelers should use common sense&#8212and their physician’s recommendation&#8212as to any other steps that might be desirable.

This report just highlights the problem. I strongly recommend you check in with the State Department’s “Country Specific Information” sheets for any places you intend to visit&#8212certainly any places outside North America or Western Europe. In addition to health and entry requirements, those pages provide a wealth of information that just about any traveler would find useful.