Enoch J. Wang, MD, FACP
As surfers we travel to all regions of the world. Often times this takes us to developing nations and tropical regions where many vaccine preventable diseases can occur. The exact requirements for vaccination vary depending on the region. Some vaccine preventable illnesses occur in certain parts of the world only. There are many good sources for recommended vaccines including the CDC (Center for Disease Control and Prevention) website. This is a governmental organization based in the United States. This website also provides updates on outbreaks such as yellow fever, Dengue, and Rabies.
There are some general rules to follow and questions to ask before travelling.
- Where are you going?
- What vaccinations are recommended in the area you will be visiting?
- Are your travel companions aware of these recommended vaccinations?
- Are you up to date on your routine vaccinations?
- Do you have any chronic medical conditions or is your immune system abnormal?
- Are you pregnant or breastfeeding?
Your destination will determine the vaccines necessary to stay healthy. Travel to many developed countries requires only routine vaccinations to be up to date. Once a destination is settled, special vaccinations may be required. It is important to schedule an appointment with your doctor or a travel medicine clinic 4 to 6 weeks prior to your travel date. Obtaining your vaccinations 4 to 6 weeks in advance ensures time for the vaccines to work and allows time for any booster shots required in some vaccination series.
Prior to travel, consult a source such as the CDC website for preventative measures.
There are routine vaccinations we all should be up to date on. These include:
- Hepatitis A
- Hepatitis B
- Tetanus, Diptheria, Pertussis
- Human Papillomavirus (For women less than 26 years)
- Measles, Mumps, Rubella
Hepatitis A is a transmissible disease through the oral route. Risks for acquiring hepatitis include eating with an infected person, poor hand hygiene, surfing in water polluted by feces. The organ infected is the liver but the symptoms are felt throughout the body. This vaccine is given in 2 doses 6 to 18 months apart.
Hepatitis B is transmitted through blood products and body fluids including sexual contact and sharing needles. Again, the organ infected is the liver but the symptoms are felt throughout the body. This vaccine is given in a 3 dose series over 6 months.
Tetanus, diptheria, pertussis comes as a series of 3 shots usually given in infancy. If you have not received this series of vaccinations, it is recommended that you receive it now. All adults need a tetanus booster every 10 years. Anytime a serious cut or puncture wound occurs, it would be important to consult with your physician regarding a tetanus booster.
Human Papillomavirus (HPV) is a relatively new vaccine recommended to women who are 26 years or younger. HPV is a sexually transmitted disease and certain strains of this virus have been associated with cervical cancer. This vaccine is given in 3 doses over 6 months.
Measles, mumps, rubella (MMR) is usually given in childhood. Individuals born after 1957 need at least one dose.
Varicella is the scientific name given to the virus that causes chickenpox. Contracted during childhood, it can cause severe illness but can also offer lifelong immunity. The illness can be much more severe if contracted as an adult. For individuals who have never contracted chickenpox, it is recommended to receive this vaccine.
The above vaccines are important when traveling to developing nations where the healthcare system may not be accessible to the entire population. Diseases that are virtually unseen in developed countries due to childhood vaccination can be common in the developing countries. Therefore, ensure you are up to date on routine vaccinations prior to travel.
When traveling to certain regions of the world, additional vaccinations may be required or recommended. Yellow fever vaccination is the only required vaccination by International Health Regulations when traveling to sub-Saharan Africa and tropical South America. Meningococcal vaccination is required by the Saudi Arabian government for annual travel during the Hajj. For more information on yellow fever and the yellow fever vaccination, the CDC has an excellent website with valuable information for travelers.
Special considerations must be made for the immunocompromised traveler. Conditions that are considered immunocompromising include:
- Individuals receiving high dose corticosteroid therapy
- HIV patients with CD4 lymphocyte count of 3. Travelers receiving chemotherapy
- Patients on immunosuppressive medications
- Bone marrow transplant patients on immunosuppressive therapy
The above conditions are not all inclusive. Having an immunocompromised condition requires special consideration when receiving vaccines especially live vaccines. Additionally, many vaccinations require an immune response from the patient to take effect. If you have any of the above conditions, please consult with your doctor prior to travelling.
For women who are pregnant or breastfeeding, consult with your doctor prior to travel.
Surf travel is fun, adventurous, and exciting. It gives us great memories and lifelong connections with people we may meet. Just don’t bring back any microscopic lifelong companions. Always try to be safe.
Dr. Wang is an attending physician of Hospital Medicine and Urgent Care/Emergency Medicine at Scripps Clinic in La Jolla, California.