Tag: travel vaccines

Hepatitis A Outbreaks

The hepatitis A vaccine, introduced in 1996, worked to decrease the incidence of hepatitis A infections in the United States.
The hepatitis A vaccine, introduced in 1996, worked to decrease the incidence of hepatitis A infections in the United States. Source – CDC Division of Viral Hepatitis

Hepatitis A is a now vaccine-preventable disease thanks to the hepatitis A vaccine that was first licensed in 1995.

Despite being added to the childhood immunization schedule in 1996 (kids living in high risk areas at first and gradually expanded to all kids in 2006), we do continue to see outbreaks of hepatitis A.

Hepatitis A

Although they are all viruses that can cause hepatitis, hepatitis A doesn’t share too much in common with hepatitis B and C.

Unlike hepatitis B and C, hepatitis A:

  • often doesn’t cause any symptoms at all in very young children
  • is spread by fecal-oral transmission (not blood and body fluids), typically from one person to another or after eating or drinking contaminated food or water
  • is much less likely to cause complications, but still did cause over 100 deaths from fulminant hepatitis A each year

In older children and adults, they symptoms of hepatitis A can include jaundice, fever, malaise, anorexia, nausea, abdominal discomfort, and dark urine, all of which can linger for up to two to six months.

Hepatitis A Epidemics and Outbreaks

In the prevaccine era, before the mid-1990s, hepatitis A outbreaks were common and “hepatitis A occurred in large nationwide epidemics”

After it became a nationally reportable disease in 1966, we saw peaks of hepatitis A disease in the early 1970s and again in the early 1990s and an estimated 180,000 infections per year in the United States.

Not surprisingly, those large nationwide epidemics soon disappeared as hepatitis A vaccination rates rose.

“Vaccination of high risk groups and public health measures have significantly reduced the number of overall hepatitis A cases and fulminant HAV cases. Nonetheless, hepatitis A results in substantial morbidity, with associated costs caused by medical care and work loss.”

CDC on the Epidemiology and Prevention of Vaccine-Preventable Diseases

We do still see some hepatitis A outbreaks though, including:

  • a multistate outbreak in 2016 linked to frozen strawberries (143 cases and 56 hospitalizations)
  • an outbreak in Hawaii in 2016 linked to raw scallops (292 cases and 74 hospitalizations)
  • a multistate outbreak in 2013 linked to pomegranate seeds from Turkey (162 cases and 71 hospitalizations)

So you can get hepatitis A if you are not immune and you are caught up in one of these outbreaks. Still, hepatitis A cases are at historic lows, with about 1,390 cases being reported in 2015.

Even more commonly, you might get hepatitis A if you are not immune and travel to a part of the world where hepatitis A either has high or intermediate endemicity (many people are infected), including many parts of Africa, Mexico, Central and South America, Eastern Europe, and Asia.

Or you could just be exposed to someone who traveled to or from one of these areas, became infected, and is still contagious.

There have also been outbreaks among men having sex with men, among IV drug users, and the homeless. These outbreaks are often the most deadly, and include fatal outbreaks in Michigan, California, and Colorado.

Avoiding Hepatitis A

How can you avoid getting caught up in one of these hepatitis A outbreaks?

Get vaccinated.

Can’t you just wash your hands or avoid eating contaminated food? Since you can get hepatitis A by simply eating food that has been prepared by someone who has hepatitis A and is still contagious, washing your own hands won’t be enough. Even drinking bottled water when traveling might not protect you from contaminated water if you use ice cubes or wash fruits and vegetables in water that might be contaminated.

Remember, if your child did not get a routine 2-dose series of the hepatitis A vaccine when they were between 12 to 23 months old, they can still get one at any time to get immunity against hepatitis A infections.

“On February 25, 2009, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis A vaccination for household members and other close personal contacts (e.g., regular babysitters) of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.”

ACIP on the  Latest Hepatitis A Vaccine Recommendations

Adults can get the vaccine too. It is an especially good idea if you are not immune and will be traveling out of the United States or are in another risk group, including food handlers, daycare workers, health care workers, and people who consume high risk foods, especially raw shellfish.

What to Know About Hepatitis A Outbreaks

Although we are at historic lows for cases of hepatitis A, make sure that your family has been vaccinated against hepatitis A so that they don’t get caught up in the next outbreak.

More Information on Hepatitis A Outbreaks:

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Vaccine-Preventable Diseases

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Today, in the United States, children typically get:

  • 36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.

While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Vaccine-Preventable Diseases

Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.

Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:

  1. adenovirus – a military vaccine
  2. anthrax – vaccine only given if high risk
  3. chicken pox – (Varivax, MMRV)
  4. cholera – vaccine only given if high risk
  5. dengue – vaccine not available in the United States
  6. diphtheria – (DTaP/Tdap)
  7. hepatitis A – (HepA)
  8. hepatitis B – (HepB)
  9. hepatitis E – vaccine not available in the United States
  10. Hib – (Hib)
  11. HPV – (Gardasil)
  12. Haemophilus influenzae type b – (Hib)
  13. measles – (MMR, MMRV)
  14. meningococcal disease – (MCV4 and MenB and MenC)
  15. mumps
  16. pneumococcal disease – (Prevnar13 and PneumoVax23)
  17. pertussis – (DTaP/Tdap)
  18. polio – (bOPV and IPV)
  19. Q-fever – vaccine not available in the United States
  20. rabies – vaccine only given if high risk
  21. rotavirus – (RV1, RV5)
  22. rubella – (MMR, MMRV)
  23. shingles – vaccine only given to seniors
  24. smallpox – eradicated
  25. tetanus – (DTaP/Tdap)
  26. tick-borne encephalitis – vaccine not available in the United States
  27. tuberculosis – (BCG) – vaccine only given if high risk
  28. typhoid fever – vaccine only given if high risk
  29. yellow fever – vaccine only given if high risk

Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.

These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.

What To Know About Vaccine Preventable Diseases

Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.

More About Vaccine Preventable Diseases

Get a Vaccine Checkup Before Traveling with Your Kids

Get vaccinated. Measles is just a plane ride away.
Get vaccinated: Bring home fun souvenirs, photos, and fantastic memories, not measles!

Got plans to travel this spring or summer?

Going out of the country?

Taking the kids?

While a trip abroad can be a great experience for kids, whether you are just site seeing or you are visiting family, don’t forget to take some simple precautions so that your family comes back safe and healthy.

Get a Vaccine Checkup Before You Travel

It is important to remember that just because your kids are up-to-date on their routine childhood immunizations, that doesn’t mean that they are ready to travel out of the country.

It might surprise some folks to know that there are many vaccines that kids in the United States don’t routinely get, like vaccines that protect against cholera, yellow fever, typhoid, and Japanese encephalitis, etc. These are considered to be travel vaccines and may be recommended or required depending on where you are going.

How do you know which vaccines your kids need?

The CDC Traveler’s Health website is the best place to figure it out. With a list of 245 destinations, in addition to offering advice on how to avoid vaccine-preventable diseases, you get recommendations on avoiding others too, like Zika and malaria.

Don’t wait until the last minute before checking on these vaccine recommendations though. These are not vaccines that most pediatricians have in their office, so call or visit your pediatrician a few months in advance to plan out how you will get them. As a last resort, if your pediatrician can’t order them, can’t help you get them from an area pharmacy, and they aren’t available at your local health department, you might look to see if there is a “travel clinic” nearby.

Don’t Forget the Early MMR Recommendations

It’s also important to remember to make sure your child’s routine vaccines are up-to-date too. Confusing things a little, that can mean getting their MMR vaccines early.

Many parents, and some pediatricians,  often forget that before traveling out of the United States:

  • Infants 6 months through 11 months of age should receive one dose of MMR vaccine. While this early dose should provide protection while traveling, it doesn’t provide full protection, doesn’t count as the 12 to 15 month routine dose, and will need to be repeated.
  • Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days. So even if your child is less than 4-years, he or she needs two doses of MMR before traveling out of the country. This second early dose won’t have to be repeated when they do turn 4.
  • Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days. While some adults are considered fully vaccinated with one dose of MMR, that isn’t true if they are traveling out of the country. Travelers need two doses!

Continuing outbreaks of measles linked to unvaccinated and partially vaccinated travelers highlight the need to spread the word about these recommendations.

Traveling is fun. Be sure to bring back some great memories and a few souvenirs. Don’t bring home measles or other diseases that you can then spread to others in your community or on the plane ride home.

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Available Vaccines

In the United States, children routinely get 13 vaccines that protect them against 16 vaccine-preventable diseases including diphtheria, chicken pox, hepatitis A, hepatitis B, Hib, HPV, influenza, measles, meningococcal disease,  mumps, pertussis, pneumococcal disease, polio,  rotavirus, rubella, and tetanus.

Routine Vaccines

These 13 routine childhood vaccines include:

  1. DTaP vaccines (Daptacel or Infanrix) – 5 doses
  2. chicken pox vaccine (Varivax) – 2 doses
  3. hepatitis A vaccines (Havrix or Vaqta) – 2 doses
  4. hepatitis B vaccine (Engerix-B or Recombivax HB) – 3 doses
  5. Hib vaccine (ActHIB, PedvaxHIB, Hiberix) – 3 to 4 doses
  6. HPV vaccines (Cervarix or Gardasil) – 3 doses
  7. Influenza – a yearly flu shot
  8. MMR II – 2 doses
  9. Meningococcal vaccines (Menactra or Menveo) – 2 doses
  10. Pneumococcal vaccines (Prevnar 13 and Pneumovax 23) – 4 doses/1 dose
  11. Polio vaccine – 4 doses
  12. Rotavirus vaccines (Rotarix or RotaTeq) – 2 to 3 doses
  13. Tdap booster (Adacel, Boostrix) – 1 dose

Another vaccine or meningococcal B disease (Bexsero or  Trumenba), which is given as 2 or 3 doses to older teens, is not exactly routine yet. It has a “permissive” recommendation in that parents are told they can get it if they want their kids to avoid menB infections, but it is not required yet.

MenHibrix is yet another vaccine, a combination between Hib Meningococcal Groups C and Y, but it is only given to high risk kids.

Combination Vaccines

The availability of combination vaccines also means that your child doesn’t necessarily need to get as many shots as you see doses. For example, Pediarix combines the three vaccines, DTaP-IPV-HepB, into a single shot. Given three times, when your infant is two, four, and six months, that means that instead of nine shots, your child only gets three.

Other combination vaccines include:

  • Pentacel – DTaP-IPV-Hib
  • Kinrix – DTaP-IPV
  • Quadracel – DTaP-IPV
  • ProQuad – MMR-Varivax

Using combination vaccines, your fully vaccinated and protected child might only get 18 shots by the time he starts kindergarten, not counting yearly flu shots.

Other Vaccines

In addition to the 13 routine vaccines that children get, other vaccines that might be given in special situations include the:

That there are so many vaccines that are not routinely given to kids should dispel the myth that pediatricians are simply vaccine pushers. After all, why don’t they push these vaccines then?

For More Information On Vaccines:

Updated April 26, 2017

Yellow Fever Vaccines

When traveling to or from some countries, a yellow fever vaccine isn't enough - you need an International Certificate of Vaccination proving that you were vaccinated.
When traveling to some countries, a yellow fever vaccine isn’t enough – you need an International Certificate of Vaccination proving that you were vaccinated.

Although the first yellow fever vaccine was developed in 1935, a yellow fever vaccine wasn’t licensed in the United States until 1953.

The current yellow fever vaccine, YF-VAX, is a live vaccine that is given as a single dose to adults and children who are at least 9-months-old.

Still, it was mosquito control more than the yellow fever vaccine that helped control yellow fever in the United States.

Unfortunately, yellow continues to be  a big problem in many areas of the world, especially parts of Africa and South America. In fact, a yellow fever vaccine is required before travel to certain countries.

We even saw deadly outbreaks of yellow fever in some countries.

Yellow Fever Vaccine Shortage

Shockingly, the United States is currently out of Yellow Fever vaccines while the manufacturer continues to finish a new manufacturing facility..

“Sanofi Pasteur, the manufacturer of the only yellow fever vaccine (YF-VAX) licensed in the United States, has announced that their stock of YF-VAX is totally depleted as of July 24, 2017.”

MMWR Update

You might be able to still get one if you can find a pharmacy or clinic that still has some left, but otherwise, you will be left looking for Stamaril, a version of the yellow fever vaccine that is used in at least 70 other countries.

YF-VAX will hopefully be available by mid-2018.

What To Know About the Yellow Fever Vaccine

Yellow fever is still a risk in area of Africa and South America, so be sure to find a yellow fever vaccine, even might be hard with the current shortages, if you are traveling to a high risk area.

More Information on Yellow Fever Vaccines:

Updated August 2, 2017

Travel Vaccines

In addition to the vaccines in the standard immunization schedule, children and adults often need a few other vaccines when traveling out of the country, including:

  • typhoid vaccine
  • yellow fever vaccine
  • Japanese encephalitis vaccine
  • Meningococcal vaccine (MenC)
  • rabies vaccine
  • an early MMR vaccine – a single dose as early as 6 months of age, while everyone over 12 months of age should have two doses of MMR separated by at least 28 days.

Although not a vaccine, keep in mind that children who are too young to be get the hepatitis A vaccine (less than 12 months old) may need a dose of immunoglobulin to get protected against hepatitis A, if they are traveling to a developing country/hepatitis A endemic area.

For more information: