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If you're planning a winter trip to another country, you may be preoccupied with booking airfare and finding lodging, but certain destinations require an extra step of planning: travel vaccines.
You might be tempted to skip the extra doctor's visit, but don't. Last year saw a record number of measles cases in Europe, and the highly contagious illness has continued to spread across the continent throughout 2019. Yellow fever remains a significant concern in South America, and hepatitis A has doctors everywhere—including in the U.S.—on alert.
You can protect yourself from all three of these illnesses (and more) if you get your shots in time. Here's a quick rundown on the travel vaccines recommended by the Centers for Disease Control and Prevention.
According to the CDC, most cases of measles in the U.S. result from international travel, when unvaccinated Americans become infected during visits to other countries, then carry the disease back home.
Measles, one of the most contagious of all infectious diseases, is spread through the cough or sneeze of an infected person. Symptoms include rash, high fever, cough, runny nose, and red, watery eyes. In rare cases, the disease can cause brain swelling and be fatal.
Measles outbreaks have become increasingly common in the past couple of years in the U.S. and other countries.
Europe is of particular concern for travelers. As CDC researchers noted in a report published in Pediatrics earlier this year, Europe had a record number of cases—more than 41,000, including 37 deaths—between January and June 2018. According to the Pediatrics report, the Ukraine reported the largest number of cases, but France, Georgia, Greece, Italy, Serbia, and the Russian Federation also had a high number.
But because Europe, a popular travel destination, isn't one that visitors usually think of as having significant risks of infectious disease, they may not consider the need for vaccinations.
In fact, a recent study in JAMA Pediatrics found that not all children are adequately vaccinated against measles before international travel. (The CDC has special recommendations for measles vaccinations for children going overseas.)
In this study, only about 41 percent of infants and preschool-age children who were eligible for pre-travel measles vaccination actually received it.
And a study by researchers at Massachusetts General Hospital in Boston, published in 2017 in the Annals of Internal Medicine, found that more than half of all U.S. travelers—not just young kids—who were eligible for the measles, mumps, and rubella (MMR) vaccine weren't getting it before leaving the country.
The CDC advises anyone who isn’t protected against measles, either through vaccination or past infection, to get vaccinated before traveling anywhere overseas.
You'll need to see your doctor at least four to six weeks before you leave. That's because it may take that much time to complete a full course of the vaccine and to give your body time to build up immunity in response to the shot. See the CDC's recommendations for travelers of different ages and Consumer Reports' coverage of when a measles booster is warranted.
Other Routine Shots
Before any international trip, you should make sure you're up to date on all of your routine vaccines, not only measles-mumps-rubella (MMR) but also diphtheria-tetanus-pertussis (DTP), varicella (chickenpox), polio, and your yearly flu shot.
Some of these diseases are quite rare in the U.S., thanks to good vaccine coverage of children here. But the CDC says these same diseases can be much more common in other countries, including areas where you wouldn’t usually worry about travel-related illnesses. Being current with your routine vaccines will give you the best protection.
Yellow fever is spread by the Aedes aegypti mosquito (the same one that spreads Zika, dengue, and chikungunya). Although the virus was eradicated from much of the world in the mid-1900s, it has re-emerged in recent years in parts of Africa and South America, including, most recently, Brazil.
Brazil has been suffering through a yellow fever outbreak that’s one of the largest the world has seen in decades.
“Since early 2018, a number of unvaccinated travelers to Brazil contracted yellow fever,” the CDC notes. “Several have died.”
According to the CDC, the vaccine that's typically used to prevent the yellow fever virus, known as YF-Vax, is currently unavailable due to production delays. To cover the shortage, the CDC and the Food and Drug Administration have turned to a different yellow fever vaccine known as Stamaril.
This other shot is already approved in more than 70 other countries around the world and is thought to be just as safe and effective as the YF-Vax shot. It's been okayed by the FDA under a special program, but its availability in the U.S. is limited.
If you're traveling to a country where yellow fever is spreading or one that requires all visitors to have a yellow fever shot, be sure to plan ahead. Unlike other travel shots, the yellow fever vaccine is available only at specially designated clinics. Because of the shortage, there will be far fewer clinics than usual.
You definitely don't want to skip this shot. Yellow fever is a serious disease. The CDC estimates that it can be fatal in 15 to 20 percent of cases. Find out where the nearest clinic is (you can search online here) and make sure you budget enough time to go.
Hepatitis A and B
Hepatitis A is a virus that causes liver disease. It spreads through contaminated food and through physical contact with an infected person, especially if that person doesn't wash his or her hands properly after using the bathroom. It's common among people who travel to developing countries, particularly those who visit rural areas, though it can also be spread in more modern tourist accommodations.
The vaccine to prevent this virus—given in two doses, six months apart—is 100 percent effective, according to the CDC.
Hepatitis B is a different but related virus that passes through blood, semen, and other body fluids. It can disappear after just a few weeks or it can linger for a lifetime, potentially causing liver disease and cancer.
This virus occurs in nearly every part of the world, but it's most common in Asia, Africa, South America, and the Caribbean. Travel-related cases are generally rare but can result from unprotected sex, intravenous drug use, and blood transfusions.
The vaccine for hepatitis B is more than 90 percent effective. It's usually given in three doses spread across six months, but ask your doctor for an accelerated schedule if your travel plans require it.
Typhoid fever is a serious disease caused by the bacteria salmonella typhi and is spread through contaminated food and water. In rare cases, it can be fatal. Typhoid is rare in developed countries like the U.S. but common in most of the rest of the world, especially South Asia. The U.S. sees about 300 travel-related cases of typhoid fever every year.
The vaccine for typhoid fever is available as a pill and an injectable. The pill contains live but weakened bacteria and is given in four doses: One capsule is taken every other day for a week. The injectable contains killed bacteria and is given in one dose. Get the injectable at least two weeks before traveling and complete the oral vaccine at least 10 days before.
The CDC concedes that the typhoid vaccine in any form is only about 50 to 80 percent effective. You should still get it before traveling to an endemic region. But you should also take basic precautions with the food you eat while traveling, sticking to bottled water in places where the tap water is questionable, for example.
Rabies is a disease caused by a virus that spreads through the saliva of infected animals. The most common sources of human infection are licks, bites, and scratches from infected dogs. But bats, foxes, raccoons, and mongooses have also been known to pass the disease to humans. Prevention of this disease is especially important because once contracted, it's almost always fatal.
Rabies is found all over the world except in Antarctica. In most developed countries, including the U.S., the risk of human infection is low because the virus is rare in domestic animals. But in much of Africa, Asia, and Latin America, rabies in dogs is still a problem.
If you're traveling to a country where the virus is prevalent in dogs, or if your itinerary will bring you into contact with wild animals like bats and other carnivores, you should consider getting a rabies shot before you travel. It's given in three doses over three weeks.
It's important to note that even if you've had your rabies shots, you should still seek immediate medical treatment if you're bitten or scratched by an animal while traveling. You can't be too careful when it comes to rabies prevention.
There’s no vaccine available against malaria, but it’s still crucial to plan ahead if you’re going to a region where malaria is common. You can take prophylactic medications that will reduce your risk of developing malaria if you’re bitten by an infected mosquito.
The recommendations vary depending on what country you’re visiting, what time of year you’re going, and whether the mosquitoes in your destination have developed resistance to certain antimalarial drugs.
The CDC offers this chart of every country and specific recommendations for preventing malaria in different destinations.
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