The holidays are just around the corner, and often they include vacations. If you have international travel plans, especially to developing nations, it’s important to talk to your doctor about vaccines to keep you safe.

Routine vaccinations, based on age and health conditions, are recommended for all travelers. This is particularly important considering that many countries don’t have robust pediatric vaccination programs, so travelers will not benefit from the herd immunity afforded by such programs.

Tetanus vaccination is recommended every 10 years, but international travelers should be vaccinated if it has been five or more years since the last booster dose.

Tetanus is found in the environment and the toxin it releases during infection causes lockjaw. Travelers should receive the vaccine in case of an accidental injury because it may be difficult to find good medical care.

The vaccine also includes protection against diphtheria, a serious throat infection, and may include protection against pertussis (whooping cough), which causes prolonged cough in adults.

Typhoid vaccination is recommended for travel in the developing world. Typhoid fever is a potentially lethal illness with the primary symptoms of fever, headache and diarrhea.

It occurs in areas with under developed sewage and water systems (for example, regions of Africa, South America, South and Southeast Asia, and the Caribbean). Typhoid is transmitted by the fecal-oral route, meaning an infected food handler practicing poor bathroom hygiene can transmit the disease to others — remember Typhoid Mary.

Typhoid vaccine is available as an injection or pill. The injection is killed (inactivated) germ and is approved for those older than 2 years of age. Protection lasts for two years.

The pill may be better for frequent travelers as it protects for five years. The pill is approved for people 6 years and older, but it’s a live but weakened germ, and so it cannot be used if someone has a weak immune system.

The pill is tricky to take correctly. It needs to be refrigerated. The pill is taken every other day, one hour prior to a meal with a cold or lukewarm drink, for a total of four doses.

Hepatitis A is also spread by the fecal oral route. Since 2008, it has been recommended routinely for children after their first birthday. The virus attacks the liver and can cause liver failure. Hepatitis A is common in Africa, Asia, Central and South America, the Middle East and the Western Pacific.

Travelers who haven’t received the vaccine should receive two doses six months apart. Those who cannot get both doses before leaving should not fret as even one dose offers excellent protection. The second dose can be given upon returning. This vaccine works incredibly well — after two doses the vaccine is nearly 100 percent effective.

Other vaccines may be recommended depending on the region to be visited and on planned activities. It’s important to speak with your doctor about vaccines and other precautionary measures such as those to protect against malaria or diarrhea. Safe travels.

Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email

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