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Question: As more people begin to travel again (domestically and abroad), what are some important vaccines travelers should be up to date on?
Answer: This is a great question that many people don't ask! As a nurse practitioner who has provided numerous travel health visits over the past six years, I would say that many people are unaware of the need to check vaccination status before international travel, much less domestic travel.
Before COVID-19, it was important for people to remain up to date on all routine vaccines, plus their flu shots. In the age of COVID-19, the Centers for Disease Control and Prevention (CDC) recommends that all domestic travelers delay travel until they are fully vaccinated with a COVID-19 vaccine.
Vaccinations Protect You While Traveling Domestically
Traveling can increase your chances of becoming sick due to various factors like stress, fatigue, decreased sleep, and spending time in high-density spaces like planes, trains, shuttles, and crowded waiting areas. Additionally, the low humidity in planes has been shown to increase the chances of getting sick.
The COVID-19 vaccine is the main way to ensure protection while traveling during the pandemic. If one chooses not to get the COVID-19 vaccine, they will have to follow the current CDC recommendations for unvaccinated people: Get tested 1-3 days before travel, test 3-5 days after travel, and complete a full seven-day quarantine after travel.
Vaccines Vary Depending on Where You Travel Domestically
While the United States includes territories that are considered domestic travel, the same international vaccine recommendations apply. Whenever someone is traveling, the provider will look up the recommended vaccines for that region.
The most common place to look up recommended vaccines is the CDC's travel health page. The specific recommendations will vary depending on the patient's precise destination and the risks based on individual activities.
Traveling Abroad Requires More Vaccine Considerations
Travelers should remain up to date on all routine vaccinations, including:
- Tdap: Tdap is a combination vaccine protecting individuals from three life-threatening bacterial diseases: tetanus, diphtheria, and pertussis (whooping cough).
- Influenza: Seasonal vaccines protect against multiple flu viruses.
- Varicella (chickenpox): The CDC recommends two doses of the vaccine for anyone who has not had chickenpox and has never been vaccinated.
- Polio: Inactivated polio vaccine protects against polio.
- MMR: This combo vaccine protects against measles, mumps, and rubella (German measles).
- Pneumococcal: This vaccine prevents some cases of pneumonia, meningitis, and sepsis.
- Meningococcal: Recipients avoid infection by Neisseria meningitidis, which decreases cases of meningitis and sepsis.
- Hepatitis A: Patients can receive a vaccine that protects just against hepatitis A or a combination vaccine for protection against hepatitis A and B.
- Hepatitis B: This vaccine prevents severe liver disease resulting from the untreated hepatitis B virus.
Vaccines Vary Depending on Where You Travel Abroad
In addition to routine vaccines, vaccine recommendations vary by region. Common travel vaccines may include:
- Yellow fever
- Japanese encephalitis
Vaccination Timing Matters When Traveling Abroad
Timing the vaccine is just as important as the vaccine itself. Without sufficient time for it to take effect and build immunity, the vaccine could be useless. Travelers should consult healthcare professionals months in advance, if possible, regarding international travel vaccines.
Also, some of these vaccines may be difficult to come by — travel vaccines are not always kept in traditional offices.
Is It Mandated to Be Vaccinated Before Traveling?
The current administration stated it would not make a mandate for COVID-19 vaccination. However, if the United States made healthcare more accessible, we could do a mandate similar to healthcare workers getting the flu shot or hepatitis B vaccine.
Mandatory vaccinations for work, school, and travel aren't unprecedented — they're actually commonplace.
- A meningococcal vaccine is required for college students.
- Travelers on Hajj or Umrah must show proof of meningococcal vaccination to gain entry into Saudi Arabia.
- Some countries require proof of yellow fever vaccination before entry.
- The U.S. requires all people seeking permanent residence to receive all of the CDC-recommended routine vaccinations that have outbreak potential, along with seasonal flu shots.
Will the COVID-19 Pandemic Result in Stricter Vaccine Requirements to Travel?
I think that, as the vaccines become readily available, there will be fewer excuses not to get them. It's difficult to mandate something that people may have limited access to. As vaccines become more available, I think we'll see more places mandate it or provide more freedoms to vaccinated individuals and restrictions on the unvaccinated.
I imagine we will continue to see restrictions on unvaccinated individuals (such as preflight and postflight testing, quarantine, and masking) and more freedoms for vaccinated individuals. Also, I imagine this will be determined by the course of the COVID-19 pandemic. If we see spikes or waves of new infections or more resistant strains, I imagine that would accelerate or broaden any potential vaccination mandate.
Regarding airline industry plans for travel mandates... the International Air Transport Association remains against a vaccine mandate for various reasons.
I know the pandemic has negatively affected the airline industry, and enforcing a universal vaccine mandate would continue to negatively affect that industry. So any future mandates, whether related to the vaccine or public health measures, need to be realistic and nondiscriminatory.
Unequal Access to Healthcare Affects Vaccination Rates
Obtaining vaccines, in general, can be difficult in the United States for some people. I've had countless encounters with people trying to get basic, routine vaccines who cannot get them due to insufficient money, lack of transportation, no insurance, local availability, etc.
There needs to be a balance between public safety and imposing significant burdens on people. I don't think we are at the point where we can expect this of people yet.
Again, it goes back to the balance between public health safety and burdensome policies. In general, I can say from personal experience that if routine vaccines were free to everyone and readily available, we would have far more Americans vaccinated.
We have a large income inequality in the U.S., which directly affects access to health insurance and healthcare. Therefore, restrictions or mandates that require access to healthcare are inherently discriminatory. The way the U.S. delivers healthcare makes things way more complicated than they need to be.
- When traveling domestically, specific vaccination recommendations will vary depending on the precise city/region.
- When traveling abroad, review specific vaccine recommendations to ensure you're protected.
- Timing matters. Travelers should consult a healthcare professional months in advance, if possible, regarding international travel vaccines.
- Vaccine mandates are common, but the COVID-19 vaccine is not currently mandated for travel by the administration.
- Overall, unequal access to healthcare affects vaccine rates.
Sara Hunt, DNP, PHN, FNP-C
Sara Hunt, DNP, is a doctoral-level, board-certified family nurse practitioner, licensed public health nurse, and professional medical writer in northern California. She has worked as adjunct faculty in nursing and health policy and served as the American Association of Nurse Practitioners Spring 2015 Health Policy Fellow in Washington D.C. Hunt has worked for six years in retail health and has extensive experience in the skincare and aesthetics industry.
Feature Image: SDI Productions / E+ / Getty Images
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