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The Vaccines You Need To Know About Before You Travel
CNN —
Few things can ruin a vacation faster than illness.
But while a mild stomach bug will probably affect most travelers at some point, there are far more dangerous diseases – including potentially lethal ones – adventurers should know how to protect themselves against.
Global concern is mounting over the spread of mpox, a viral illness formerly known as monkeypox, that initially killed 1 in 10 people who contracted it, but now kills up to 3.3%.
In August, Sweden became the first country outside the African continent to confirm a case of the newer and more severe mpox strain, clade Ib, which has now also spread to Asia, with a confirmed case in Thailand and suspected cases in Pakistan and the Philippines.
The World Health Organization (WHO) has declared the ongoing mpox outbreak across more than a dozen central African nations a "public health emergency of international concern," the highest level of alarm under international health law.
The US Centers for Disease Control and Prevention (CDC) recommends vaccination with two doses of the Jynneos mpox vaccine for people in the US at high risk of catching the virus.
In terms of bite prevention, travelers are urged to use insect repellent and wear permethrin-treated long-sleeved shirts and long pants when outdoors – the same advice as for other mosquito-borne diseases such as malaria or dengue fever.
Both have also been in the news lately, this time for more positive reasons.
Until recently, there wasn't a widely available dengue vaccine for travelers. But in the past couple of years, a vaccine called Qdenga has been rolled out in the UK, the European Union and some countries outside Europe, while Dengvaxia is offered in the United States.
But according to Dr. Nicky Longley, consultant in infectious diseases and travel medicine at The Hospital for Tropical Diseases (HTD) at University College London Hospitals, dengue vaccination is not quite the silver bullet travelers had hoped for.
"The Qdenga vaccine reduces the risk of getting severely ill and dying if you catch dengue a second time, but if you haven't had dengue before, it offers almost no protection," she says, "and there is a theoretical risk that it might increase your risk of severe infection."
Longley advises people who haven't previously contracted the virus to hold off on the vaccine while trials are still ongoing, and instead take the above-mentioned precautions against mosquito bites – as should everyone, regardless of vaccination status.
One traveler who welcomes the arrival of the new Qdenga vaccine is UK-based travel writer Chris Dwyer.
After catching dengue while on vacation in Malaysia in 2014, he developed joint pain, weak limbs, a fever and a temperature that got progressively worse.
Dwyer had to be hospitalized and put on a drip while doctors monitored his liver and white blood cell count.
He eventually recovered, but the experience was clearly harrowing, and Dwyer knows that having previously been infected with dengue, he would be at even greater risk if he were to catch it a second time.
"I am seriously considering getting jabbed with Qdenga now, as I'm frequently in Asia and know how dangerous it would be to get sick again," Dwyer says.
Meanwhile, headlines proclaiming that malaria could be eradicated within a decade are generating excitement after the development of an affordable vaccine against the devastating disease that kills 600,000 people, the vast majority being African children under the age of 5, every year.
Malaria is a disease spread when the female anopheline mosquito feeds on a person with malaria and then feeds on another.
Babies in South Sudan and the Ivory Coast were given the first doses of the vaccine last month, with more African countries said to be authorizing it.
It's good news for the world's second-most populous continent, but the chances that it could also result in a malaria vaccine for global travelers within a similar time frame are "almost zero," says Longley.
"It's just not a suitable vaccine for travelers, because you need constant boosters and exposure, and it doesn't offer full protection."
What it does do, she explains, is reduce the risk of death in children, and once a whole population is vaccinated against malaria, the disease will eventually be eradicated.
But we are still a long way away from a malaria-free world, and anyone visiting affected regions (it can occur in the US, although cases are relatively rare) should be aware of how to do so safely and responsibly.
Equally keen to spread that message is Anniina Sandberg, the Finnish founder of boutique travel agency Visit Natives, who has been exploring remote regions of Africa for at least two decades.
As a professional traveler, she knows exactly which antimalarial drug works best for her and always packs mosquito nets when traveling to the African savanna, not just for her own safety but also because they make lifesaving gifts for local communities.
However, Sandberg herself once came close to death after getting ill on a trip many years ago and wants to share her experience as a cautionary tale.
Ahead of a year-long field trip among the Maasai in Tanzania when she was still a student, Sandberg was prescribed an antimalarial drug in combination with antibiotics. However, after a few months, the daily medication "began to seem unnecessary."
"I noticed that the local population would regularly get malaria and recover from it, so I naively began to think of it as just a bout of flu," she says.
"Of course, it's a lot more dangerous than that, and as soon as I stopped taking the tablets, I got very sick, with a high fever, aches and pains."
Even though she visited a hospital and was given malaria medication, Sandberg's condition rapidly deteriorated with additional severe stomach flu.
After she was rushed back to the hospital, it transpired that she didn't just have malaria but also typhoid fever, a bacterial infection common in parts of the world with poor sanitation and limited access to clean water.
Typhoid vaccines are widely available, with booster doses recommended every few years.
Sandberg's ordeal didn't put her off intrepid adventures.
"You can be super cautious, but you can never eliminate every health risk when traveling, in any destination," says Sandberg, who also had a rabies scare a few years ago.
While visiting the Tanzanian Datoga tribe, whose traditional way of life revolves around herding sheep on the savanna, she spotted an animal in the herd that was clearly very unwell.
"I couldn't know for sure if it had rabies or something else, but it was definitely very sick, and I did my best to avoid it," she says.
However, a few days later, Sandberg suddenly realized that the sheep was right behind her and had just licked her foot, where she had a broken blister.
"I got very anxious," she says. "I knew I had to seek medical help as soon as possible."
As she was miles from a hospital, Sandberg had to wait until her return to Helsinki, Finland, a few days later before she could be given a course of post-exposure rabies shots.
This is vital when there is a risk of infection, even if you have been vaccinated against rabies; initial vaccination just buys you more time.
"If you haven't had the vaccine before, we normally say you should start treatment within a week, but obviously the sooner the better," advises the HTD's Longley.
The length of time it would take to develop rabies, she clarifies, depends on the location of the infected wound. It could take weeks or even months for the virus to enter the nervous system and reach the spinal cord and the brain. Once it does, there is no hope of survival.
With successful post-exposure treatment being a race against time, there have been cases of people choosing to seek treatment locally rather than flying home, only to find out later that it wasn't actually the rabies vaccine they were given.
In a foreign environment, Longley warns, "you can't necessarily know if the vaccine you're getting is verified or not, or if it has been stored at the right temperature."
Rabies vaccination is "super important," she says, "because rabies is relatively widespread."
Contrary to popular perception, the virus isn't just a threat mainly in Asia. It's present in more than 150 countries across every continent except Antarctica.
"There are bits of Europe, bits of the Americas – places you wouldn't necessarily think of – where it is also a big risk," says Longley.
Tick-borne encephalitis (TBE), a human viral infectious disease that affects the central nervous system and circulates in various parts of the world, some far from tropical, is another virus whose risk people often underestimate.
"There are parts of central Europe for which we would definitely recommend vaccinating against TBE, especially if you're going hiking or camping," says Longley.
"TBE is not rabies at all, but like with rabies, if you have TBE, there isn't a specific treatment for it, and although the majority of people will recover, some people are severely unwell with it and can become disabled, and there are some deaths with it.
"If you are someone who is going to potentially be exposed to lots of ticks regularly, it's well worth investing in the vaccine."
The cost of vaccines – for TBE and generally – can vary significantly between clinics.
It's worth shopping around for affordable vaccines, says Longley, but more important still is ensuring that the health advice you seek out ahead of a trip is the best possible.
"Actually, the advice is often more important than the vaccine you think you want," adds Longley.
Childhood vaccination is one of the most effective public health strategies to control and prevent disease.
In the United States, several vaccines are included in the standard recommendations for children at specific ages between birth and 10 years, including hepatitis A, measles, Covid, mumps and rubella. More, like tetanus and diphtheria, are added for adolescent. The CDC has a full list, but its also advisable to ask your doctor.
Adults are advised to keep a record of their immunizations and when they need to be boosted. When planning a trip, it is a good idea to consult the CDC's destination pages for travel health information, to ensure that you have all the recommended and required vaccines for your destination, and know how else to protect yourself from the risk of disease.
Whooping Cough Cases Are Rising To New High Levels In Pa.
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Whooping cough is making a big comeback in communities nationwide, with especially high numbers in Pennsylvania.
The commonwealth has recorded about 2,008 cases of this bacterial infection, also known as pertussis, so far this year — that's 10 times the number seen at this point last year and the highest in any single state or territory nationally, according to federal data.
Public health experts and researchers say the rise in cases and infections is likely part of the disease's return to circulation after years of low activity during the pandemic.
"It went away because it spreads through respiratory droplets, and all the COVID measures really helped us decrease its incidence," said Dana Perella, acute communicable disease program manager at the Philadelphia Department of Public Health. "But it's increasing again and we're seeing kind of higher than what we had in pre-pandemic years."
But it's unclear why this hasn't happened sooner and why some areas are seeing exceptionally high cases over others.
Health officials say they're closely monitoring whooping cough outbreaks in communities, especially in schools, daycares and hospital admissions.
Whooping cough, at first, can look like other common respiratory illnesses. Symptoms include a runny or stuffy nose, fever and a mild cough. But about a week or two later, someone with an infection could develop difficulty breathing and painful coughing fits, "characterized by this high-pitched whoop sound when someone is inhaling after they cough," explained Perella.
"The coughing fits are so violent, they make someone feel very tired and very fatigued after the fit. It may cause difficulty breathing at night and fractured ribs."
In severe cases, people can become hospitalized and develop sleep apnea, pneumonia and brain swelling. One in 100 people will die from complications, according to the Centers for Disease Control and Prevention.
Antibiotics for bacterial infections and illnessesWhooping cough can be successfully treated with antibiotics. Perella said people who suspect they've been infected should seek testing and medication as soon as possible.
"The treatment helps with stopping the bacteria from being contagious," she said. "Say we have a school student who is diagnosed with pertussis — we let them go back to school after five days of antibiotics, whereas they're contagious for three weeks if they're untreated."
A post-exposure prophylactic course of antibiotics may also be prescribed for other household members and close contacts.
Infants and young children are most at risk of severe illness. Seniors and other adults who have immunocompromised conditions or chronic diseases like asthma can also develop complications.
In a statewide health advisory issued earlier this month, Pennsylvania Department of Health officials said there has been an increase in hospitalizations of older adults with whooping cough this year.
"This is likely due to a multitude of factors, including waning vaccine protection and the lack of timely recognition and testing by adult providers, leading to more severe infections, co-infections and hospitalizations," the advisory stated.
The state health department warned that all health care providers should have an "increased suspicion of pertussis in all patients who present with symptoms."
DTap and Tdap vaccines for kids and adultsTo prevent or reduce the likelihood of illness from the start, Perella said children and adults should be up to date on their pertussis vaccinations, which are given as part of the standard childhood immunization schedule and as boosters later in life.
A total of five doses of the DTaP vaccine, which also includes protection against diphtheria and tetanus, are given to children at two months, four months, six months, between 15 to 18 months, and between four and six years.
One dose of Tdap, a similar combination vaccine against the same set of diseases, is recommended for kids 11 to 12 years old and for pregnant people between 27 and 36 weeks of gestation.
"There is a passing along of antibodies to the newborn during that time frame," Perella said. "So, it's a way to help protect those most at risk for severe disease."
Pertussis vaccine boosters are also recommended for any adults or caregivers who will be in close contact with newborns.
"If you are an older adult and you have grandkids in particular who are too young to have gotten their primary vaccine series yet, you must make sure that your pertussis vaccine is up to date," said Dr. Richard Lorraine, medical director at the Montgomery County Health Department. "As much as you don't want to get pertussis, which is a nasty illness, you certainly don't want to give it to a baby."
In all other cases, the CDC recommends a routine Tdap vaccine for all adults every 10 years.
While vaccines don't 100% completely prevent infection, they effectively reduce severe illness in the immediate years following immunization.
Before the pandemic, Pennsylvania had recorded 649 cases of whooping cough in 2017, 311 cases in 2018, and 278 cases in 2019 by mid-September. Perella said it may take time for the disease to return to typical levels.
"It may take this academic year, and then it will start mellowing out again or going back to that baseline," she said.
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Woman With Rare Disease Claims She's Now Blind And Bruised After Doctors Made Her Get 3 Vaccines
A 23-year-old Florida woman has been temporarily blinded and bruised after allegedly being required to receive multiple vaccines before a blood transfusion for a rare autoimmune disorder.
Alexis Lorenze was diagnosed with Paroxysmal Nocturnal Hemoglobinuria (PNH) in January.
The extremely rare condition affects approximately one in a million people, causing the immune system to attack and destroy red blood cells.
Alexis Lorenze was diagnosed with Paroxysmal Nocturnal Hemoglobinuria (PNH) in January. Todd Lorenze/FacebookEarlier this month, Lorenze reportedly traveled to California for a transfusion to replenish her damaged blood cells.
Upon her arrival at UCI Medical, she claims doctors informed her that she could not receive the transfusion unless she first received vaccines for tetanus, pneumonia and meningitis, all administered simultaneously.
She said that within 10 minutes after the vaccinations, she began to experience alarming symptoms: her vision darkened in both eyes, her jaw locked, she began vomiting, and her body swelled and bruised.
Medical experts have voiced concerns about the potential dangers of administering multiple vaccines at once, especially in patients with autoimmune conditions like PNH as these patients can have heightened immune responses, leading to severe complications.
One such complication, cytokine storms, can cause the body to attack its own healthy tissues and organs. It can be life-threatening and lead to irreversible damage.
The extremely rare condition affects approximately one in a million people, causing the immune system to attack and destroy red blood cells. Todd Lorenze / Facebook"While it's usually safe for most people to get these vaccines together, in her case, the immune response could have been too much and led to complications," Dr. Raj Dasgupta, chief medical advisor for Fortune Recommends Health, told Daily Mail.
"To avoid overloading her system, it would be reasonable to space out the vaccines and closely monitor for any worsening symptoms."
Doctors have suggested that the vaccines themselves were unlikely the direct cause of Lorenze's severe reactions, they suggested that her PNH condition may have been unstable, and the vaccinations could have triggered a flare-up or allergic reaction.
Earlier this month, Lorenze reportedly traveled to California for a transfusion to replenish her damaged blood cells and claims that she suffered a horrific reaction after doctors gave her three vaccines at once. Todd Lorenze/Facebook"There's also the possibility that what she's experiencing isn't just from the vaccines," Dr. Dasgupta said.
"PNH can flare up on its own, and we have to consider whether the condition itself is behind her severe reaction. Both factors (her PNH and the vaccines) need to be carefully weighed when looking at what's happening."
Lorenze's case has sparked significant debate, particularly regarding the hospital's rationale for allegedly requiring the vaccines so urgently.
She said that within 10 minutes after the vaccinations, she began to experience alarming symptoms: her vision darkened in both eyes, her jaw locked, she began vomiting, and her body swelled and bruised. @lexxvuitton/TikTokVaccines for meningitis and pneumonia are often recommended for certain high-risk groups, including those undergoing immunotherapy, as they become more susceptible to infections. However, several medical experts questioned whether the vaccines were genuinely necessary prior to her transfusion.
In a series of viral TikTok videos, Lorenze claimed that she hadn't received any vaccines since childhood. Her family has claimed that the hospital insisted the vaccinations were mandatory for the transfusion, but some experts argue that this is not a standard requirement.
Lorenze's family is now seeking to transfer her to a private hospital in Los Angeles for further treatment, as she continues to experience pain and swelling.
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