The 10 most important vaccinations for an overland trip
Anna is a doctor, in particular a pediatrician. In her opinion, vaccinations are an easy step to prevent damage to your body – and to the body of a baby or a immunodeficient child. Both could not get any vaccination (yet). If you are healthy and keep in mind staying healthy (workout, healthy food, non-smoking etc.), you can copy with vaccinations without a problem (besides a painful shoulder or a short fever).
We know, it is a widely discussed topic and there are many anti-vaxxer out there. But from Anna’s point of view, it was clear that we take all the vaccinations the pharma industry can offer.
After some trips in regions suspect to health, Anna already got many vaccinations and only needed some booster. But Heiner almost started from the beginning and got painful shoulders several times in the last months before starting our trip. In our case Anna’s health insurance paid for all the vaccines, Heiner had to pay for his own because of his private health insurance. But of course he saved the medical treatment with his private doctor at home.
Not only the medical and traveling experiences from Anna but mostly the very helpful support and advice from the Institute of Tropical Medicine at UKD in Dusseldorf, where we went to university, led us to the following list of vaccinations we identified as important for an overland trip:
Hepatitis A
| Pathogen | Hepatitis A virus; worldwide, mainly developing countries |
| Transmission | fecal-oral (contact-/smear infection); human to human, water/food |
| Characteristics | Incubation 15-50 days; mostly asymptomatic, sometimes general malaise, fever, gastrointestinal afficition, jaundice |
| Initial immunication | 2 injections: Day 0 - after 6-12 months |
| Booster | none, protection for around 25 years |
Hepatitis B
| Pathogen | Hepatitis B virus; worldwide |
| Transmission | mainly blood-blood; pre-/perinatal |
| Characteristics | Incubation 45-180 days; depending on immune defense, acute icteric hepatitis/acute anicteric hepatitis/asymptomatic; potential chronification |
| Initial immunication | usually in childhood (in Germany 3-4 injections as infant); without initial immunication as child 3 injections: Day 0 - after 4 weeks - after 6 months |
| Booster | usually none; maybe necessary in case of low titer of antibodies |
Japan B-Encephalitis
| Pathogen | Japan Encephalitis virus (Flavi virus); Asia |
| Transmission | mosquito bite (reservoir pigs, birds) |
| Characteristics | Incubation 5-15 days; mostly asyptomatic or mild malaise, seldom severe fever, headache, chills, myalgia, seizures, coma |
| Initial immunication | Day 0 - 28 |
| Booster | after 2 years |
Measels
| Pathogen | measels virus; worldwide, mostly Africa and Asia |
| Transmission | droplet-/smear infection from infected person |
| Characteristics | Incubation 8-10 days (exanthem after 14 days); beginning with fever, cough, rhinitis, conjunktivitis and enanthem with Koplik spots; after 3-7 days macula-papulous exanthem beginning retroauricular; compliactions: bacterial superinfection, postinfectious encephalitis, after 6-8 years rarely "SSPE - subacute sclerosing panencephalitis" |
| Initial immunication | usually in childhood: age 11-14 months - second injection age 15-23 months (in combination with mumps, rubella and varicella); every adult born after 1970 (>18 years of age) without initial immunication as child, unknown immunication or only 1 injection as child: 1 injection |
| Booster | none |
Meningitis ACWY
| Pathogen | Neisseria meningitidis, 12 different sero types: i.a. A, B, C, W135, Y; worldwide, A, W, X in so called meningitis belt sub-Saharan Africa and Asia |
| Transmission | close contact to infected person, contact-/smear infection (oropharyngeal secretion) |
| Characteristics | Incubation usually 3-4 days; ca. 60% meningitis, ca. 30% sepsis; beginning with malaise, then fever, severe headache, chills and vertigo; later neck stiffness and vomiting, seizures, coma; DIC and multi-organ failure |
| Initial immunication | usually 1 injection |
| Booster | none, protection for 3 years |
Rabies
| Pathogen | Rabies virus; worldwide, mainly Africa and Asia |
| Transmission | bite from infected animal (i.a. dog, cat, fox, bat) or contact saliva to injured skin or mucosa |
| Characteristics | Incubation usually 3-6 weeks; 1. stadium: headache, malaise, painful bite wound, 2. stadium: hydrophobia, muscle cramps, paralysed cranial nerves; 3. stadium: coma, respiratory paralysis, death after max. 7 days |
| Initial immunication | Day 0 - 7 - 21 (28) |
| Booster | after around 2-5 years |
Tetanus (lockjaw)
| Pathogen | Clostridium tetani; worldwide |
| Transmission | contaminated dust/dirt into wound |
| Characteristics | Incubation 3 days-3 weeks; due to toxine neurological disorder with severe, painful muscle cramps, high rate of mortality. |
| Initial immunication | usually in childhood (in Germany 4 injections as infant); without initial immunication as child 3 injections: Day 0 - after 4-8 weeks - after another 6-12 months |
| Booster | every 10 years |
Tick-borne Encephalitis (TBE)
| Pathogen | TBE virus (Flavi virus); Southern Germany, Eastern Europe, Asia |
| Transmission | tick bite |
| Characteristics | Incubation 7-14 days; mainly asymptomatic; seldom mild, flu-like beginning, after 1 week meningitis, encephalitis, myelitis |
| Initial immunication | Day 0 - after 1-3 months - after another 9-12 months (depending on age and manufacturer) |
| Booster | every 3-5 years |
Typhus
| Pathogen | Salmonella enterica serotype Typhi resp. Paratyphi A, B and C; worldwide, especially Africa, South America, Southeast Asia |
| Transmission | fecal-oral; mainly contaminated water and food |
| Characteristics | Incubation ca. 3-60 days; malaise, progressively high fever, headache, somnolence, abdominal pain, first constipation, later diarrhea; seldom roseola (efflorescence of the skin); complications like intestinal perforation |
| Initial immunication | 1 injection |
| Booster | protection for 3 years (around 60%) |
Yellow fever
| Pathogen | Yellow fever virus (Flavivirus); tropical and subtropical areas of South America and Africa |
| Transmission | mainly transmitted through the bite of the mosquito Aedes aegypti (urban cycle), besides that there is a sylvatic cycle (forest cycle or jungle cycle), where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors; in Africa there is a third cycle, intermediate cycle, between the jungle and urban cycles |
| Characteristics | Incubation 3-6 days; mostly mild infection with fever, headache, chills, back pain, fatigue, loss of appetite, muscle pain, nausea, and vomiting; rare cases with second, toxic phase with multiple bleeding and liver damage |
| Initial immunication | 1 injection |
| Booster | none, sometimes booster after 10 years required |
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This list might not be complete. It also depends on the region you are traveling to.
Be aware that this isn’t a medical advice you should rely on. Please go to a doctor specialized in tropical diseases/travel health before your trip for individual consulting before every trip! The vaccination recommendation, especially during childhood, are based on the recommendation of the German STIKO.
Of course, always keep in mind during traveling:
„Peel it, cook it, or forget it!“
and sufficient protection against insect bites.
Reference: www.rki.de
This is the third stage of our Trip Planning Series. You can read all stages here.
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