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Taking a Shot at Disease Prevention

March 11, 2001|KATHLEEN DOHENY

The couple arrived at the travel medicine clinic in Pasadena bearing a long list of vaccinations recommended by the tour company in charge of their upcoming three-month cruise. The clinic's physician, Dr. Brian Terry, gave them only what they needed, saving them money and perhaps discomfort.

"Many travelers think they need more vaccinations than they do," says Dr. Terri Rock, a Santa Monica family practice doctor who often provides travel medicine services.

At the other end of the spectrum are the people who think vaccinations are only for schoolchildren.

To stay healthy, travelers should check with their physicians about vaccinations that may need to be updated. Travelers going overseas, particularly to developing countries, should consult a specialist in global disease risks.

Travelers often focus on protecting themselves from exotic diseases, but they forget to keep immunizations updated for more common risks. Tetanus, for instance, can be contracted at home. It occurs when wounds become infected with the Clostridium tetani bacterium often found in soil and dust. Boosters against tetanus and diphtheria, another bacterial disease, are recommended every 10 years for adults.

Measles, mumps and rubella vaccinations should be up to date. People born in or after 1957 should consider a second dose of measles vaccine before going overseas, according to the CDC. Travelers who aren't sure whether they had chickenpox in childhood should consider getting tested because there is a vaccine for it.

Once routine vaccinations are current, your doctor may also discuss other immunizations.

* Vaccination against hepatitis A, a viral liver disease transmitted via contaminated water, ice, shellfish or other foods or by person-to-person contact may be recommended; this disease is prevalent in developing countries.

* Vaccination against hepatitis B, a liver disease spread by sexual activity with an infected person or activities that result in exchanges of blood, may be needed.

* Meningitis vaccine is recommended for travelers to sub-Saharan Africa during the dry season, December through June.

* Rabies vaccine is often recommended for travelers destined for countries where rabies is common, such as India, Nepal and Vietnam.

* Typhoid fever vaccine is recommended for those going to areas where the disease is common.

* Vaccination for yellow fever, a mosquito-borne viral disease, is recommended for travel in certain parts of Africa and South America.

* A polio booster may be needed. Adults who received a complete series of polio vaccine as children should have received a single dose at age 18. For those who did not, a booster is in order for travel to high-risk areas. These include most of Africa, the Middle East, the Indian subcontinent, most of the former Soviet Union, Dominican Republic and Haiti.

* The risk of cholera, an acute intestinal infection usually transmitted in contaminated food or water, is considered low for U.S. travelers who follow precautions about what they ingest. Oral cholera vaccine is available overseas but not in the U.S.

Timing is everything in reducing disease risk during travel. Many travelers don't consult a doctor far enough in advance of their trip to get all the immunizations they ideally need-at least two months before departure, says Terry, the Pasadena physician. But, he adds, even one injection of a vaccine usually is better than none if time is tight.

Two organizations maintain lists of travel specialists: the International Society of Travel Medicine, Internet, and the American Society of Travel Medicine and Hygiene, at


The Healthy Traveler column appears the second and fourth Sundays of each month.

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