Travel Health & Vaccinations

There are many things to consider when booking that long awaited time away. Where to stay, what to see and do, how many pairs of shoes will you pack?

But at gpbondi we can help you sort through your itinerary and explain the risks, how to minimise them and stay healthy.

Certain destinations carry special risks, so where are you heading?

Africa
India
Southeast Asia
South America

When coming for a travel medicine consultation, please bring with you, your full itinerary and a list of any previous vaccinations (including those given in childhood if possible). We also recommend that you organise the consultation 6-8 weeks prior to departure but know that travel is often at short notice or vaccines are forgotten about - come and see us anyway as we will be able to advise you on what steps to take to have a safe and healthy trip.

Travel Health and Safety are important things to consider before booking your time away.

Destination
Is where I’m going safe right now? What are the common illnesses in travellers there, how easy is it to get medical attention?

Your Personal Health
Making sure your own health is managed before heading overseas makes a big difference, is your asthma and eczema well controlled? Any niggling muscle and joint problems? Sore tooth you haven’t got around to treating?

Immunisation status
If you’re a frequent traveller you may have had some vaccinations along the way, but do you know which ones and how long ago? The most important vaccinations are for the commonest illnesses and the most significant. Influenza vaccination is highly recommended and should be yearly 2016 was a bad year, but 2017 was about four times worse.

Typhoid only lasts for three years, and hepatitis A immunisation offers lifelong immunity if you’ve received a full course (most people have 1 injection and forget about the follow up).

If you were born in a country that doesn’t have hepatitis B immunisation, it’s important to be caught up. Please visit our pages on all available vaccinations and when it’s important to consider them.

Level of Activity
For some, the ideal holiday is going on a food tour through Europe, for others it’s trekking to Everest Base Camp. We’re a diverse lot and it’s important we talk about risks for each of our destinations whether it’s altitude sickness, diving injuries, coral cuts or dog bites (from the casual morning jog before a business meeting in Jakarta) it’s important to understand how to minimise these risks.

Medical kit
Do you have what you need in the event of a minor illness or injury? We can help you prepare an individualised medical kit including appropriate antibiotics for travellers’ diarrhoea, acute respiratory illnesses, cuts and abrasions, and your regular medications. Some countries need documentation of medications for entry, and others prohibit certain medications altogether. We can help prepare the necessary documentation.

Travel insurance
Possibly the most important of all is to have appropriate insurance for your personal needs. Does it cover skiing and snow or specifically prohibit it? How about Scuba diving without an official open water certification? Make sure you know before you go.
Print out our travel checklist to see what you might have forgotten while packing.
follow links to :
Diseases and vaccinations
Common travel vaccinations and illnesses

Travel Vaccinations Specific Advice

Cholera is an acute, diarrhoeal illness caused by infection of the intestine with the bacterium Vibrio cholerae. An estimated 3-5 million cases and over 100,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 10 (5-10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Cholera is endemic in Africa, Asia, South America and Central America. Cholera epidemics are common in circumstances where food and water supplies can become contaminated, such as after natural disasters and civil unrest. Cases of cholera in Australia (about 2 to 6 cases a year) almost always occur in individuals who have been infected in endemic areas overseas. However, the overall risk of cholera to travellers with access to a safe water source and hygienic food preparation is considered to be low, even when visiting countries where cholera is endemic.

What is helpful however, is the reduction in risk of Traveller’s Diarrhoea associated with E.Coli. The cholera vaccine can reduce the risk of getting E.Coli by 67% for 3 months. So if travelling to a destination where trying the local cuisine and eating authentically is a must, consider this very useful vaccination.

Cholera vaccination is given as a drink, and two doses are required a minimum of 1 week and maximum of 6 weeks apart

Japanese encephalitis is a disease spread through mosquito bites. Symptoms usually take 5-15 days to develop and include fever, headache, vomiting, confusion, and difficulty moving. Symptoms that develop later include swelling around the brain and coma. JE is a serious disease that may cause death.

Travelers who go to Asia are at risk for getting JE.

Most travellers from developed countries to developing countries are at high risk of Hepatitis A. The risk for Hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they have good hygiene and that they are careful about what they drink and eat.

It is spread by food and water, and very rarely through sexual contact.

Symptoms include a sudden onset of fever, tiredness, loss of appetite, nausea, vomiting, stomach pain, and jaundice (yellowing of the skin and eyes). Some people have no symptoms, while others have symptoms that last 1-6 months. Most people recover with no lasting liver damage.

There have been some food source contaminations in Australia over the last few years with frozen berries being a common source. Fortunately these were identified early, and recalls made swiftly so the number of people affected were minimal.

Hepatitis A vaccinations can be given on their own, combined with hepatitis B vaccinations or with typhoid vaccinations depending on your requirements.

Once a full course of Hepatitis A vaccine is given, immunity is lifelong. Most people forget their booster shot to complete vaccination, which is done 6-36 months following the first shot depending on which vaccine you’ve received. Any longer than this and you have to start again.

From 2003, children in Australia receive Meningococcus C vaccine as part of their routine childhood immunisation, and this has severely cut the number of infections since then.

However there are 13 strains of Meningococcus, with the most common being A, B, C, W, and Y. In Australia, B now predominates, and fortunately a vaccine is available to combat this which is given to young children, and those in high school.

The risk is highest in people living in close quarters (military personnel, hostels, student accommodation) and people travelling to endemic areas such as the ‘meningitis belt’ of sub-Saharan Africa, or on large congregations such as the Hajj, the Olympics or the FIFA World Cup.

Meningococcal disease is a serious illness caused by a type of bacteria called Neisseria Meningitidis. It can lead to meningitis (infection of the lining of the brain and spinal cord) and infections of the blood. Meningococcal disease often occurs without warning – even among people who are otherwise healthy.

Even when it is treated, Meningococcal disease kills 10 to 15 infected people out of 100. And of those who survive, about 10 to 20 out of every 100 will suffer disabilities such as hearing loss, brain damage, kidney damage, amputations, nervous system problems, or severe scars from skin grafts.

Meningococcal ACWY vaccines can help prevent Meningococcal disease caused by serogroups A, C, W, and Y. A different Meningococcal vaccine is available to help protect against serogroup B.

Typhoid fever is common in all parts of the world except industrialised nations such as the United States, Canada, Western Europe, Australia, New Zealand and Japan. Travellers to the developing world should consider this vaccination, with the highest risk being South Asia.

Typhoid fever is a serious disease spread by contaminated food and water. It is caused by the bacteria Salmonella Typhi.

Although ensuring your food is clean, peeled and cooked is important, it is often not of extra reassurance to be eating at resorts and restaurants, as the food sources and chains are often the same as street side stalls.

Avoiding ice cubes, and only drinking boiled or bottled water can help prevent infections.

Symptoms of typhoid include lasting high fevers, weakness, stomach pains, headache, and loss of appetite. Some patients have constipation, and some have a rash. Internal bleeding and death can occur but are rare.

Immunisation against typhoid typically lasts 2.5-3 years, so be sure to check when you last received it.

Malaria occurs in Africa, Central and South America, parts of the Caribbean, Asia, Eastern Europe, and the South Pacific.

People spending time outdoors, including sleeping outside, are at higher risk for malaria. There were 314 cases of Malaria reported in Australia acquired overseas, from 1st July 2011 to 30th June 2012.

Malaria is a disease spread through mosquito bites. Symptoms usually appear within 7-30 days but can take up to one year to develop. Symptoms include high fevers, shaking chills, and flu-like illness. Without treatment, malaria can cause severe illness and even death.

Malaria can be prevented by a combination of taking precautions against mosquitoes, and daily medication. To see which medication best suits your itinerary, have a chat to your doctor.

Rabies is found in everywhere on Earth, with the exception of Antarctica. Travelers who may come into contact with wild or domestic animals are at risk for rabies. This includes travelers spending a lot of time outdoors (such as campers and cavers), travelers with occupational risks (such as veterinarians and wildlife professionals), and long-term travelers and expatriates. Children are also at higher risk because they often play with animals, might not report bites, and are more likely to be bitten on the head and neck.

In many countries the risk of rabies is similar to Australia, including most of Europe, Japan, Canada, and the United States. However, in many other parts of the world, rabies in dogs is still a problem, and access to preventive treatment may be hard. These areas include much of Africa, Asia, and Central and South America. If traveling to a country where there is an increased risk of rabies, especially in dogs, rabies vaccination may be recommended before your trip.

Rabies is a deadly disease caused by a virus that is spread in the saliva of infected animals. All mammals can get rabies. People usually get rabies from licks, bites, or scratches from infected dogs and other animals such as bats, foxes, raccoons, monkeys and mongooses.

Rabies affects the central nervous system, ultimately causing brain disease and death. Once symptoms of rabies appear, the disease is nearly always fatal, so prevention is especially important.

Consider medical evacuation insurance

Adequate vaccination for exposure to rabies is not available in all parts of the world, so consider buying supplemental health insurance.

Medical evacuation insurance may cover the cost to transfer you to the nearest destination where complete care can be obtained. Some policies may cover your eventual return to your home country

Rabies vaccine is given as Pre-Exposure Prophylaxis (PrEP) before travelling. This is three vaccinations at day 0, 7 and 21-28. If exposed to rabies through a bite, it is important you seek immediate medical attention as you will need further vaccinations given. Please ask your doctor for more detailed information.

An important vaccination that is a requirement before entering many countries, or returning to Australia if spending time in a Yellow Fever endemic country.

Yellow fever is a disease caused by a virus that is spread through mosquito bites. Symptoms take 3–6 days to develop and include fever, chills, headache, backache, and muscle aches. About 15% of people who get yellow fever develop serious illness that can lead to bleeding, shock, organ failure, and sometimes death.

It’s important to know if Yellow Fever is a requirement anywhere in your itinerary, otherwise you might either have to cut your trip short, receive a vaccine at the border of the country you’re trying to enter (and still may be denied entry) or be kept in quarantine in Australia on your return (see maps for South America and Africa).

Have a look at the map below to see where you’re travelling, but also make sure you know the entry requirements before you enter.

Here is the Australian Government’s list of countries that require a Yellow Fever Vaccination before being allowed back into Australia.

Africa

Angola
Benin
Burkina Faso
Burundi
Cameroon
Central African Republic
Chad
Congo, Democratic Republic of the
Congo, Republic of the
Cote d’Ivoire (Ivory Coast)
Equatorial Guinea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Liberia
Mali
Mauritania
Niger
Nigeria
Senegal
Sierra Leone
South Sudan
Sudan
Togo
Uganda

South America & Central America

Argentina – Misiones Province
Bolivia
Brazil
Colombia
Ecuador excluding Galapagos Islands
French Guiana
Guyana
Panama
Paraguay
Peru
Suriname
Trinidad
Venezuela

How can I protect myself against Yellow Fever?The vaccine does go a long way to preventing Yellow Fever, as it is safe and almost 100% effective.
However avoiding mosquitoes is an added step that will also prevent against other conditions such as Malaria, Chikungunya, Zika and Dengue.

Here are some tips:

Wear a mosquito repellent containing DEET or picaridin
Wear light coloured, long-sleeved clothes when you’re outdoors
Avoid wearing perfume or cologne (some of these can attract mosquitoes)
Prevent mosquitoes entering your accommodation
Use a mosquito net at night-time (if mosquitoes are likely to be present)

Yellow Fever vaccination can ONLY be given at accredited vaccination clinics, such as gpbondi. It is an important vaccine, so make sure you talk to your doctor if this is the right vaccine for you. It must be given at least 10 days before entry into a Yellow Fever endemic area, and is valid for life (some countries still only count it for 10 years – however the WHO is ensuring all nations accept a valid vaccination as providing lifelong exposure).

Common Destination Advice

A continent diverse as it is large, there’s no two trips to Africa that are the same. Whatever adventures you have planned for your African adventure, there are some things that you don’t want to experience. Check the tabs below for useful information and make a booking with your doctor at GSH to receive customised advice specific for your trip.

Infectious diseases present include

Yellow Fever, endemic in 30 African countries – and a requirement for re-entry to Australia if travelling in endemic countries
Polio, high risk in Nigeria)
Hepatitis B, most prevalent in Sub-Saharan Africa
Typhoid, higher risk in Northern and Western Africa
Cholera, occurs predominantly in rural areas
Meningococcal, Particularly high risk in Sub-Saharan Africa – see map
Hepatitis A, Rabies, Dengue, Malaria

Considerations

40% of visitors may develop diarrhoea within the first week of travel
Medical facilities in urban areas are usually readily available, but may be limited elsewhere
Flu shot: Consider this immunisation, especially if embarking on winter travel
Intending to visit farms/game reserves? Avoid contact with animal tissues or blood and drinking unpasteurised milk
Wear appropriate clothing: Protect yourself from sun, cold and mosquitoes
Mosquito repellent: Always carry and regularly apply
Antimalarial medication: Your doctor will advise if and what medication is required
Water: Don’t assume tap water is safe to drink, even in built up areas
Avoid raw or uncooked food: Boil it, cook it, peel it or forget it

Be aware of

High levels of crime. Exercise extreme caution
Very high HIV/AIDS rates. Always practice safe sex
Malaria: Spread by mosquitoes, practice bite prevention
Animals: Diseases such as rabies are carried by dogs, bats and monkeys
Lakes and streams: Water may be contaminated and carry disease

The second largest population in the world, and home to 1599 different languages, you could explore this place for the rest of your life and find something new every day. You don’t want to find yourself locked to your bathroom with Delhi Belly however, so check the tabs below for useful information and make a booking with your doctor at GSH to receive customised advice specific for your trip.

Infectious diseases present include

Typhoid, most cases in Australia are from returning travellers from the Indian subcontinent
Malaria is prevalent throughout India including Bombay and Delhi
Japanese Encephalitis, Vaccination is recommended if visiting rural areas, or staying >1month
Rabies, Found in dogs, bats and other mammals
Hepatitis A, Hepatitis B, Tetanus

Considerations

Monsoon season The risk of Malaria and other mosquito borne disease can increase during May-October with high temperatures, heavy rains and flooding
Hand sanitiser: A pocket germ killer
Medication kit: Anti-diarrhoeal is highly recommended
Toilet paper: Often sparse, best to carry your own supply
Culture shock: Be prepared for different practices, attitudes and poverty

Be aware of

Traffic accidents. Exercise extreme caution
Public transportation. Inevitably delayed, pack food and water
Street peddlers: Be aware of your surroundings
Weather check: Flash floods can cause dangerous environmental conditions
Homosexuality: Has been recriminalized in parts of India – harsh penalties may apply

Copacabana, the Andes, the Galapagos and Machu Pichu. An amazing continent with the largest rainforests, rivers, magnificent mountain ranges and history. You can’t get much further away from home, so to minimise the health risks so check the tabs below for useful information and make a booking with your doctor at GSH to receive customised advice specific for your trip.

Infectious diseases present include

Yellow fever is endemic in 13 South American countries. You’ll need evidence of Yellow Fever immunisation to be allowed into some of these, but also to get back into Australia.
Typhoid, common across much of the continent
Hepatitis A one of the most common vaccine-preventable diseases acquired during travel
Malaria endemic across South America, excluding Chile and Uruguay
Dengue fever, Rabies, Hepatitis B

Considerations

Medical services: Hospitals often require confirmation of medical insurance or upfront payment prior to providing any services, including emergency care
Weather check: Storms, flashflooding and landslides are common in Southern Brazil in the wet season December – March
Water borne diseases: Schistosomiasis is a risk, so avoid swimming in fresh water lakes and rivers
Altitude sickness: Many trips may involve mountain climbing
Use experienced guides: Getting lost or injured while trekking is a hazard
Wear appropriate clothing: Protect yourself from sun, cold, mosquitoes and plant irritation
Water: Bottled, boiled or chemically treated
Food: Peel it, boil it, cook it or forget it

Be aware of

Very high HIV/AIDS rates. Always practice safe sex
Unregistered taxis: Look for photo ID displayed
Don’t assume drivers will stop at red lights
High rates of crime: Be street smart

The most popular destination for Australian tourists. We almost made Bali another Australian state! Although you’ll run into many compatriots, it doesn’t minimise the health risks so check the tabs below for useful information and make a booking with your doctor at GSH to receive customised advice specific for your trip.

Infectious diseases present include

Typhoid, of highest risk to travellers compared to anywhere else in the world
Japanese Encephalitis, Vaccination is recommended if visiting rural areas, or staying >1month – however check for up to date information, a recent case report of transmission in a Bali resort was reported in an Australian traveller
Rabies, Transmitted by animal bites. Children, those with significant outdoor exposure %/or visiting rural areas are at greatest risk
Malaria risk depends on region and the time of year – your doctor can advise appropriate protection
Hepatitis A widespread risk throughout South East Asia
Hepatitis B transmitted by bodily fluid through activities such as unprotected sex and non-sterilised tattoo equipment
Tetanus

Considerations

Food: Boil it, cook it, peel it or forget it
Water: Bottled, boiled or chemically treated
Animals: Look, but don’t touch. Many mammals can transmit condition, but dogs carry the highest rabies risk
Medical services: Hospitals often require confirmation of medical insurance or upfront payment prior to providing any services, including emergency care

Be aware of

Driving standards and vehicle maintenance may be lower than expected
Tough drug laws. In some countries, possession is punishable by death
Cultural sensitivity: Buddhist, Hindu and Muslim cultures may be conservative
Political turmoil: Can arise unexpectedly. Register your trip with smarttraveller
Drink spiking: Never leave drinks unattended

Routinely Recommended Vaccinations

Varicella is a highly contagious infection spread by respiratory secretions, including aerosol transmission, or from the vesicle fluid of the skin lesions of varicella or zoster infection. Varicella is usually a mild disease of childhood.

However, complications occur in approximately 1% of cases. It is more severe in adults and in persons of any age who are immunocompromised, in whom complications, disseminated disease and fatal illness can occur.

Varicella vaccine should be offered to unvaccinated travellers who have not had clinical disease, or where serology shows no immunity in those who can’t recall having had chickenpox.

Adult travellers should be adequately protected against tetanus before departure, particularly if their risk of sustaining tetanus-prone wounds is high or there could be delays in accessing health services where they can receive tetanus toxoid boosters safely if required. We can use this opportunity to also boost your immunity status against pertussis (whooping cough) by using a dTpa vaccine.

Before departure, adults should receive a booster dose of diptheria and tetanus (dT), if more than 10 years have elapsed since the last dose, or dTpa if not given previously. For high-risk trips, consider a booster of either dTpa or dT if more than 5 years have elapsed.

While all children born in Australia are offered immunisation against Hepatitis B as part of the national immunisation program, some people begin to lose their immunity into their 20’s and may either need a booster, or repeat the full course of vaccinations.

Whilst the risk to most travellers is low, it is highest risk in people engaging in unprotected sex, receiving tattoo’s or undergoing medical procedures overseas.

There are certain countries where Hepatitis B is endemic, so make sure you’re immune status is checked before you leave.

A survey has shown that about half of Australian travellers who spent at least 3 nights in Southeast or East Asia had participated in at least one activity with a risk of acquiring hepatitis B.

A full course is given as 3 vaccinations over a 6 month period (at 0, 1 and 6 months) but you can start the course and have some coverage before you head away.

The Hepatitis B vaccine also comes in a combination with Hepatitis A if this is required.

Most measles outbreaks in Australia now result from an infection imported by inadequately vaccinated young travellers. Incidences of measles and mumps are higher in some overseas countries, regions or communities, including developed countries, than in Australia. For Australians, Bali is a particularly endemic travel destination.

Recent outbreaks in Sydney and Melbourne have highlighted the need to ensure immunity is up to date.

For those who have not completed a full course of the MMR vaccine, were born after 1966 or have negative serology can receive a free vaccine as per NSW Health.

Australians born during or since 1966 who have not received 2 doses of measles-, mumps- and rubella-containing vaccines should be vaccinated with the MMR vaccine before travelling (noting pregnancy precautions)

The polio vaccine could be one of the most lifesaving, and world changing vaccinations ever created, and is responsible for the eradication of polio from the Western world. However it would only take 1 infected person to come and spread infection again to an unvaccinated population.

Whilst most adults don’t need an immunisation as they were immunised as children, those who are travelling to areas with polio in the population should consider a booster.

Polio is a disease caused by a virus. It enters the body through the mouth. Usually it does not cause serious illness. But sometimes it causes paralysis (can’t move arm or leg), and it can cause meningitis (irritation of the lining of the brain). It can kill people who get it, usually by paralyzing the muscles that help them breathe.

Polio used to be very common in the Australia. It paralyzed and killed thousands of people a year before we had a vaccine.

Currently 2 countries in the world have never eradicated poliomyelitis, and these are Afghanistan and Pakistan.

There is also circulating polio as a result of outbreaks in Madagascar, Guinea and Ukraine.

The following countries are vulnerable to outbreak, and people spending time there should also consider a booster;

Cameroon
Equatorial Guinea
Ethiopia
Iraq
Israel
Laos
Nigeria
Somalia
South Sudan
Syrian Arab Republic

It should also be considered at areas of large gatherings of international visitors, such as the Olympic Games, FIFA World Cup or the Hajj.

Polio vaccine in Australia is given as inactivated polio virus, as opposed to the live virus given as an oral dose overseas. It can be given separately, or as part of the Diphtheria, Tetanus and Pertussis vaccination, and can be boosted every 10 years.

Travel Health & Vaccinations