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Travel vaccinations

Different countries have infectious diseases that don’t exist, or aren’t very common, in the UK. Vaccinations can prevent people who travel to these countries from becoming ill or dying from an infectious disease.

Vaccination involves exposing your body’s immune system to a weakened or harmless version of a bacteria or virus. This helps your body to produce its own antibodies, which will fight the infection for which you have had the vaccination. You can prevent infection from many of the diseases found in foreign countries by being vaccinated before you travel.

Before you travel, it’s important to find out whether you will need vaccinations for the country you’re visiting. In order to visit some countries, you will need to show proof that you have had vaccinations for certain diseases. It’s best to see your GP or go to a travel medicine clinic six to eight weeks before you travel. If there are less than six weeks before you plan to travel, you should still visit your GP or travel clinic. It may be possible to get vaccinated at short notice.

If you need to have more than one injection for a particular disease, this can be done over a number of weeks. The time between injections will allow your body to respond to the vaccine, so you develop immunity ready for when you arrive. You will probably have vaccine injections given in your upper arm or on the outside of your upper thigh.

You’re unlikely to need any vaccinations if you’re going to the United States, Western Europe, and most parts of Australia or New Zealand.

The UK has a routine childhood vaccination programme, which includes vaccinations against diseases such as polio, diphtheria, tetanus and measles. If you didn’t have your routine vaccinations as a child, or if you missed some of them, you may not be protected. If you’re unsure about whether you have been vaccinated, talk to your GP for more information. You may need to have some of the routine childhood vaccinations before you travel.

You will need to pay for some travel vaccinations, not all of them are available from the NHS.

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  • Cholera Cholera

    Cholera is a bowel infection caused by bacteria. It’s usually spread through infected water or food. Cholera is mainly found in places where there is poor hygiene and sanitation, for example, where there is no clean water or sewers. This includes parts of Africa and Asia. Cholera can cause severe diarrhoea and dehydration, which can be particularly serious in babies, children and older people.

    You will need a cholera vaccination if you’re travelling to an area that has a cholera epidemic. An epidemic is when a large number of people are affected by an infectious disease which spreads quickly. You should also have the cholera vaccination if you’re a relief or disaster aid worker, or are travelling to places where you have limited access to medical care.

    The cholera vaccine is given as a liquid which you drink. Don’t eat or drink anything for one hour before or after you take the vaccine. Adults need to have two doses between one and six weeks apart. Make sure you have the second dose at least a week before you travel. Children between the ages of two and six need a third dose one to six weeks after the second dose. The vaccine is not recommended for children under two.

    The cholera vaccine doesn't give you lifelong immunity and you will need to have a booster to keep you protected. Adults and children over six need the booster two years after the first dose, and children aged two to six need it six months after.

  • Hepatitis A Hepatitis A

    Hepatitis A is a liver disease caused by an infection with the hepatitis A virus. People usually become infected by having food or water that has the virus in it. Hepatitis A causes liver inflammation and becomes more serious the older you are when you get it. The virus is found all over the world, but it’s more common in parts of Africa, Asia, and Central and South America.

    You will need to have two hepatitis A injections for your body to develop full immunity to the infection. You should have a booster dose six to 12 months after the first. It’s best to have the first injection about two weeks before you travel, but it’s possible to have it the day before you leave. The vaccine (if the booster dose is given) can give up to 30 years of protection.

    You can have a combined vaccine, which protects against hepatitis A and B, or one which jointly protects against hepatitis A and typhoid.

  • Hepatitis B Hepatitis B

    Hepatitis B is a liver disease caused by infection with the hepatitis B virus. The disease can be mild or severe and for some people the infection can be life-threatening. You get it from direct contact with an infected person’s blood or other body fluids, such as semen or vaginal fluid.

    Hepatitis B is found all over the world but it’s more common in Africa, the Middle East and the Far East.

    There are different immunisation schedules, but generally you have three doses. After the first dose, you will need the second a month later and a third five months after that. If you need to be vaccinated quickly, you can ask for the vaccinations in a shorter time.

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  • Japanese encephalitis Japanese encephalitis

    Japanese encephalitis is a serious viral infection and you can become infected from a mosquito bite. It causes inflammation of the brain and it can be life-threatening. It’s found in Asia and the far north of Australia.

    You may need the vaccine if you’re travelling to an endemic area (a place where a particular disease is regularly found) for a month or longer, especially if you’re going to rural areas. Ideally, you should get vaccinated at least a month before you travel.

    Adults have two injections and children over the age of one have three, usually over the course of a month. You will need to have a booster 12 months after the initial vaccination if you’re still at risk of being infected.

  • Meningococcal meningitis Meningococcal meningitis

    Meningococcal meningitis is an infection that affects the thin lining that surrounds your brain and spinal cord. It’s found all over the world, but it’s most common in central Africa, in countries just below the Sahara desert. You can catch the infection from close contact with infected people, for example, from coughs and sneezes.

    If you're staying in a country with a high risk of meningitis and you're backpacking or living in a rural area, you will need to have a combined vaccine against the different types of meningitis. If you’re going on pilgrimage to Mecca then you must have the vaccination before you go. The Saudi Arabian authorities will ask for proof of this before you can enter the country.

    You should have the vaccine two weeks before you travel. Adults and children over a year old will need one injection. Children under one year old will need two injections. The first is given two months before travel, the second is given one month after the first.

  • Poliomyelitis Poliomyelitis

    Poliomyelitis (polio) is caused by a virus. It affects your nervous system and can cause a range of symptoms from fever to paralysis. You catch polio by eating or drinking food or water that has the virus in it, by swimming in dirty water, or by close contact with someone carrying the polio virus. It’s mainly found in Africa and Central Asia.

    If you were born before 1962 in the UK, you may not have been adequately vaccinated against polio, or had a low strength vaccine.

    If you're travelling to a country where polio is common, you should make sure that you have been fully immunised. This means having a course of 3 injections with two further boosters. The polio vaccine is normally given along with the tetanus and diphtheria vaccination in the same injection. In young children the vaccine is given with pertussis (whooping cough) and HIB (Haemophilus Influenzae Type B) as a 5-in-one injection.

    If you’re travelling to a country where the risk of polio infection is high, and you haven’t had a booster within 10 years you may be advised to have one.

  • Rabies Rabies

    Rabies is a viral infection that can be spread from animals to people. You can catch it after being bitten or scratched by an infected animal. Both pets and wild animals carry rabies. It’s a serious condition and once symptoms develop there is no specific treatment and the infection is almost always fatal.

    Rabies is found throughout the world but it’s more common in Africa, Asia, the Far East, and Central and South America.

    You may need a rabies vaccine if you’re travelling for a month or more to an area where the risk of rabies is high and you can’t easily get to medical care. If you may be exposed to rabies due to your activities, for example if you’re working with animals, you may also need the vaccination.

    If you need the rabies vaccine, you will usually be given three injections spread over a month. You may need to have booster vaccinations if you remain in high risk areas.

    Having the rabies vaccine doesn't mean you're completely immune to the disease. If you’re bitten by an animal and it’s possible that the animal was infected with rabies, then you should get immediate medical help. If you have a further dose of the vaccine and a blood product called immunoglobulin, before any symptoms start, you may be able to prevent rabies from developing.

  • Tetanus Tetanus

    Tetanus is caused by bacteria that live in the soil. It causes muscle spasms and paralysis and can be life-threatening. You can get tetanus if dirt, dust or manure gets into a cut or wound. Tetanus is found all over the world, but is more common in developing countries.

    In the UK, you will usually have had the tetanus vaccine as part of your routine childhood immunisations, unless you were born before 1961 when the UK-wide vaccine programme started. Make sure that you have had the full course of injections – three initial injections with two boosters.

    If you're travelling to a country where you won’t be able to get to medical care quickly, you should have a booster vaccination for tetanus if you have not had one within the last 10 years.

  • Tickborne encephalitis Tickborne encephalitis

    Tick-borne encephalitis is a viral infection that is passed on mainly through tick bites. It can cause inflammation of the brain. There are different types of the disease, which are linked to the area they are found in – Europe, the Far East and Siberia. It’s mainly found in the countryside, particularly in woods and forests. You should have the vaccination for tick born encephalitis if you’re travelling to the countryside in an area where the infection is common during spring and summer.

    The vaccine is given in three doses over a year. If you need more immediate protection, you can have two doses, two weeks apart.

  • Typhoid Typhoid

    Typhoid and paratyphoid fever are both caused by bacteria. You become infected by drinking water or eating food that has the bacteria in it. It causes similar symptoms to food poisoning but for some people it can cause more serious problems such as pneumonia and a brain infection. Typhoid outbreaks are most common in Asia, Africa and Latin America.

    Getting vaccinated against typhoid is important if you're planning to stay in areas where typhoid is common and hygiene is poor. You can have the vaccine as one single injection or as a capsule to swallow in three separate doses. You will need to have a booster vaccine every three years if you continue to visit areas where typhoid is common. You may be able to have a combined typhoid and hepatitis A vaccine, if it’s available – check with your GP or travel clinic.

  • Yellow fever Yellow fever

    Yellow fever is a disease caused by a virus which is passed on by mosquito bites. It can vary in severity. You may have flu like symptoms that get better over a few days, or a severe illness which causes serious damage to your organs and can be fatal. Yellow fever is found mainly in tropical areas of Africa and South America.

    You will need to have the yellow fever vaccine if you're going to, or travelling through, a country affected by the disease. If you’re travelling to some of these countries you will need to show certificates to prove you have been vaccinated before you can enter. In the UK, you can only get the vaccination at approved yellow fever vaccination centres.

    You will need to have the yellow fever vaccine at least 10 days before you travel. You will be given a certificate that lasts for 10 years. You can have a booster after 10 years if you’re still at risk of getting yellow fever.

  • FAQs FAQs

    Can I have travel vaccinations if I am pregnant?

    Answer

    If possible, you should try to not have vaccinations if you're pregnant. If you do need a vaccination, you will need to weigh up the risk of getting the disease against the risk of potential harm to your unborn child.

    Explanation

    If possible, it’s best not to travel to an area with a high risk of disease when you’re pregnant. But if you need to, you may need to have vaccinations.

    In theory, if you have a live vaccine then there is a chance that your unborn child will become infected with the disease. However, it’s not known how likely this would be to happen isn’t known.

    At present, there is limited scientific research to say that vaccines can harm an unborn child. However, if at all possible you should not have vaccinations until after your baby has been born. You should only consider vaccinations if there are no other alternatives. Ask your GP or travel clinic for information if you’re travelling and you’re pregnant.

    Can I still take other medicines on the day I have a travel vaccination?

    Answer

    Some medicines can affect certain travel vaccinations. It’s important to let your GP or travel clinic know if you’re taking any medicines before you have your vaccine.

    Explanation

    Tell your GP or travel clinic if you’re taking any medicines and where you plan to travel to. Only some vaccines affect certain medicines. Some of these are listed below.

    • The typhoid vaccine that you swallow may be affected by antibiotics, so they shouldn’t be taken at the same time. This is because antibiotics may prevent the vaccine from working properly. If you’re taking antibiotics, your GP or travel clinic may offer you a typhoid injection instead.
    • The antimalarial medicine chloroquine can affect how your body responds to the rabies vaccine. If you’re taking this medicine, your doctor will need to give you the rabies injection deep into your muscle rather than just into your skin.
    • Antmalarial medicines can also interact with medicines to treat heart disease, HIV/AIDS, epilepsy and depression.
    • Other medicines may affect how well malaria tablets work. For example, you must wait at least four hours after taking an antacid medicine before having chloroquine.

    Ask your GP or travel clinic if the vaccines you need may interfere with any medicines you take.

    Is there a travel vaccination for malaria?

    Answer

    No, there isn't a vaccination which will prevent malaria, but there are tablets that you can take. It’s important to prevent malaria by avoiding bites from mosquitos. This means always using a mosquito net when you sleep, applying insect repellent, and wearing trousers and long sleeved tops to cover your skin.

    Explanation

    Malaria is a tropical disease that you get after being bitten by a mosquito infected with a parasite. Mosquitos are most likely to bite you at night, between dusk and dawn. Malaria affects your red blood cells and organs such as your brain and kidneys. It can be a serious condition and may be life-threatening.

    You can get malaria in many countries in the world including those in Africa, Central and South America, the Indian subcontinent, Asia, the Middle East, and the Pacific islands.

    There are several different tablets available to prevent malaria. There are different tablets for certain parts of the world. It’s important to check with a health professional to find out which tablets are best for the country you’re travelling to. Some malaria tablets can also be taken by children.

    See your GP or go to a travel health clinic six to eight weeks before you’re due to travel. You will need to start taking malaria tablets before you travel, while you’re away and when you return to the UK. It’s very important to take the tablets as they have been prescribed and to finish the full course when you come back to the UK. This is to make sure you’re properly protected.

    If you have come to the UK from a country with malaria, it’s very important to take antimalarial tablets if you return to your country of origin. Any immunity you have built up against malaria is quickly lost after living in the UK, which means that you will be at risk of getting malaria.

    Taking medicines to prevent malaria may not be totally effective, so it is important to see your GP if you develop a high fever after travelling to an area where there is malaria. It’s also important to prevent mosquito bites. You can do this by following the advice listed below.

    • Use an insect repellent that contains DEET on your skin and clothing.
    • Use a mosquito net when you sleep. Nets treated with an insecticide such as permethrin are much more effective than untreated nets. You can also spray your sleeping area with an insecticide – you can combine this with mosquito coils or vaporisers. However, if you’re staying in a hotel with air conditioning and insect netting over the windows, this may not be necessary.
    • Wear long trousers, long-sleeved tops and appropriate footwear after dusk to cover up your skin.

    What’s the difference between a live and an inactive vaccine?

    Answer

    A live vaccine is a weakened version of a virus or bacterium. An inactive vaccine is a dead version.

    Explanation

    There are different types of vaccine – live and inactivated. Live vaccines contain a weakened, live virus that’s designed to help your body develop an immune response without you developing symptoms of the disease itself. Inactivated vaccines use parts of a dead virus or bacteria to help your body develop an immune response. You may need more than one dose of an inactive vaccine to build up enough immunity to a disease, for example you may need a number of injections over a period of time.

    Live vaccines include:

    • yellow fever
    • oral typhoid vaccine
    • BCG (tuberculosis vaccine)
    • some childhood vaccines

    Inactivated vaccines include:

    • tetanus
    • polio
    • hepatitis A
    • hepatitis B
    • meningococcal meningitis
    • rabies
    • Japanese encephalitis

    If you have a healthy immune system, then it’s safe for you to have live virus vaccines. However, because live vaccines contain a small amount of a weakened live virus, if you have a weakened immune system (from having HIV/AIDS or chemotherapy treatment for example), you may not be able to have some live vaccines. Your doctor will be able to tell you if it is safe for you to have a particular vaccine.

  • Resources Resources

    Further information

    Sources

    • Immunisations. Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Travellers. National Travel Health Network and Centre. www.nathnac.org, accessed 14 August 2013
    • Health professionals. National Travel Health Network and Centre. www.nathnac.org, accessed 14 August 2013
    • Vaccine-preventable diseases and vaccines. World Health Organisation. www.who.int, published 2013
    • Immunisation procedures. The Green Book. Department of Health. www.gov.uk, published March 2013
    • Factsheet on Travel Vaccinations. Health Protection Agency. www.hpa.org.uk, published August 2006
    • Malaria. Health Protection Agency. www.hpa.org.uk, published April 2012
    • Understanding how vaccines work. Centers for Disease Control and Prevention. www.cdc.gov, published February 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 29 August 2013
    • US vaccine names. Centers for Disease Control and Prevention. www.cdc.gov, published August 2011
    • Interactions among travel vaccines and drugs. Centers for Disease Control and Prevention. wwwnc.cdc.gov, published August 2013
    • The global burden of cholera. World Health Organisation. www.who.int, published January 2012
    • Chiodini PL, Field VK, Hill DR at al. Guidelines for malaria prevention in travellers from the United Kingdom. London, Public Health England, July 2013.
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    Reviewed by Sarah Smith, Bupa Health Information Team, May 2014.

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