Vaccines that actually move the needle for travellers

The five most-relevant

For the average traveller heading to most-visited destinations, the five vaccines that meaningfully change risk and that most people do not have current:

• Hepatitis A: fecal-oral transmission; present in most tropical and subtropical destinations. Standard recommendation for almost all non-domestic travel.
• Typhoid: fecal-oral; recommended for South Asia (where attack rate is highest), Central Asia, sub-Saharan Africa, parts of South America.
• Yellow fever: mosquito-borne; required (not just recommended) for entry to many countries when arriving from infected areas. Tropical Africa and South America the primary endemic zones.
• Rabies (pre-exposure): dramatically underused. Especially relevant for India, Southeast Asia, parts of Africa, anywhere with stray dogs or close-contact wildlife work. Pre-exposure shortens and simplifies post-exposure prophylaxis.
• Japanese encephalitis: mosquito-borne; limited to rural areas of South and Southeast Asia in transmission season. Most short urban trips do not need it; extended rural stays do.

This guide is not medical advice. Consult a travel-health clinic for individual recommendations based on your itinerary, vaccination history, and personal medical factors.

The adult baseline

Before considering travel-specific vaccines, confirm the adult-baseline vaccinations the CDC and WHO recommend for all adults regardless of travel:

• MMR (measles, mumps, rubella): two doses confirmed if born after 1957 (U.S.) or 1970 (most of Europe). Measles outbreaks have been a recurring traveller risk in 2024-2025; the European 2024-2025 measles spike affected vaccinated-but-aged adults in particular.
• Tdap (tetanus, diphtheria, pertussis): booster every 10 years.
• Varicella (chickenpox): if not previously had or vaccinated.
• Influenza: annual; relevant if travelling during a destination’s flu season (Southern Hemisphere June-September, Northern Hemisphere November-March).
• COVID-19: per local guidance.
• Hepatitis B: typically given in childhood in countries with universal infant immunisation; recommended for travellers if not previously vaccinated and visiting regions with high prevalence or with extended stays.

Yellow fever and the yellow card

Yellow fever is the most operationally consequential travel vaccine because it is the only one that can block entry at borders. Many countries require an International Certificate of Vaccination or Prophylaxis (ICVP, the “yellow card”) when entering from a country with risk of yellow-fever transmission.

• Vaccine: single-dose, lifetime protection per current WHO guidance (changed from 10-yearly boosters in 2016). Must be given at a designated yellow-fever vaccination centre that can issue the ICVP.
• Timing: must be given at least 10 days before entering an at-risk country. The certificate becomes valid 10 days after vaccination.
• Endemic zones: tropical Africa (much of sub-Saharan Africa from Senegal to Tanzania) and tropical South America (Amazon Basin, Bolivia, Peru, Ecuador, Colombia, Venezuela, Brazilian states).
• Required-on-arrival countries: vary. Most countries in Africa and South America require the ICVP if arriving from another at-risk country. Some require it unconditionally. Verify on the WHO IHR list before flying.
• Exemption letter: medical exemptions for immunocompromised, pregnant, or allergic travellers; issued by yellow-fever centres on the same certificate format.

Hepatitis A and typhoid

• Hepatitis A: two doses 6 to 12 months apart; first dose offers around 95 percent protection within 2-4 weeks. Lifetime protection after the second. Recommended for almost all international travel outside of high-income destinations.
• Typhoid: two main vaccine types. The injectable polysaccharide gives ~70 percent protection for 2 years; the oral live-attenuated (Vivotif) gives ~70 percent for 5 years. Recommended for South Asia (where travel-related typhoid cases concentrate), parts of Africa, and outbreak regions. Newer typhoid conjugate vaccines (Typbar-TCV) deliver longer protection but availability varies by country.

Rabies (the underused one)

Rabies is fatal once symptomatic. Post-exposure prophylaxis (PEP) within hours of a bite is highly effective; without it, rabies kills around 59,000 people worldwide annually, mostly in countries where stray-dog exposure is universal.

The pre-exposure rabies vaccine is recommended for travellers whose itinerary involves significant exposure (children, long stays, cycling/running in stray-dog regions, rural areas, animal-contact occupations). Pre-exposure does not eliminate the need for post-exposure PEP after a bite, but it:

• Eliminates the need for the often-unavailable rabies immunoglobulin (HRIG) component of PEP.
• Reduces the post-exposure regimen from 5 to 2 doses.
• Gives more time to find appropriate care.
• Crucially matters in countries where HRIG is unavailable (much of rural Asia and Africa). The 2023 WHO data on rabies-PEP access showed major gaps in countries with the highest rabies burden.

The pre-exposure schedule is 2 or 3 doses on days 0, 7, and 21 or 28. Standard recommendation for travellers spending more than a month in India, Southeast Asia, Bangladesh, or parts of Africa.

Japanese encephalitis

Mosquito-borne flavivirus with high case-fatality rate (around 20-30 percent) and high disability rate among survivors. Endemic in rural South and Southeast Asia. JE vaccine is recommended for:

• Extended stays (1 month+) in rural endemic regions.
• Shorter stays where extensive outdoor or rural-area activity is planned.
• Travel to regions with active transmission and current outbreaks.

Two-dose schedule, 28 days apart. Not needed for typical short urban trips to Bangkok, Singapore, KL, Tokyo, Seoul, where JE risk is essentially zero.

Tick-borne encephalitis

Endemic across forested regions of central and Northern Europe, Russia, and parts of East Asia. Tick-borne, sometimes food-borne via unpasteurised dairy. Recommended for:

• Extended outdoor stays (camping, hiking, forestry) in endemic areas during transmission season (April through October).
• Travel to specific high-incidence countries (Austria, Czechia, Estonia, Latvia, Lithuania, parts of Germany, Switzerland, Sweden, Finland, Poland, Russia).

Three-dose schedule (two doses 1-3 months apart, third dose 5-12 months later). Boosters every 3-5 years.

Cholera (specific contexts)

Routine traveller need is small. The current oral vaccine (Dukoral or Shanchol) is recommended for:

• Travel to active cholera outbreak regions.
• Aid workers or medical workers responding to outbreaks.
• Specific high-risk circumstances per travel-clinic assessment.

Most travellers do not need cholera vaccine; standard food- and-water discipline and ORS for any acute diarrhoeal illness is the practical defence.

Timing and the travel-clinic visit

The practical schedule:

• 6 to 8 weeks before travel: ideal for any multi-vaccine schedule. Yellow fever needs 10 days minimum; hepatitis A first dose at least 2 weeks; rabies pre-exposure needs 21 to 28 days minimum for the full schedule; JE needs 28 days for the two-dose series. Travel clinics typically book 2-3 weeks ahead in spring/summer.
• 3 to 4 weeks before travel: minimum for most schedules but compressed; some doses may need to be given at destination.
• 1 week before travel: only single-dose vaccines and accelerated schedules viable; some protection rather than full.
• The week of travel: too late for yellow fever (10-day window) and most others; effective only for tetanus boost.

The travel-clinic visit also includes prescriptions you may want: malaria prophylaxis (Malarone, doxycycline, mefloquine per region and personal factors), azithromycin for traveller’s diarrhoea, altitude-sickness prophylaxis (acetazolamide / Diamox) for high-altitude destinations.

Country brief

• India: hep A, typhoid, rabies (pre-exposure recommended for extended stays), standard adult baseline.
• Indonesia: hep A, typhoid, JE for extended rural stays, rabies for Bali (endemic).
• Thailand: hep A, typhoid, JE for rural extended stays.
• Brazil: yellow fever (required for Amazon and several states), hep A, typhoid.
• Peru: yellow fever required for Amazon (Iquitos, Puerto Maldonado), hep A, typhoid.
• Tanzania: yellow fever required for entry from infected countries, hep A, typhoid, malaria prophylaxis.
• Kenya: yellow fever required, hep A, typhoid, malaria prophylaxis, optional JE.
• Rwanda: yellow fever required, hep A, typhoid, malaria prophylaxis for lower elevations.
• Colombia: yellow fever required for Tayrona, Amazon, certain Caribbean coast; hep A, typhoid.
• Egypt: hep A, typhoid; standard adult baseline.
• Morocco: hep A, typhoid; standard adult baseline; rabies for extended rural stays.
• Finland, Austria, Czechia, Poland, Sweden: TBE for extended outdoor stays in transmission season.

One more time

The five most-relevant travel vaccines: hepatitis A, typhoid, yellow fever (especially the yellow card requirement), rabies pre-exposure (especially for India and Southeast Asia rural stays), Japanese encephalitis (rural Asia extended). Confirm the adult baseline (MMR, Tdap, varicella, flu, COVID, hep B). Book the travel-clinic visit 6 to 8 weeks before travel; yellow fever needs 10 days minimum to validate. This guide is not medical advice. The Field Manual’s outbreak decision guide covers what to do when an outbreak hits a destination you’ve booked.