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Disease Prevention Tools


                          Vaccinations and Prophylactic Medications

Prescriptions generally needed for the following vaccinations and medications:

Chikungunya
Cholera (oral)
Japanese Encephalitis 

Tick Borne Encephalitis (TBE)

Typhoid (oral)

Yellow Fever<br>

Malaria Prophylactic Medications

Scroll Down to learn more.


Routine Vaccines:


Make sure you are up to date with all of your routine vaccines. Most people >17 have already received at least one dose of most of these vaccinations. Please check your records.




Most Routine prescriptions do NOT need prescription orders from a Physician.


Protective Routine Vaccinations include:

COVID-19

Haemophilus influenzae type b (Hib)

Hepatitis A


Hepatitis B


Herpes Zoster (Shingles)
 

Human Papillomavirus (HPV)
Influenza

Measles-Mumps-Rubella (MMR) 
          

Meningococcal 
    

Monkeypox                             Pneumococcal
                             Poliomyelitis (Polio)

Rabies

Rotavirus

Respiratory Syncytial Virus (RSV)

Tetanus/Diphtheria/Pertussis
  (TDap)  

Varicella (Chickenpox)


To further clarify who receives which vaccinations:


Everyone:

* Influenza: annual vaccine recommended for everyone
* COVID-19: annual vaccine recommended for everyone
* Tetanus, diphtheria, pertussis: (TDap) vaccine every 10 years recommended for everyone

*Hepatitis A is now recommended as a Travel vaccine for all travel for everyone

* Meningitis (MenACWY) is now recommended as a Travel vaccine for anyone traveling to the Meningitis Belt

* Poliovirus boosters are now recommended as a Travel vaccine for anyone traveling to countries with Poliovirus incidents.


Childhood/infant vaccinations:
* Hepatitis A
* Hepatitis B
* Haemophilus influenzae type b (Hib)
* Measles, mumps, rubella (MMR)

* Meningitis (MenACWY)

* Pneumococcal (Prevnar/PCV series: PCV15 or PCV20)
* Poliovirus

*Rotavirus

* Tetanus/Diphtheria/Pertussis
 (TDap)

* Varicella (Chickenpox)


Vaccinations for teenagers:

* Human Papilloma Virus (HPV)

* Meningococcal vaccines: Meningococcal A, C, W, Y (MenACWY)


Vaccinations for those living in college dorms, military barracks or other group situations, or work in lab with meningococcal bacteria:
* Meningococcal vaccines: Meningococcal A, C, W, Y (MenACWY) and Meningococcal B (MenB)

Vaccinations for pregnant women:
* Tetanus/Diphtheria/Pertussis
 (TDap; every pregnancy)

Vaccinations for those with high risk sexual practices:
* Monkeypox

Vaccinations for those who work in healthcare:
* Hepatitis B


Vaccinations for all adults aged 19 through 59 years  (and >age 59 with risk factors) who have not previously received it:

* Hepatitis B


Vaccinations for those who work in veterinary medicine:
* Rabies

Vaccinations for those who have had or will have splenectomy:
* Meningococcal, Haemophilus influenzae type b (HIB) and Pneumococcal vaccines (both Prevnar/PCV 15 or PCV 20 and Pneumovax/PPSV23)

Vaccinations for age 50 years and older:
* Herpes Zoster


Vaccinations for age 50 years and older, and those with medical diagnoses that put them at risk for Pneumonia::

*Pneumococcal (Prevnar 15/PCV15 + Pneumovax/PPSV23 1 year later OR either Prevnar 20/PCV20 or Prevnar/PCV21 alone)


Vaccinations for those age 60 years or older with chronic or high risk medical conditions (chronic heart or lung disease, diabetes, kidney or liver disorders, or weakened immune systems):
* Respiratory Syncytial Virus (RSV)

Vaccinations for age 65 years and older, and those with medical diagnoses that put them at risk for Pneumonia::
* Pneumococcal vaccines (Pneumovax/PPSV23)

Vaccinations for age 75 years and older:
* Respiratory Syncytial Virus (RSV)








Let's Discuss Rabies Vaccines.


Two types of Rabies Vaccines exist: pre-exposure and post-exposure vaccines.


Rabies Vaccines can be expensive. They are generally reserved for those who work in occupations or do activities that expose them to wild animals. If you are traveling to a country where it is not uncommon for stray dogs or wild bats to be infected and the country does not have a good supply of post-exposure vaccines, it is a personal choice whether or not to get a pre-exposure vaccine. Many insurances do not pay for pre-exposure vaccines. Many insurances do pay for post-exposure vaccines if you are being treated in the U.S.

Unlike most Routine vaccines, Rabies vaccines usually do require a prescription.

Let's Discuss Hepatitis A Vaccines.


Hepatitis A became a routine childhood vaccine in 1995. If you were born before this, you may not have had this vaccine. Hepatitis A Vaccines are now recommended for all travel, to every country.


The Hepatitis A vaccine is a 2-dose vaccine series, given 6 to 18 months apart. If you only have time for the first vaccine prior to your trip, that vaccine generally gives you protection for six months. The complete two doses gives 25 years of protection.


Hepatitis A vaccines are usually offered without a need for a prescription.

Let's Discuss Hepatitis B Vaccines.


Hepatitis B Vaccines became a routine childhood vaccine in 1991. If you were born before this and do not work in healthcare, you may not have had this vaccine. 


Hepatitis B Vaccines are now recommended for all travel, to every country.


The Hepatitis B vaccine is a 2-dose, 3-dose, or 4-dose vaccine series with differing schedules. If you only have time for the first vaccine prior to your trip, that vaccine generally gives you 50% protection. Completing the full series gives you >95%, long-term protection.


Hepatitis B vaccines are usually offered without a need for a prescription.

Let's Discuss Poliovirus Vaccines.


Poliovirus Vaccines became a routine childhood vaccine in 1954. If you were born before this, it is recommended that you complete this series as an adult at any age. 


Poliovirus Vaccine boosters for those who have already completed the vaccine series are recommended for travel to the following countries:


Afghanistan

Algeria

Angola

Benin

Botswana

Burkina Faso

Burundi

Cameroon

Central African Republic

Chad

Côte d'Ivoire

Democratic Republic of the Congo

Egypt

Ethiopia

Gambia

Guinea

Indonesia

Kenya

Liberia

Madagascar

Mali

Mauritania

Mozambique

Niger

Nigeria

Pakistan

Republic of the Congo

Senegal

Sierra Leone

Somalia

South Sudan

Sudan

Tanzania

Uganda

Yemen

Zambia

Zimbabwe


The Poliovirus vaccine is a 3-dose vaccine series, completed at 0, 1, and 6 months. Accelerated doses are available.


Poliovirus vaccines are usually offered without a need for a prescription.

Let's Discuss Meningitis Vaccines.


There are 3 types of Meningitis vaccines available:


MenACWY

Protects against Meningococcal sertotypes A,C,W,Y.

The CDC recommends that all preteens (11 to 12 years old) get the MenACWY vaccine, and then a booster shot at 16 years old.

MenACWY became a routine adolescent vaccine in 2005.


MenB

Protects against Meningococcal sertotypes B.

This vaccine remains optional for most teens and is usually given at ages 16-18 years old.

It is recommended for those with asplenia, Complement deficiencies or taking complement inhibiting medications, or are at higher risk of disease during outbreaks.


MenABCWY

Protects against Meningococcal sertotypes A,B,C,W,Y. This one vaccine is an option for those who need both of the above vaccines. 


MenACWY vaccine is recommended for anyone traveling to the "Meningitis Belt." This is a region in sub-Saharan Africa where meningococcal disease is highly prevalent with epidemics occuring regularly. This region includes the following countries:


Burkina Faso

Cameroon

Central African Republic

Chad

Eritrea

Ethiopia

Gambia

Ghana

Guinea

Guinea-Bissau

Kenya

Mali

Niger

Nigeria

Senegal

South Sudan

Sudan

Uganda


Meningitis vaccines are usually offered without a need for a prescription.

Travel Vaccines:


Chikungunya
Cholera (oral)
Japanese Encephalitis 

Tick Borne Encephalitis (TBE)

Typhoid (oral)

Yellow Fever


Honorable mentions

(these are vaccines that are considered Routine, but boosters or new vaccines are needed because of Travel:


Hepatitis A (given to all travelers to any country, if not received before).


Poliovirus (a booster is needed for travel to countries with incidents of Poliovirus infections).


Meningitis (the MenACWY vaccine is recommended for anyone traveling to the "Meningitis Belt" in sub-Saharan Africa).



Most Travel Vaccines DO need prescription orders from a Physician.


Take the Questionnaire to Find out if you need Travel Vaccines:


<<Questionnaire>>

Let's Discuss Chikungunya Vaccines.


Chikungunya vaccines are recommended in all travelers to countries with outbreaks of Chikungunya virus, and to only certain travelers to countries with transmission/presence of Chikungunya virus, but no outbreaks. It is also recommended for laboratory workers with potential exposure to the virus.

For countries at increased risk of Chinkungunya virus, but no current documented transmission, it is recommended that travelers avoid mosquito bites, and the vaccine is not recommended.

Whether or not you receive a vaccine, it is important to prevent mosquito bites in any country with incidents of Chikungunya virus.


The list of countries with outbreaks (and so the Chikungunya vaccine is recommended to all travelers to these countries) is below:


Currently none.


For the countries that have Chikungunya virus, but do not currently have outbreaks, the Chinkungunya vaccine is recommended in the following groups:

1) Travelers aged 65 years or older (especially those with underlying medical conditions) who plan to spend at least 2 weeks (cumulative time) in indoor or outdoor areas where mosquitoes are present, and

2) People planning to stay in the country for a cumulative period of 6 months or more.

These countries are listed below:


Argentina

Barbados

Belize 

Bolivia 

Brazil

Burma (Myanmar)

Cambodia

China

Colombia

Congo, Republic of the

Costa Rica 

Ecuador, including the Galápagos Islands

Ethiopia

Gambia, The

Guatemala

India

Indonesia

Jamaica

Kenya

Laos

Malawi

Malaysia

Maldives

Mali

Mexico 

Nicaragua

Nigeria

Pakistan

Panama

Paraguay

Peru 

Philippines 

Réunion (France)

Saint Lucia

Suriname 

Taiwan

Thailand

Timor-Leste (East Timor)

Uruguay

Venezuela

Vietnam


The countries at increased risk of Chinkungunya virus, for which the Chikungunya vaccine is not recommended at this time, but in which travelers should avoid mosquito bites are the following:


Burkina Faso 

Burundi

Cameroon

Cape Verde

Central African Republic

Chad

Christmas Island (Australia)

Cocos (Keeling) Islands (Australia)

Comoros

Côte d’Ivoire

Democratic Republic of the Congo

Djibouti

Equatorial Guinea

Eritrea

Eswatini (Swaziland)

Gabon

Ghana

Guinea

Guinea-Bissau

Hong Kong (China)

Lesotho

Liberia

Macau (China)

Madagascar

Mauritania

Mauritius

Mayotte (France)

Micronesia, Federated States of (Including Yap Islands, Pohnpei, Chuuk, and Kosrae)

Mozambique

Namibia

New Caledonia (France)

Niger

Palau

Rwanda

Sao Tome and Principe

Senegal

Seychelles

Sierra Leone

Singapore

Somalia

South Africa

South Sudan

Sudan

Tanzania, including Zanzibar

Togo

Trinidad and Tobago

Uganda

Yemen

Zambia

Zimbabwe


Chikungunya vaccines usually do require a prescription.

Let's Discuss Japanese Encephalitis Vaccines.


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Japanese Encephalitis vaccines usually do require a prescription.


Let's Discuss Tick-Borne Encephalitis Vaccines.


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Tick-Borne Encephalitis vaccines usually do require a prescription.

Let's Discuss Typhoid Vaccines.


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Typhoid vaccines usually do require a prescription.












 

Let's Discuss Yellow Fever Vaccines.


Yellow Fever vaccines are a requirement for entry into certain countries. Yellow Fever vaccinations must be received at least 10 days prior to travel to these countries. You only need one vaccination per lifetime--as long as you can show proof of it.


These are the countries that currently require all arriving travelers to show an international Health certificate proof of Yellow Fever Vaccination:


 Angola
 Benin
 Burkina Faso
 Burundi
 Cameroon
 Central African Republic
 Congo, Republic of the
 Côte d’Ivoire
 Democratic Republic of the  Congo
 Equatorial Guinea
 French Guiana
 Gabon
 Ghana
 Guinea
 Guinea-Bissau
 Liberia
 Mali
 Mauritania
 Niger
 Sierra Leone
 South Sudan
 Togo
 Uganda

These are the countries that currently require those travelers arriving from another country that has Yellow Fever incidents to show an International Health Certificate proof of Yellow Fever Vaccination:

  Albania
  Algeria
  Antigua and Barbuda
  Aruba
  Australia
  Bahamas
  Bahrain
  Bangladesh
  Barbados
  Belize
  Bolivia
  Bonaire
  Botswana
  Brunei
  Cape Verde
  Cambodia
  Chad
  China
  Christmas Island
  Cocos Islands
  Colombia
  Costa Rica
  Cuba
  Curacao
  Dominica
  Dominican Republic
  Ecuador
  Egypt
  El Salvador
  Eswatini
  Ethiopia
  Fiji
  French Polynesia
  Gambia
  Grenada
  Guadeloupe
  Guatemala
  Guinea
  Guyana
  Haiti
  Honduras
  India
  Indonesia
  Iran
  Iraq
  Jamaica
  Jordan
  Kazakhstan
  Kenya
  Madagascar
  Malawi
  Malaysia
  Maldives
  Malta
  Martinique
  Mayotte
  Montserrat
  Mozambique
  Myanmar (Burma)
  Namibia
  Nepal
  New Caledonia
  Nicaragua
  Nigeria
  Niue
  Norfolk Island
  North Korea
  Oman
  Panama
  Papua New Guinea
  Paraguay
  Pitcairn Islands
  Rwanda
  Saint Helena
  Saint Kitts
  Saint Lucia
  Saint Martin
  Saint Vincent
  Saint-Barthelemy
  Samoa
  Sao Tome
  Saudi Arabia
  Senegal
  Seychelles
  Singapore
  Sint Eustatius
  Solomon Islands
  Somalia
  South Africa
  Sri Lanka
  Sudan
  Suriname
  Tanzania
  Thailand
  Trinidad and Tobago
  Uganda
  UAE
  Uruguay
  Venezuela
  Zambia
  Zimbabwe

Unlike most Travel Vaccines, Yellow Fever vaccines usually do not require a prescription. They are not offered at all pharmacies, so you will need to some research as to which pharmacy will give them.

                                                           Preventing Malaria

Mosquitos unwittingly spread Malaria, as well as other diseases, through biting humans. Those people living in endemic regions build up some resistance to Malaria, after repeated exposure, if they survive. Those people who do not live in endemic regions, including those who used to live in those regions, but left >1 year ago, are at increased risk for more severe disease when infected with Malaria.


In malaria-endemic regions, which currently includes >90 countries, it is especially important to try to prevent mosquito bites using long sleeves/long pants, bed nets, window screens and mosquito repellent containing DEET. Since mosquitos in these regions are particularly persistent and mosquito bites are inevitable, it is also important to take malaria prophylactic medication.














Source: MAP, CDC

Malaria Prophylactic Medications are Currently Recommended in the following countries:

*means only in certain areas


Afghanistan                                                                         Gabon                                                                                  Panama 

Algeria*                                                                                Gambia                                                                                Papua New Guinea 

Angola                                                                                  Georgia*                                                                             Paraguay* 

Argentina                                                                             Ghana                                                                                 Peru 

Azerbaijan*                                                                          Greece*                                                                              Philippines 

Bangladesh                                                                          Guatemala                                                                         Russian Federation* 

Belize                                                                                    Guine                                                                                  Rwanda 

Benin                                                                                    Guinea-Bissau                                                                   Sao Tome and Principe 

Bhutan                                                                                 Guyana                                                                               Saudi Arabia 

Bolivia, Plurinational State                                               Haiti                                                                                     Senegal 

Botswana                                                                            Honduras                                                                           Sierra Leone 

Brazil                                                                                    India                                                                                    Solomon Islands 

Burkina Fasa                                                                        Indonesia                                                                           Somalia 

Burundi                                                                               Iran, Islamic Republic of                                                   South Africa 

Cambodia                                                                           Iraq* 

Cameroon                                                                          Kenya                                                                                   Sudan 

Cape Verde                                                                        Korea, Democratic People’s Republic of*                      South Sudan 

Central African Republic                                                  Korea, Republic of*                                                           Suriname 

Chad                                                                                   Kyrgyzstan*                                                                         Swaziland 

China                                                                                  Lao People’s Democratic Republic                                  Syrian Arab Republic* 

Colombia                                                                           Liberia                                                                                  Tajikistan 

Comoros                                                                            Madagascar                                                                        Thailand 

Congo                                                                                 Malawi                                                                                 Timor-Leste 

Congo, Democratic  Republic of the                             Malaysia                                                                               Togo  

                                                                                            Mali                                                                                       Turkey* 

Costa Rica                                                                          Mauritania                                                                           Uganda 

Côte d’Ivoire                                                                      Mayotte                                                                                United Republic of Tanzania 

Djibouti                                                                              Mexico                                                                                  Uzbekistan* 

Dominican Republic                                                        Mozambique                                                                        Vanuatu 

Ecuador                                                                             Myanmar                                                                              Venezuela, Bolivarian Republic of 

Egypt                                                                                  Namibia                                                                                Vietnam 

El Salvador                                                                        Nepal                                                                                     Yemen 

Equatorial Guinea                                                           Nicaragua                                                                              Zambia 

Eritrea                                                                               Niger                                                                                       Zimbabwe 

Ethiopia                                                                            Nigeria    

French Guiana                                                                 Oman 

                                                                                           Pakistan


The current Malaria Prophylactic Medications available are the following:

Note: Not all Malaria Prophylactic Medication work in every country due to drug resistance. Medications are chosen based on countries visited, timeline of trip, and possible side effects.


Atovaquone/Proguanil (Malarone)

Begin 1 – 2 days before travel, daily during travel, and for 7 days after leaving.

CONS:

  • Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg
  • Cannot be taken by people with severe renal impairment
  • Tends to be more expensive than some of the other options (especially for trips of long duration)

Chloroquine

Begin 1 – 2 weeks before travel, once/week during travel, and for 4 weeks after leaving.

CONS:

  • Cannot be used in areas with Chloroquine or Mefloquine resistance
  • May exacerbate psoriasis
  • Some people would rather not take medication for 4 weeks after travel

Doxycycline

Begin 1 – 2 days before travel, daily during travel, and for 4 weeks after leaving.

CONS:

  • Cannot be used by pregnant women and children <8 years old
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
  • Can increase risk of sun sensitivity
  • Can cause stomach irritation

Mefloquine

Begin 1 – 2 weeks before travel, weekly during travel, and for 4 weeks after leaving.

CONS:

  • Cannot be used in areas with Mefloquine resistance
  • Cannot be used in patients with certain psychiatric conditions
  • Cannot be used in patients with a seizure disorder
  • Not recommended for persons with cardiac conduction abnormalities
  • Needs to be started at least 2 weeks prior to travel
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel

Primaquine

Begin 1 – 2 days prior to travel, daily during travel, and for 7 days after leaving

CONS:

  • Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
  • Cannot be used in patients who have not been tested for G6PD deficiency (and there are costs and delays associated with getting a G6PD test done)
  • Cannot be used by pregnant women
  • Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
  • Can cause stomach irritation

Tafenoquine (ArakodaTM)

Begin daily for 3 days prior to travel, weekly during travel, and for 1 week after leaving.

CONS:

  • Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
  • Cannot be used in patients who have not been tested for G6PD deficiency (and there are costs and delays associated with getting a G6PD test done)
  • Cannot be used by children
  • Cannot be used by pregnant women
  • Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
  • Not recommended in those with psychotic disorders


Malaria Prophylactic Medications do need prescription orders from a Physician.

Take the Questionnaire to Find out if you need Malaria Prophylactic Medication prescriptions.


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