Travellers

Going on a trip?

Staying in good health while travelling can help ensure that your trip overseas will be a happy and enjoyable one. This page provides health information on vaccine-preventable diseases related to travellers.

Planning before travel1

Before departure, you should:

  • gather information on your travel destinations and possible activities.

  • see a travel health doctor to obtain any necessary vaccinations or preventive medication

  • provide the following information for your healthcare provider to assess your travel health risks:

     i. travel destination(s) including stopovers
     ii. duration and season of travel
     iii. purpose of travel
     iv. standard of accommodation
     v. activities planned
     vi. current health status and medical history
     vii. vaccination history

When should I seek pre-travel consultation?

Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey.2

  • This consultation should take place at least 4–8 weeks before the journey.2
  • For those going to live or work overseas, seek advice 6 months prior to departure.3
  • Last-minute travellers can also benefit from a medical consultation, even as late as the day of travel.2

Vaccination is a highly effective method of preventing certain infectious diseases.2

Which vaccines do I need?

All individuals

  • It is recommended that all travellers be up-to-date on routine vaccinations including measles-mumps-rubella (MMR), diphtheria, tetanus, pertussis (DTP or Tdap), polio, hepatitis B, varicella (chickenpox), influenza and pneumococcal.4-7
  • If there is a risk of malaria at your destination, your healthcare provider may prescribe medicine to prevent malaria.8

Depending on your travel destination

  • Find out the latest health updates for areas you plan to visit.9
  • Learn about infectious diseases and discover vaccinations you might need for your destinations.9
  • Refer to the travel recommendations by country tab for general vaccine recommendations by country and discuss with your doctor on suitability.9

Depending on what you do

Certain vaccines are recommended depending on your activities while away.

  • Japanese Encephalitis
    Japanese encephalitis vaccination is recommended mainly for travellers to rural areas in Asia who will have extensive outdoor activities during the transmission season. Transmission occurs mainly during the rainy season in Southeast Asia but may take place all year round, particularly in tropical climate zones; and in temperate regions transmission occurs mainly during summer and autumn.10

  • Rabies
    Rabies occurs in most parts of the world. Pre-exposure vaccination is recommended for travellers involved in activities that might bring them into direct contact with bats, dogs and other wild animals.10

  • Cholera
    Cholera occurs mainly in low-income countries with inadequate sanitation and lack of clean drinking water. Many developing countries are affected, particularly in Africa, Asia and to a lesser extent in Central and South America. Humanitarian relief workers in disaster areas and refugee camps are at risk.10

Recommended vaccines for Travellers
    RISK AREAS:11

    Asia, Africa, Central & South America and Eastern Europe.

    DISEASE:12

    Hepatitis A is caused by the hepatitis A virus. It infects the liver cells and causes inflammation. The disease is often more severe in adults and full recovery may take several months.

    TRANSMISSION:12

    Contaminated food, water and close contact with an infected person.

    SIGNS AND SYMPTOMS:12

    The symptoms of liver inflammation include:

    • Loss of appetite
    • Fever
    • Dark urine
    • Nausea
    • Abdominal pain
    • Vomiting
    • Jaundice (yellowish discolouration of the skin and eyes)
    POSSIBLE COMPLICATIONS:12

    There is no treatment for hepatitis A. The most serious complication of hepatitis A is acute liver failure.

    RECOMMENDATIONS:11

    All non-immune travellers should be vaccinated against hepatitis A.

    RISK AREAS:13

    Asia, Africa, Central & South America and Caribbean.

    DISEASE:13

    Typhoid fever is an infection caused by Salmonella typhi.

    TRANSMISSION:13

    Contaminated food and water.

    SIGNS AND SYMPTOMS:14

    Early symptoms include:

    • Fever
    • Headache
    • Weakness and fatigue
    • Muscle aches
    • Dry cough
    • Weight loss
    • Abdominal pain
    • Diarrhoea or constipation
    • Rash
    • Swollen abdomen

    As the disease progresses, patients develop:

    • High fever
    • Profound tiredness
    • Delirium
    POSSIBLE COMPLICATIONS:14

    The most serious complication of typhoid fever is intestinal bleeding or perforation. A perforated intestine occurs when your intestine or bowel develops a hole, causing intestinal contents to leak into the abdominal cavity and triggering severe abdominal pain, nausea, vomiting and bloodstream infection.12

    RECOMMENDATIONS:13

    Vaccination is recommended for travellers to areas where there is an increased risk of exposure to S.typhi.

    RISK AREAS:15

    Asia and parts of Western Pacific.

    DISEASE:15

    Japanese encephalitis (JE) is a potentially severe disease
    caused by Japanese encephalitis virus that can cause
    inflammation of the brain (encephalitis).

    TRANSMISSION:15

    It is transmitted by mosquitoes, related to the rainy season in Southeast Asia but may take place all year round, particularly in tropical climate zones.

    In the temperate regions of China, Japan, the Korean peninsula and eastern parts of the Russian Federation, transmission occurs mainly during summer and autumn.

    SIGNS AND SYMPTOMS:15

    Most human infections are asymptomatic or result in only mild symptoms. However, a small percentage of infected persons develop inflammation of the brain (encephalitis), with symptoms including:

    • High fever
    • Disorientation
    • Coma
    • Tremors
    • Convulsions
    • Sudden onset of headache
    POSSIBLE COMPLICATIONS:15

    There is no specific treatment for JE. Patient management focuses on supportive care and management of complications. Steps to prevent JE include vaccination and using personal protective measures to prevent mosquito bites.

    RECOMMENDATIONS:15

    Vaccination is recommended for travellers with extensive outdoor exposure (camping, hiking, working, etc) during the transmission season.

    RISK AREAS:16

    Sub-saharan Meningitis Belt and Mecca.

    DISEASE:16,17

    Meningococcal Disease is caused by the bacterium Neisseria meningitidis.
    Meningococcal meningitis causes inflammation affecting the brain and spinal cord. This occurs when bacteria from the respiratory tract enter the bloodstream.

    TRANSMISSION:16

    It is transmitted through respiratory droplets and close contact (e.g. coughing, kissing, sneezing).
    In industrialised countries, sporadic cases occur in schools, colleges, military barracks and other crowded places.

    SIGNS AND SYMPTOMS:16

    Early symptoms include:

    • Sudden onset of intense headache
    • Fever
    • Nausea
    • Vomiting
    • Sensitivity to light
    • Stiff neck

    Later symptoms of meningitis can be very severe,e.g. seizures.

    POSSIBLE COMPLICATIONS:

    Meningococcal infections can be treated with drugs. Still, many people who get the disease die from it and many others are affected for life. Preventing the disease through the use of meningococcal vaccine is important for people at highest risk.16 Invasive meningococcal disease can kill within 24 hours. Up to 2 in 10 survivors of meningococcal meningitis are left with permanent consequences such as mental retardation, deafness, epilepsy or other neurological disorders.17

    RECOMMENDATIONS:16

    Vaccination is recommended for travellers to industrialised countries who are at risk of exposure to sporadic cases and travellers to the sub-Saharan meningitis belt. Pilgrims visiting Mecca for Hajj or Umrah are required to be vaccinated.

    RISK AREAS:18

    Africa and Central & South America.

    DISEASE:18

    Yellow fever is a haemorrhagic fever transmitted by Aedes mosquitoes.

    TRANSMISSION:19

    Travellers to the tropical areas of Africa and Central & South America are at risk. Those who enter forests and jungle areas are at greatest risk.

    SIGNS AND SYMPTOMS:19

    In mild cases, yellow fever causes:

    • Fever
    • Headache
    • Nausea and vomiting

    In severe cases, yellow fever can cause:

    • Bleeding from the nose/mouth/eyes
    • Heart dysfunction
    • Liver and kidney problems
    POSSIBLE COMPLICATIONS:19

    Up to 50% of people with the more severe form of yellow fever die of the disease.

    RECOMMENDATIONS:18

    Vaccination is recommended for travellers to or living in risk areas. In some countries, yellow fever vaccination is mandatory for travellers entering and coming from risk areas.

    RISK AREAS:20

    Most parts of the world.

    DISEASE:20

    Rabies is a deadly virus.

    TRANSMISSION:20

    It is spread to people from the saliva of infected animals (such as dogs, cats, monkeys, bats) through a bite.
    Risk to travellers in areas where rabies occurs is related to the probability of contact with potentially rabid animals.

    SIGNS AND SYMPTOMS:20

    Early symptoms include:

    • Fever
    • Headache
    • Agitation
    • Anxiety
    • Confusion
    • Excessive salivation
    • Hallucinations
    • Partial paralysis

    Later symptoms of meningitis can be very severe,e.g. seizures.

    POSSIBLE COMPLICATIONS:20

    Once a person begins to show signs and symptoms of rabies, the disease is nearly always fatal.

    RECOMMENDATIONS:20

    Pre-exposure vaccination is recommended for travellers anticipating close contact/exposure to rabid animals. Post-exposure vaccination is given to prevent the development of clinical rabies, after the bite of an animal suspected of having rabies.

    RISK AREAS:21

    Worldwide.

    DISEASE:21
    • Influenza (flu) is a contagious disease caused by influenza viruses.
    • There are 4 strains of flu viruses circulating. Ask your healthcare provider on how to protect against the 4 flu viruses.
    TRANSMISSION:
    • Respiratory droplets when people with flu cough, sneeze or talk.22
    • Touching a surface or object that has flu virus on it and then touching your own mouth, eyes, or possibly your nose.22
    • Singapore has year-round influenza activity and has had variable peak activity in some years. Due to undefined peak of disease activity, the Ministry of Health in Singapore issues advisories once or twice a year when new vaccines with a change in formulation are released. Ensure that you are protected against flu through vaccination.23
    SIGNS AND SYMPTOMS:24

    Flu and the common cold are both respiratory illnesses but they are caused by different viruses. These two types of illnesses have similar symptoms. In general, flu is worse than the common cold, and symptoms are more intense.

    RECOMMENDATIONS:25

    Everyone who is at least 6 months of age should get the flu vaccine. It’s especially important for these high risk groups to get vaccinated:

    • Children below 5 years of age
    • Adults 65 years of age and above
    • Those with medical conditions:
      1. asthma
      2. chronic obstructive pulmonary disease (COPD)
      3. diabetes
      4. heart disease
    • People who live with or care for others who are at high risk
    • Pregnant women
    RISK AREAS:26

    Developing countries particularly in Africa and Asia, and to a lesser extent in Central & South America.

    DISEASE:26

    Cholera is an acute bacterial, intestinal infection caused by toxigenic Vibrio cholera.

    TRANSMISSION:26

    Contaminated food like fish and shellfish or water.

    SIGNS AND SYMPTOMS:26

    Most infections are asymptomatic. In mild cases, acute watery diarrhoea occurs without other symptoms. In severe cases, there is a sudden onset of profuse watery diarrhoea with nausea and vomiting and rapid development of dehydration.

    POSSIBLE COMPLICATIONS:26

    In severe untreated cases, death may occur within a few hours due to dehydration leading to circulatory collapse.

    RECOMMENDATIONS:26

    The risk for most travellers is very low. However, humanitarian relief workers in disaster areas and refugee camps should be vaccinated against cholera.

Tips for travelling well

Food and water precautions27

Contaminated food or drinks can cause travellers’ diarrhoea and other diseases. Travellers to developing countries are especially at risk.
Reduce your risk by sticking to safe eating and drinking habits.

  • Always drink boiled, filtered or bottled water.
  • Avoid ice in drinks.
  • Eat only food that is cooked and served hot.

Jet lag and adapting to a new time zone28

Three tips to adapting to a new time zone:

  • Sunshine: a walk in the sunshine on the morning after arrival stimulates the optic nerve and helps to reset the body clock.
  • Meal times: your body uses food as a clue to the time of the day, so eat meals appropriate to the local time.
  • Sleeping times: try to sleep at the local time.

Avoiding motion sickness29

  • Request a seat in the mid-section of the cabin where movements are less pronounced, and keep the motion sickness bag, provided at each seat, readily accessible.
  • Consult your doctor or travel medicine physician about medication that can be taken before flying to help prevent problems, and should avoid drinking alcohol during the flight and for 24 hours beforehand.

Pack a medical kit30

A medical kit should include:

  • Medications taken on a regular basis at home.
  • Basic first-aid items, medicine to treat stomach problems, skin infections, cough and colds, and pain.
  • Water purification tablets to ensure safe water.
  • Items that assist comfort during travel such as eye masks and compression stockings.

Avoid being bitten2

  • Use insect repellents and mosquito nets.
  • Avoid direct contact with domestic and wild animals in areas where rabies occurs.
  • Travellers to tropical, subtropical and desert areas should be aware of the possible presence of venomous snakes, scorpions and spiders.

References:

  1. CDC. Traveler’s Health. See a Doctor Before You Travel. Available at here. Last accessed Aug 2019.
  2. WHO. International Travel and Health 2012.
  3. Mills D. Travelling Well by the Travel Doctor, 14th Edition. Published by Dr Deborah Mills, November 2012.
  4. Health Promotion Board. National Childhood Immunisation Schedule, Singapore. Available at here. Last accessed Aug 2019.
  5. KK Women’s Clinic and Children’s Hospital. Vaccinations. Available at here. Last accessed Aug 2019.
  6. MOH, Singapore. Influenza. Available at here. Last accessed Aug 2019.
  7. MOH, Singapore. Available at here. Last accessed Aug 2019.
  8. CDC. Travelers’ Health. Last-Minute Travelers. Available at here. Last accessed Aug 2019.
  9. CDC. CDC Features. Travel Smart: Get Vaccinated. Available at here. Last accessed Aug 2019.
  10. WHO. International Travel And Health. Vaccine-preventable diseases and vaccines - 2017 update. Available at here. Last accessed Aug 2019.
  11. CDC. Traveller’s Health. Chapter 3. Infectious Diseases Related to Travel. Hepatitis A. Available at here. Last accessed Aug 2019.
  12. CDC. Viral Hepatitis. Hepatitis A Questions and Answers for the Public. Available at here. Last accessed Aug 2019.
  13. CDC.Traveller’s Health.Chapter 4 Travel-Related Infectious Diseases. Available at here.Last accessed Aug 2019.
  14. Mayo Clinic. Typhoid fever. Available at here. Last accessed Aug 2019.
  15. CDC. Japanese Encephalitis. Frequently Asked Questions. Available at here. Last accessed Aug 2019.
  16. CDC. Traveller’s Health. Chapter 3. Infectious Diseases Related to Travel. Meningococcal Disease. Available at here. Last accessed Aug 2019.
  17. CDC. Vaccine Information Statements (VISs). Meningococcal ACWY VIS. Available at here. Last accessed Aug 2019.
  18. WHO. Yellow fever. Available at here. Last accessed Aug 2019.
  19. Mayo Clinic. Yellow fever. Symptoms and Treatment. Available at here. Last accessed Aug 2019.
  20. Mayo Clinic. Rabies. Available at here. Last accessed Aug 2019.
  21. CDC. Influenza (Flu). About Flu. Available at here. Last accessed Aug 2019
  22. CDC. Cold Versus Flu. Available at here. Last accessed Aug 2019.
  23. WHO. Bulletin of the World Health Organization. Research. Available at here. Last accessed Aug 2019.
  24. CDC. Influenza (Flu). Cold Versus Flu. Available at here. Last accessed Aug 2019.
  25. CDC. Influenza (Flu). Vaccination: Who Should Do It, Who Should Not and Who Should Take Precautions. Available at here. Last accessed Aug 2019.
  26. CDC. Traveller’s Health. Chapter 3. Infectious Diseases Related to Travel. Cholera. Available at here. Last accessed Aug 2019.
  27. CDC. Food and Water Safety. Available at here. Last accessed Mar 2019.
  28. CDC. Traveller’s Health. Chapter 8. Jet Lag. Available at here. Last accessed Aug 2019
  29. WHO. Air Travel Advice. Available at here. Last accessed Aug 2019.
  30. CDC. Traveler Advice Pack Smart. Available at here. Last accessed Aug 2019.