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Consultation for International Travel

Student Health Services (SHS) provides MUSC students planning international travel with information about the countries they are planning to visit, evaluates individual health care needs and risks, and provides appropriate immunizations (for a fee.) Please note, not all required  vaccines are available at SHS. Student anticipating travel should make an appointment a minimum of eight weeks prior to travel to allow time for counselling and administration of immunizations. 

Additional information can be found on the Center for Disease Control and Prevention travel information site. 

Pre-Travel Vaccines:Other Travel Considerations:
Hepatitis A VaccineMosquito Repellent
Hepatitis B VaccineMalaria Prophylaxis
Typhoid VaccineTraveler's Diarrhea
Meningitis VaccineTB Testing
Tdap/Td BoosterAltitude Sickness
Yellow FeverHealth Insurance
Rabies VaccineBlood Borne Pathogen Exposures
Cholera VaccineTravel Alerts

Common Pre-Travel Vaccines Include:

Hepatitis A Vaccine

Hepatitis A is common in areas of the world with poor sanitation.  It can be spread from person –to-person or from sewage- contaminated food/drink (water, ice, shellfish, fruits/vegetables that are raw or inadequately cooked).   The Hepatitis A vaccine is a 2 dose series and is highly effective at preventing infection.  The first vaccine should ideally be given at least one month before travel to allow time to develop protective antibodies.  For durable, long lasting protection, the second and final vaccine should be given 6-12 months later – studies indicate that after the second dose, protective immunity may persist for 25 years or more. return to top

Hepatitis B Vaccine

Hepatitis B is a viral pathogen that can be transmitted from exposure to blood or blood -containing body fluids.  Infections can be transmitted through healthcare related occupational exposures (needle sticks, etc.), sexual exposure to an infected source, and from contaminated needles (tattooing, acupuncture).   Most healthcare students have completed the hepatitis B vaccine series and should know if they developed the desired immunity from the vaccine (immune Hepatitis B Surface Antibody titer).   Completion of the hepatitis B vaccine series (3 vaccines) and knowledge of one’s hepatitis B immune status is important for students who will be engaged in activities that place them at risk for bloodborne pathogen exposure while participating on medical rotations/mission work in foreign countries. return to top

Typhoid Vaccine

“Typhoid Fever” is a bacterial infection caused by Salmonella Typhi.  It is found in areas of the world with poor sanitation and can be spread from person-to-person contact, as well as from sewage-contaminated food and water.  Untreated infections can be fatal in up to 30% of persons.   There are 2 vaccines available that provide about 50-80% protection from infection:  (1) Typhoid Injectable Vaccine is a dead vaccine that needs to be administered at least 2 weeks before travel.  A booster dose is recommended after 2 years.  (2) Oral Typhoid Vaccine is a live, attenuated strain of Salmonella that consists of 4 capsules, 1 given every other day, with the 4th and final dose being completed at least 7 days before travel.   A booster dose is recommended after 5 years.  return to top

Meningitis Vaccine

Neisseria meningitides can cause bacterial meningitis.  It is a found worldwide, but the highest incidence is found in the “meningitis belt” of sub-Saharan Africa.   In previously vaccinated persons who will be visiting an area of the world that is endemic for meningococcal infection, a booster dose is recommended if it has been 5 or more years since the last vaccine. return to top

Tdap/Td booster

Most children in the U.S. have received the primary Diphtheria-Pertussis-Tetanus (DPT) vaccine series. Pertussis remains endemic throughout the world (including the U.S.), and disease rates are highest in developing countries where vaccination coverage for children is low.   After completion of the childhood vaccine series, immunity wanes over time and booster doses are necessary.   A Tetanus booster (Td) should be given every 10 years.  Adults > 19 years old should receive single dose of the acellular pertussis vaccine (Tdap) instead of the Td vaccine.  After this adult Tdap “booster”, they should return to receiving Td boosters at 10 year intervals. return to top

Yellow Fever

Yellow fever is a viral infection transmitted by mosquitos.  It is endemic in sub-Saharan Africa and tropical South America.  While most of the travel vaccines are recommended to protect your health, the Yellow Fever Vaccine is required for entry by certain countries.  The vaccine is administered by certified Yellow Fever Vaccine clinics and needs to be given at least 10 days before travel. return to top

Rabies Vaccine

Rabies is a fatal viral infection that is transmitted through bites/scratches from infected mammals (dogs, bats, other carnivores).   Pre-exposure vaccination is recommended for travelers who will be involved in outdoor activities that will bring them in contact with potentially infected animals (hiking, biking, caving, adventure travel).  The vaccine series consists of 3 intramuscular injections given on days 0, 7, and 21 or 28.   Even for fully vaccinated individuals, it is still necessary to seek immediate medical attention after a bite from a potentially rabid animal. return to top

Cholera Vaccine

Cholera is a bacterial infection that can cause acute diarrhea with profound GI fluid losses.  It can be transmitted from contaminated food/water, as well as from person-to-person contact.   It is primarily found in resource-limited parts of the world where there is poor sanitation and limited access to clean water.   A single-dose oral cholera vaccine was approved on June 2016 which is up to 90% effective in preventing cholera.  Cholera in travelers is rare and is not recommended for most foreign travel.   The cholera vaccine should be considered for travel to areas of the world reporting active cholera transmission.  The vaccine should be given at least 10 days before travel. return to top
 

Other travel considerations include:

Mosquito Repellent:  If there is transmission of mosquito- borne viral infections (including Zika, Chikungunya, Dengue, Malaria) reported in the areas you will visit, regular use of an effective mosquito repellent is recommended for all travelers.  Effective agents include: DEET 20-30%, Oil of Lemon Eucalyptus 30%, and Picaridin 20%.   Certain “natural” repellents do NOT provide effective protection and should be avoided (including cedar, cinnamon, citronella, clove, geranium, lemongrass, rosemary, and peppermint).  For further info on finding the right repellent:

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Malaria Prophylaxis – Malaria transmission occurs throughout the world, including areas of Africa, Latin America, Caribbean, Asia, Eastern Europe, and the South Pacific.  Flu-like symptoms (fever, chills, muscle aches, headache) can occur as early as 1- 2 weeks after the bite of an infected female Anopheles mosquito.   Preventive measures include regular use of an effective mosquito repellent and anti-malarial medications. If anti-malarial medication is recommended, your provider will discuss effective medication options that are specific to the area of the world you will be traveling.  return to top

Traveler’s Diarrhea - Diarrhea is the most common travel-related illness and is common in areas of the world with poor sanitation and substandard water treatment.  The majority of cases are transmitted from contaminated food or drink, so one can lessen their chances of getting ill by eating food that is cooked and served hot.  Avoiding unwashed or unpeeled raw fruit/vegetables/fresh salsa is also recommended.   Many travelers carry a short course of antibiotics, which when used early, can shorten the severity and duration of the illness.   If the area you will be visiting has poor sanitation standards, you can discuss with your provider whether or not it is necessary to bring a course of antibiotics.  return to top

TB Testing - If you will be delivering medical care in areas of the world with increased incidence of tuberculosis (hospitals, prisons, homeless shelters), make sure your TB skin test is current before travel, and return for a repeat TB skin test 8-10 weeks after return.  Most TB infections will be asymptomatic (Latent TB Infection or LTBI) and will only be discovered on subsequent TB testing.  return to top

Altitude Sickness -  Low oxygen pressures found at high altitudes can lead to hypoxia with subsequent high altitude illness symptoms which include headache, nausea, and fatigue.  For example, at 10,000 ft, the oxygen pressure (pO2) of inspired air is only 69% that of the oxygen pressure found at sea-level.  Altitude sickness can occur when flying directly to destinations with high altitudes (> 8,000 feet) with no opportunity to acclimatize over several days.  There are medications available such as Acetazolamide to help prevent altitude sickness. The usual dosage is 125 or 250 mg twice daily starting 24 hours before ascent and continuing for 48 hours after arrival at altitude. Since Acetazolamide is a diuretic, it is important to maintain proper hydration while taking it by drinking enough water for your urine to run clear to pale yellow.  return to top

Health Insurance – make sure your insurance plan provides medical coverage for foreign countries, including medical evacuation benefits.    If your foreign travel is MUSC school-related, you can visit the MUSC Global Health site and register your travel for additional travel assistance:  

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Blood Borne Pathogen Exposures – students who will be traveling to resource-limited areas of the world who will be engaged in clinical activities that place them at risk for an occupational blood exposure (needle stick, blood splash to eye, etc.) should ensure that a contingency plan is in place to appropriately manage such exposures.  The medical director of the trip should ensure that there is: (1) A qualified individual on-site who can conduct the appropriate assessment and management of an occupational exposure.  (2) Appropriate supervision of participants during any exposure prone procedure.  (3) Appropriate personal protective equipment (gloves, gowns, eyewear) available. (4) Availability of immediate lab testing of the source patient’s blood (HIV, Hepatitis C, Hepatitis B) in the event of an exposure. (5) Availability of anti-viral medications to initiate within 1-2 hours of an HIV exposure.   

Travel Alerts – check for travel alerts to the place (s) you will be traveling. Additional information can be found at:                                                                                                                              

Additional resources for vaccine requirements/recommendations and preventive measures include:

Regional:
South Carolina Department of Health and Environmental Control (Regional Information):  http://www.scdhec.gov/index.htm

Local:
MUSC Center for Global Health: http://globalhealth.musc.edu/

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