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Traveler's advisory.

"What shots do I need to travel to?" is probably the first question that comes to mind when planning an overseas trip. The answer is always twofold: immunizations required by the country where one is going and those recommended by our own health authorities.

Thanks to some remarkable recent accomplishments, the answer to the first part, usually, is "none." When the last case of smallpox was identified October 1977 in Somalia, and the patient recovered, that dread disease was essentially obliterated from the earth (the virus is carried only by humans). In May 1980, the World Health Organization (WHO) officially declared the global eradication of the disease, and, since 1982, the smallpox vaccine is no longer required by any country. Although the vaccine is still available, its use is restricted to laboratory workers directly involved with smallpox and related viruses.

Although cholera is still prevalent in some areas of the world, the risk of a traveler being infected today is almost zero. Because the disease is easily treated if it does occur, and because its vaccine is not very effective, WHO no longer recommends its use for travelers to any country and has advised all countries not to require vaccination for entry. At last count, only Pakistan and Sudan still require a certificate of vaccination, contrary to WHO regulations, for persons coming from a cholera-intested area. This requirement can be circumvented by obtaining a letter form one's physician stating that vaccination should not be performed for medical reasons. (To avoid the possibility that some illiterate health inspector might ignore such a letter, physicians have been known to simply certify on the "yellow card" that the vaccination has been given-a little white lie to keep patients from getting unnecessary shots.)

This leaves only one vaccination-yellow fever-on the "required" list, since the disease is still found in some areas of South America and Central Africa. Yellow fever vaccination is available only in certain approved centers, so you must contact your local or state health department to determine whether you will need it and where to get it.

Recommended immunizations for foreign travel are another matter. Immunity against diseases still prevalent in the U.S. (measles, mumps, German measles, tetanus, etc.) is recommended for everyone, whether traveling or not, and foreign travel is, for many adults, the first time since childhood that they are called upon to review their immune status. In addition, there are diseases peculiar to certain countries for which your doctor should recommend immunization or prophylaxis. We have discussed the most important of these, malaria, in our November 1989 issue, and others will be covered in subsequent issues.
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Title Annotation:immunization
Publication:Medical Update
Date:Feb 1, 1990
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