Pre-Travel Vaccinations

Travel vaccines fall into three categories, and there is no single “correct” list for any destination — the right choice is an individual risk–benefit assessment, not a checklist:

• Routine — recommended regardless of travel (e.g. influenza, tetanus, measles). See the National Immunisation Schedule.
• Recommended — advised on the basis of itinerary, activities and exposure risk (e.g. hepatitis A, typhoid, rabies, Japanese encephalitis).
• Required — mandated by International Health Regulations or for entry into specific countries (e.g. yellow fever, meningococcal ACWY).

See also The Travel Consultation for the broader pre-travel risk assessment this page sits within.

Risk–benefit assessment

Take a detailed vaccine history (Australian Immunisation Register, handheld records) to identify gaps and avoid unnecessary vaccines — serology can help where history is uncertain. Weigh:

• Disease risk — likelihood of exposure and potential severity. Common diseases (COVID-19, influenza) aren’t necessarily the highest-impact ones; low-incidence diseases like Japanese encephalitis or yellow fever can carry a much greater impact per case. Public health impact also matters — e.g. measles’ risk of onward spread on return.
• Vaccine attributes — adverse event profile, cost, duration of protection, level of protection. Hepatitis A, yellow fever, JE and rabies vaccines give long-term protection and can be framed as a long-term investment; influenza and typhoid need periodic re-vaccination. A multi-trip assessment (considering likely future travel, not just this trip) can change the calculus.
• Traveller factors — age, medical history, risk tolerance, itinerary, duration; VFR travellers face different risks to typical tourists (particularly tuberculosis and typhoid) and often underestimate them.

Figure adapted from Steffen R, Chen LH, Leggat PA. Travel vaccines — priorities determined by incidence and impact. J Travel Med 2023;30(7):taad085, via the 2025 AJGP article. Axes: incidence (per 100,000 travellers) vs impact (case-fatality rate and/or sequelae). A useful visual aid for pre-travel discussions — it’s why JE and yellow fever vaccination get pushed hard despite low absolute incidence, while pertussis/typhoid outside South Asia sit in the lower-priority corner.

Vaccines commonly available in Australia

Recreated from the AJGP’s Table 2 (itself drawn from the Australian Immunisation Handbook). Age limits are the minimum across all brands of that vaccine type — some brands have higher minimums.

Transmission category	Disease	Vaccine type	Route	Lower age limit	Population recommendations
Food- and water-borne / faecal–oral	Cholera	Inactivated whole-cell recombinant	Oral	2 years	Travellers at increased exposure risk (e.g. aid workers) or risk of severe disease (e.g. inflammatory bowel disease) visiting cholera-endemic or outbreak areas
		Live-attenuated	Oral	2 years
	Hepatitis AB	Inactivated	IM	1 year	Travellers to moderately to highly endemic areas for hepatitis A
	PoliomyelitisC	Inactivated	SC	6 weeks	Travellers to areas where polio is circulating; booster every 10 years
	TyphoidB	Inactivated	IM	2 years	Travellers to typhoid-endemic areas
		Live-attenuated	Oral	6 years
Vector-borne	Japanese encephalitis	Live-attenuated	SC	9 months	Travellers spending 1 month or more in endemic areas during transmission season; consider for shorter-term travellers
		Inactivated	IM	2 months
	Yellow feverD	Live-attenuated	IM or SC	9 months	Travellers to an area with yellow fever virus transmission risk
Aerosol- or droplet-borne	COVID-19	Inactivated	IM	6 months	As per routine recommendations; may be given earlier than recommended interval if travel is imminent
	DiphtheriaC	Inactivated toxoid	IM	6 weeks	As per routine recommendations; booster for travellers to countries with limited health services if last dose >10 years ago, or >5 years ago for high-risk areas (e.g. Southeast Asia)
	Influenza	Inactivated	IM	6 months	As per routine recommendations; can have a second dose if travelling to the Northern Hemisphere during influenza season (October–May)
	Meningococcal ACWY disease	Inactivated	IM	6 weeks	Travellers to the "meningitis belt" of Sub-Saharan Africa or those attending mass gatherings (e.g. pilgrims to Hajj or Umra)
	Meningococcal B disease	Recombinant (inactivated)	IM	6 weeks	As per routine recommendations
	MeaslesC	Live-attenuated	IM or SC	6 months	Travellers born during or since 1966 should receive 2 doses of measles-containing vaccine unless documented evidence of prior vaccination or serological evidence of immunity
	MumpsC	Live-attenuated	IM or SC	6 months	As per routine recommendations
	PertussisC	Acellular (inactivated)	IM	6 weeks	As per routine recommendations; booster if last dose >10 years ago
	RSV	Recombinant (inactivated)	IM	50 yearsE	As per routine recommendations
	RubellaD	Live-attenuated	IM or SC	6 months	As per routine recommendations
	Varicella (chickenpox)	Live-attenuated	IM	9 months	As per routine recommendations
	Zoster (shingles)	Recombinant (inactivated)	IM	18 years	As per routine recommendations
Blood-borne and sexually transmitted	Hepatitis B	Recombinant (inactivated)	IM	Birth	Travellers to intermediate/high-endemicity regions at increased risk of exposure or travelling long term or frequently
	Human papillomavirus	Recombinant (inactivated)	IM	9/10 years	As per routine recommendations
Animal and environmental exposures	Rabies	Inactivated	IM or ID	Birth	Travellers to rabies-enzootic regions based on risk assessment considering likelihood of animal interaction and access to emergency medical attention
	TetanusC	Inactivated toxoid	IM	6 weeks	As per routine recommendations; booster if last dose >10 years ago; those at high risk of a tetanus-prone wound should have a booster if last dose >5 years ago

Footnotes

• A — Age listed is the minimum for all brands of that vaccine type; some brands have higher minimums. Administering at the minimum age/interval may affect Australian Immunisation Register eligibility and childcare subsidy compliance — see the Handbook’s table of minimum acceptable ages for NIP-funded vaccines in infants.
• B — The combination hepatitis A–typhoid vaccine was removed from the Australian market in 2024; monovalent options remain available.
• C — Available in combination formulation (e.g. diphtheria-tetanus- pertussis-polio; measles-mumps-rubella).
• D — Only approved clinics can administer yellow fever vaccination — see health.gov.au’s yellow fever page.
• E — Also available on the NIP schedule for pregnant women between 28 and 36 weeks’ gestation.

Practical considerations

• Consult 4–6 weeks before travel for optimal protection, but even last-minute travellers benefit — a single hepatitis A dose is effective even given on the day of departure, and a yellow fever certificate becomes valid from 10 days after vaccination.
• Co-administration minimises visits and protection delays. Deltoid is the recommended IM site from 12 months of age; up to two injections can be given per site, 2.5 cm apart.
• Live injectable viral vaccines (MMR, yellow fever, Japanese encephalitis) should be given simultaneously or spaced ≥4 weeks apart. BCG can be given at the same time as, or any time after, other vaccines including MMR.
• Refer to a specialist travel medicine clinic where risk assessment or vaccine decisions are complicated — immunosuppression, pregnancy, extremes of age (especially for live vaccines like yellow fever), or complex multi-country itineraries needing vaccines less familiar to general practice.
• With the exception of rabies, most travel vaccine schedules are straightforward — the harder part is the logistics: a dedicated vaccine fridge stocked with the full range of travel vaccines lets a practice offer a “one-stop-shop” so both doctor and patient can be confident the agreed vaccines are actually given and the cold chain preserved, and a practice wanting to administer yellow fever vaccine itself needs accreditation as an approved yellow fever vaccine provider.

Recent changes

• Rabies — pre-exposure prophylaxis now has 4 schedule options, with no preferential recommendation between them (choose based on the individual’s circumstances and preferences):

  Schedule	Route	Doses	Notes
  3-visit	IM or ID	Days 0, 7, 21–28	Standard course
  2-visit	IM	Days 0, 7	Short-term protection only
  2-visit	ID	Days 0, 7 (2 injections/visit)	Short-term protection only; not for adults >50y (poor seroconversion)

  2-visit schedules must not be used in immunocompromised people. If further protection is needed after a 2-visit course, give a single IM booster at 1 year (adequate regardless of the original route, even if given later than 1 year). The ID route is off-label, restricted to providers experienced in the technique, and shouldn’t be used with chloroquine/mefloquine/hydroxychloroquine at the time of vaccination or within 1 month after (reduces immune response). Every traveller to an endemic area needs an animal-bite plan regardless of pre-exposure status — rabies immunoglobulin can be difficult to source in-country.

• Japanese encephalitis — a risk for travellers to Asia and, since 2022, documented locally in south-eastern Australia. Decision aids (monash.edu/vaccinedecisionaids-je) and risk calculators (vaxical.com) can help with the risk–benefit discussion.

• Mpox — recommended for people at risk of sexual exposure (e.g. GBMSM, sex workers), and worth considering for other travellers who may have sexual risk activities in countries with clade I transmission. Available only via state/territory health departments, not general practice stock. See Mpox — Vaccination for eligibility, the 2-dose schedule, side effects and time to protection.

• RSV — Abrysvo (Pfizer, ≥60y and pregnancy) and Arexvy (GSK, ≥50y with risk conditions) became available in 2024. Funded on the NIP for pregnant women since early 2025; otherwise recommended for ≥75y and 60–74y with additional risk factors, but privately funded.

• Dengue and chikungunya vaccines — not registered in Australia but accessible via the TGA’s Special Access Scheme; see Table below.

New, emerging or hard-to-source vaccines

Not routinely stocked in general practice — accessed via the TGA’s Special Access Scheme (SAS) or specific arrangements where noted.

Disease	Vaccine type	Route	Lower age limit	Status and considerations
Chikungunya (Ixchiq)	Live-attenuated	IM	18 years	Not registered; available via SAS. Consider for travellers to outbreak areas, particularly longer-stay and higher-severity-risk travellers
Chikungunya (Vimkunya)	Virus-like particle (inactivated)	IM	12 years	Not registered in Australia
Dengue (Qdenga)	Live-attenuated, 2 doses 3 months apart	SC	4 years	Not registered; available via SAS. Consider for travellers with laboratory-confirmed prior dengue infection travelling to risk areas for >4 weeks or on frequent trips
Tick-borne encephalitis (TBE)	Inactivated	IM	1 year	Not registered; available via SAS. Consider for high exposure risk (hiking/camping in forested endemic regions) during spring/summer, or relocating to an endemic area
Mpox	Non-replicating live-attenuated	SC	Birth	Available only via state/territory health departments — see Mpox — Vaccination
Tuberculosis (BCG)	Live-attenuated	ID	Birth	Licensed vaccine currently unavailable; other vaccines available under special prescribing arrangement. Recommended for children <5y, particularly VFR travellers, going to countries with high TB incidence (>40/100,000/year)

Two single-dose chikungunya vaccines are now available overseas: Ixchiq (live-attenuated, ≥18y) and Vimkunya (virus-like particle, ≥12y); neither is registered in Australia. Note on chikungunya vaccine safety: following reports of severe adverse events, Ixchiq (the live-attenuated option) was temporarily paused in older adults in the US and Europe in 2025; the pause was lifted after review, with age ≥65 retained as a precaution.

For dengue, a newer live-attenuated vaccine (Qdenga) given as two doses three months apart is available in Europe and, overseas, is considered for travellers aged ≥4 years with a history of dengue infection going to risk areas — the previously available Dengvaxia is being discontinued because of low global demand.

Yellow fever — a closer look

Yellow fever vaccine is highly effective and generally safe, but it’s the travel vaccine most likely to need genuine shared decision-making, particularly in older travellers — it can rarely cause serious, sometimes fatal, adverse events, and the Australian Immunisation Handbook singles out age ≥60 as a precaution requiring explicit risk counselling.

Recommendation: 1 dose for age ≥9 months travelling to an area with yellow fever transmission risk (includes expatriates and VFR travellers). An International Certificate of Vaccination or Prophylaxis (ICVP) has been valid for life under Australian policy since 16 June 2016, but only becomes valid 10 days after vaccination — factor this into last-minute travel planning. A booster after ≥10 years is recommended for specific groups: those pregnant or HIV-positive at the time of their 1st dose, extended stays in a high-risk location, travel to an area with an ongoing outbreak, or post-haematopoietic stem cell transplant.

Contraindications: anaphylaxis to a previous dose, any vaccine component, or eggs (though the vaccine has been safely given to some egg-anaphylactic children — discuss with an immunologist/allergist first); routine use in infants <9 months (outbreak settings may lower this to 6 months); severe immunocompromise; any history of thymus disorder (myasthenia gravis, thymoma, thymectomy, DiGeorge syndrome, thymic damage from chemoradiotherapy/GVHD) — this is a distinct and easy-to-miss contraindication, driven by an increased risk of vaccine-associated viscerotropic disease.

Precautions: adults ≥60 years have a higher risk of severe adverse events than younger adults — vaccinate only if genuinely travelling to an endemic country, and counsel on the (very low absolute) risk. Not recommended in pregnancy or when breastfeeding an infant <9 months except where exposure is genuinely unavoidable (vaccine-strain virus can transfer via breast milk, rarely causing probable vaccine-associated neurotropic disease in the infant — all reported cases resolved with normal neurological follow-up).

Adverse event rates by age:

Age	Neurologic disease	Yellow fever–like illness (viscerotropic)	Severe allergic reaction	Total	Death
60–69	1.6	1.0	1.8	4.4	0.5
≥70	2.3	2.3	1.8	6.4	1.1

Rates per 100,000 doses. The Handbook independently confirms vaccine-associated viscerotropic disease occurs in 3–4 cases per million doses overall, with older age and thymus disease history as the two identified risk factors — consistent with the table above.

For comparison, the risk of not vaccinating — estimated disease rates for travellers exposed for 2 weeks during peak transmission season (data based on local-resident exposure, likely an overestimate for typical travellers with less outdoor exposure and repellent use):

Destination	Illness	Death
West Africa	50	10
South America	5	1

Rates per 100,000 travellers. Between 1970–2011 there were just 9 reported cases of yellow fever in unvaccinated travellers — but a Brazil outbreak starting December 2016 infected 10 unvaccinated travellers over the following 15 months, 4 of whom died, underlining that low historical incidence doesn’t mean negligible risk during an active outbreak. West Africa’s transmission peaks July–October; South America’s peaks January–May. For destinations that don’t mandate vaccination, some older travellers may reasonably weigh non-vaccine precautions (repellent, covering clothing) more heavily — but this is a shared decision, not a default.