Traveling to France and Italy this May...are there any vaccination requirements for these two countries. Thanks very much. NG

Hi naturegirl,

If you're American, living in the US there are no required vaccinations. You might consider updating your tetnus shot if you haven't had one in 10 years.

Adrienne is correct on both counts.

Thanks very much for the information - sounds like I need to roll up my sleeve for a shot! NG

While it is somewhat resposible to keep your tetanus immunization up to date, it's worth remembering how you get tetanus: from an infected wound. If it's bad enough to need stitches, almost any emergency room anywhere will insist on giving you a new tetanus shot, unless perhaps you have documentation of when you last had one.

I think that most adults, say... over age 22... just figure that they'll get their tetanus immunization up to date if and when they sustain such a wound.

Of course, this assumes that you WILL seek medical care for those notorious kinds of wounds that don't seem to NEED medical care (stepping on an up-pointing nail), but likely to be a set-up for tetanus.

Best wishes,

Rex

Indeed, puncture woulnds are much more likely to convey tetanus compared to wounds that bleed freely, washing away infectious materials.

Talk to your doctor or a travel health specialist (often in your local health department or university). The CDC, in cooperation with several other groups (e.g. American Academy of Family Practitioners) has recently released vaccintion recommendations for adults (not just travelers), reccommending that certain adults get not only a tetanus booster but also Hepatitis, rabies, and chicken pox if they didn't have chicken pox as a child. If you travel a lot (even to developed countries), it's proabably not a bad idea (but again, talk to your doctor). It's also a good idea to get a flu shot before traveling if they still have a supply where you live.

Andrea... rabies? No such recommendation that I can find, and I think that the other two are mentioned out of context - - having essentially nothing to do with travel to Western Europe.

For rabies, "pre-exposure" prophylaxis is only recommended for SOME (not all) veterinarians and other high risk animal workers who might be bitten by an (infected) animal. There is essentially no other way to get rabies.

Chickenpox? 90% of adults (in the US) are immune to chickenpox (you mention this, admittedly) due to prior immunity from a childhood infection. But of the other 10%, only pre-school teachers and other high risk groups are among those adults for whom immunization is recommended.

Hepatitis (B) is quite another story. You get this from dirty needles, blood products, or sex. Little by little, there is the goal to get the entire population (starting with the Western world, it seems) immunized. Babies have been immunized from birth for over a decade here in the US, and almost all "health care workers" are supposed to be immunized, as an at risk group. No one thinks it is a bad idea, nor a waste of time to immunize any other adult - - but any individual's decision ought to be based on likely exposure - - through one of those three modes mentioned above.

If your travel will possibly include unprotected sex, then hepatitis B immunization would be a good idea - - true whether you are traveling across town, or across an ocean.

I am NOT a "travel medicine" expert, nor do I even treat adults, healthy or otherwise. But I think this is all accurate information.

As an addendum, "bleeding the bacteria out" is just part of the explanation on tetanus susceptibility. The tetanus organism requires an oxygen-free environment, such as in some kinds of dirt or some "closed" wounds. Exposure to air, as well as blood helps prevent tetanus in non-immune individual's wounds.

None of this is to be considered medical advice to any particular individual.

Rex Bickers, M.D.

I'd be more concerned with HepA, than HepB, which isn't even recommended to NGOs, Peace Corp, etc. unless they plan to be away and in contact with blood for more than 3-months.

HepA can be contracted anywhere, even at home. Any food preparer, regardless if at the finest restaurant, who has not or doesn't wash hands when leaving the bathroom, or if earlier diapering a baby with the runs - can infect everyone.

Though most of us don't think about needing any inoculations while at home or in western countries, we should realize that the inoculations we had as children have long lost their protective life.

Since most inoc - such as Tetanus, HepA/B, are good for 10 years, those from their 40s and up should, in consultation with their physician, bring their inocs up-to-date.

As to "exotic" travel (Africa, Asia, Eastern Europe, India, some Pacific/Atlantic Islands - Yellow Fever (if required by country you are visiting), even a Polio booster, should be considered.

Once you get into the habit of being current with basic inocs, you won't be surprised when one is required for travel to a particular destinations.

In terms of "needed" immunizations, if you are actually going to seek out a travel specialist or a "travel clinic" you might also ask about the possibility of having titres drawn for certain diseases such as Varicella (Chicken pox), Measles, etc., before getting innoculations. This way immunity from childhood (or adulthood) can be verified and there is no reason to receive a "booster" for something you already have adequate immunity to.

Emergency Rooms in this country almost inevitably recommend a Tetanus booster if a "dirty" wound is involved unless, as was previously stated, you are certain you've had a booster recently..even then a lot of folks get another booster on the spot just for "certainty."
As Rex has very carefully disclaimed, none of this can be taken as actual "medical advice" since that would imply the practice of medicine out of the jurisdiction covered by the license belonging to the particular advice giver.

Seek out professional care where you live and abide by that.