International travel health requirements are more complex than ever, with varying vaccination mandates, medical entry requirements, and health screening protocols across destinations. As a travel agent, understanding these requirements and guiding clients through proper medical preparation is essential for successful trips and client safety.
Understanding Vaccination Categories
Travel vaccinations fall into three categories, and agents must help clients understand which apply to their specific itinerary.
Routine Vaccinations: These are standard immunizations most people received as children or adults in their home countries. They include measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTaP), varicella (chickenpox), polio, and annual influenza vaccines. Before any international trip, clients should ensure these are current, as outbreaks of preventable diseases still occur globally.
Recommended Vaccinations: These depend on the destination, season, activities, and duration of travel. Examples include Hepatitis A and B, typhoid, Japanese encephalitis, rabies (for adventure travelers), and meningitis. While not legally required for entry, these protect against region-specific disease risks.
Required Vaccinations: Some countries legally require proof of specific vaccinations for entry, most commonly yellow fever. Failure to provide required documentation results in entry denial or forced quarantine. Some countries also maintain COVID-19 vaccination or testing requirements, though these are decreasing globally.
Yellow Fever: Critical Entry Requirement
Yellow fever vaccination is the most common legally required travel vaccine. Over 40 countries in Africa and South America require proof of vaccination, documented on an International Certificate of Vaccination (the "yellow card").
Who Needs Yellow Fever Vaccination:
- Travelers to countries with yellow fever risk (endemic countries)
- Travelers transiting through endemic countries, even without leaving the airport in some cases
- Travelers arriving from countries with yellow fever risk within 6 days to 2 weeks (varies by country)
Important Details: The vaccine must be given at least 10 days before travel to be valid. It's administered only at designated yellow fever vaccination centers. The certification is now valid for life (previously 10 years), but some countries may not recognize this change. The vaccine costs $200-$300 and may not be covered by insurance.
Medical Exemptions: People with egg allergies, immune system disorders, thymus disorders, or age under 9 months cannot receive the vaccine. Medical exemption letters from physicians are sometimes accepted, but many countries do not recognize exemptions and will deny entry.
Critical for agents: Always check if clients are transiting through yellow fever countries. A client flying to South Africa via Addis Ababa, Ethiopia needs the vaccine even though South Africa itself doesn't have yellow fever risk. This catches many travelers unprepared.
Malaria Prevention
Unlike most travel diseases, no malaria vaccine exists for travelers (though breakthrough vaccines are in early rollout in some African countries for children). Instead, malaria prevention relies on prophylactic medications and bite prevention.
Malaria Risk Destinations: Sub-Saharan Africa, parts of South Asia, Southeast Asia, Central and South America, and parts of the Middle East have varying levels of malaria risk. Risk varies by region within countries and by season.
Antimalarial Medications:
- Atovaquone-proguanil (Malarone): Taken daily starting 1-2 days before travel, during trip, and 7 days after. Well-tolerated with few side effects. Expensive ($100-$150 for a two-week supply).
- Doxycycline: Taken daily starting 1-2 days before, during, and 28 days after travel. Inexpensive ($20-$40) but can cause sun sensitivity and digestive issues.
- Mefloquine (Lariam): Taken weekly starting 2 weeks before, during, and 4 weeks after. Longer dosing schedule but weekly dosing is convenient. Can cause neuropsychiatric side effects in some people.
Clients need prescriptions from their doctors, and they must start medications before departure. Advise clients to consult travel medicine specialists 4-6 weeks before travel to determine the best option for their itinerary and medical history.
Region-Specific Health Requirements
Southeast Asia: Japanese encephalitis vaccine recommended for travelers spending extended time in rural areas, especially during rainy season. Dengue fever risk exists across the region with no widely available vaccine for travelers. Emphasize mosquito bite prevention.
Sub-Saharan Africa: Yellow fever vaccine often required. Malaria prophylaxis essential for most regions. Meningitis vaccine recommended for travel during dry season (December-June) to the "meningitis belt" from Senegal to Ethiopia. Typhoid and Hepatitis A vaccines strongly recommended.
South America: Yellow fever required for Amazon basin travel and some countries require it for entry. Altitude sickness considerations for Andean destinations like Peru, Bolivia, and Ecuador. Typhoid and Hepatitis A vaccines recommended.
Middle East: Meningococcal vaccine required for Hajj and Umrah pilgrims to Saudi Arabia. Polio vaccination required for travelers from certain countries. General food and waterborne disease precautions necessary.
India and South Asia: Typhoid and Hepatitis A vaccines highly recommended due to food and water contamination risks. Japanese encephalitis for rural travel. Rabies vaccine consideration for adventure travelers or those working with animals.
COVID-19 Considerations in 2025
While most countries have eliminated COVID-19 entry requirements, some maintain testing or vaccination requirements, particularly for unvaccinated travelers or arrivals from certain countries. China, Japan, and some Pacific islands may still require pre-departure testing.
Even without formal requirements, recommend clients:
- Ensure COVID-19 vaccinations are up-to-date
- Carry vaccination cards or digital proof
- Pack COVID-19 rapid tests for peace of mind
- Understand destination-specific mask requirements (some healthcare settings, public transport)
- Review travel insurance coverage for COVID-19 related trip disruptions
Medical Preparation Timeline
Advise clients to schedule travel medicine consultations 4-8 weeks before departure. This provides adequate time for multi-dose vaccine series and allows vaccines to become effective before travel.
8 Weeks Before Travel:
- Schedule travel medicine consultation
- Begin multi-dose vaccines (Hepatitis A/B, Japanese encephalitis, rabies)
- Obtain prescriptions for antimalarial medications
- Schedule yellow fever vaccination if required
4 Weeks Before Travel:
- Complete second doses of multi-dose vaccines
- Receive single-dose vaccines (typhoid, meningitis)
- Fill prescriptions for antimalarials and other medications
- Obtain travelers' diarrhea treatment antibiotics
2 Weeks Before Travel:
- Verify yellow fever certificate received and valid
- Confirm all vaccination records are complete
- Pack medical documentation and prescription medications
- Start antimalarial medication if prescribed
Finding Travel Medicine Specialists
Regular primary care physicians may not have current travel medicine knowledge. Direct clients to specialists through:
- International Society of Travel Medicine (ISTM) clinic directory
- CDC's travel clinic finder tool
- Local travel medicine clinics affiliated with universities or hospitals
- Passport Health or other travel medicine clinic chains
Travel medicine consultations typically cost $150-$300 plus vaccine costs. Most insurance plans don't cover travel-specific vaccines, though some vaccines (Hepatitis A/B) may be covered as routine immunizations.
Medical Documentation for Travel
Clients should carry:
- International Certificate of Vaccination (yellow card) for yellow fever and other required vaccines
- Copies of prescriptions for all medications in their original containers
- Letter from physician explaining medical conditions and necessary medications
- List of drug allergies and current medical conditions
- Contact information for their physicians at home
- Blood type information (especially important for destinations with limited medical facilities)
For controlled substances (pain medications, ADHD medications, anxiety medications), clients need physician letters and should check destination-specific regulations. Some countries heavily restrict or ban medications commonly used in Western countries.
Special Considerations for Different Travelers
Pregnant Travelers: Many vaccines are contraindicated during pregnancy. Yellow fever vaccine should be avoided except when travel to high-risk areas is unavoidable. Malaria during pregnancy can be severe. Pregnant clients should consult obstetricians before international travel and consider postponing trips to high-risk areas.
Immunocompromised Travelers: Live vaccines (yellow fever, MMR, varicella) are generally contraindicated. These travelers need specialized advice from travel medicine specialists and infectious disease physicians. Some destinations may be inadvisable due to infection risks.
Elderly Travelers: May need updated routine vaccines (shingles, pneumonia) before travel. May have contraindications for certain travel vaccines due to health conditions. Require extra attention to altitude, heat, and physical demands of itineraries.
Children: Vaccine schedules differ from adults. Some destinations have increased disease risks for children. Yellow fever vaccine not given before 9 months of age (some experts recommend waiting until 12 months). Malaria can be severe in children requiring careful medication selection.
Creating a Health Information Sheet
Develop a standardized health information sheet for clients that includes:
- Destination-specific vaccine requirements and recommendations
- Timeline for vaccination schedule
- Travel medicine clinic referrals in their area
- Malaria risk assessment and prevention advice
- Food and water safety guidelines
- Emergency medical contact information for destination
- Travel insurance information including medical evacuation coverage
Provide this at booking confirmation, allowing adequate time for medical preparation. Follow up 6 weeks before departure to verify clients have scheduled medical appointments.
Agent's Professional Responsibility
While you're not a medical professional, you have a duty to inform clients about health requirements and strongly recommend they consult travel medicine specialists. Document all health information provided to clients and any advice given.
Never provide medical advice beyond referring clients to appropriate medical professionals. However, you should be knowledgeable enough to explain why health preparation is important and what resources are available.
Visit dmcquote.com to access destination-specific health requirement guides, or login to your agent portal for printable vaccination checklists and client health information templates. For questions about health requirements for specific itineraries, contact our team for guidance.
Proper medical preparation ensures your clients travel safely and helps you build a reputation as a thorough, professional travel agent who prioritizes client wellbeing above all else.
