Advise Patients About Travel Vaccines

Over the past few years, especially through the various stages of the COVID-19 pandemic, community pharmacies have become the primary place for people to receive vaccines.¹ In fact, of the approximately 32.2 million doses of updated 2023-2024 COVID-19 vaccines administered in the US, community pharmacies have administered nearly 30 million as of March 9, 2024.2 With growing numbers of patients looking to their local pharmacist for their vaccination needs, it is important for pharmacists to be prepared to recommend and administer all vaccines. It is not an exaggeration to say pharmacists are now widely considered vaccine experts, so it is critical that they be prepared to discuss not only routine vaccines such as influenza, COVID-19, varicella-zoster, and pneumococcal, but ones that are less common, as well.

Examples of nonroutine vaccines are those required for travel. As international travel returns to prepandemic rates, travelers who need vaccinations for their destinations will likely consult their pharmacists for assistance. It is possible that some pharmacists may not have experience in administering vaccines that provide protection against yellow fever virus, Japanese encephalitis virus, cholera, rabies virus, and typhoid fever. However, many pharmacists have provided doses of vaccines intended for travel purposes for different indications, such as those that offer protection against hepatitis A; hepatitis B; measles, mumps, and rubella; meningococcal disease; and tetanus.¹ Although vaccination laws vary by state, pharmacists can generally administer all travel-related vaccines either through their prescriptive authority or a vaccine protocol in collaboration with a physician.

For pharmacists who are unfamiliar with travel health, continuing education courses are available on multiple platforms. 3 The first step in any travel vaccine consultation is gathering information from the patient. Recommendations will vary based on factors such as destination, duration of travel, lodging, altitude, and planned activities, among others. It should be noted that many travel health consultations also include prophylactic medications and behavioral advice.

The CDC provides a resource that allows health care providers to enter a traveler’s destination and view vaccine recommendations for that area.⁴ This information changes based on current disease activity and other factors, such as seasonal variations in risk (eg, mosquitos are more prevalent in some areas during the rainy season). Although there are many resources for pharmacists to use when preparing travel vaccine recommendations, the CDC’s website is a common starting point.

When recommending and administering travel vaccines, pharmacists should consider that many vaccines require multiple doses before the traveler’s departure date.¹ Therefore, they should encourage patients who are taking trips to new or unfamiliar countries to have a travel health consultation at least 1 month before traveling. In some cases, accelerated dosing schedules are available for vaccines that are normally administered over a longer period. For example, it takes 6 months to be fully protected against hepatitis B when using traditional vaccine products and their dosing schedules. However, the time to effectiveness can be reduced to just 1 month using a 2-dose series of the recombinant,-adjuvanted hepatitis B vaccine (Heplisav-B; Dynavax) or accelerated dosing of the combination hepatitis A and hepatitis B vaccine (Twinrix; GSK).^5,6

Another consideration for pharmacists when recommending travel-related vaccines is that some countries require proof of vaccination for certain vaccines, such as the yellow fever vaccine. Importantly, only providers that have registered with their local jurisdiction’s department of health can administer the yellow fever vaccine. Some countries require all travelers to show proof of yellow fever vaccination before entering the country in the form of an International Certificate of Vaccination or Prophylaxis.⁷ Other countries require proof of vaccination from travelers arriving from countries with a risk of yellow fever virus exposure. Yellow fever is most prevalent in African countries such as Burundi, the Gambia, Cameroon, Ghana, Sierra Leone, Guinea, Chad, and Sudan.⁸ Pharmacists can help patients not only get vaccinated, but also help navigate situations for people visiting multiple countries, as the order of travel may be important if one of the countries is at high risk for yellow fever.

Community pharmacists are providing more vaccines than ever, and those related to travel health are no exception. Pharmacists who are familiar with these vaccines and the resources available to help create travel health recommendations will be better prepared to serve their patients’ needs and keep them protected while traveling.

References

1. Need travel vaccines? Plan ahead. CDC. Updated January 13, 2023. Accessed February 19, 2024. https://wwwnc.cdc.gov/travel/page/travel-vaccines

2. Weekly COVID-19 vaccination dashboard. CDC. Updated April 3, 2024. Accessed April 3, 2024. https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/vaccination-dashboard.html

3. Travel medicine. Pharmacist’s Letter. Accessed February 19, 2024. https://pharmacist.therapeuticresearch.com/Browse/Results?id=%7BAA4E0EC7-2A02-4ECE-90DF-9CDD9A2504AD%7D&parentid=%7B9699B0E4-2B97-47AA-A093-045A928D8C5B%7D

4. Travelers’ health. CDC. Accessed February 19, 2024. https://wwwnc.cdc.gov/travel/

5. Hepatitis B. CDC. Updated November 8, 2022. Accessed February 19, 2024. https://wwwnc.cdc.gov/travel/diseases/hepatitis-b#:~:text=It%20usually%20takes%206%20months,A%20and%20hepatitis%20B%20vaccine

6. Twinrix. Prescribing information. GSK; 2023. Accessed February 19, 2024. https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Twinrix/pdf/TWINRIX.PDF

7. International Certificate of Vaccination or Prophylaxis (ICVP). CDC. Updated October 13, 2023. Accessed February 19, 2024. https://wwwnc.cdc.gov/travel/page/icvp#:~:text=Yellow%20fever%20vaccination%20(travel)%20clinics,after%20the%20date%20of%20vaccination

8. Yellow fever maps. CDC. Updated January 15, 2019. Accessed February 19, 2024. https://www.cdc.gov/yellowfever/maps/index.html