Vaccine Recommendations for Travelers Under 2 Years Old

Routine childhood immunizations should be up to date or accelerated prior to travel.
The following vaccines should be reviewed with a health care provider as far in advance of travel as possible to ensure the proper scheduling of recommended vaccines. The number of doses of routinely recommended vaccines a child needs depends on his or her age.

Infants and children up to 2 years of age should have received at least 3, and preferably 4 doses, of diphtheria, tetanus and acellular pertussis (DTaP) vaccine by 2 years of age. One dose of DTaP affords little protection, 2 doses provide some protection and 3 doses 70 percent to 80 percent protection. Parents must be aware that a child with less than the minimum of 3 recommended doses of DTaP may not be protected from pertussis. Travelers should consider receiving the remaining doses of the vaccine at the recommended intervals (at least one month between each of the first 3 doses; six months between the third and fourth dose) while abroad.

Measles, mumps and rubella (MMR) vaccine should be administered to all children 12 months of age or older. Measles vaccine or MMR may be given to infants 6 to 11 months of age who are going to areas of high risk for measles. Infants less than 6 months of age are protected by maternally derived antibodies.

Three doses of inactivated polio vaccine (IPV) are recommended for all infants and children by 2 years of age. If an unvaccinated child is traveling in less than four weeks to an area where polio is known to be present, a single dose of oral polio vaccine (OPV) is recommended. If four or more weeks is available before travel, IPV is recommended, with four weeks separating the 3 doses.

Three doses of hepatitis B vaccine are recommended for all children by 2 years of age. The vaccination series may be begun at birth. The first 2 doses should be separated by at least four weeks. The third dose should follow the second dose by at least two months, and be given at least four months after the first dose. The third dose should not be given before 6 months of age.

Three or 4 doses (depending on the brand of vaccine used) of Hib vaccine are recommended by age 2 years. The vaccine can be given as early as 6 weeks of age, and each of the first 2 or 3 doses should be separated by at least four weeks. The last (third or fourth) dose of the series should be given on or after 12 months of age.

The following immunizations may be recommended:

• Immune globulin for protection against hepatitis A is recommended for infants and children under 2 years of age traveling to areas of the world with intermediate or high rates of hepatitis A. Hepatitis A vaccines are not currently licensed for use by children under 2 years old.
• For typhoid fever, breast-feeding is likely to protect infants. Careful preparation of formula and food from boiled or chlorinated water can help protect non-breast-fed infants and children up to 2 years of age. The old, injectable killed typhoid fever vaccine is licensed for use in children as young as 6 months of age. The new injectable ViCPS typhoid vaccine is recommended for children between 2 and 6 years of age traveling to areas where there is questionable sanitation.
• For meningococcal vaccine, effectiveness of the vaccine in children is dependent upon the child's age when the vaccine is administered. Protection may not be completely effective in children vaccinated between 3 months and 2 years, especially for vaccination before 3 months of age. The vaccine may be safely given to infants, but it may be less effective than in adults.
• Yellow fever vaccine should not be administered to any infant under 4 months of age and children 4 to 6 months old should be considered only under very unusual circumstances. Infants 6 to 9 months old can receive the vaccine if they cannot avoid traveling to areas of risk and when a high level of protection against mosquito bites is not possible. Infants 9 months or older should be vaccinated as required or recommended for travel to South America or Africa.
• One cholera vaccine, administered parenterally with a 2-dose primary series, is currently licensed in the United States. The risk of cholera to U.S. travelers of any age is so low that it is questionable whether vaccination is of benefit. No data are available concerning the efficacy or side effects of cholera vaccine in children less than 6 months of age. Cholera vaccine is not recommended for children less than 6 months of age. Breast-feeding is protective against cholera; careful preparation of formula and food from safe water and foodstuffs should protect non-breast-fed infants. If a child under 6 months old is traveling to areas requiring cholera immunization, a medical waiver should be obtained before travel. For older infants and children traveling to areas that require vaccination, a single dose of vaccine is sufficient to satisfy local requirements.

Source: American Academy of Pediatrics