Pharmacists: travel vaccines and health advice

Information for pharmacists when advising clients on travel vaccinations and staying healthy while travelling.

Travellers may visit your pharmacy to ask for advice about travel vaccinations or over the counter medications. Travellers may also present with a travel vaccine prescription from their general practitioner (GP).

This travel consultation is an important opportunity to discuss a traveller's plans and minimise their health risks.

The travel consultation

As well as vaccination, overseas travellers need information about other risks to their health. You can provide this travel advice during a vaccine consultation.

You can identify potential health risks by reviewing the traveller's itinerary. You should take into account their destination, medical history and health status.

The consultation will:

inform the traveller of risks and methods for prevention, including safe behaviours
supply and administer appropriate travel vaccinations
recommend medication for prophylaxis or self-treatment of travel-related illness
refer the traveller to their doctor for relevant prescribed medication
recommend they have adequate travel insurance.

Travel risk assessment framework

Use the – This Person, This Trip, This Time – framework to assess a traveller’s risk. Below is a summary of the considerations in this framework. A person identified as high risk should be referred to their GP, or a travel clinic for additional review and advice.

This person

age – especially the very young or elderly
general health and fitness
medical history and chronic conditions
medications and the need for adequate supplies and appropriate storage
allergies – especially if past history of anaphylaxis
immune status – past exposures, past immunisation, and immunocompromised status due to medical conditions or medical treatment.

This trip

urban, rural or remote
extremes of climate and altitude
length of trip, and risk of exposure
purpose of travel – holiday, business, visiting friends and relatives, expatriate, disaster relief or aid work
style of travel – accommodation, cruise holidays, transport, dining
specific or unusual activities
exposure to animals.

This time

wet or dry season
current disease outbreaks
political unrest
weather events
mass events that may increase risk.

Vaccine review framework

The Three R's framework – Required, Routine, Recommended – can be applied to determine the appropriate vaccines for the traveller.

When applying the framework you will:

Determine if vaccines are required to cross international borders under International Health Regulations or specific country requirements. See the WHO International Travel and Health website for detailed information about requirements for travel.
Ensure the person is up to date with routine immunisations in accordance with the National Immunisation Program Schedule and the Australian Immunisation Handbook.
Determine which additional vaccinations should be recommended based on review of the itinerary, individual circumstances and past immunisation history. See Fit For Travel (UK) or Travellers' Health (USA) for more information.
Develop and record a vaccination schedule that includes all the traveller’s vaccines. Considerations include:
- Immunise opportunistically and pragmatically. Unless there are significant concerns about side effects developing while away, it is never too late to vaccinate before a trip. Particularly for longer trips, some immunity will develop during travel. Immune priming will also occur that could benefit future travel. Advice regarding incomplete immunity should be provided when relevant.
- If necessary, use accelerated vaccine regimes to provide the best possible protection during the trip, as per the Australian Immunisation Handbook.
- Ensure appropriate spacing between vaccine doses, including those given elsewhere noting that if two live vaccines are to be given they must be given together or at least four weeks apart.
- Ensure that the person is aware of future visits to complete vaccination courses.
- Discussion of available combination vaccines.
Refer to the traveller’s doctor or a travel medicine clinic for additional vaccinations that are indicated, but not authorised for supply without prescription in the ACT. Considerations include:
- Vaccines such as Japanese encephalitis, rabies, oral typhoid, cholera, mpox, and tick-borne encephalitis.
- Where travel itinerary includes travel to a Yellow Fever endemic region, vaccination may be indicated and can only be provided by authorised providers.

When to refer a traveller

You are encouraged to refer any traveller to their GP or travel health clinic if they feel additional assessment or advice is required.

Use the following checklists to identify high risk travellers that should be referred.

Travel itinerary

travel to altitude >2500m above sea level
exposure to extreme heat or extreme cold
risk of malaria – patient may require prescription for antimalarial prevention
prolonged visits to developing countries
volunteer, missionary, or aid work including disaster relief
risk of yellow fever, Japanese Encephalitis or tick-borne encephalitis
risk of exposure to Zika virus when pregnant or planning pregnancy, including for male partners
increased risk of animal bite, or likely poor access to post-exposure rabies prophylaxis.

Patient history

pregnancy
disability that may be impacted by travel
immunocompromise or immunosuppression (including splenectomy or non-functional spleen)
traveller is aged 65 years or more
traveller is under age 5
surgery or hospitalisation within last 3 months
underlying chronic health conditions requiring additional support
past history of deep vein thrombosis or pulmonary embolism or high risk of thromboembolic events
prescription medication may be needed for the trip:
- prevention or emergency treatment of malaria
- management of jet lag
- precautionary antibiotics
- HIV PrEP
- adequate supply of regular medications
previous Dengue infection and potential for exposure during intended travel.

Discussing health care needs

The following table will assist you to conduct a travel consultation. The table lists topics for discussion relevant to individual travel plans and the traveller’s health status.

Considerations	Discussion topics
Medication management	Ensure the traveller has sufficient supply of medications for the expected trip plus any delays. Discuss medication management whilst travelling - original packaging, time zone changes, appropriate storage. Ensure that the traveller has an official letter listing all prescribed medications, and/or a medication management app listing their medications. Discuss issues around travelling with medications that are restricted in destinations in the traveller’s itinerary.
Food and water borne diseases	Discuss strategies to minimise food and water borne illness. Discuss medications which could be used to self-manage diarrhoeal illness. Discuss strategies to treat water for drinking, if indicated. Discuss vaccines that can be used to prevent food and water borne illness such as Hepatitis A, Typhoid, cholera.
Respiratory illnesses	Discuss hand and respiratory hygiene. Consider those at higher risk of severe outcomes and preventative strategies. Consider evidence-based supply of non-prescription medications.
Vector borne diseases	Educate travellers of risk of vector-borne diseases based on travel itinerary, including high risk time periods and activities. Inform travellers that avoiding mosquito (or other relevant insect) bites is essential. Advise travellers on insect-bite avoidance and prevention strategies including appropriate repellents, clothing, insecticide treatments for clothing and mosquito nets.
Deep vein thrombosis (DVT) and pulmonary embolism (PE)	Assess risk of DVT. Give standard advice to all travellers. Discuss appropriate use of stockings, if indicated. Refer possible high-risk travellers to their doctor.
Environmental hazards – extreme temperatures	Ensure the person is properly equipped for the anticipated environmental conditions, including: cold and wet weather clothing hat, sunglasses, sunscreen and protective clothing such as long-sleeved shirts and trousers first aid kit.
Environmental hazards – altitude	Discuss risk and how to minimise based on itinerary. Refer for appropriate treatments for altitude sickness.
Fresh water and soil infections	For high-risk itineraries, advise of the risk of contracting infections through skin exposed to contaminated soil or freshwater.
Sexual health and blood borne pathogens	Advise travellers to: practise safe sex when abroad with new partners consider taking own condoms avoid skin penetrating procedures like tattoos, acupuncture, or manicures.
Rabies	Assess risk of rabies exposure including place, remoteness, personal factors (age or interaction with animals). Consider need for pre or post exposure prophylaxis. Advise avoidance of all contact with animals, including those in tourist sites and national parks, to reduce the potential for bites and scratches that can transmit rabies. If bitten or scratched by an animal, advise the traveller to wash the wound immediately and thoroughly with soap and water and seek medical assistance as soon as possible.
Jet lag	Commonly affects travellers crossing more than 5 time zones, particularly in an easterly direction. Advise person to avoid coffee and alcohol, drink plenty of water. Particularly for business travellers, be well rested in the days before travel.
Motion sickness	If prone to motion sickness, advise the person to avoid activities requiring close concentration such as reading. Don't eat large meals prior to or during the journey. Medications can be used in children and adults if appropriate.
Over-the-counter medications and first aid items	Individuals may want to consider carrying some over-the-counter medications and first aid items. This will depend on factors including general health, travel itinerary, and access to items at destination. Consider appropriate items, including: alcohol-based hand rub analgesics/antipyretics anti-diarrhoeal medication antifungal cream antiseptic liquid, cream or ointment condoms decongestant or saline nasal spray dressings and bandages ear plugs for use in-flight insect repellent mild corticosteroid cream motion sickness medication rehydration products sunscreen sports tape thermometer water purification tablets. Remind the person that frequently used medicines available in the supermarket or in pharmacies in Australia may not be as readily available overseas. Medications with poor evidence of effect should not be provided.

Links for further information

For pharmacists

Australian Immunisation Handbook – Vaccination for International Travellers
Australian Department of Health and Aged Care – Health Alerts
Department of Foreign Affairs and Trade, safety and security advice – Smartraveller.gov.au
World Health Organization – International Travel and Health
Centers for Disease Control and Prevention (USA) – Clinician Resources
National Travel Health Network & Centre (UK) – Travel Health Pro
Program for Monitoring Emerging Diseases – ProMed mail
NSW Health – Webinar for pharmacists on vaccination expansion
National Health Service (UK) – Fit for Travel

For travellers

Australian Department of Health – Travel Health Information
HealthDirect – Travel Health Advice
Department of Foreign Affairs and Trade – Health advice for travelling Australians
Medicare – Travelling Overseas with PBS Medicines
Therapeutic Goods Administration – Travelling with Medicines or Devices
Services Australia – Reciprocal Health Care Agreements
World Health Organisation – Travel advice
Centers for Disease Control and Prevention (USA) – Travellers' Health

Content on this page has been modified from NSW Health, with thanks.