Travel vaccinations for Marshall Islands

Hepatitis A is a viral infection transmitted through contaminated food and water or by direct contact with an infectious person. Symptoms are often mild or absent in young children, but the disease can be more serious with advancing age. Recovery can vary from weeks to months. Following hepatitis A infection immunity is lifelong. All travellers should take care with personal, food and water hygiene. As hepatitis A vaccine is well tolerated and affords long-lasting protection, it is recommended for all previously unvaccinated travellers.

Tetanus is caused by a toxin released from Clostridium tetani bacteria and occurs worldwide. Tetanus bacteria are present in soil and manure and may be introduced through open wounds such as a puncture wound, burn or scratch. Travellers should thoroughly clean all wounds and seek medical attention for injuries such as animal bites/scratches, burns or wounds contaminated with soil. Travellers should have completed a tetanus vaccination course according to the UK schedule. If travelling to a country or area where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously. Country-specific information on medical facilities may be found in the 'health' section of the FCDO foreign travel advice pages.

Typhoid is a bacterial infection transmitted through contaminated food and water. Previous typhoid illness may only partially protect against re-infection. Vaccination is recommended for most travellers, particularly travellers visiting friends and relatives, those in contact with an infected person, young children, frequent or long-stay travellers visiting areas where sanitation and food hygiene are likely to be poor, and laboratory personnel who may handle the bacteria for their work. All travellers should take care with personal, food and water hygiene. Oral and injectable typhoid vaccinations are available.

Dengue is a viral infection spread by mosquitoes which mainly feed during daytime hours. It causes a flu-like illness, which can occasionally develop into a more serious life-threatening illness. Severe dengue is rare in travellers. The mosquitoes that spread dengue are more common in towns, cities and surrounding areas. There is a risk of dengue in this country.Information on current outbreaks, where available, will be reported on our outbreak surveillance database. Travellers should avoid mosquito bites, particularly during daytime hours. Vaccination can be considered for individuals aged 4 years of age and older who have had dengue infection in the past and who are: travelling to areas where there is a risk of dengue infection or areas with an ongoing outbreak of dengue, or are exposed to dengue virus through their work, such as laboratory staff working with the virus Exceptionally, vaccination can be considered in those who have not had dengue in the past. In these situations, further expert advice should be considered. Detailed guidance on how to ascertain previous infection is available in the UK Health Security Agency Immunisation against infectious disease the 'Green book'. The final decision on vaccination rests with the health professional and the traveller after a detailed risk assessment has been performed and the potential risks of vaccination explained.

Hepatitis B is a viral infection spread through blood, semen and vaginal fluids. This mostly occurs during sexual contact or as a result of blood-to-blood contact (for example from contaminated equipment during medical and dental procedures, tattooing or body piercing procedures, and sharing of intravenous needles). Mothers with the virus can also pass on the infection to their baby during childbirth. This country is considered to have an intermediate or high prevalence of hepatitis B. Travellers should avoid contact with blood or body fluids. This includes: Avoiding unprotected sexual intercourse. Avoiding tattooing, piercing, public shaving, and acupuncture (unless sterile equipment is used). Not sharing needles or other injection equipment. Following universal precautions if working in a healthcare or other higher risk setting. A sterile medical equipment kit may be helpful when travelling to resource poor areas. Vaccination could be considered for all travellers and is recommended for those whose activities or medical history put them at increased risk. This includes: Those who may have unprotected sex. Those who may be exposed to contaminated needles through injecting drug use. Those who may be exposed to blood or body fluids through their work (e.g. health and aid workers). Those at high risk of requiring medical or dental procedures or hospitalisation e.g. those with pre-existing medical conditions, those who may require travelling for medical care abroad, or those travelling to visit families or relatives. Long-stay travellers. Those who are participating in contact sports. Families adopting children from this country.

Although rare, bat lyssaviruses (bat rabies) can be transmitted to humans or other animals following contact with the saliva of an infected bat most often by a bite. The disease can also be transmitted if the saliva of an infected bat gets into open wounds or mucous membranes (such as on the eye, nose or mouth). Bat lyssaviruses can cause disease in humans that is indistinguishable from rabies. Symptoms can take some time to develop, but when they do the condition is almost always fatal. The risk to most travellers is low. However, it is increased for certain occupations for example bat handlers and veterinarians, or certain activities such as caving. Rabies has not been reported in this country; therefore most travellers are considered to be at low risk. However, bats may carry bat lyssavirus (bat rabies). Travellers should avoid contact with bats. Bites from bats are frequently unrecognised. Rabies-like disease caused by bat lyssaviruses is preventable with prompt post-exposure rabies management. Following a possible exposure, wounds should be thoroughly cleansed and an urgent local medical assessment sought, even if the wound appears trivial. Although rabies has not been reported in other animals in this country, it is sensible to seek prompt medical advice if bitten or scratched. It is possible, although very rare for bats to pass rabies like viruses to other animals including pets. Post-exposure treatment and advice should be in accordance with national guidelines. A full course of pre-exposure vaccines simplifies and shortens the course of post-exposure treatment and removes the need for rabies immunoglobulin which is in short supply world-wide. Pre-exposure rabies vaccinations are recommended for those who are at increased risk due to their work (e.g. laboratory staff working with the virus and those working with bats). Pre-exposure vaccines could be considered for those whose activities put them at increased risk of exposure to bats.

TB is a bacterial infection most commonly affecting the lungs but can affect any part of the body. When a person with TB in their lungs or throat coughs or sneezes they could pass TB on to other people. TB is curable but can be serious if not treated. The BCG vaccination helps to protect some people, particularly babies and young children who are at increased risk from TB. This country has reported an annual TB incidence of greater than or equal to 40 cases per 100,000 population at least once in the last five years (further details). Travellers should avoid close contact with individuals known to have infectious pulmonary (lung) or laryngeal (throat) TB. Those at risk during their work (such as healthcare workers) should take appropriate infection control and prevention precautions. BCG vaccine is recommended for those at increased risk of developing severe disease and/or of exposure to TB infection. See UK Health Security Agency Immunisation against infectious disease, the 'Green Book'. For travellers, BCG vaccine is recommended for: Unvaccinated, children under 16 years of age, who are going to live for more than 3 months in this country. A tuberculin skin test is required prior to vaccination for all children from 6 years of age and may be recommended for some younger children. Unvaccinated, tuberculin skin test-negative individuals at risk due to their work such as healthcare or laboratory workers who have direct contact with TB patients or potentially infectious clinical material and vets and abattoir workers who handle animal material, which could be infected with TB. There are specific contraindications to BCG vaccine. Health professionals must be trained and assessed as competent to administer this vaccine intradermally. Following administration, no further vaccines should be administered in the same limb for 3 months. The BCG vaccine is given once only, booster doses are not recommended.