When going to many parts of the world, it is recommended that certain vaccines are taken as a precaution against many diseases. The Center for Disease Control have a list of vaccines that are recommended before travel, but one important factor to know is that all of these vaccines, apart from one, are only recommended, not mandatory. No other vaccine apart from yellow fever is required for travel.

So, if that is the case, then it is important to review the other vaccines to evaluate the risks and benefits of each of them. This is perhaps especially the case when getting children vaccinated, as they have already been vaccinated against many diseases.

The following vaccines are often recommended for travel:

Hepatitis B: this is a viral infection spread through contact with blood. It is different than Hepatitis A which is the most commonly caught form of hepatitis. The latter condition is a virus passed through the fecal-oral route due to contaminated water. The only real chance of catching Hepatitis B when traveling is through intimate contact with someone who is infected or through other forms of blood contamination eg sharing dirty needles. Therefore, the risk of getting Hepatitis B is extremely low and even if hepatitis B is caught, more than 95% of those who contract hepatitis B fully recover. No one would want to get Hepatitis B as the symptoms can make a person very ill, with classic symptoms of jaundice, liver enlargement, exhaustion and inability to take fats and other rich foods but the vaccine itself is also very controversial, with potentially serious side effects and has been stopped in certain countries, including France.

Hepatitis A produces similar symptoms to Hepatitis B and can make a person quite ill. However, the vast majority of people recover from the disease, but it is much easier to catch than Hepatitis B and many long- term travelers in the Indian subcontinent and Africa catch hepatitis. The best way to avoid the disease is through personal hygiene, eating in clean places that wash vegetables and fruit thoroughly, avoid eating raw fruits and vegetables unless peeled, drinking clean water and generally keeping good hygiene. There is now a vaccine for hepatitis A using a killed virus, which is apparently but there are certain risks with the vaccine. An alternative is to take a shot of gammaglobulin, which injects antibodies into the system but this only lasts 2-3 months. Prevention is the best line to take and gammablobulin or the vaccine should only be considered in areas where the disease is very common and you are likely to be coming into contact with it. Visiting a country for 2-3 weeks and staying in clean places, and being careful with hygiene is mostly likely to be enough.

Polio is another disease that vaccines are recommended for travel. Polio is caused by a virus that affects the nervous system. The disease primarily affects young children under 5 years of age. Generally the first symptoms of polio are very similar to that of the flu. Paralysis results in approximately 1-2% of children affected. Therefore the vast majority recover fully from the disease, a fact not widely understood. However, given the seriousness of the disease, polio has been one of the vaccines that children routinely receive. Today, polio has mostly disappeared from the world, the countries mostly affected being Afghanistan, Egypt, India, Niger, Nigeria, Pakistan and Somalia. In the USA and Europe there have been no wild cases of polio since 1991. The only cases have been from secondary infections from the "live virus" vaccine. There have also been only six cases of polio between 1980 and 1998 that were imported from other countries. Therefore, the risk of catching polio is extremely remote.

Tetanus is another disease that is commonly vaccinated against. There are several forms of tetanus but the one concerning travelers is generalized tetanus which is mostly commonly caught from a deep injury with a contaminated object as the bacteria does not survive when exposed to oxygen. Incubation of tetanus between time of infection and symptom expression can range from 5 days to 2 months, but initial symptoms often begin within 14 days, with symptoms of headache, restlessness, itching or pain at site of injury. Gradual muscle rigidity and muscle spasm can follow after this. Again, contrary to common knowledge, even being fully vaccinated does not necessarily prevent against infection. The best precaution is to ensure that all wounds are thoroughly cleaned, to allow the wound to bleed profusely and if necessary to take prophylactic antibiotics such as penicillin which are effective against the bacteria.

Another disease spoken about it is typhoid, a condition commonly seen in the past due to contaminated water. Although found in India, Africa, other parts of Asia and Central and South America it is highly unlikely that travelers visiting these countries will catch this disease unless they live there for long periods of time and are exposed to contaminate water for prolonged periods. The same applies for Cholera, another commonly spoken about disease in developing countries. Also it is now accepted that the cholera vaccine only offers protection against certain strains of the disease.

Yellow fever, as mentioned earlier is the one disease that has mandatory vaccine policy for certain parts of Africa. You should check with the CDC as to which countries require this vaccine. Yellow fever is a mosquito-borne viral disease that varies in severity from flu like symptoms to severe hepatitis and hemorrhagic fever. The vaccine has been shown to create some potentially serious side-effects. It is a "live virus" vaccine and has been shown to cause encephalitis (inflammation of the brain), especially in children under nine months, and about 11% suffer post-vaccine syndrome of multiple pains and fever. So, generally, if you need this vaccine, then you have to have it, otherwise, it is perhaps best not to.

Sometimes it is recommended to get vaccinated against childhood diseases such as measles. This vaccine is very controversial and has shown serious side effects and therefore should not be taken lightly, especially for short term vacations.

One disease in which there is no vaccine is Malaria, a disease commonly found throughout the developing world and one of the largest killer diseases in the world. It is still the case that more people die in the world today as a result of Malaria than of AIDS. This disease is caused by a parasite spread by the sting of an infected mosquito. Symptoms of malaria include fever, chills, headache, muscle aches, vomiting, diarrhea and fatigue. It can then lead to dehydration, kidney failure and death. Symptoms usually develop 10 days to 4 weeks after infection, but can at times occur up to one year after. Any symptoms such as intermittent chill, fever and shaking after returning from travel should be checked out by your doctor. Traditionally, quinine has been given for over 200 years as a treatment and precaution against malaria, yet there are now many strains of malaria resistant to quinine and other malaria drugs. A new array of drugs are now given as a precaution against malaria, but there are sometime serious side effects from these drugs, which are increased the longer they are taken. The decision whether to take these drugs depends partly on the area to be visited, the incidence of malaria at the time of visit and the time going to be spent in that region. It is worth while doing some research to find out the outbreaks of malaria in the area to be visited and the current drugs recommended. Generally speaking, it is much more likely to be caught in rural areas than if you are staying in major cities or resort areas. Having spent over 2 years in India, I have not taken any malaria medication or taken any other vaccines.

If you do catch malaria, there are alternatives to taken the conventional medication offered. It has been found that over 2,000 years ago, Chinese people were taking a plant called wormwood or Artemesia for malaria, which has now been synthesized into artemisinin. Research is now being carried out into this substance to evaluate its clinical efficacy. In homeopathic medicine, there are many remedies that can be given for the effects of malaria, including homeopathic preparations of quinine. However, it may be best to visit a homeopathic practitioner to ensure that the correct remedy can be found.

Therefore, before assuming that you have to take all the vaccines listed, consider all the points above and the risks and benefits of taking vaccines.