tauranga travel vaccines

Travel vaccination

Imac is unable to provide vaccination advice for travellers..

Advice is available in centres specialising in travellers’ health and vaccination in the larger cities in New Zealand. In most towns and cities general practitioners are also able to provide advice and recommended vaccinations.

Click here for travel health advice from the Ministry of Health.

Links from this website to non-IMAC websites are for information only and do not constitute endorsement, expressed or implied, by IMAC. These websites are not managed by the Immunisation Advisory Centre. We do not review, control or take responsibility for the content on these sites although we believe the sites provide credible information. If you would like to discuss content on any of these websites please contact us .

Travel advice can also be obtained from the following websites:

New Zealand Ministry of Foreign Affairs & Trade - Manatū Aorere https://www.safetravel.govt.nz/ ‍

Centers for Disease Control and Prevention - Travellers' Health http://wwwnc.cdc.gov/travel/ ‍

MD Travel Health - Complete travel health information, updated daily, for physicians and travellers https://redplanet.travel/mdtravelhealth ‍

World Health Organization - International Travel and Health http://www.who.int/ith/vaccines/en/ ‍

Country specific vaccine recommendations and disease surveillance information

http://travelhealthpro.org.uk/countries ‍

Travel health information from the UK

http://www.fitfortravel.nhs.uk/home.aspx

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COVID-19 Vaccination in Waikato

Everyone in Aotearoa New Zealand aged 5 and over can get a free COVID-19 vaccine now. You can get a booster if you are aged 16 or over. It does not matter what your visa or citizenship status is.

Children aged 6 months to 4 years can get the paediatric Pfizer vaccine if they are at higher risk of severe illness from COVID-19.

Find out all you need to know about COVID-19 vaccinations and booster doses  here

Where to get your vaccination

Our mobile vaccination clinics are offering COVID-19 vaccinations for 5+ and MMR vaccinations to children aged 3-12 years (please take younger children to your GP). Anyone can drop into a mobile vaccination clinic with the weekly schedule updated at Mobile Vaccination Clinics.

Bookings for COVID-19 vaccinations 5+ in Aotearoa New Zealand can be made through Book My Vaccine. Or by booking an appointment with the COVID Vaccination Healthline team on 0800 28 29 26 (8am to 8pm, 7 days a week).   

You can also get your vaccinations from participating pharmacies, GP practices or a community health provider  or visit  www.healthpoint.co.nz/covid-19-vaccination/waikato/   

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For accurate and reliable information visit: COVID-19 website   

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Vaccines for Travelers

Vaccines protect travelers from serious diseases. Depending on where you travel, you may come into contact with diseases that are rare in the United States, like yellow fever. Some vaccines may also be required for you to travel to certain places.

Getting vaccinated will help keep you safe and healthy while you’re traveling. It will also help make sure that you don’t bring any serious diseases home to your family, friends, and community.

On this page, you'll find answers to common questions about vaccines for travelers.

Which vaccines do I need before traveling?

The vaccines you need to get before traveling will depend on few things, including:

• Where you plan to travel . Some countries require proof of vaccination for certain diseases, like yellow fever or polio. And traveling in developing countries and rural areas may bring you into contact with more diseases, which means you might need more vaccines before you visit.
• Your health . If you’re pregnant or have an ongoing illness or weakened immune system, you may need additional vaccines.
• The vaccinations you’ve already had . It’s important to be up to date on your routine vaccinations. While diseases like measles are rare in the United States, they are more common in other countries. Learn more about routine vaccines for specific age groups .

How far in advance should I get vaccinated before traveling?

It’s important to get vaccinated at least 4 to 6 weeks before you travel. This will give the vaccines time to start working, so you’re protected while you’re traveling. It will also usually make sure there’s enough time for you to get vaccines that require more than 1 dose.

Where can I go to get travel vaccines?

Start by finding a:

• Travel clinic
• Health department
• Yellow fever vaccination clinic

Learn more about where you can get vaccines .

What resources can I use to prepare for my trip?

Here are some resources that may come in handy as you’re planning your trip:

• Visit CDC’s travel website to find out which vaccines you may need based on where you plan to travel, what you’ll be doing, and any health conditions you have.
• Download CDC's TravWell app to get recommended vaccines, a checklist to help prepare for travel, and a personalized packing list. You can also use it to store travel documents and keep a record of your medicines and vaccinations.
• Read the current travel notices to learn about any new disease outbreaks in or vaccine recommendations for the areas where you plan to travel.
• Visit the State Department’s website to learn about vaccinations, insurance, and medical emergencies while traveling.

Traveling with a child? Make sure they get the measles vaccine.

Measles is still common in some countries. Getting your child vaccinated will protect them from getting measles — and from bringing it back to the United States where it can spread to others. Learn more about the measles vaccine.

Find out which vaccines you need

CDC’s Adult Vaccine Quiz helps you create a list of vaccines you may need based on your age, health conditions, and more.

Take the quiz now !

Get Immunized

Getting immunized is easy. Vaccines and preventive antibodies are available at the doctor’s office or pharmacies — and are usually covered by insurance.

Find out how to get protected .

Covid 19 coronavirus Delta outbreak: Tauranga Crossing to provide new vaccination centre for residents

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The Tauranga Crossing vaccination clinic is inside the shopping centre on the ground floor. Photo / File

The region's latest vaccination walk-in clinic opens at Tauranga Crossing today.

The centre will be able to vaccinate up to 500 people a day and will be open from 9am to 6pm, seven days a week.

The centre has been opened by Bay of Plenty District Health Board and Pharmacy Care Group to "help more Bay of Plenty residents get vaccinated close to home".

Tauranga Crossing chief executive Lauren Riley said they were proud to help the community by providing a familiar and easily accessible location for residents to receive their vaccination.

"We're proud to be playing a part in New Zealand's biggest-ever mass vaccination effort."

The Tauranga Crossing vaccination clinic is inside the shopping centre on the ground floor.

Entry is via the ground floor of the multi-deck carpark. People will need to register and make an appointment via Book My Vaccine, bookmyvaccine.covid19.health.n z.

Key information to prepare for vaccination at Tauranga Crossing

• Appointments can be booked at bookmyvaccine.covid19.health.nz. Please arrive 10 minutes before your appointment.

• Walk-in vaccinations are permitted and the clinic will try to accommodate you, but booked appointments will be prioritised. Walk-in patients may not be able to receive the vaccine depending on the schedule for the day.

• It is useful if you can bring your NHI number; while it isn't essential, it will make the registration faster. You will find your NHI number on a prescription or prescription receipt, X-ray or test result, or a letter from the hospital.

• It is recommended to eat a light meal before coming and bring water. People will need to remain at the centre immediately following their vaccination for 15 minutes, and will not be permitted a toilet break.

• Please do not come to the centre if you are unwell, are a close or casual contact of a Covid-19 positive case, or are awaiting the results of a Covid-19 test.

• This is not a Covid-19 testing centre.

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Authorised yellow fever vaccination centres

On this page, counties manukau, lakes (rotorua and taupō), bay of plenty, hawke's bay, capital, coast and hutt valley, nelson marlborough, south canterbury.

Please note, some centres may only offer yellow fever vaccination to their registered patients.

Authorised yellow fever vaccination centres in Te Whatu Ora Te Tai Tokerau.

Authorised yellow fever vaccination centres in Te Whatu Ora Waitematā.

Authorised yellow fever vaccination centres in Te Whatu Ora Te Toka Tumai.

Te Whatu Ora Counties Manukau does not currently have any authorised yellow fever vaccination centres.

Authorised yellow fever vaccination centres in Te Whatu Ora Waikato.

Authorised yellow fever vaccination centres in Te Whatu Ora Lakes.

Authorised yellow fever vaccination centres in Te Whatu Ora Hauora a Toi Bay of Plenty.

Authorised yellow fever vaccination centres in Te Whatu Ora Tairāwhiti.

Authorised yellow fever vaccination centres in Te Whatu Ora Te Matau a Māui, Hawkes Bay.  

Authorised yellow fever vaccination centres in Te Whatu Ora Taranaki.

Authorised yellow fever vaccination centres in Te Whatu Ora Te Pae Hauora o Ruahine o Tararua MidCentral.

Te Whatu Ora Whanganui does not currently have any authorised yellow fever vaccination centres. 

Te Whatu Ora Wairarapa does not currently have any authorised yellow fever vaccination centres.

Authorised yellow fever vaccination centres in Te Whatu Ora Capital, Coast and Hutt Valley.

Authorised yellow fever vaccination centres in Te Whatu Ora Nelson Marlborough.

Te Whatu Ora West Coast does not currently have any authorised yellow fever vaccination centres.

Authorised yellow fever vaccination centres in Te Whatu Ora Waitaha Canterbury.

Authorised yellow fever vaccination centres in Te Whatu Ora South Canterbury.

Authorised yellow fever vaccination centres in Te Whatu Ora Southern.

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What vaccines do you need to travel?

The vaccines you need will depend on where you’re traveling and what you will be doing during your travels. Walgreens pharmacists are able to assist in helping you determine which vaccines you may need.

Which travel vaccines are available at Walgreens?

Travel vaccines Walgreens offers include: Yellow Fever, Meningitis, Polio, Typhoid, Japanese Encephalitis, Tick-Borne Encephalitis, Hepatitis A, Hepatitis B and Rabies*.

*Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability.

What other vaccines should I have before traveling?

It’s important to be up-to-date on routine vaccinations before traveling as well—like Measles-Mumps-Rubella (MMR), Tetanus, Flu and COVID-19.

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Travel vaccination advice

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Vaccinations are available to protect you against infections such as yellow fever , typhoid and hepatitis A .

In the UK, the  NHS routine immunisation (vaccination) schedule protects you against a number of diseases, but does not cover all of the infectious diseases found overseas.

When should I start thinking about the vaccines I need?

If possible, see the GP or a private travel clinic at least 6 to 8 weeks before you're due to travel.

Some vaccines need to be given well in advance to allow your body to develop immunity.

And some vaccines involve a number of doses spread over several weeks or months.

You may be more at risk of some diseases, for example, if you're:

• travelling in rural areas
• backpacking
• staying in hostels or camping
• on a long trip rather than a package holiday

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Which travel vaccines do I need?

You can find out which vaccinations are necessary or recommended for the areas you'll be visiting on these websites:

• Travel Health Pro
• NHS Fit for Travel

Some countries require proof of vaccination (for example, for polio or yellow fever vaccination), which must be documented on an International Certificate of Vaccination or Prophylaxis (ICVP) before you enter or when you leave a country.

Saudi Arabia requires proof of vaccination against certain types of meningitis for visitors arriving for the Hajj and Umrah pilgrimages.

Even if an ICVP is not required, it's still a good idea to take a record of the vaccinations you have had with you.

Find out more about the vaccines available for travellers abroad

Where do I get my travel vaccines?

First, phone or visit the GP practice or practice nurse to find out whether your existing UK vaccinations are up-to-date.

If you have any records of your vaccinations, let the GP know what you have had previously.

The GP or practice nurse may be able to give you general advice about travel vaccinations and travel health, such as protecting yourself from malaria.

They can give you any missing doses of your UK vaccines if you need them.

Not all travel vaccinations are available free on the NHS, even if they're recommended for travel to a certain area.

If the GP practice can give you the travel vaccines you need but they are not available on the NHS, ask for:

• written information on what vaccines are needed
• the cost of each dose or course
• any other charges you may have to pay, such as for some certificates of vaccination

You can also get travel vaccines from:

• private travel vaccination clinics
• pharmacies offering travel healthcare services

Which travel vaccines are free?

The following travel vaccines are available free on the NHS from your GP surgery:

• polio (given as a combined diphtheria/tetanus/polio jab )
• hepatitis A

These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were brought into the country.

Which travel vaccines will I have to pay for?

You'll have to pay for travel vaccinations against:

• hepatitis B
• Japanese encephalitis
• tick-borne encephalitis
• tuberculosis (TB)
• yellow fever

Yellow fever vaccines are only available from designated centres .

The cost of travel vaccines that are not available on the NHS will vary, depending on the vaccine and number of doses you need.

It's worth considering this when budgeting for your trip.

Other things to consider

There are other things to consider when planning your travel vaccinations, including:

• your age and health – you may be more vulnerable to infection than others; some vaccines cannot be given to people with certain medical conditions
• working as an aid worker – you may come into contact with more diseases in a refugee camp or helping after a natural disaster
• working in a medical setting – a doctor, nurse or another healthcare worker may require additional vaccinations
• contact with animals – you may be more at risk of getting diseases spread by animals, such as rabies

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations.

But it's important to check that you're up-to-date with routine vaccinations available on the NHS.

Pregnancy and breastfeeding

Speak to a GP before having any vaccinations if:

• you're pregnant
• you think you might be pregnant
• you're breastfeeding

In many cases, it's unlikely a vaccine given while you're pregnant or breastfeeding will cause problems for the baby.

But the GP will be able to give you further advice about this.

People with immune deficiencies

For some people travelling overseas, vaccination against certain diseases may not be advised.

This may be the case if:

• you have a condition that affects your body's immune system, such as HIV or AIDS
• you're receiving treatment that affects your immune system, such as chemotherapy
• you have recently had a bone marrow or organ transplant

A GP can give you further advice about this.

Non-travel vaccines

As well as getting any travel vaccinations you need, it's also a good opportunity to make sure your other vaccinations are up-to-date and have booster vaccines if necessary.

Although many routine NHS vaccinations are given during childhood, you can have some of them (such as the MMR vaccine ) as an adult if you missed getting vaccinated as a child.

There are also some extra NHS vaccinations for people at higher risk of certain illnesses, such as the flu vaccine , the hepatitis B vaccine and the BCG vaccine for tuberculosis (TB) .

Your GP can advise you about any NHS vaccinations you might need.

Find out about NHS vaccinations and when to have them

Page last reviewed: 16 March 2023 Next review due: 16 March 2026

International travelers to the US will be able to skip proof of COVID vaccine, WH says

The Biden administration will lift the COVID-19 vaccine requirement for inbound international air travelers on Friday.

"As we continue to monitor the evolving state of COVID-19 and the emergence of virus variants, we have the tools to detect and respond to the potential emergence of a variant of high consequence," President Joe Biden said in a proclamation Tuesday. "Considering the progress that we have made, and based on the latest guidance from our public health experts, I have determined that we no longer need the international air travel restrictions that I imposed in October 2021."

Biden announced the change last week , along with the end of vaccine requirements for federal employees and contractors, foreign nationals at the land border and others. The requirement for air travelers will lift at midnight Thursday as the coronavirus public health emergency ends. Biden previously  signed a bill ending the COVID national emergency  in April.

So, what does that mean for travelers? Here's what we know.

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Is there still a vaccine requirement for international travelers coming to the US?

Not as of later this week.

Currently, all "non-U.S. citizen, non-U.S. immigrants traveling to the United States by air" must show proof of vaccination with limited exceptions, according to the Centers for Disease Control and Prevention's  website .

Industry group the U.S. Travel Association, which had called on the Biden administration to  end the vaccine requirement  for inbound international visitors and argued the rule was an impediment to tourism, applauded the change when it was announced last week.

“Today’s action to lift the vaccine requirement eases a significant entry barrier for many global travelers, moving our industry and country forward," Geoff Freeman, the organization's President and CEO, said in a statement last week. He also called on the federal government to "ensure U.S. airports and other ports of entry are appropriately staffed with Customs and Border Protection officers to meet the growing demand for entry."

The U.S.  lifted a requirement  that air travelers coming from China show proof of a negative COVID test in March. The policy took effect in January amid a surge of cases in China.

The U.S.  dropped its COVID testing rule  for international flyers in June.

Do travelers need a vaccine to cross the Mexico or Canada borders to the US?

The Department of Homeland Security also said in a news release that it will no longer require non-U.S. travelers coming into the country by land or at ferry terminals to be fully vaccinated or show proof of their vaccination status.

Do US travelers need to be vaccinated against COVID to travel internationally?

That depends. Many destinations have dropped their vaccination and testing requirements for travel, though some still have rules in place. The Philippines, for example, still requires travelers to be fully vaccinated or show proof of a negative COVID test in order to visit, according to the  U.S. Embassy in the Philippines .

AI, self-service are taking over travel: Will everything become a DIY experience?

The CDC also recommends travelers be up to date on their COVID vaccinations before leaving the country. The agency defines up to date as having one updated Pfizer-BioNTech or Moderna vaccine for people age 6 and up, which "protect against both the original virus that causes COVID-19 and the Omicron variant BA.4 and BA.5," according to its  website .

Nathan Diller is a consumer travel reporter for USA TODAY based in Nashville. You can reach him at [email protected].

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The CDC issues new rules for bringing dogs into the U.S., aimed at keeping out rabies

Traveling internationally with a dog — or adopting one from abroad — just got a bit more complicated. The CDC issued new rules intended to reduce the risk of importing rabies. mauinow1/Getty Images/iStockphoto hide caption

Traveling internationally with a dog — or adopting one from abroad — just got a bit more complicated. The CDC issued new rules intended to reduce the risk of importing rabies.

The Centers for Disease Control and Prevention announced new rules Wednesday aimed at preventing dogs with rabies from coming into the United States.

Under the new regulations, all dogs entering the U.S. must appear healthy, must be at least six months old, must have received a microchip, and the owner must verify the animal either has a valid rabies vaccine or has not been in a country where rabies is endemic in the last six months.

Dogs coming from a country that is considered at high risk for rabies and who received a rabies vaccine from another country must meet additional criteria. Those include getting a blood test before they leave the other country to make sure the animal has immunity against rabies, a physical examination upon arrival and getting a U.S. rabies vaccine. If the dog doesn't have a blood test showing immunity, it must be quarantined for 28 days.

These are much stricter requirements than existing regulations for dog importation — for those who want to adopt from abroad and for those traveling internationally with their pets.

Shots - Health News

Vaccine hesitancy affects dog-owners, too, with many questioning the rabies shot.

But, U.S pet owners shouldn't panic, says Dr. Emily Pieracci , a CDC veterinary medicine officer. "This really isn't a big change," she says. "It sounds like a lot, but not when you break it down, it's really not a huge inconvenience for pet owners."

Rabies was eliminated in dogs in the United States in 2007 , but unvaccinated canines can still contract the disease from rabid wildlife such as raccoons, skunks or bats.

And rabies remains one of the deadliest diseases that can be transmitted from animals to humans around the world. Globally, about 59,000 people die from rabies each year. The illness is nearly always fatal once a person begins to experience symptoms .

Today, pet dogs in the United States are routinely vaccinated against rabies.

"This new regulation is really set to address the current challenges we're facing," Pieracci says. Those include an increased risk of disease "because of the large-scale international movement of dogs," she adds, as well as fraudulent documentation for imported dogs.

The U.S. imports an estimated 1 million dogs each year. In 2021, amid a surge of pandemic-inspired dog adoptions, the CDC suspended importations from 113 countries where rabies is still endemic because of an increase in fraudulent rabies vaccination certificates. The countries include Kenya, Uganda, Brazil, Colombia, Russia, Vietnam, North Korea, Nepal, China and Syria.

That suspension will end when the new rules go into effect Aug. 1.

"This will bring us up to speed with the rest of the international community which already has measures in place to prevent the importation of of rapid dogs," Pieracci said. "So, we're playing catch-up in a sense."

The new regulations replace rules that date back to 1956. Those rules only required that dogs be vaccinated before entering the country.

To control rabies in wildlife, the USDA drops vaccine treats from the sky

"As you can imagine a lot has changed since then," Pieracci says. "International travel has increased dramatically and people's relationships with dogs have changed since the 1950s. During that time, it really wasn't common for dogs to be considered family member. They didn't sleep in peoples' beds. They certainly didn't accompany them on international trips."

The new rules won praise from the American Veterinary Medical Association . The organization "is pleased to see the implementation of this new rule that will help protect public health and positively impact canine health and welfare," said Dr. Rena Carlson, president of the AVMA in a statement to NPR.

Dog rescue advocates also welcomed the changes.

"This updated regulation will allow us to continue bringing dogs to the U.S. safely and efficiently," Lori Kalef, director of programs for SPCA International, said in a statement.

"We have seen that dogs have been a lifeline for U.S. service members during their deployments. One of our key programs reunites these service members and their animal companions here in the U.S. once they have returned home," she said. "The CDC's commitment to improving its regulations has a profound impact on the animals and service members we support, and this new policy is an important piece of that effort."

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Fauci Makes Huge Admissions On Vaccine Mandates And Lab Leak Theory Legitimacy

D r. Anthony Fauci faced intense questioning from the House Select Subcommittee on the Coronavirus Pandemic, where he admitted that the six-foot social distancing rule had little scientific basis.

He also acknowledged that the lab-leak hypothesis is not a conspiracy theory and that vaccine mandates might increase hesitancy.

Despite supporting travel restrictions from China, Fauci was accused of playing down the lab-leak theory. (Trending: Clintons Scramble To Delete Embarrassing Photo, But Were Too Slow)

“It just sort of appeared,” wrote the committee, mocking Fauci with his own quote.

“Dr. Fauci acknowledged that the lab-leak hypothesis is not a conspiracy theory,” their statement continued.

“This comes nearly four years after prompting the publication of the now infamous ‘Proximal Origin’ paper that attempted to vilify and disprove the lab-leak hypothesis,” explained the committee.

The committee said Fauci still “advised American universities to impose vaccine mandates on their students.”

The committee wrote that Fauci, “played semantics with the definition of a ‘lab-leak’ in an attempt to cover up the inaccurate conclusions of ‘Proximal Origin.’”

Sen. Wenstrup said, “During his interview today, Dr. Fauci claimed that the policies and mandates he promoted may unfortunately increase vaccine hesitancy for years to come.”

“Further, the social distancing recommendations forced on Americans ‘sort of just appeared’ and were likely not based on scientific data,” he continued.

Wenstrup said the hearing “revealed systemic failures in our public health system and shed a light on serious procedural concerns with our public health authority.”

“It is clear the dissenting opinions were often not considered or suppressed completely,” lamented the lawmaker.

“Should a future pandemic arise, America’s response must be guided by scientific facts and conclusive data,” declared Wenstrup.

The committee highlighted systemic failures in public health and emphasized the need for future responses to be guided by scientific facts and conclusive data.

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Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

• Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

• Fluvoxamine
• Metoclopromide
• Tetracycline
• Calcineurin inhibitors
• Ciprofloxacin
• CYP2D6 enzyme substrates 1
• CYP3A4 enzyme inhibitors 2
• Methotrexate
• QT- prolonging agents 3
• Bismuth subsalicylate
• Barbiturates
• Carbamazepine
• Iron- containing preparations
• mTOR inhibitors
• Antiarrhythmic agents
• Beta blockers
• Calcium channel receptor antagonists
• CYP3A4 enzyme inducers 4
• H1 receptor antagonists
• Lumefantrine
• Phenothiazines
• Protease inhibitors
• Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

• HIV medications
• Antacids containing magnesium or aluminum hydroxide
• Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

• Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

• Acetaminophen
• Anticholinergics
• Aspirin, high dose
• Dextroamphetamine
• Diclofenac sodium
• Mecamylamine
• Anticholinesterases
• Digitalis preparations
• Hypoglycemic agents
• Macrolide antibiotics
• Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

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