5. Polio: Most young adults have been immunized with at least four doses of trivalent oral polio vaccine (OPV?). Many adults (>18 years of age) cannot remember, however, whether they received all serotypes of OPV (mass campaigns used monovalent vaccines) and should be given inactivated polio vạccine (IPV). IPV should be boosted every five years for international travel.

6. Gamma globulin: Most travelers from industrialized nạtions are susceptible to hepatitis A. Hepatitis is the most common serious infectious disease contracted abroad. Published attack rates vary from 1/150 to 1/500 for a routine two-week trip to most developing countries. Immune serum globulin (ISG) is effective in reducing the risk of hepatitis A. For adults, 2cc is given intramuscularly for trips of less thạn two months' duration, while 5 cc is of benefit for up to four to six months. ISG should ideally not be given with or prior to immunizations with live at tenuated virus vaccines.

7. Meningococcal meningitis: Vaccination with the quadrivalent polysaccharide vaccine (A,C、 Y. -W 135) is recommended for travel to Northern India, Nepal, certain parts of sub-Saharan Africa, and Saudi Arabia.

8. Typhoid: Typhoid vaccination is clearly indicated for travelers with ach!orhydria, immunosuppression, or sickle cell anemia. Vaccination is often recommended for prolonged travel (more than three weeks) to areas with poor sanitation.

9. Other vaccines: Some travelers need special consideration, including missionaries, physicians, and anthropologists, who live for prolonged pericds in developing countries or are at special risk for contracting certain highly contagious diseases.

Consideration should be given to immunization with hepatítis B. Japanese B encephalitis, plague, rabies, and BCG' vaccines.

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