It has been almost 50 years since the introduction of immune serum globulin in the United States as the first immunobiologic product for the protection of international travelers. Although only a trickle of new vaccines occurred from 1950 to 1970, there was more rapid development during the 1970s and 1980s with the introduction of measles-mumps-rubella combination; meningococcal; pneumococcal; hepatitis B; and improved rabies vaccines. During the 1990s, the vaccine cascade continued. This included the restitution of the controversial Japanese encephalitis (JE) vaccine and the introduction of oral typhoid capsules, injectable Vi capsular polysaccharide typhoid, hepatitis A, Haemophilus influenzae type b, varicella, rotavirus, a new rabies vaccine, and several combination vaccines. In 1997, Canada licensed a new oral liquid vaccine for both cholera and typhoid. In the near future, it is likely the rapid introduction of new vaccines, or combination of vaccines, will continue at a rate of one or two each year.

Within this framework, the health care provider may be asked to prepare a vaccine schedule for the international traveler. Many factors must be taken into consideration, including the time available before departure, duration of stay, general health of the traveler, compatibility of the recommended vaccines, potential adverse reactions, and risk of disease in the host country. Additionally, the onset of protective efficacy and the duration of protection of each vaccine must be carefully calculated in order to provide optimal protection. In the end, the traveler may have a personal aversion to injections or may object to the ideal vaccine schedule because of the significant cost of the vaccines or the number of visits involved. This article highlights vaccines for cholera, JE, rabies, rotavirus, typhoid, and malaria.