Norman J. Bizon, PA-C, CTH® is Medical Director at TravelBug Health. Over 30 years of clinical experience and certified in travel medicine and international health.

Tessa E. McFall, ASN, EMT is a Travel Health Specialist Clinician at TravelBug Health.

Last updated April 21, 2026

You should not receive the vaccine, or should receive it only after careful consultation, if you:

• Are younger than 6 months of age
• Have a severe allergy to eggs, chicken proteins, or gelatin
• Are severely immunocompromised. Low CD4 HIV, active cancer therapy, organ transplant, primary immunodeficiency, high-dose corticosteroids
• Have a thymus disorder or have had a thymectomy. Myasthenia gravis, DiGeorge syndrome
• Are pregnant, unless travel is unavoidable and risk is high
• Are breastfeeding an infant younger than 9 months

If a contraindication applies, we can often issue a medical waiver letter accepted at many required-entry borders. The letter is not universally accepted. The definitive alternative is to adjust the itinerary.

We walk through every option at your consultation and help you decide what’s safe and practical for your specific trip.

First-time recipients aged 60+ face a slightly higher risk of rare serious adverse events. We weigh the risk of severe vaccine reaction against the risk of yellow fever exposure on your specific itinerary. This is a conversation, not a checkbox.

If you take Humira, Enbrel, Remicade, Stelara, Cosentyx, Rituxan, or similar, the vaccine is generally contraindicated. Some patients can receive it after a carefully timed pause, coordinated with your prescribing physician. Bring a complete medication list.

Vaccination during pregnancy is generally avoided because the vaccine uses a live virus. If travel to a high-risk destination is unavoidable, vaccination may be considered after detailed risk-benefit review. Postponing or adjusting the trip is strongly preferred.

Yellow fever vaccine is produced in chicken eggs and contains residual egg protein. Severe egg allergy is a contraindication. Mild egg allergy can sometimes be managed with a graded-dose protocol in a medical setting. Bring documentation.

Not recommended under 6 months due to rare neurologic side effects. Between 6 and 9 months, considered only in outbreak or high-risk-exposure scenarios. From 9 months onward, the standard adult dose applies.

For contraindicated travelers heading to required-entry destinations, we can issue medical waiver letters accepted at many borders. We coordinate documentation with your specific itinerary.

A single dose of yellow fever vaccine is approximately 99 percent effective at preventing the disease after the 10-day incubation period.

In 2013, the WHO Strategic Advisory Group of Experts on Immunization concluded a single dose provides lifetime protection for the vast majority of recipients. In 2016, the International Health Regulations were formally amended. The ICVP is now valid for the life of the person vaccinated.

A booster is still considered for a narrow set of individuals. Pregnancy at the time of initial vaccination, organ or stem cell transplant recovery, HIV at the time of vaccination, frequent occupational lab exposure, or travelers heading into very active outbreak zones who were vaccinated more than 10 years ago.

You’ll be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The yellow fever vaccine itself
• WHO-approved ICVP issuance
• Any other vaccines or prescriptions you elect

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including yellow fever?
• What CPT code do I submit? Yellow fever is typically 90717
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Mild soreness, redness, or swelling at the injection site (1 to 3 days)
• Low-grade fever, fatigue, mild headache, or muscle aches (possible in the first 5 to 10 days)
• Temporary joint soreness

Yellow fever vaccine-associated neurologic disease. Approximately 1 in 150,000 to 250,000 doses, more common in first-time recipients over 60. Symptoms include encephalitis, meningitis, or acute disseminated encephalomyelitis.

Yellow fever vaccine-associated viscerotropic disease. Approximately 1 in 250,000 to 400,000 doses, more common in first-time recipients over 60 and those with thymus disorders. Severe multi-organ illness.

The vaccine needs 10 days to generate full protection. Your ICVP isn’t valid for border crossings until then. Plan at least 10 days, ideally 4 to 6 weeks, before departure.

Low-grade fever, tiredness, or headache between days 5 and 10 is normal. Rest, fluids, and acetaminophen help. Call us if symptoms are severe or persist beyond 10 days.

Keep the yellow card with your passport. Never in checked luggage. Some airlines request it at check-in. Most required-entry countries check it at immigration.

Yellow fever can be given the same day as most other vaccines. If you need additional live vaccines (MMR, varicella), we coordinate the sequence at your consultation.

• CDC-certified yellow fever center
• Issues WHO ICVP yellow card at appointment
• Specialist-led itinerary-based risk consultation
• Same-day or next-day appointments often available
• Coordinates full panel of travel vaccines
• Medical waiver letters when appropriate

• Not authorized to administer yellow fever
• Cannot issue the WHO ICVP yellow card
• Limited or general consultation only
• Variable scheduling
• Limited stock of travel-specific vaccines
• Cannot issue medical waivers

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated May 4, 2026

The oral typhoid vaccine is a live attenuated bacterial vaccine. Do not use it if you:

• Are under 6 years of age
• Are immunocompromised for any reason: HIV with low CD4 counts, active cancer therapy, organ transplant, primary immunodeficiency, or high-dose corticosteroids
• Are currently taking antibiotics (must wait at least 24 hours after the last antibiotic dose before starting the series)
• Are taking mefloquine or chloroquine for malaria prevention (complete the oral vaccine series at least 10 days before starting mefloquine or chloroquine)
• Are pregnant (live vaccine. Injectable preferred if vaccination is necessary)
• Have a known hypersensitivity to any component of the formulation

The injectable vaccine is not a live vaccine and has a narrower contraindication list:

• Children under 2 years of age
• Previous severe allergic reaction (anaphylaxis) to this vaccine or any of its components
• Active moderate or severe acute illness. Defer until recovered

For most immunocompromised travelers, the injectable vaccine is the appropriate choice. It is not a live vaccine and can be given safely to patients who cannot receive live vaccines.

One injection is simpler and requires no refrigeration during travel. Four oral capsules taken on alternating days over a week last longer (5 years vs. 2 years) and suit frequent travelers to endemic regions. Drug interactions and immune status often decide the question. We walk through both options at your consultation.

Antibiotics kill the live bacteria in the oral vaccine and prevent it from working. Mefloquine and chloroquine also inhibit Ty21a. If you are taking any of these for prophylaxis or treatment, timing matters. Injectable typhoid avoids all of these interactions entirely. Bring your full medication list to your appointment.

Patients on biologics, disease-modifying antirheumatic drugs, cancer therapy, or post-transplant immunosuppression should receive the injectable Vi polysaccharide vaccine, not the oral live vaccine. The injectable is appropriate for most immunocompromised patients. Bring your medication list and any recent labs relevant to immune function.

The injectable vaccine is approved for children 2 years and older. The oral vaccine is approved for children 6 years and older. Neither is recommended below those age thresholds. For young children traveling to high-risk destinations, we coordinate the injectable vaccine alongside the full pediatric travel medicine consultation.

Extensively drug-resistant Typhi from Pakistan and parts of India is resistant to nearly all standard oral antibiotics. Azithromycin and carbapenems remain active, but XDR typhoid in a returning traveler is a difficult clinical situation. Vaccination is protective against XDR strains as well as susceptible ones. This makes pre-travel vaccination especially important for Pakistan travel.

Travelers who visit family or friends in endemic countries face higher exposure than typical tourists: home-cooked food, local water, and longer stays in domestic settings. Oral typhoid (5-year protection) is often the better long-term choice for frequent travelers, provided no contraindications apply. We help you plan a sustainable multi-year vaccination schedule.

The injectable Vi polysaccharide vaccine (Typhim Vi) achieves approximately 55 to 72 percent protective efficacy in field trials, with CDC citing a range of approximately 50 to 80 percent depending on the study population and duration of follow-up.

The oral Ty21a vaccine (Vivotif) achieves approximately 51 to 67 percent efficacy across meta-analyses, with some field trials reporting up to 76 percent protection over 3 years of follow-up. Efficacy declines as protection duration extends beyond the approved interval.

Neither vaccine eliminates risk entirely. Safe food and water practices remain essential throughout your trip, regardless of vaccination status. The vaccine adds a meaningful layer of protection. It does not replace behavioral precautions.

Protection begins approximately 2 weeks after the injectable dose and approximately 1 week after completing the oral series. Injectable protection lasts 2 years. Oral protection lasts 5 years. Booster dosing is recommended before return travel to endemic regions after those intervals.

You will be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The typhoid vaccine (injectable or oral formulation)
• Any other vaccines or prescriptions you elect during the visit
• Malaria prevention counseling and prescriptions if applicable

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including typhoid?
• What CPT code do I submit? Injectable typhoid is typically 90691. Oral typhoid is typically 90690
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Soreness, redness, or swelling at the injection site (most common, resolves within 1 to 3 days)
• Low-grade fever in approximately 1 percent of recipients
• Headache and malaise in approximately 3 percent of recipients
• Nausea or abdominal discomfort (uncommon)

• Nausea, abdominal cramping, or loose stools during the dosing week (typically mild and brief)
• Low-grade fever and headache
• Rash or urticaria (uncommon)
• Vomiting (uncommon. If vomiting occurs within 30 minutes of a dose, that dose should be repeated)

Anaphylaxis is rare but possible with either formulation. We observe all patients for 15 minutes after the injectable dose. Severe allergic reactions to the oral capsule are extremely uncommon.

There are no serious neurologic or viscerotropic adverse events associated with typhoid vaccines comparable to those rare events seen with the yellow fever vaccine.

If you chose the oral vaccine, all 4 capsules must be taken on alternate days and finished at least 1 week before arrival. Do not take antibiotics during the dosing week. Keep capsules refrigerated until each dose. Missing or misordering doses reduces protection.

Typhoid vaccines are 55 to 80 percent protective, not 100 percent. Safe food and water practices remain essential throughout your trip: drink bottled or treated water, avoid ice made from tap water, eat cooked foods served hot, and peel your own fruit.

Injectable protection expires after 2 years. Oral protection expires after 5 years. If you return to an endemic region after those intervals, a booster is required. Keep a record of your vaccination date and the formulation you received so we can schedule your next dose accurately.

Typhoid is rarely the only vaccine needed for South Asia or Southeast Asia. Hepatitis A, hepatitis B, Japanese encephalitis, rabies, and malaria prevention all depend on your destination, itinerary, and activities. We build the full picture at your consultation and coordinate timing to avoid interactions.

• Specialist-led itinerary-based risk consultation
• Both injectable and oral formulations stocked and available
• Drug interaction review for oral vaccine with antibiotics and antimalarials
• Malaria prevention prescriptions and timing coordination
• Hepatitis A, hepatitis B, and other travel vaccines same visit
• Same-day or next-day appointments often available

• Limited or general consultation only
• Often injectable formulation only
• Drug interactions with oral vaccine often missed
• Limited malaria prevention coordination
• May not stock full panel of travel vaccines
• Variable scheduling

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

You should not receive the hepatitis A vaccine, or should discuss it carefully with your provider first, if you:

• Have had a severe allergic reaction (anaphylaxis) to a previous dose of hepatitis A vaccine
• Have a known severe allergy to a vaccine component: aluminum hydroxide adjuvant (both Havrix and VAQTA), neomycin (VAQTA), or 2-phenoxyethanol (Havrix)
• Are currently experiencing a moderate or severe acute illness. Defer vaccination until you have recovered
• Are pregnant. Hepatitis A vaccine is not a live virus and ACIP considers it acceptable when the benefit outweighs the risk. Discuss your specific itinerary and risk level with your provider before deciding

Because the hepatitis A vaccine is inactivated, it is safe to administer to people who are immunocompromised, including those with HIV, organ transplant recipients, and people on immunosuppressive medications. The immune response may be lower in these individuals. Antibody titer testing after vaccination can confirm seroconversion.

People with chronic liver disease, including hepatitis B, hepatitis C, cirrhosis, or fatty liver disease, are among the strongest candidates for vaccination because they face a dramatically higher risk of severe illness and fulminant liver failure if infected.

People with hepatitis B, hepatitis C, cirrhosis, alcoholic liver disease, or nonalcoholic fatty liver disease face a significantly higher risk of fulminant hepatic failure and death if they contract hepatitis A. ACIP lists chronic liver disease as one of the strongest indications for vaccination. If you have any liver condition and are planning international travel, vaccination is not optional.

Because hepatitis A vaccine is inactivated, it is safe for travelers on biologics, chemotherapy, corticosteroids, or immunosuppressants after organ transplant. Immune response may be blunted. We can coordinate post-vaccination antibody titer testing to confirm protection, and we counsel on whether additional food and water precautions are warranted for your specific regimen.

Hepatitis A vaccine contains no live virus. ACIP guidance considers the vaccine acceptable during pregnancy when the benefit of protection outweighs the theoretical risk. If you are pregnant and traveling to a high-endemicity country, the risks of infection and vaccination are weighed together at your consultation. Postponing or adjusting the trip remains an option we discuss.

Hepatitis A vaccine is part of the routine US childhood immunization schedule starting at 12 months. Unvaccinated children traveling to endemic regions should receive the first dose at least two weeks before departure. The second dose completes long-term protection. Children who received both doses on the standard schedule are already protected and do not need additional doses.

Travelers who need protection against both hepatitis A and hepatitis B can receive Twinrix, a combined vaccine given as three doses at 0, 1, and 6 months. An accelerated schedule (0, 7, and 21 to 30 days, plus a booster at 12 months) is available for travelers with less lead time. We evaluate your hepatitis B status and vaccination history to recommend the most efficient approach.

Travelers born in the US who visit relatives in endemic countries are among the highest-risk groups and among the most commonly under-vaccinated. They tend to eat home-cooked local meals, stay in private homes where food safety practices differ from tourist restaurants, and may incorrectly assume cultural familiarity provides biological protection. It does not. First-generation US residents returning to home countries are especially vulnerable.

A single dose of hepatitis A vaccine produces seroconversion in 94 to 100 percent of healthy adults within four weeks. One dose given at least two weeks before travel provides reliable short-term protection for the vast majority of recipients.

Completing the two-dose series generates approximately 100 percent seroconversion. Mathematical modeling of antibody decay rates suggests protection persists for at least 25 years, and most experts consider the series to confer lifelong immunity. The CDC and ACIP do not currently recommend booster doses for healthy individuals who have completed the two-dose series.

Immune response may be lower in people who are immunocompromised, on dialysis, or have chronic liver disease. Post-vaccination antibody titer testing can be arranged for travelers in these groups who need confirmation of protection before high-risk itineraries.

You’ll be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The hepatitis A vaccine itself (Havrix, VAQTA, or Twinrix depending on your needs)
• Any other vaccines or prescriptions you elect during the visit
• Second-dose scheduling and documentation

Pricing varies based on services. Call (480) 435-2774 for current pricing. We are transparent so there are no surprises at checkout.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including hepatitis A?
• What CPT codes apply? Hepatitis A vaccine is typically 90632 for the adult single-antigen dose, plus an office-visit code
• Do I need pre-authorization?
• Can I apply HSA or FSA funds to travel vaccination?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items for each service

Reimbursement outcome is between you and your insurer. We give you everything needed to file a complete claim.

• Soreness, redness, or swelling at the injection site (resolves in 1 to 3 days in most people)
• Warmth or mild induration at the injection site

• Headache
• Fatigue or malaise (typically mild, resolves within 1 to 2 days)
• Loss of appetite
• Low-grade fever
• Nausea

Anaphylaxis is estimated to occur in approximately 1 per 1 million doses. Signs include hives, difficulty breathing, swelling of the throat, drop in blood pressure, and rapid pulse. We observe all vaccinated patients for 15 minutes after injection and are equipped to respond to allergic reactions on-site.

Most healthy adults achieve protective antibody levels 2 to 4 weeks after the first dose. Aim to schedule your vaccination at least two weeks before departure. Earlier is better. Four to six weeks gives us time to address your full travel health plan without rushing any part of the process.

The second dose is given 6 to 18 months after the first. Do not skip it. The first dose provides excellent short-term protection. The second dose completes the series and generates immunity estimated to last a lifetime. We send reminders and can administer both doses at our Scottsdale clinic.

The hepatitis A vaccine protects only against HAV. Safe food and water practices remain important for preventing other foodborne illnesses, including typhoid and travelers’ diarrhea, which the vaccine does not cover. Eat cooked foods served hot, avoid raw shellfish, and use sealed bottled water.

Destinations where hepatitis A is endemic often carry risk for other vaccine-preventable diseases. Depending on your itinerary, we may also recommend typhoid, hepatitis B, cholera, or malaria prophylaxis. All can be coordinated at your consultation appointment.

• Specialist-led itinerary-based risk assessment
• Full travel vaccine panel coordinated at one visit
• Prescription travel medications (malaria, altitude, diarrhea) prescribed on-site
• Twinrix (Hep A plus Hep B) series managed and tracked here
• Second-dose scheduling and reminders
• Same-day or next-day appointments often available

• Limited or general consultation only, not itinerary-based
• Very limited travel vaccine stock
• Travel prescriptions generally not available
• Twinrix availability inconsistent, series tracking variable
• Second-dose reminders vary by provider
• Variable scheduling, may not accommodate short lead times

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

You should defer or discuss vaccination carefully if you:

• Have had a severe allergic reaction (anaphylaxis) to a prior dose of hepatitis B vaccine
• Have a known severe allergy to yeast. Most hepatitis B vaccines are produced using yeast-derived recombinant technology and contain trace yeast proteins
• Are currently experiencing a moderate to severe acute illness. Vaccination should be deferred until recovery

Pregnancy, breastfeeding, and immunocompromising conditions are not contraindications to hepatitis B vaccine. The decision to vaccinate in those settings is based on benefit-risk assessment, not prohibition.

If you completed a hepatitis B series years ago and are unsure whether protection persists, a simple blood test measuring anti-HBs (hepatitis B surface antibody) can confirm your immune status before travel. This is particularly relevant for:

• Healthcare workers with ongoing occupational risk
• Travelers with immunocompromising conditions who may not have mounted a full response to the original series
• Anyone who received their series more than 20 years ago and is traveling to a very high-risk destination

We order titer testing when appropriate and interpret results in the context of your travel plans.

OSHA mandates that employers offer hepatitis B vaccination to workers with blood or body fluid exposure risk. Healthcare students entering clinical rotations typically need documented vaccination plus a post-series titer confirming protective immunity. We handle both vaccination and titer testing in one place.

People on immunosuppressive therapy, those with HIV, and organ transplant recipients can and should receive hepatitis B vaccine, but may not mount a full immune response to the standard 3-dose series. Higher-dose formulations and post-vaccination titer testing help confirm protection. We coordinate with your specialist when needed.

Patients on hemodialysis are at elevated risk for hepatitis B and typically require a higher-dose formulation plus additional doses to achieve protective antibody levels. Annual titer checks are recommended. We work within your dialysis care team’s schedule.

Hepatitis B vaccine is not a live virus. It is considered safe during pregnancy and is recommended for pregnant people who are at risk of exposure, including those traveling to endemic regions. The benefit of preventing hepatitis B infection outweighs any theoretical risk from the vaccine itself.

Routine infant hepatitis B vaccination was not universal in the U.S. until the 1990s. ACIP now recommends vaccination for all unvaccinated adults through age 59, and for older adults who want protection. If you are unsure whether you were vaccinated, a titer test or catch-up series is the safest path forward.

Extended stays in endemic regions increase cumulative exposure risk through medical care, dental work, social activities, and emergency situations. Completing the full series before departure is especially important for expats, long-term volunteers, and people relocating for work or education.

Approximately 95 percent of healthy adults who complete the full hepatitis B vaccine series develop protective levels of surface antibody (anti-HBs). Protection appears to be long-lasting. Studies following vaccinated individuals for 30 years show that immunologic memory persists even as measured antibody levels decline, and boosters are not currently recommended for immunocompetent adults.

Immune response rates decrease somewhat with age. Adults over 60 have a response rate closer to 75 percent, and those with obesity, chronic illness, or immunosuppression may respond less robustly. For these groups, post-vaccination titer testing helps confirm whether protection was achieved.

A 2-dose series using Heplisav-B (approved for adults 18 and older) achieves comparable seroprotection rates on a faster schedule: two injections one month apart. Twinrix, a combination hepatitis A and B vaccine, is an option for travelers who need both vaccines.

You’ll be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The hepatitis B vaccine doses you receive that day
• Any other vaccines or prescriptions you elect
• Post-vaccination titer testing if indicated

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including hepatitis B?
• What CPT code do I submit? Hepatitis B vaccine is typically 90739 or 90746 depending on formulation and dose, plus an office-visit code
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Soreness, redness, or swelling at the injection site (most common, typically resolves within 1 to 2 days)
• Fatigue or mild headache
• Low-grade fever (less common, usually brief)
• Mild nausea or muscle aches

A subset of recipients experience temporary fatigue or flu-like symptoms lasting 24 to 48 hours after an injection. These are more common after the second or third dose. Acetaminophen or ibuprofen can help manage discomfort. No specific treatment is needed.

Anaphylaxis occurs in fewer than 1 in 600,000 doses. It typically begins within minutes of injection. We observe all patients for a brief period after each dose and are equipped to respond if a reaction occurs. This is an established precaution across all injectable vaccines.

The first dose starts the immune response, but full protection requires all three doses. Return for your second dose at one month and your third at six months. Missing or significantly delaying doses reduces the effectiveness of the series. We send reminders.

Injection site soreness and brief fatigue are common after any dose. Rest, fluids, and acetaminophen manage discomfort well. Call us if symptoms are severe, involve difficulty breathing, or persist beyond 48 hours.

Store your vaccination record somewhere safe. You may need it for employment, school enrollment, immigration, or long-term visa applications. We retain your records and can reissue documentation if yours are lost or damaged.

Hepatitis B can be given the same day as most other travel vaccines. If you also need hepatitis A vaccine, Twinrix combines both in a single series. We coordinate the full schedule at your consultation to minimize visits and protect you before departure.

• Specialist-led itinerary-based risk consultation
• Accelerated and 2-dose scheduling available
• Post-vaccination titer testing, on-site ordering
• Same-day or next-day appointments often available
• Coordinates full panel of travel vaccines
• Series completion reminders and tracking included

• Limited or general consultation only
• Accelerated schedules not always offered
• Titer testing variable or unavailable
• Variable scheduling
• Limited stock of travel-specific vaccines
• Series tracking generally not provided

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated May 4, 2026

You should not receive Tdap, or should receive it only after careful consultation, if you:

• Have had a severe allergic reaction (anaphylaxis) to a previous dose of any tetanus, diphtheria, or pertussis-containing vaccine
• Developed encephalopathy (coma, decreased consciousness, prolonged seizures) within 7 days of a previous pertussis-containing vaccine, with no other identifiable cause
• Have a moderate or severe acute illness with or without fever (defer until recovery)
• Have a history of Guillain-Barre syndrome within 6 weeks of a previous tetanus-containing vaccine (consult your physician)

Several conditions warrant a discussion but generally do not prevent vaccination:

• History of severe local reaction (Arthus reaction) after a prior dose
• Bleeding disorders or anticoagulant therapy (use small needle, hold pressure)
• Progressive or unstable neurologic disorders (defer until stable)
• Mild illness, low-grade fever, or routine antibiotic therapy (no deferral needed)

Tdap is recommended in every pregnancy between 27 and 36 weeks. Earlier in the window is preferred to maximize antibody transfer to the infant. The vaccine is safe for both mother and fetus. Receive it even if you had Tdap in a previous pregnancy or recently as a non-pregnant adult.

Patients on warfarin, DOACs, antiplatelets, or with hemophilia or thrombocytopenia can safely receive Tdap. We use a fine 23-gauge needle, apply firm pressure for 2 minutes, and provide post-injection care to minimize bruising.

Tdap is an inactivated vaccine, safe for immunocompromised patients including those on chemotherapy, biologics, or after transplant. Response may be reduced. Consult your specialist for optimal timing.

For a clean minor wound, a booster is indicated if the last dose was more than 10 years ago. For deep, contaminated, or puncture wounds, the threshold drops to 5 years. We can give Tdap or Td based on your prior vaccination history.

The adolescent Tdap booster restores waning pertussis immunity. ACIP recommends one dose at the 11 to 12 year well-child visit regardless of interval since the last DTaP dose. Adolescents who missed this dose should receive it at the earliest opportunity.

Adults aged 65 and older should receive Tdap if they have not received it as adults. Tetanus-related deaths in the United States increasingly occur in older adults whose immunity has waned. Boosters every 10 years are essential.

Tdap provides near-complete protection against tetanus and diphtheria after the initial Tdap dose, with continued protection from the Td booster every 10 years. Pertussis protection is high but wanes over time, which is why pertussis-containing boosters are recommended in pregnancy and for close infant contacts.

Tetanus and diphtheria efficacy approach 100 percent in fully vaccinated adults. Pertussis effectiveness is 80 to 90 percent in the first year after Tdap and gradually decreases over the following 5 to 10 years.

The single most important takeaway: keep Td or Tdap boosters current every 10 years. After a clean adult Tdap dose, switch to Td or Tdap boosters at the 10-year interval.

You will be charged for:

• Travel health consultation when relevant
• The Tdap vaccine
• Any other vaccines or prescriptions you elect

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover Tdap (CPT 90715)?
• Is it covered under medical or pharmacy benefits?
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT code 90715 (Tdap) and administration code
• Diagnosis code
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Soreness, redness, or swelling at the injection site (1 to 3 days)
• Mild arm fatigue or limited range of motion
• Temporary tenderness when lifting

Mild systemic effects within 1 to 3 days of vaccination, all self-limited:

• Low-grade fever
• Mild headache or fatigue
• Body aches or chills
• Nausea or upset stomach

• Anaphylaxis: approximately 1 in 1 million doses, treated immediately on site
• Severe local reaction (Arthus): rare, usually with very frequent prior boosters
• Guillain-Barre syndrome: approximately 1 in 1 million doses if seen at all (causal link debated)

Mild soreness or redness at the injection site is normal and peaks at 24 to 48 hours. A cold compress and over-the-counter pain relief help. Symptoms resolve within 3 to 5 days.

We provide a vaccination record with the date, lot number, and clinician signature. Add it to your immunization records, employer records if relevant, and personal travel health folder.

Mark your calendar. The Td booster (tetanus and diphtheria) is due every 10 years after your Tdap. If you sustain a significant wound before that interval, check your status. A deep wound may require a dose sooner.

Tdap can be given the same day as most other travel vaccines. We coordinate your full pre-travel panel at one appointment, including hepatitis A, hepatitis B, typhoid, and others.

• Specialty travel-medicine consultation
• Coordinates Tdap with your full pre-travel vaccine panel
• Same-day or next-day appointments often available
• Immediate documentation for employer or travel use
• Detailed itinerary-based risk assessment
• Wound-management consultation if recently injured

• Tdap available, but no travel-medicine specialty
• Limited or no coordination with other travel vaccines
• Variable scheduling and stock
• Standard immunization record only
• General consultation only
• No specialty follow-up for travel-related questions

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

You should not receive the flu vaccine, or should discuss your options carefully, if you:

• Have had a severe allergic reaction (anaphylaxis) to a previous dose of any flu vaccine or to a vaccine component
• Are younger than 6 months of age (no flu vaccine is approved for this age group)
• Have had Guillain-Barre Syndrome within 6 weeks of a prior flu vaccine (precaution, not absolute contraindication; discuss with your provider)
• Are currently experiencing a moderate or severe acute illness with or without fever (defer vaccination until recovered)
• For the live-attenuated nasal spray (FluMist) specifically: are immunocompromised, pregnant, under age 2 or over age 49, or are a close contact of severely immunocompromised individuals requiring a protected environment

Most flu vaccines are produced in eggs. Current ACIP guidance permits flu vaccination in people with egg allergies of any severity, with the following approach:

• Mild egg allergy (hives only): any licensed flu vaccine may be given in any setting
• Severe egg allergy (anaphylaxis, angioedema, respiratory distress, or required epinephrine after eating eggs): use a cell-based (Flucelvax) or recombinant (Flublok) formulation, both produced without eggs

We stock multiple formulations and will select the right one for your allergy history. Bring documentation of any prior severe reactions to your appointment.

Standard flu shots generate a weaker immune response in older adults. ACIP preferentially recommends high-dose (Fluzone High-Dose), adjuvanted (Fluad), or recombinant (Flublok) formulations for this age group. Studies show high-dose flu vaccine is approximately 24% more effective than standard-dose at preventing flu illness in adults 65 and older. We stock preferred formulations and will confirm which option is right for you.

Flu vaccination is strongly recommended at any stage of pregnancy. The inactivated flu shot is safe for the mother, reduces the risk of flu-related complications including preterm birth, and passes maternal antibodies to the newborn, offering protection during the infant’s first months before they are old enough to be vaccinated. The live-attenuated nasal spray is not used during pregnancy.

Patients on chemotherapy, biologics such as rituximab or methotrexate, or high-dose corticosteroids should receive only the inactivated flu shot. The nasal spray is contraindicated. Timing matters: vaccination before a treatment cycle begins typically produces a stronger immune response than vaccination mid-cycle. Bring a complete medication list so we can coordinate appropriately.

Children under 9 years old receiving a flu vaccine for the very first time need two doses, given at least 4 weeks apart. The first dose primes the immune system and the second generates adequate protective immunity. In subsequent seasons, one annual dose is sufficient. Schedule early so the second dose is complete before flu season peaks in Arizona.

Travelers crossing hemispheres face double flu seasons in a single calendar year. If you are heading to Australia, New Zealand, or South America between April and September, you may encounter circulating strains not covered by your Northern Hemisphere shot. We review your itinerary and advise on formulation timing, potential mid-year revaccination, and how flu fits alongside your other travel vaccines.

Annual flu vaccination for healthcare personnel reduces transmission to vulnerable patients who cannot be effectively vaccinated themselves. Many Arizona healthcare employers require annual flu documentation for credentialing. We provide printed records that meet most employer requirements, and same-day appointments so you can stay current without disrupting your schedule.

Flu vaccine effectiveness varies from season to season depending on how closely the vaccine strains match the viruses actually circulating. In most seasons, CDC estimates that flu vaccination reduces the risk of medically attended flu illness by approximately 40 to 60 percent among the overall population.

Against flu-related hospitalization, protection is generally higher, with studies estimating approximately 40 to 70 percent reduction in hospitalizations among vaccinated adults. In adults 65 and older receiving high-dose or adjuvanted formulations, protection against severe outcomes is meaningfully better than with standard-dose vaccines.

Even in seasons with a suboptimal strain match, vaccination reduces the severity of illness among those who do get infected, lowers the risk of hospitalization, and decreases the likelihood of spreading flu to household contacts. These benefits are consistent across seasons regardless of exact efficacy numbers.

Protection from flu vaccination is best in the 3 to 4 months following the shot and wanes over the season, which is why annual revaccination is recommended rather than relying on a prior-year dose.

You may be charged for:

• Travel health consultation (itinerary-based risk assessment and formulation timing guidance)
• The flu vaccine itself (formulation will depend on your age and health status)
• Any other vaccines or prescriptions you elect during your visit

Pricing varies based on formulation and services. Call (480) 435-2774 for current pricing. We are transparent so there are no surprises.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover annual flu vaccination, and is it covered at 100% with no cost-sharing?
• What CPT code applies? Standard flu shot is typically 90686 or 90688. High-dose is 90662
• Do I need to go to an in-network provider?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer. We give you everything needed to file successfully.

• Soreness, redness, or mild swelling at the injection site (1 to 2 days)
• Low-grade fever, fatigue, headache, or muscle aches (typically 1 to 2 days)
• Brief fainting (syncope), most often in adolescents. We observe you after your injection

Studies suggest a very small increased risk of Guillain-Barre Syndrome (GBS) in the weeks following flu vaccination, estimated at approximately 1 to 2 additional cases per million people vaccinated. For context, flu infection itself carries a substantially higher risk of GBS than the vaccine. For most people, the benefit of vaccination far outweighs this risk.

Anaphylaxis occurs in approximately 1 to 2 people per million doses administered, typically within minutes of injection. We observe you after vaccination and are prepared to respond. This is precisely why we review your allergy history before administering any vaccine.

Protection builds gradually and reaches its peak at approximately 2 weeks after vaccination. During this window you are not yet fully protected. Continue standard hygiene practices, hand washing, avoiding close contact with sick individuals, and staying home if you develop symptoms.

Soreness at the injection site and mild fatigue or low-grade fever in the day or two following vaccination are normal immune responses, not flu infection. Rest and fluids help. Over-the-counter pain relievers are appropriate for discomfort. Call us if symptoms are severe, worsen after 48 hours, or include difficulty breathing or swallowing.

Flu vaccination is an annual commitment. Protection wanes over the season and circulating strains change from year to year, so last year’s shot does not substitute for this year’s. Set a reminder for September or October. If you are a traveler heading to the Southern Hemisphere in spring or summer, contact us about mid-year revaccination options.

Flu vaccine can be administered at the same visit as most other inactivated travel vaccines, including Hepatitis A, Hepatitis B, Tdap, and typhoid. If your travel plans require multiple vaccines, we sequence and co-administer them efficiently so you can complete your full panel without multiple trips.

• Specialist-led travel timing and formulation consultation
• High-dose, adjuvanted, and recombinant options for adults 65 and older
• Egg-free cell-based and recombinant formulations for egg-allergic patients
• Same-day or next-day appointments often available
• Coordinates flu with full travel vaccine panel at one visit
• Printed vaccination records meeting employer and school documentation requirements

• General consultation only; limited travel-specific timing guidance
• Variable availability of high-dose and adjuvanted formulations
• Often limited stock of egg-free alternative formulations
• Variable scheduling
• Limited co-administration of travel vaccines at a single visit
• Vaccination records generally available but without travel health context

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated May 4, 2026

You should not receive MMR, or should receive it only after careful consultation, if you:

• Are pregnant or planning pregnancy within the next 4 weeks
• Have severe immunodeficiency (HIV with low CD4, active cancer therapy, organ transplant, primary immunodeficiency, high-dose corticosteroids)
• Have a history of severe allergic reaction to a previous MMR dose, or to neomycin or gelatin
• Are younger than 6 months of age
• Recently received a blood product or immune globulin (timing of MMR may need adjustment)

Several conditions warrant careful consultation but generally do not prevent vaccination:

• Recent moderate or severe acute illness (defer until recovery)
• History of thrombocytopenic purpura (rare association with MMR)
• Personal or family history of seizures (febrile seizures slightly more common after MMR in young children)
• Egg allergy is NOT a contraindication for MMR (the vaccine is grown in chick embryo cells, not eggs)

MMR is a live vaccine and is contraindicated during pregnancy. Receive MMR at least 4 weeks before conception. Postpartum women without rubella immunity should be vaccinated before discharge after delivery to protect future pregnancies.

MMR is generally contraindicated in patients with severe immunodeficiency. Some HIV-positive patients with adequate CD4 counts can safely receive MMR. Coordinate with your specialist. Household contacts of immunocompromised patients can and should receive MMR safely.

Despite the persistent myth, MMR is NOT contraindicated in egg-allergic patients. The vaccine is grown in chick embryo fibroblast cells, not in eggs. Even patients with severe egg allergies can safely receive MMR without special precautions.

Recent administration of immune globulin or blood products can interfere with MMR efficacy. The recommended interval before MMR varies from 3 to 11 months depending on the product. Bring documentation of recent blood products or IVIG to your appointment.

Infants 6 to 11 months traveling to areas with active measles transmission can receive an early dose of MMR. This dose does not count toward the routine 2-dose series. The child should still receive routine doses at 12 to 15 months and 4 to 6 years.

If you can’t find your vaccination records, we offer titer testing (a blood test) to confirm immunity to measles, mumps, and rubella. This is useful for healthcare workers, college applicants, and adults with unclear records. Vaccination without testing is also acceptable.

Two doses of MMR provide approximately 97 percent protection against measles, 88 percent against mumps, and 97 percent against rubella. Protection is generally lifelong. A small percentage of recipients may have waning immunity over decades, particularly for mumps.

One dose of MMR provides approximately 93 percent protection against measles, 78 percent against mumps, and 97 percent against rubella. The second dose primarily addresses the small fraction of people who didn’t respond to the first dose.

Routine boosters are not recommended for the general population. Healthcare workers in some outbreak settings and adults vaccinated decades ago with first-generation formulations may benefit from a third dose. We assess this at your consultation.

You will be charged for:

• Travel health consultation when relevant
• The MMR vaccine
• Titer testing if requested
• Any other vaccines or prescriptions you elect

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover MMR (CPT 90707)?
• Is it covered under medical or pharmacy benefits?
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT code 90707 (MMR) and administration code
• Diagnosis code
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Soreness or redness at the injection site
• Low-grade fever (typically 7 to 12 days after vaccination)
• Mild rash, often called a measles-like rash, in 5 percent of recipients
• Temporary swelling in glands of the cheek or neck

• Febrile seizures: approximately 1 in 3,000 doses, typically in young children
• Temporary low platelet count (idiopathic thrombocytopenic purpura): approximately 1 in 30,000
• Joint pain or stiffness, particularly in adult women

• Anaphylaxis: approximately 1 in 1 million doses, treated immediately on site
• Encephalitis: approximately 1 in 1 million doses if seen at all (causal link debated)
• The vaccine does NOT cause autism. This has been definitively disproven by multiple large studies

Mild soreness at the injection site is normal and resolves within 1 to 3 days. A cold compress and over-the-counter pain relief help. The mild fever or rash, if they occur, typically appear 7 to 12 days later.

We provide a vaccination record with the date, lot number, and clinician signature. Add it to your immunization records, employer records if relevant, and personal travel health folder.

If you are completing a 2-dose series, the second dose is given at least 28 days after the first. For routine childhood schedule, the second dose is at age 4 to 6. For adults catching up, 4 weeks is the minimum interval.

MMR can be given the same day as most other vaccines. Live vaccines like varicella and yellow fever should be given the same day as MMR or separated by at least 28 days.

• Travel-medicine specialty consultation
• Coordinates MMR with your full pre-travel vaccine panel
• Same-day or next-day appointments often available
• Titer testing on site for unclear vaccination history
• Immediate documentation for school, work, or travel
• Detailed itinerary-based risk assessment

• MMR available, but no travel-medicine specialty
• Limited or no coordination with other travel vaccines
• Variable scheduling and stock
• Titer testing may require separate lab visit
• Standard immunization record only
• General consultation only

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

Vaccination should be deferred or discussed in detail if you:

• Have had a severe allergic reaction (anaphylaxis) to a prior dose of IPV
• Are allergic to neomycin, streptomycin, or polymyxin B. These antibiotics are used in trace amounts during vaccine production
• Are experiencing a moderate to severe acute illness. Defer until recovery. Mild illness with no fever is not a reason to delay
• Are pregnant. IPV is an inactivated vaccine and no evidence of fetal harm exists, but vaccination is generally deferred unless travel to an endemic area is unavoidable and the risk of exposure is genuine

Because IPV contains no live virus, it is safe for people who are immunocompromised, including those with HIV, cancer, organ transplants, or on immunosuppressive medications. Vaccination is especially important for immunocompromised individuals who may be at higher risk of severe illness if exposed to poliovirus.

Immunocompromised patients may have a reduced immune response to the vaccine. We discuss timing and dose considerations at your consultation.

Wild poliovirus type 1 remains endemic in both countries. Adults who completed childhood vaccination should receive a one-time booster before travel. Travelers spending four or more weeks should carry documentation of IPV given within the preceding twelve months, as exit health checks occur at some border crossings and airports.

Circulating vaccine-derived poliovirus outbreaks have affected multiple African countries in recent years. The specific countries with active transmission change over time. We pull current CDC and WHO outbreak maps at your appointment and advise based on your exact destination and planned activities.

Many adults vaccinated in the 1970s or 1980s received OPV (oral polio vaccine) and have no paper records. CDC guidance is simply to complete or repeat the series. There is no harm in additional IPV doses if prior vaccination status is uncertain.

IPV is an inactivated vaccine and no studies have shown fetal harm. Vaccination is generally deferred during pregnancy unless travel to a polio-endemic region is unavoidable. If you are pregnant and must travel to Afghanistan, Pakistan, or an area with active cVDPV, we walk through a detailed risk-benefit discussion and can vaccinate when the clinical case is clear.

Children who received OPV (oral polio vaccine) outside the United States may still benefit from completing an IPV series to ensure documented immunity recognized in the U.S. We review records from foreign vaccination programs and advise on the minimum number of additional IPV doses needed.

IPV is safe for immunocompromised individuals and is preferred over OPV in this population. Patients on biologics, chemotherapy, or post-transplant immunosuppression should receive IPV. Immune response may be reduced, so timing around therapy cycles and coordination with the treating physician can optimize protection.

Studies have consistently shown that two doses of IPV provide approximately 90 percent protection against paralytic polio. After three or more doses, protection rises to approximately 99 percent and is long-lasting for the vast majority of recipients.

The inactivated formulation used in the United States since 2000 produces strong serum antibody responses that prevent viral spread to the nervous system. Protection from a completed childhood series persists into adulthood, though adults traveling to endemic areas are advised to receive one lifetime booster to ensure robust immunity.

IPV does not contain live virus and cannot cause vaccine-associated paralytic polio (VAPP), a rare risk that existed with the older oral poliovirus vaccine. Every dose given in the U.S. today is IPV.

You’ll be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The IPV vaccine dose or doses
• Vaccination documentation suitable for travel or employer requirements
• Any other vaccines or prescriptions you elect

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover IPV for adults or as a travel vaccine?
• What CPT code do I submit? IPV is typically 90713
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Children covered by Medicaid or the VFC program may receive IPV at no cost. Ask about eligibility when you call.

• Soreness, redness, or swelling at the injection site (resolves within 1 to 2 days)
• Mild tenderness with pressure on the arm
• Fussiness or mild irritability in infants, typically resolving within 24 hours

Low-grade fever has been reported after IPV, most commonly when it is co-administered with other vaccines in infancy. Mild fatigue or fussiness beyond the first 24 hours is uncommon. Systemic reactions to IPV alone are much less frequent than with many other childhood vaccines.

Anaphylaxis is extremely rare with IPV. It can occur with virtually any injectable medication. We observe patients briefly after vaccination. If you have a known allergy to neomycin, streptomycin, or polymyxin B, tell us before your appointment so we can take appropriate precautions.

Most people notice only mild soreness at the injection site, if anything at all. Low-grade fever is uncommon. Resume normal activity immediately. Acetaminophen or ibuprofen can address soreness if needed.

Store your updated immunization record with your passport and travel documents. For travel to endemic areas, carry documentation of your vaccination date. Some countries request proof of IPV for travelers staying four or more weeks.

If you are starting or completing a series, schedule your follow-up doses before your departure date. We map the timing at your first visit. Minimum intervals between doses must be respected to ensure full protection.

IPV can be given the same day as most other vaccines. If your itinerary includes Afghanistan, Pakistan, or sub-Saharan Africa, you may also need hepatitis A, typhoid, or other vaccines. We review the full picture at your consultation.

• Specialist-led itinerary-based risk consultation
• Complete IPV series and travel booster available
• Clinician-signed documentation for endemic-area exit requirements
• Same-day or next-day appointments often available
• Coordinates full panel of travel vaccines
• Catch-up series for unvaccinated adults and children

• Limited or general consultation only
• May not stock all IPV formulations or schedules
• Documentation for exit requirements varies widely
• Variable scheduling
• Limited stock of travel-specific vaccines
• Adult catch-up series often inconsistent

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

You should not receive the vaccine, or should discuss it carefully with our provider, if you:

• Have a known severe allergic reaction (anaphylaxis) to a previous dose of any meningococcal vaccine
• Have a severe allergy to any component of the specific vaccine formulation (including diphtheria toxoid in Menactra and MenQuadfi, or CRM197 in Menveo and Bexsero)
• Are currently acutely ill with moderate or severe illness with or without fever (defer until recovered)
• Have a history of Guillain-Barre syndrome (discuss benefit and risk with your provider, especially for Menactra)

Pregnancy is not a contraindication. MenACWY conjugate vaccines may be given during pregnancy when the benefit outweighs any theoretical risk. Our providers assess this case by case.

Certain individuals face dramatically higher risk of severe meningococcal disease and have the most to gain from vaccination:

• Asplenic patients (sickle cell disease, surgical splenectomy): vaccination with both MenACWY and MenB, plus scheduled booster intervals
• Complement deficiency (C3, C5 to C9, properdin): highest individual risk, both MenACWY and MenB recommended
• Patients on eculizumab (Soliris) or ravulizumab: ACIP recommends MenACWY and MenB before initiating these drugs
• HIV-positive individuals: MenACWY recommended at diagnosis and every 5 years

Saudi Arabia requires MenACWY for all pilgrims. The certificate must come from an authorized provider on official letterhead. We supply the required documentation at your appointment, verify current Saudi Ministry of Health formulation requirements, and confirm your timing window before the pilgrimage season opens.

If you have sickle cell disease, have had your spleen removed, or have complement deficiency, you face dramatically elevated risk of fatal meningococcal disease. ACIP recommends a more intensive vaccination schedule including both MenACWY and MenB, with specific booster intervals. Bring a complete medical history so we can build the right plan.

College students, gap-year travelers, study-abroad participants, and those staying in dormitories or group housing in at-risk areas face heightened transmission risk. MenB requires two separate doses spaced at least one month apart, so start the vaccination conversation early if you are heading to an African university or abroad program in the meningitis belt.

Unlike live vaccines, MenACWY and MenB are inactivated and are not contraindicated in pregnancy. ACIP guidance supports vaccination during pregnancy when the individual has a clear indication such as travel to the meningitis belt, Hajj, or a medical risk factor. We weigh timing, destination risk, and gestational age at your appointment.

These complement-blocking drugs (used in PNH and atypical HUS) prevent the immune system from killing meningococcal bacteria, making infection almost always fatal without vaccination. ACIP recommends both MenACWY and MenB at least 2 weeks before starting therapy. If already on these drugs, vaccinate immediately. Bring your prescribing records.

If you received the older polysaccharide meningococcal vaccine (sold as Menomune, now discontinued) rather than a conjugate vaccine, Saudi Arabia and other travel authorities require revaccination with MenACWY conjugate. We verify your prior vaccine type from your records and issue updated documentation.

MenACWY conjugate vaccines demonstrate 85 to 100 percent effectiveness against the serogroups they cover in clinical trials and real-world outbreak settings. Effectiveness against serogroup A (the dominant strain in the African meningitis belt) is particularly high.

Immunity develops within 7 to 10 days of vaccination. Unlike the older polysaccharide vaccine, conjugate vaccines generate immune memory, producing more durable protection. However, immunity wanes over time in high-risk individuals. ACIP recommends boosting every 5 years for travelers and others with ongoing risk.

MenB vaccines (Bexsero and Trumenba) demonstrate approximately 63 to 88 percent effectiveness against serogroup B strains based on vaccine-strain coverage assessments. No clinical efficacy trials were conducted. Effectiveness is inferred from bactericidal antibody responses using human complement serum assays.

No meningococcal vaccine covers all serogroups. Combined MenACWY plus MenB vaccination provides the broadest protection currently available.

You’ll be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The meningococcal vaccine or vaccines you elect
• Hajj and Umrah vaccination documentation if applicable
• Any other vaccines or prescriptions you receive

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover meningococcal vaccines for travel?
• CPT code for MenACWY conjugate is typically 90734. MenB Bexsero is 90621. MenB Trumenba is 90620
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Pain, redness, or swelling at the injection site (most common, resolves within 1 to 3 days)
• Headache, fatigue, or malaise (24 to 48 hours after vaccination)
• Low-grade fever (less common in adults than adolescents)
• Muscle or joint aches (more common with MenB vaccines)

MenB vaccines (Bexsero in particular) are more reactogenic than MenACWY. Clinical trials showed up to 80 percent of recipients experienced injection-site pain and roughly 50 percent experienced fatigue or headache. These reactions are self-limited and resolve within 1 to 2 days. Acetaminophen or ibuprofen taken at the time of vaccination reduces severity.

Anaphylaxis: severe allergic reaction is rare, estimated at fewer than 1 in 1,000,000 doses. We observe all vaccine recipients for 15 minutes post-injection.

Guillain-Barre syndrome has been reported in temporal association with Menactra (MenACWY-D) in a very small number of cases. Current data do not confirm a causal link. We discuss this at your consultation if you have a prior GBS history.

Full protective immunity develops within 7 to 10 days of vaccination. Schedule your appointment at least 2 weeks before departure to allow a comfortable margin, especially if you also need other vaccines.

A sore arm, mild fatigue, or low-grade fever in the 24 to 48 hours following your shot is normal. Acetaminophen or ibuprofen taken with or just after the vaccine helps reduce discomfort. Call us if symptoms are severe or last beyond 3 days.

Hajj and Umrah pilgrims must present their meningococcal vaccine certificate to the Saudi consulate and again at the border. Keep the original document with your travel paperwork. We retain a copy in your record for re-issuance if needed.

If you need MenB, two doses are required at least one month apart (Bexsero) or two to three doses (Trumenba). Start early. For ongoing meningitis belt travel or high-risk occupational exposure, MenACWY boosters every 5 years are recommended.

• CDC-recommended travel medicine clinic
• Hajj and Umrah official documentation issued at appointment
• Specialist-led itinerary-based risk consultation
• Same-day or next-day appointments often available
• Coordinates full panel of travel vaccines
• Both MenACWY and MenB available

• Not a CDC-designated travel medicine center
• Cannot issue Hajj or Umrah official documentation
• Limited or general consultation only
• Variable scheduling
• Limited stock of travel-specific vaccines
• May not carry all meningococcal formulations

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

Consult carefully before receiving pre-exposure rabies vaccination if you:

• Have a documented history of severe allergic reaction to a prior dose of rabies vaccine or to any vaccine component, including neomycin, gelatin, or human albumin (varies by formulation)
• Are immunocompromised due to HIV with low CD4 counts, active cancer treatment, organ transplant, or high-dose corticosteroids. The vaccine is not contraindicated, but immune response may be reduced. Serologic titer testing after the series is recommended to confirm protective antibody levels
• Are taking chloroquine, hydroxychloroquine, or mefloquine for malaria prophylaxis. These antimalarials can reduce the immune response to intradermal rabies vaccine. The intramuscular route is preferred in this situation

There are no absolute contraindications to post-exposure prophylaxis. If you have been exposed, the vaccine must be given regardless of prior reactions, because the alternative is a virtually always fatal disease.

The rabies vaccine is inactivated and contains no live virus. It is considered safe during pregnancy when there is meaningful risk of exposure. Unlike the yellow fever vaccine, pregnancy does not create a presumptive contraindication. The decision is based on the risk the destination and itinerary pose, not on the vaccine itself. We review this at every consultation and can coordinate with your OB as needed.

Breastfeeding is not a contraindication to rabies vaccination at any stage.

Severely immunocompromised individuals may generate inadequate antibody titers after the standard two-dose series. ACIP recommends serologic titer testing one to two weeks after completing the series to confirm protective levels. If titers are inadequate, additional doses may be given. Bring a complete medication and diagnosis list to your consultation.

The two-dose series requires a minimum of seven days between doses. If your departure is in fewer than seven days, we discuss your options: initiating the first dose before departure and arranging the second dose abroad, or evaluating whether the destination and itinerary warrant that approach. Do not skip the series entirely without this conversation.

Chloroquine and hydroxychloroquine suppress the immune response to intradermal rabies vaccine. If you are taking either drug for malaria prevention, the intramuscular route must be used for all doses. We coordinate the entire travel health package at your appointment, including this interaction, so nothing is missed.

Children are one of the highest-priority groups for rabies pre-exposure vaccination. They are more likely to be bitten, less likely to report the exposure, and often bitten on the face or head where the virus reaches the brain more quickly. The standard adult dose and schedule apply from infancy onward. We discuss age-appropriate wound-washing education at every pediatric travel consult.

If you were not pre-vaccinated and are bitten abroad, you need four doses of rabies vaccine (days 0, 3, 7, and 14) plus rabies immune globulin on day 0. Immune globulin is frequently unavailable or cost-prohibitive in low-income countries. Call us immediately. We help coordinate access to care from Scottsdale and can advise on evacuation decisions.

Veterinarians, laboratory workers, and wildlife personnel require periodic serologic titer testing rather than a fixed booster schedule. We provide orders to perform blood draws for titer levels and interpret results against the WHO standard protective threshold. A booster is given only when titers fall below the recommended level, avoiding unnecessary doses.

Arizona has documented rabies in multiple bat species. Exposure in your own backyard is a real scenario, particularly during summer months when bats are active. If you find a bat in your room and cannot rule out contact while sleeping, post-exposure evaluation is warranted. We see Arizona residents for bat-exposure consultations in addition to travel-related pre-exposure care.

The rabies pre-exposure vaccine series generates a protective antibody response in essentially 100 percent of healthy, immunocompetent adults following the two-dose ACIP schedule. No confirmed human rabies deaths have occurred in anyone who received a complete, correctly administered post-exposure prophylaxis course after a documented exposure.

Pre-exposure vaccination does not replace post-exposure care. If you are bitten, you still need to act immediately: wash the wound thoroughly with soap and water for at least 15 minutes, then receive two additional vaccine doses on days 0 and 3 after exposure. What pre-exposure vaccination removes is the need for rabies immune globulin, which is expensive, derived from human plasma, and often unavailable in the countries where travelers most need it.

For unvaccinated individuals who receive complete post-exposure prophylaxis promptly after a confirmed exposure, the four-dose series plus immune globulin is also virtually 100 percent effective when started without delay. Delay is the primary cause of post-exposure prophylaxis failure. Every hour between exposure and first dose matters.

You will be charged for:

• Travel health consultation (itinerary-based risk assessment)
• Each rabies vaccine dose (two doses for the pre-exposure series)
• Any additional vaccines or prescriptions you elect
• Titer orders and interpretation if indicated for animal workers or occupational travelers

Pricing varies based on services. Call (480) 435-2774 for current pricing. We are transparent so there are no surprises.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including rabies pre-exposure prophylaxis?
• What CPT code do I submit? Rabies vaccine intramuscular is typically 90675
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer. We provide everything needed to file successfully.

• Pain, redness, swelling, or itching at the injection site (most common, resolves in 1 to 3 days)
• Induration or tenderness with repeated doses
• Headache, nausea, abdominal pain, muscle aches, or dizziness (5 to 40% of recipients)
• Low-grade fever
• Typically self-resolving within 24 to 48 hours

Seen primarily with booster doses of the HDCV formulation (Imovax), not typically with the primary series. Presents as urticaria (hives), angioedema, joint pain, and fever, usually 2 to 21 days after the booster dose. Believed to result from a reaction between beta-propiolactone-altered human albumin in the vaccine and pre-existing antibodies. Generally not life-threatening but uncomfortable. RabAvert (PCECV) may be substituted if this reaction occurs.

Anaphylaxis: Rare severe allergic reaction, typically within minutes to hours of vaccination. We observe all patients for 15 minutes after each dose. Epinephrine is available at our clinic.

Neurologic reactions: Extremely rare with modern cell-culture vaccines. Historical reports of neuroparalytic events were associated with older nerve-tissue vaccines, which are no longer used or approved in the United States.

The two-dose ACIP pre-exposure series requires the second dose on day 7. Plan to return to our clinic or arrange the second dose before departure. A partial series provides some immune priming but does not confer the full simplified post-exposure benefit. Both doses are needed.

Wash the wound immediately with soap and water for at least 15 minutes. This single step reduces transmission risk meaningfully. Then seek medical care the same day for post-exposure evaluation. Do not wait and observe, even if you were previously vaccinated.

Keep a written record of your vaccination dates and the vaccine formulation received. If you are bitten abroad, local clinicians need to know whether you were pre-vaccinated and with which product. This determines whether you need two doses or four, and whether immune globulin is required on day 0.

Rabies vaccine can be administered the same day as most other inactivated travel vaccines. If you are also receiving typhoid, hepatitis A, hepatitis B, Japanese encephalitis, or other vaccines, we coordinate the full panel at your consultation. Live vaccines can also be co-administered on the same day.

• Current ACIP 2022 two-dose pre-exposure schedule
• Specialist-led itinerary-based risk consultation
• Same-day or next-day appointments often available
• Coordinates full panel of travel vaccines at the same visit
• Post-exposure guidance and administration of post exposure prophylactic series if bitten abroad
• Ordering and interpretation of serologic titer testing available 

• May use older three-dose schedule not current with ACIP 2022
• Limited or general consultation only
• Variable scheduling
• Limited stock of travel-specific vaccines
• Rabies vaccine often not carried in stock
• Post-exposure prophylaxis generally not available
• Titer testing may require referral to another facility

Norman J. Bizon, PA-C, CTH® is Medical Director at TravelBug Health. Over 30 years of clinical experience and certified in travel medicine and international health.

Tessa E. McFall, ASN, EMT is a Travel Health Specialist Clinician at TravelBug Health.

Last updated April 21, 2026

You should not receive Ixiaro, or should discuss carefully before receiving it, if you:

• Have had a severe allergic reaction (anaphylaxis) to a previous dose of Ixiaro or to any component of the vaccine, including protamine sulfate
• Are under 2 months of age (the vaccine is approved from 2 months onward)
• Are pregnant (the vaccine should be used only if the benefit clearly outweighs the risk; limited safety data are available)
• Are breastfeeding (safety data are limited; discuss with your provider)
• Are moderately or severely ill at the time of vaccination (defer until recovery)

Because Ixiaro is an inactivated (killed) vaccine, it is not contraindicated in immunocompromised individuals the way live vaccines are. However, immunocompromised travelers may develop a reduced immune response, potentially requiring additional doses or closer post-vaccination review.

Immunocompromised travelers also face more severe outcomes from JE itself, which often shifts the risk-benefit analysis decisively toward vaccination. Bring a complete medication list including any biologics, chemotherapy agents, or systemic steroids.

For adults, the 2-dose series is given on days 0 and 7, with travel beginning no sooner than 7 days after dose 2. That is a minimum ~14-day window. Children continue to follow the days 0 and 28 schedule, with at least 7 days after dose 2 before travel. If departure is imminent, we discuss the risk honestly. Partial protection combined with aggressive mosquito bite prevention may be the practical approach.

Safety data for Ixiaro in pregnancy are limited. The vaccine is not a live virus, which removes the theoretical fetal infection concern, but the benefit-risk balance should be reviewed carefully. If travel to a high-risk area is unavoidable, vaccination may be the right call. We review each case individually.

Ixiaro is approved for children aged 2 months and older. Children 2 months to under 3 years receive a half-dose formulation. Children 3 years and older receive the standard adult-volume dose. The 28-day interval between doses applies for pediatric patients; the accelerated 7-day adult schedule is FDA-approved only for ages 18 to 65. Bring vaccination records for all children traveling with you.

Long-term travelers, expats, and those making repeated short trips to endemic areas should receive the booster dose at one year after the primary series. After that first booster, ongoing need is reassessed based on continued exposure. We track your vaccination history and alert you when a booster is due.

Patients on biologics, DMARDs, systemic corticosteroids, or other immunosuppressants can receive Ixiaro because it is inactivated. Immune response may be reduced, and additional doses are sometimes warranted. Bring a full medication list so we can assess timing and discuss expectations for immunity levels.

Most Asia-bound travelers need more than just JE vaccine. We coordinate hepatitis A, typhoid, hepatitis B, rabies pre-exposure prophylaxis, and malaria medications in a single appointment, sequencing vaccines appropriately and giving you one itemized receipt.

Ixiaro, the inactivated Vero cell-derived JE vaccine used in the United States, has demonstrated seroprotection rates of up to 96 percent in clinical trials following the 2-dose primary series. Seroprotection is defined as a virus neutralization titer of 1:10 or higher, which correlates with protection against clinical disease.

For adults, the primary series is 2 doses given 7 days apart. Travel should begin no sooner than 7 days after the second dose, so plan a minimum ~14-day window. Children follow the longer schedule of 2 doses 28 days apart, with at least 7 days after dose 2 before travel (a 35-day window).

A booster dose is recommended at 1 year if ongoing risk is anticipated. After the booster, available data support continued protection for at least 2 years. Long-term durability data beyond that are still being collected.

Ixiaro replaced the older mouse-brain-derived JE vaccine in the United States. The newer formulation carries a significantly improved safety profile with the same strong efficacy.

You will be charged for:

• Travel health consultation (itinerary-based risk assessment)
• Ixiaro (JE vaccine), per dose
• Administration fee
• Any other vaccines or prescriptions you elect at the same visit

Pricing varies based on services. Call (480) 435-2774 for current pricing. We are transparent so there are no surprises.

Before your appointment, call the member services number on your insurance card and ask:

• Does my plan cover travel vaccines, including Japanese encephalitis?
• What CPT code do I submit? JE vaccine is typically 90738
• Do I need pre-authorization?
• Can I apply HSA or FSA funds?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items

Reimbursement outcome is between you and your insurer.

• Pain, tenderness, redness, or swelling at the injection site (1 to 3 days)
• Headache (most commonly reported systemic reaction)
• Myalgia (muscle aches)
• Low-grade fever and fatigue
• Nausea

A small proportion of recipients report flu-like symptoms lasting 1 to 3 days, including chills, mild joint aches, or gastrointestinal discomfort. These reactions are self-limiting and do not require treatment beyond rest, fluids, and acetaminophen if needed.

Severe allergic reactions (anaphylaxis) are rare. We observe all vaccinated patients for at least 15 minutes post-injection. Individuals with a history of reaction to protamine sulfate, used in certain cardiac procedures or insulin formulations, should disclose this before vaccination, as protamine is present in Ixiaro.

Adults aged 18 to 65 need 7 days between dose 1 and dose 2, plus 7 more days before travel begins, so 14 days at a minimum. Children and adults outside that age range need 28 days between doses plus 7 more days, so 35 days at a minimum. We schedule both doses at your initial appointment so nothing is left to chance.

Soreness at the injection site and a mild headache or fatigue in the 24 to 48 hours following each dose is normal. Acetaminophen or ibuprofen can help. Contact us if symptoms are severe or last longer than 3 days.

JE vaccine is highly effective but not 100 percent. Continue using DEET-based repellents, permethrin-treated clothing, and sleeping in screened or air-conditioned rooms. Culex mosquitoes bite predominantly from dusk to dawn, so evening protection is especially important.

If you expect to return to endemic areas or travel frequently to Asia, a booster is recommended at 1 year after the primary series. Note the date at your second appointment. We keep records and can remind you when it is due.

• Stocks Ixiaro (JE vaccine) in clinic
• Specialist-led itinerary-based JE risk assessment
• Schedules both doses at your initial appointment
• Same-day or next-day appointments often available
• Coordinates full Asia pre-travel vaccine panel
• Booster tracking and reminders for ongoing travelers

• Rarely stocks Ixiaro; often must order and reschedule
• Limited or general travel risk consultation only
• Variable dose scheduling coordination
• Variable scheduling availability
• Limited stock of travel-specific vaccines
• Generally no booster tracking or reminders

Norman J. Bizon, PA-C, CTH
Medical Director, 30+ years clinical experience

Tessa E. McFall, ASN, EMT
Travel Health Clinician

Last updated April 21, 2026

You should not receive the vaccine, or should receive it only after careful consultation, if you:

• Have a known hypersensitivity to any component of the vaccine
• Are currently taking antibiotics, or have completed a course of antibiotics within the past 14 days (antibiotics kill the live bacterial vaccine strain)
• Are taking chloroquine for malaria prevention (chloroquine can impair the immune response to the oral cholera vaccine; separate the two by at least 10 days)
• Are younger than 2 years of age (not approved in this age group)
• Are 65 years of age or older (clinical trials did not include this age group; discuss with your provider)
• Are severely immunocompromised (the vaccine contains live bacteria; safety data in this population are limited)
• Are pregnant or breastfeeding (safety has not been established; discuss risks and benefits)

If the oral cholera vaccine is not appropriate for you, we focus the consultation on risk-reduction strategies: safe food and water practices, oral rehydration salt supplies, and practical guidance for identifying and responding to early symptoms of cholera in the field.

For travelers with antibiotic timing conflicts, we can often coordinate your schedule to allow the required 14-day washout period before departure. Bring a complete list of all medications, including antimalarials and any recent or ongoing antibiotic courses.

For humanitarian workers with immune system considerations, we review the clinical evidence and work with your prescribing physician to develop the safest possible pre-deployment plan.

Humanitarian workers are the highest-risk group for cholera exposure, often deploying on short timelines to active outbreak zones with compromised water and sanitation. We are experienced with pre-deployment travel health consultations and can coordinate the full vaccine panel, antimalarials, and field medications in a single visit.

The oral cholera vaccine must not be taken within 14 days of any antibiotic course. This is a common scheduling challenge for travelers finishing a dental course, treating an infection, or starting malaria prophylaxis with doxycycline before departure. Bring a complete medication list and we will map out the correct sequence.

Chloroquine, sometimes used for malaria prophylaxis in certain destinations, can inhibit the immune response to the oral cholera vaccine. If chloroquine is part of your malaria prevention plan, we sequence your vaccines and medications so the cholera vaccine is taken at least 10 days before chloroquine begins, preserving full effectiveness of both.

Safety of the oral cholera vaccine during pregnancy and breastfeeding has not been established in clinical trials. For pregnant travelers facing unavoidable exposure, we weigh the risk of cholera infection against the theoretical risks of the live bacterial vaccine together with your obstetric provider. Postponing non-essential travel is strongly preferred.

Vaxchora is FDA-approved for ages 2 to 64 only. For children under 2 and adults 65 or older, the vaccine is not approved. We focus the consultation on strict food and water precautions, oral rehydration preparation, and practical field guidance for caregivers and older travelers heading to endemic regions.

Travelers on biologics, high-dose corticosteroids, chemotherapy, or other immunosuppressive therapies face theoretical risk from the live bacterial vaccine. We review your specific immunosuppressive regimen, assess the degree of immune compromise, and discuss whether vaccination is appropriate or whether risk-reduction counseling is the safer path.

In a human challenge study that formed the basis of FDA approval, a single oral dose of Vaxchora was approximately 90 percent effective against severe cholera when assessed 10 days after vaccination. This is the window that matters most for travelers: the period immediately following arrival in a high-risk region.

It is important to understand that protection wanes over time. Studies suggest effectiveness begins to decline after 3 months and may be substantially reduced by 6 months post-vaccination. Travelers planning extended stays or repeat deployments should discuss timing and the potential need for revaccination at their consultation.

The CDC currently recommends revaccination if 2 or more years have passed since the initial dose. This guidance may evolve as post-approval effectiveness data accumulate. We review current ACIP recommendations at every appointment.

You will be charged for:

• Travel health consultation (itinerary-based risk assessment)
• The oral cholera vaccine (Vaxchora) itself
• Any other vaccines or prescriptions you elect, including antimalarials, typhoid, or hepatitis A
• Detailed vaccination documentation for employer or organizational records

Pricing varies based on services. Call (480) 435-2774 for current pricing.

Many NGOs, humanitarian organizations, and global health employers cover the cost of pre-deployment travel vaccines as a condition of service. Before your appointment, check with your organization:

• Does my deployment package include travel vaccine reimbursement?
• Which CPT codes should I submit? Vaxchora is typically billed under CPT 90625
• Do I need a prior authorization or deployment letter?
• Can I apply HSA or FSA funds if not covered?

After your appointment, we provide a detailed itemized receipt with:

• CPT codes
• Diagnosis codes
• Clinician’s NPI
• Itemized line items