For ease of counselling and decision making destinations are divided into either first or third world. This helps to quantify potential risk as well as the source of the expected risk. For example third world countries or developing countries have poor sanitation and water purification practices and the use of tap water is not recommended. The risk of exposure thus from food and water borne diseases like  hepatitis A, shigella, typhoid, polio are thus far greater in these regions. Not to say that one cannot contract hepatitis A form a trip to New York. For Hepatitis A is strongly associated with travel and thus not a destination specific (in this case first world) problem but an activity related issue (travel).

Generally speaking first world travellers should consider hepatitis A vaccination and those travelling to third world countries need hepatitis A vaccination plus any other vaccine deemed necessary for their trip. These travellers also require advice with regard to certain lifestyle adjustments to try to minimise their risk of illness eg. mosquitoes transmit Dengue and there is some concern in the SE- Asian region including port cities of India. The tropics are the battle ground for most diseases and the abundance of insects (vectors) which transmit these diseases do very well in these regions. Thought must be given to avoid these vectors eg.mosquitoes, tse-tse fly.

Travellers need to know exactly where they are going to in order to try and quantify their risk and offer appropriate advice with regard to behaviour and provide an appropriate vaccination schedule.

• Destination.
• Number of trips per year.
• Length of stay.
• Visa requirements as is the case with Yellow Fever endemic areas.
• Urban or rural stay.
• Medical history and patient profile.

• Yellow fever
• Hepatitis A and B
• Typhoid
• Meningitis ACWY strains
• Polio, tetanus, diphtheria, pertussis as one vaccine
• Cholera
• Rabies pre and post exposure prophylaxis offered as necessary