The routine immunizations we all had as children should be brought up-to-date before you travel. In addition, depending upon your destination, there are other vaccinations you need to consider.

It is vital to ensure you had a tetanus shot within the last 10 years, as tetanus exists everywhere and you are bound to get a scratch or cut while traveling.

If you were born after 1956 you should make sure you have an up-to-date measles shot. Those under 20 need to ensure they have had two shots (usually at 1 and 4 years of age). For those 20 and older, it is important to have at least one vaccination documented (or they should get the MMR booster). It is usually assumed that people 47 and older (born before 1956) have had the measles, but your doctor can do a measles titer to be certain. If there is doubt, it is better to get an MMR (measles mumps and rubella) booster shot.

Influenza is worldwide, and vaccination should be considered for those who usually get an annual shot here in the U.S. (those with other chronic diseases or who are at risk for complications should they get the flu). The flu season will be at different times of year in different parts of the world, so you will need to discuss your trip with your doctor to determine if the flu shot is indicated.

It is also a good idea to get the skin test for tuberculosis before you go. This is especially true for those traveling for a long period of time or to rural areas in developing nations. You should then be retested upon return. If you have "converted" (on return tested positive for exposure to tuberculosis, although not necessarily contracted disease from it), you should discuss with your doctor what further tests and treatments may be needed.

Although polio vaccination has eliminated naturally occurring polio here in the U.S., cases still occur in Africa, Asia and parts of the Middle East, as well as areas of Eastern Europe. A booster dose of the polio vaccine is indicated for people traveling to endemic areas.

Having done all that, you are now up to date on the routine vaccinations, and we can turn our discussion to other diseases.

Cholera is a disease acquired by ingestion of contaminated food or water. For an otherwise healthy tourist who acquires cholera, symptoms are usually limited to a few days of diarrhea and then full recovery. The cholera vaccine is not very effective, and is usually not recommended. In the past, certain countries have required proof of cholera vaccination in order to allow a traveler entry, so you should check your itinerary with your doctor to see if this may affect you. Otherwise, cholera vaccination is not routinely recommended.

Hepatitis A is an inflammatory disease of the liver, acquired by ingesting contaminated food or water. Vaccination for this disease is recommended for anyone traveling to a developing country, and in general is not such a bad idea even for people in the U.S., as occasionally we get small outbreaks here as well.

Hepatitis B is another inflammatory disease of the liver, but is transmitted by sexual intercourse, contaminated needles or contaminated body fluid exposures. We now vaccinate all children to protect them against this disease, and health care workers (who are at increased risk to be exposed to accidental needle sticks or to be splashed by contaminated body fluids) have been vaccinated for many years. Even if your travel plans do not pose a risk for exposure, it is not a bad idea to consider vaccination, in case you have an emergency and require either medical care or blood transfusions while abroad.

Japanese encephalitis is a viral illness spread by mosquito bites. It causes an inflammatory condition in the brain, with symptoms of fever, lethargy and possibly coma or death. Thankfully, it is a pretty rare disease. The series of three shots spread over a few weeks is only recommended for travelers planning to spend over a month in endemic areas in parts of Asia during the risky season (usually May through October).

Meningococcal meningitis is a serious bacterial infection that spreads from person to person via airborne droplets (for example, an infected person coughs on you). It infects the meninges, which is the tissue lining the brain and spinal cord. Symptoms include fever, stiff neck, confusion, coma and death, although it is treatable by antibiotics and most people recover with appropriate treatment. Outbreaks of this disease occur sporadically (even here in the U.S.), and more often in areas in sub-Saharan Africa. Travelers visiting rural areas where outbreaks of the disease occur may benefit from vaccination.

Rabies is spread by the bite of an infected animal, and is a viral illness that develops very slowly, but is fatal if not treated. The rabies vaccination is effective even after being bitten, because the infection develops so slowly. Travelers to areas where they may be at risk of being bitten, and who will not then be able to seek prompt medical care, should consider vaccination before their travels.

Typhoid fever is a bacterial infection transmitted by the ingestion of contaminated food or water, with symptoms of fever, headache, rash (rose spots), malaise and gastrointestinal symptoms, and can progress to other complications and even death. Although typhoid fever can occur in almost any country, it is more common in developing nations. Vaccination (I like the new oral vaccination) is recommended for travelers going to rural areas in endemic nations.

Yellow fever is a viral infection spread by mosquito bites. Symptoms usually begin days to a week after being infected and include fever, fatigue and then the yellowish hue to your skin for which the disease is named. It occurs in parts of South America and Africa. The vaccination is effective, and is recommended for people traveling to endemic areas.