Notes: Most Aetna HMO plans exclude coverage of vaccines for travel. Most Aetna traditional plans cover medically necessary travel vaccines for members of plans with preventive services benefits. Please check benefit plan descriptions.
The following table lists vaccines that may be required for travel, and their medically necessary indications, standard administration schedule, and contraindications:
|Vaccine||Standard Schedule||Indications||Precautions and Contraindications|
Primary: 0.5 ml intramuscularly or subcutaneously, or 0.2 ml intradermally, 2 doses 1 week to 1 month apart at least 6 days before travel.
Booster: 0.5 ml intramuscularly or subcutaneously or 0.2 ml intradermally every 6 months.
|Travel to endemic areas. No longer required under international health regulations.||Safety in pregnancy unknown; previous severe local or systemic reaction.|
Meningococcal polysaccharide (see CPB 0356 - Meningococcal Vaccine)
Primary: 1 dose (0.5 ml) subcutaneously or intramuscularly.
Booster: not recommended
|Travel to areas with epidemic meningococcal disease.||Safety in pregnancy unknown.|
|Typhoid, inactivated bacteria||
Primary: 2 doses (0.5 ml) subcutaneously given 4 or more weeks apart.
Booster: 0.5 ml subcutaneously or 0.1 ml intradermally, every 3 years.
|Risk of exposure to typhoid fever.||Previous severe local or systemic reaction.|
|Typhoid, attenuated live bacteria||Primary: 4 oral doses; re-immunize every 5 years.||Risk of exposure to typhoid fever.||Immuno-compromised host †; enteric illness; concurrent antimicrobial treatment.|
|Oral polio (see CPB 0402 - Polio Vaccine)||
Childhood dose: injectable vaccine is preferred; 4 doses administered before school entry, at 2, 4 and 6 to 18 months and 4 to 6 years.
Adult dose: 1 oral dose.
|One-time booster for previously immunized persons; complete the series in partially immunized adults; alternative to inactivated vaccine when there is less than 1 month before travel exposure; not used for primary immunization in persons 18 years old or older.||Immuno-compromised host† or immuno-compromised contacts or recipients.|
Primary: 1 dose (0.5 ml) subcutaneously, 10 days to 10 years before travel.
Booster: every 10 years.
|As requested by individual countries.||Avoid in pregnant women, unless engaged in high-risk travel; immuno-compromised host†; hypersensitivity to eggs.|
|Hepatitis B (see CPB 0410 - Hepatitis B Vaccine)||
Primary: 2 doses (10 mg/dose) intramuscularly in deltoid, 1 month apart; third dose 5 months after second.
Booster: not routinely recommended.
|For health care workers* in contact with blood; persons residing for more than 6 months in areas of high endemnicity of hepatitis B surface antigen; others at risk.||Safety to fetus is unknown; pregnancy not a contraindication in high-risk persons.|
|Hepatitis A (see CPB 0048 - Hepatitis A Vaccine)||
Primary: 2 doses, 0 and 6 to 12 months.
Booster: The need for periodic booster doses has not been established.
|Men who have sex with men; IV drug users; certain populations (e.g., Pacific Islander, Native Americans, and Alaska Native Populations); institutionalized persons and workers in these institutions*; travelers to endemic countries.|
|Inactivated polio (see CPB 0402 - Polio Vaccine)||
Childhood dose: 4 doses administered before school entry, at 2, 4 and 6 to 18 months and 4 to 6 years.
Adult primary dose: 2 doses (0.5 ml) subcutaneously, 4 to 8 weeks apart; third dose 6 to 12
|Preferred for primary immunization; one-time booster dose for travelers.||Safety in pregnancy unknown; anaphylactic reactions to streptomycin and neomycin.|
|Japanese B encephalitis||Primary: 3 doses (1.0 ml) subcutaneously on days 0, 7, and 30 or at weekly intervals.||Travel to areas of risk with rural exposure or prolonged residence.||Pregnancy; allergy to mice or rodents; immuno-compromised host.†|
|Rabies (human diploid-cell vaccine)||
Pre-exposure: 1 ml intramuscularly in deltoid on days 0, 7, and 21 or 28; or 0.1 ml intradermally, on days 0, 7, and 21 or 28.
Booster: every 2 years or when antibody titer falls below acceptable level.
|For persons at high-risk of rabies exposure including international travelers who are likely to come in contact with animals in areas where dog rabies is enzootic.||Allergy to previous doses; may be given in pregnancy if indicated; intradermal route should be completed 30 days or more before travel; intradermal route should not be used with concurrent chloroquine administration.|
|Lyme vaccine (LYMErix)††||
Primary: 3 doses, 30 mg/0.5 ml, with the second dose 1 month after the first, and the third dose given at 1 year.
Booster: The need for periodic booster doses has not been established.
|Age 15 to 70 and live, work,* or travel or take part in regular recreational activities that make them likely to come into contact with infected deer ticks.||Hypersensitivity to vaccine; safety in pregnancy unknown; not tested in pediatric patients less than 15 years of age.|
† Persons who are immunocompromised because of immune deficiency diseases, leukemia, lymphoma, generalized cancer, or the acquired immunodeficiency syndrome, or who are receiving immunosuppressive therapy with corticosteroids, alkylating agents, anti-metabolites, or radiation.
†† LYMErix was withdrawn from the U.S. market in February 2002.
* Most Aetna benefit plans exclude coverage of vaccines for work. Please check benefit plan descriptions.
Note: Many of these vaccines may also be considered medically necessary for reasons other than travel, and may be covered when medically necessary in members with preventive benefits, regardless of whether the plan excludes coverage of travel vaccines.
Note: Malaria vaccine for travel is considered experimental and investigational because an effective malaria vaccine has yet to be developed.
Note: The Advisory Committee on Immunization Practices (1996) states that plague vaccination is not indicated for most travelers to countries in which cases of plague have been reported.
The Centers for Disease Control and Prevention (CDC)'s recommended vaccinations for travelers can be found at the following website: http://wwwn.cdc.gov/travel/contentVaccinations.aspx.
In a Cochrane review on vaccines for preventing malaria, Graves and Gelband (2006a) concluded that there is no evidence for protection by SPf66 vaccines against P. falciparum in Africa. There is a modest reduction in attacks of P. falciparum malaria following vaccination with SPf66 in South America. There is no justification for further trials of SPf66 in its current formulation. Further research with SPf66 vaccines in South America or with new formulations of SPf66 may be justified.
In another Cochrane review, Graves and Gelband (2006b) concluded that the MSP/RESA (Combination B) vaccine shows promise as a way to reduce the severity of malaria episodes, but the effect of the vaccine is MSP2 variant-specific. Pre-treatment for malaria during a vaccine trial makes the results difficult to interpret, particularly with the relatively small sample sizes of early trials. The results show that blood-stage vaccines may play a role and merit further development.
Vaughan et al (2009) presented a comprehensive meta-analysis of more than 500 references, describing nearly 5,000 unique B cell and T cell epitopes derived from the Plasmodium genus, and detailing thousands of immunological assays. This was the first inventory of epitope data related to malaria-specific immunology, plasmodial pathogenesis, and vaccine performance. The survey included host and pathogen species distribution of epitopes, the number of antibody versus CD4(+) and CD8(+) T cell epitopes, the genomic distribution of recognized epitopes, variance among epitopes from different parasite strains, and the characterization of protective epitopes and of epitopes associated with parasite evasion of the host immune response. The results identified knowledge gaps and areas for further investigation. This information has relevance to issues, such as the identification of epitopes and antigens associated with protective immunity, the design and development of candidate malaria vaccines, and characterization of immune response to strain polymorphisms.
Currently, there is an ongoing phase III clinical trial of a candidate vaccine for malaria, but the study has not been completed (Birkett, 2010).
The Advisory Committee on Immunization Practices (ACIP) of the CDC provided the following recommendations regarding the prevention of plague (1996):
In a Cochrane review, Ahmed et al (2013) evaluated the safety, effectiveness, and immunogenicity of vaccines for preventing entero-toxigenic Escherichia coli (ETEC) diarrhea. These investigators searched the Cochrane Infectious Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and http://clinicaltrials.gov up to December 2012. Randomized controlled trials (RCTs) and quasi-RCTs comparing use of vaccines to prevent ETEC with use of no intervention, a control vaccine (either an inert vaccine or a vaccine normally given to prevent an unrelated infection), an alternative ETEC vaccine, or a different dose or schedule of the same ETEC vaccine in healthy adults and children living in endemic regions, intending to travel to endemic regions, or volunteering to receive an artificial challenge of ETEC bacteria were included for analysis. Two authors independently assessed each trial for eligibility and risk of bias. Two independent reviewers extracted data from the included studies and analyzed the data using Review Manager (RevMan) software. They reported outcomes as risk ratios (RR) with 95 % confidence intervals (CI) and assessed the quality of the evidence using the GRADE approach. A total of 24 RCTs, including 53,247 participants, met the inclusion criteria -- 4 studies assessed the protective efficacy of oral cholera vaccines when used to prevent diarrhea due to ETEC and 7 studies assessed the protective efficacy of ETEC-specific vaccines. Of these 11 studies, 7 studies presented efficacy data from field trials and 4 studies presented efficacy data from artificial challenge studies. An additional 13 trials contributed safety and immunological data only. The currently available, oral cholera killed whole cell vaccine (Dukoral®) was evaluated for protection of people against “travelers' diarrhea” in a single RCT in people arriving in Mexico from the USA. These researchers did not identify any statistically significant effects on ETEC diarrhea or all-cause diarrhea (1 trial, 502 participants; low-quality evidence). Two earlier trials, one undertaken in an endemic population in Bangladesh and one undertaken in people travelling from Finland to Morocco, evaluated a precursor of this vaccine containing purified cholera toxin B subunit rather than the recombinant subunit in Dukoral®. Short-term protective efficacy against ETEC diarrhea was demonstrated, lasting for around 3 months (RR 0.43, 95 % CI: 0.26 to 0.71; 2 trials, 50,227 participants). This vaccine is no longer available. An ETEC-specific, killed whole cell vaccine, which also contains the recombinant cholera toxin B-subunit, was evaluated in people traveling from the USA to Mexico or Guatemala, and from Austria to Latin America, Africa, or Asia. These investigators did not identify any statistically significant differences in ETEC-specific diarrhea or all-cause diarrhea (2 trials, 799 participants), and the vaccine was associated with increased vomiting (RR 2.0, 95 % CI: 1.16 to 3.45; 9 trials, 1,528 participants). The other ETEC-specific vaccines in development have not yet demonstrated clinically important benefits. The authors concluded that there is currently insufficient evidence from RCTs to support the use of the oral cholera vaccine Dukoral® for protecting travelers against ETEC diarrhea. Moreover, they stated that further research is needed to develop safe and effective vaccines to provide both short- and long-term protection against ETEC diarrhea.
Also, an UpToDate review on “Travelers' diarrhea” (Wanke, 2014) states that “Use of vaccines to protect against travelers’ diarrhea is hindered by the varied pathogens that can cause it. Although enterotoxigenic E. coli (ETEC) predominates as an etiology of travelers’ diarrhea, vaccination strategies that have focused on this pathogen as a target have been suboptimal. Although vaccination to protect against cholera is not routinely recommended for travelers, a number of trials suggest that the oral, killed whole-cell vaccine given with the nontoxic B subunit of cholera toxin (Dukoral) provides protection for travelers against ETEC infection. The rationale for such protection is that the B subunit of cholera is antigenically similar to the heat-labile enterotoxin of ETEC. In two randomized trials, the killed whole-cell vaccine combined with the B subunit of cholera toxin reduced the incidence of diarrhea caused by ETEC by 67 percent in a trial in Bangladesh and 52 percent among travelers to Morocco. The Dukoral vaccine was approved in the United States in late 2006 for use as a travelers' diarrhea vaccine. However, a conservative estimate that took into account the incidence of ETEC infection throughout the world and the efficacy of the vaccine suggested that it may prevent ≤7 percent of travelers' diarrhea cases. The 2006 guidelines on travel medicine from the Infectious Diseases Society of America concluded that the decision to use the vaccine to prevent travelers' diarrhea must balance its cost, adverse effects, and limited utility against the known effectiveness and costs of self-treatment as described above. A separate vaccination strategy for ETEC also appears to have limited utility. Despite initial promising data on vaccination with heat-labile enterotoxin from ETEC via a skin patch, it was not effective in decreasing the incidence of moderate to severe diarrhea due to either ETEC or any cause in a randomized, placebo controlled trial that included 1,644 individuals who traveled to Mexico or Guatemala. In a subgroup analysis, the vaccine provided modest protection against ETEC that produced only heat-labile enterotoxin (vaccine efficacy 61 percent [95 % CI, 7 to 84 percent]), but not ETEC that produced heat-stable toxin or both. This highlights the limitations of a single-antigen vaccine for travelers’ diarrhea”.
|CPT Codes/ HCPCS Codes / ICD-9 Codes|
|CPT codes covered if selection criteria are met:|
|90632||Hepatitis A vaccine, adult dosage, for intramuscular use|
|90633||Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use|
|90634||Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use|
|90636||Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use|
|90675||Rabies vaccine, for intramuscular use|
|90676||Rabies vaccine, for intradermal use|
|90690||Typhoid vaccine, live, oral|
|90691||Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use|
|90692||Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use|
|90712||Poliovirus vaccine, (any types(s)) (OPV), live, for oral use|
|90713||Poliovirus vaccine, inactivated, (IPV), for subcutaneous or intramuscular use|
|90717||Yellow fever vaccine, live, for subcutaneous use|
|90725||Cholera vaccine for injectable use|
|90733||Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use|
|90734||Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent, for intramuscular use|
|90735||Japanese encephalitis virus vaccine, for subcutaneous use|
|90738||Japanese encephalitis virus vaccine, inactivated, for intramuscular use|
|90740||Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use|
|90743||Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use|
|90744||Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use|
|90746||Hepatitis B vaccine, adult dosage, for intramuscular use|
|90747||Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use|
|90748||Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use|
|Other CPT codes related to the CPB:|
|90460||Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered|
|+90461||each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)|
|+ 90472||each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)|
|90473||Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)|
|+ 90474||each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure)|
|90644||Meningococcal conjugate vaccine, serogroups C & Y and hemophilus influenza B vaccine, tetanus toxoid conjugate (Hib-MenCY), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use|
|90727||Plague vaccine, for intramuscular use|
|HCPCS codes covered if selection criteria are met:|
|G0010||Administration of hepatitis B vaccine|
|ICD-9 codes covered if selection criteria are met:|
|V03.0||Need for prophylactic vaccination and inoculation against cholera alone|
|V03.1||Need for prophylactic vaccination and inoculation against typhoid-paratyphoid alone [TAB]|
|V04.0||Need for prophylactic vaccination and inoculation against bacterial diseases, poliomyelitis|
|V04.4||Need for prophylactic vaccination and inoculation against yellow fever|
|V04.5||Need for prophylactic vaccination and inoculation against rabies|
|V04.89||Need for prophylactic vaccination and inoculation against other viral diseases|
|V05.0||Need for prophylactic vaccination and inoculation against arthropod-borne viral encephalitis|
|V05.3||Need for prophylactic vaccination and inoculation against viral hepatitis|
|V06.0||Need for prophylactic vaccination and inoculation against cholera with typhoid-paratyphoid [cholera+TAB]|
|V06.2||Need for prophylactic vaccination and inoculation against diphtheria-tetanus-pertussis, with typhoid-paratyphoid [DTP+TAB]|
|V06.3||Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis with poliomyelitis [DTP-polio]|
|Other ICD-9 codes related to the CPB:|
|001.0 - 001.9||Cholera|
|002.0||Typhoid and paratyphoid|
|008.02||Intestinal infection due to enterotoxigenic E. coli|
|042||Human immunodeficiency virus [HIV] disease|
|045.0 - 045.9||Acute poliomyelitis|
|060.0 - 060.9||Yellow fever|
|070.0 - 070.1||Viral hepatitis A|
|070.20 - 070.23, 070.30 - 070.33||Viral hepatitis B|
|140.0 - 208.91||Malignant neoplasm|
|279.00 - 279.09||Disorders involving the immune mechanism|
|V08||Asymptomatic human immunodeficiency virus [HIV] infection status|
|V58.0||Encounter for radiotherapy|
|V58.69||Long-term (current) use of other medications|