One of life’s unfailing maxims is that there can be no pleasure without pain. This is true even when it comes to planning a RTW trip: it’s not just fun and games, gazing longingly at photos of white sand beaches and hot air balloon rides. No, because our trip will take us to the far reaches of the globe (ok, more like “outside of Western Europe & North America”), one of the most important bits of travel preparation we could do was to pay people to stick needles in our arms to help keep us healthy while we are away. After all, the souvenirs we’re most interested in bringing back are photos and the entries on this blog… no need for a crippling case of Polio as a permanent reminder as well.
Obviously the vaccinations you need in preparation for your big trip vary based on where in the world you are planning to visit. While I am all for doing internet research and WebMDing the crap out of mystery illnesses, generally your best course of action will be to visit a doctor who specializes in travel medicine and can provide you with a professional plan of action. Still, if you are anything like me, you probably want to head into your appointment with at least some idea of the vaccinations you might be in for.
One of the critical things on my to-do list following my successful dissertation defense (but prior to leaving Nashville) was to avail myself of Vanderbilt’s medical travel services, which were free to me as a student. After speaking to the travel nurse and explaining that my trip would take me through China, South East Asia, Central Asia, Northern Africa (Morocco & Egypt), and Eastern Europe, we decided that the following vaccinations were necessary:
- Typhoid (I took the oral vaccine, which provides 5 years protection; the shot version only offers 3 years protection)
- Hepititis A (2 shot series, which are administered at least 12 months apart… I only had time to get the first shot, but it will afford me protection until I get the second shot some time in 2013/2014, at which point I will have lifetime immunity)
- Tetanus booster (I was administered the Tdap booster, which provides protection against Tetanus, Diptheria, and Pertussis for up to 10 years)
- Polio booster (this was the last one that I needed to provide lifetime immunity)
I had already received the three Hepititis B shots that afford lifetime immunity while in middle school, otherwise that would have been another shot I would want to get.
Although my nurse STRONGLY suggested that I get vaccinated against Japanese Encephalitis, I ultimately declined this. JE is a mosquito-borne illness that is pretty devastating if you get it, but honestly, the incidence rate is really quite low and based on my own research, it doesn’t seem like many people contract it. This paired with the fact that the vaccination is a 2-dose series where each shot costs somewhere in the ballpark of $270 was enough to dissuade me from getting this course of shots. Ultimately, there are several mosquito-borne illnesses such as malaria (see below) and Dengue Fever that are pretty nasty and which you can’t be vaccinated against, so in the end I really believe that my best course of action is to just do my best not to get bitten by mosquitoes (we already have several small bottles of 99% DEET insect repellant and thankfully I am not allergic to it!).
The Requisite Part About Malaria
As a prophylaxis against malaria, I purchased 200 Doxycycline pills. In theory, this would be enough to provide approximately 3 months of protection to Tony and myself. Given that malaria is a concern in the Philippines, parts of Vietnam, Cambodia, Laos, and India, this is likely not enough medication for the entire duration of our trip. HOWEVER, doxy is cheap and readily available in malarial areas, so I know that should we need to refuel on the road, that will not be difficult to do.
MAJOR CAVEAT ABOUT DOXY: Doxy is often associated with extreme sun sensitivity, which may make it a no go for us. Tony has been known to burn to painful shades of purple when in warmer climes without any medicinal aids, so this medication may not be a feasible option for him. Also, for female travelers, there is some risk of doxy interfering with hormonal birth control methods (read: the Pill), so it’s worth noting that you may need to use a backup “barrier” method (read: condoms) to provide protection against pregnancy if you choose to use this medication.
Given the above caveats, Tony and I decided to get some doxy pills “just in case”, but at this stage of the game, we don’t actually know if we will use them. So long as we can avoid mosquito bites (and we have good reason to, since as I said earlier, mosquitoes can carry a wide variety of illnesses), I see no pressing need to use them. It seems the rare traveler who acquires malaria on the road, regardless of whether medical precautions were taken or not. Another malaria med option is Malarone, which doesn’t seem to be associated with any major side effects, however, it comes at a price: generally 1 Malarone pill costs anywhere from $1-3! For a trip of our length, the price of this medication for 2 people (even for just 6 months, which is a conservative estimate for our time in potential Malarial zones) was just too prohibitive for us. We have decided to take our chances with doxy – if it makes our lives miserable, we can ditch it without worrying about financial repercussions and will do our best to avoid mosquito bites at all costs.
Because Tony had a fairly crappy health insurance plan, which ultimately wouldn’t have covered any vaccinations, we decided to wait until we were in Toronto to have his travel consult done. My wonderful Aunt Maureen made him an appointment at the Travel Medicine Clinic in downtown Toronto. The doctor we met with was WONDERFUL, so fellow Torontonians (or even those who aren’t local) would be wise to visit this place. I’ve heard about many travel doctors masquerading as fear mongers, scaring their clients into countless expensive but ultimately unnecessary vaccinations. Our doctor didn’t offer any bullshit. He flat-out told us that if we were interested in getting the Japanese Encephalitis vaccination, we should just do that while we were in Thailand, since we were going there anyway. He showed us the website for the Thai Travel Clinic based in Bangkok, and pointed out that the vaccination they offer only requires a single shot and only costs $14! The same is also true for the rabies vaccination: $11 vs the $480 we would pay in Toronto.
In the end, Tony wound up getting the following vaccinations:
- Hepititis A (1st of the 2 shot series; will get 2nd shot in 2013/2014)
- Td/IPV booster (provides 10 years protection against Tetanus & Diptheria, and was the final booster he needed to provide lifetime Polio immunity)
- Typhoid (oral vaccination, providing 5 years protection)
Like myself, Tony already had the full course of Hep B shots as a teenager so no need to get them now!
Adding insult to injury, most vaccinations tend to be very expensive in the Western world. Thankfully, by doing our research, Tony and I saved A LOT of money and did not have to break the budget to make sure all of our healthcare needs were met for this trip.
As mentioned earlier, my travel consult was provided for free, and I also found out that I had rather generous vaccination benefits under my student health insurance plan: each vaccination I received only required a $5 co-pay. So, for the 3 shots I received, plus the 1 oral prescription for Typhoid, I paid a grand total of $20.
I also purchased our Cipro for traveler’s diarrhea ($5/dose) and malaria meds ($18/100 Doxy pills) through student health, so the total cost of our travel meds amounts to $56.
Tony’s trip to the travel clinic had a $40 consultation fee attached to it. However, the Td/IPV booster is provided FREE OF CHARGE in Ontario (even though Tony is not a Canadian citizen or an Ontario resident!), and the Hep A shot only cost $60. Because I procured him the oral Typhoid vaccination through student health for $5, Tony’s total vaccination costs were $105.
In sum: For 2 people, we paid $181 TOTAL for all our necessary vaccinations and medications.
[Note: This number may grow slightly because we think it might be worth getting the JE vaccination while we’re in Thailand. We may also go ahead and get our Yellow Fever vaccination there as well, because that normally runs around $120 in North America, but can be administered for just $38 in Asia. The YF vaccination is important for those visiting South America and certain parts of Africa; although we do not plan to visit any places where YF is a concern on this trip, the certificate you receive is good for 10 years and given the price, it seems like a good investment for future travel plans. If we do decide to get any vaccinations while in Thailand, as Johnny Vagabond did, we will be sure to write about the experience!]
Now it’s your turn! Tell us, which vaccinations (if any) have you received before traveling abroad? And for all those long-term travelers out there, how have you chosen to keep malaria at bay?