Just a Couple of Pricks: The Vaccination Post

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...

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.

Steph’s Vaccinations

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.

Tony’s Vaccinations

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!

The Costs

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?

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22 comments Leave a comment

  1. Hi guys, I’m just starting to plan my vaccinations for a similarly long, world-encompassing trip and this has given me a rough indication on the amount of injections I’ll need.

    Most helpful, and also most interestingly, is the bit on Malaria. Malaria advice seems to ridiculously unhelpful online but the majority suggests taking avoidance rather than vaccination methods as the best methods.

    Thanks again, loving following your build up. Cheers, Marco

    Jul. 29 2012 @ 1:20 pm
    1. Marco Fiori author

      Yeah, malaria is obviously a concern, but based on my reading, it seems like liberal use of DEET-based insect repellant and covering up at dawn/dusk is a sufficient safeguard while traveling in SEA. If we were planning to travel to parts of Africa where malaria is a SERIOUS problem, we would probably be more concerned about taking a prophylaxis in that region, but really, so long as you can avoid getting bit, there is no need to worry!

      Jul. 30 2012 @ 12:39 pm
  2. I just got my vaccines too – I got Hepatitis A and Typhoid. I’ll be in Thailand to get the second Hep A. I too already got Hep B. We are still deciding on our solution for malaria – probably picking up some doxy in Hong Kong. Like you, we didn’t do Japanese Encephalitis – theoretically once we are in the risk areas, it won’t be the season for it. Yours were a lot cheaper though – we paid 112,000 Korean Won (about $98 USD) for ours – they’re not covered by national health insurance here in Korea.

    Jul. 29 2012 @ 8:42 pm
    1. Rachel author

      $98 is still nothing to scoff at when it comes to vaccinations! I have seen travelers who have paid close to $500 (not including known expensive vaccinations like rabies and JE). And you are right that malaria risks vary significantly based on the season – since we will likely not be in SEA during the wet season (perfect breeding weather for mosquitos), the risk will probably be much lower.

      Jul. 30 2012 @ 12:41 pm
  3. I’m bookmarking this for later use. You guys are hitting a lot of the same areas as we are. I didn’t realize the Hep A had to be given so far apart from each other. Might be worth looking into now while we still have a while until departure. Given what I saw Kim at So Many Places paid for her shots, you got really lucky!

    One thing I’d like to know (and this goes for everyone)…is anyone aware of whether or not you can use Flexible Spending Account funds (the one you contribute to yourself) to get reimbursed for travel vaccinations? My insurance won’t cover vaccinations for personal travel, but I’m hoping to use some tax-free money to cover the cost.

    Jul. 30 2012 @ 9:25 am
    1. Carmel

      Hi Carmel,
      My boyfriend Dave has Aetna for his health insurance and it seems he can use the FSA money for the travel vaccines.

      Jul. 30 2012 @ 11:30 am
    2. Carmel

      Don’t quote me on this, but I am pretty sure you can use the FSA/HSA money on this, as Vicky said. At my work we were told that you could use the money for literally anything you want, of course if you buy a flat screen TV you have to submit the receipt and pay the tax (plus a fee I think). Odds are good that you wouldn’t be taxed on the purchase since it is of a medical nature, so it may not be as good as a co-pay, but it’s better than nothing!

      Jul. 30 2012 @ 12:43 pm
    3. Carmel author

      Yeah, if I had realized that my vaccinations could be procured so cheaply, I definitely would have gotten my Hep A vaccinations done years ago! Just remember that even if you can’t get them both done before you leave, the first vaccination will give you protection for at least a year… the second shot is just to ensure that your immunity is locked in for life (or at this point 25 – 30 years… the vaccination hasn’t been around for longer than that!). So if you had to get the other shot on the road, or even waited until you came home, you would probably be ok!

      Also, I don’t know anything about Flexible Spending Accounts, but Vicky’s comment suggests that might be an option!

      Jul. 30 2012 @ 12:44 pm
  4. Ugh. I have my travel appointment on Friday and it’s not going ot be cheap. My insurance covers almost nothing and the appointment alone is $35. Luckily I have some of the bigger ones like yellow fever already.

    Hopefully it won’t break the bank! You have a good idea about waiting til I am overseas…I’ll have to check that out.

    Jul. 30 2012 @ 9:37 am
    1. Liz| Traveling Liz author

      It is definitely worth shopping around when it comes to vaccinations – when I was looking at clinics in Nashville, the cost for shots varied quite a bit from clinic to clinic. We were lucky that my health insurance was so good (for once!), and that the shots Tony needed are relatively cheap in Canada. For some of the basics (essentially the ones we got), we wouldn’t have wanted to wait for Thailand to get those shots (unless Thailand was our first major stop in SEA… which it may or may not be following Japan), but for things like JE, YF, and rabies (and even meningitis), I think the risk of contracting those things is sufficiently low that waiting to get them in a place where they are significantly cheaper is something we can affford to do. Good luck with your appointment… if it’s any consolation, the three shots I got were not nearly as painful as I had heard they would be (and I hate needles!).

      Jul. 30 2012 @ 12:50 pm
    2. Liz| Traveling Liz

      Hey Liz,
      I know you are in the DC area and was just wondering which travel clinic you’re going to?

      Jul. 31 2012 @ 7:43 am
  5. Great to read this post as we are currently going through all the frustrations of travel vaccinations and medications. Thankfully Dave has a medical clinic at this work where we can both get the Typhoid, Polio, Tdap, and Hep A shots for free along with a travel medical kit. We just got out yellow fever vaccine last week (decided to just get it done here) and are most likely going to get the Jap E vaccine as well. The cheapest place I found in DC prices each shot at $240 so it is incredibly expensive but we figure we’ll just get it done and not have to worry about it when we’re abroad. In terms of malaria we are trying to figure out how many pills we need and where we need to take them but it’s pretty annoying considering you need to take doxy for a whole month after you exit the malaria zone. Now that they released a generic version of malarone if your health insurance covers it you can get a 90 day supply for $10 here in the US. I figure we’ll bring a 90 days supply of both doxy and malarone and then just figure out which we want to take when we’re on the road. We also got prescribed z-packs, cipro and altitude sickness meds. Hopefully it should be enough!

    Jul. 30 2012 @ 11:29 am
    1. Vicky author

      How nice that you were able to get all of your major shots for free! It’s a shame that most vaccinations are so expensive and most health insurance plans don’t seem to cover them, so you guys really lucked out!

      Because your itinerary is so similar to ours I am a bit surprised that you opted to get the YF vaccinations done – my understanding is that YF is only a concern for those traveling to parts of South America and Africa, which I thought you guys were skipping on this trip. However, given the fact that you didn’t have to pay for your other vaccinations, shelling out for YF here in North America isn’t going to break the bank!

      Also, I wasn’t aware that there was now a generic malarone-equivalent on the market! That is good information to have, and while Tony and I aren’t in the position where our current health insurance would cover presecription meds, I am sure other people out there investigating this topic will find that info useful! I have just discovered that the Asian Malarone equivalent (Mararil) is available for purchase at the Thai hospital where we may get our extra shots, so that may be something to investigate while we are there (on the off chance that it, like so many other things, is cheaper there!).

      Jul. 30 2012 @ 12:57 pm
      1. Steph

        We decided to get the yellow fever done while we’re here in case our travel plans change and we decide we want to travel to Africa/South America during our trip. Since it’s good for 10 years (I think) now we just have it taken care of and out of way in case our travel plans change. In terms of the generic malarone I think it came out recently so that has been great news for us since our health insurance seems to cover it and we’ll be able to get the 3 month supply. I am incredibly paranoid (border line neurotic) about catching every disease known to man on our travels so right now I’m thinking I’ll be taking pills for everything daily – though who knows if that attitude will change once we actually start traveling.
        I do hear people traveling through Asia without taking anti malaria pills or even using lots of DEET mosquito spray and being fine, but when I spent summers in Russia at my family’s country house I could get bitten by a dozen mosquitoes a night so I don’t see how I wouldn’t be bitten and be a malaria magnet in Asia. Who knows.

        Jul. 31 2012 @ 7:49 am
        1. Vicky author

          I tend to be a mosquito magnet as well, so I guess we’ll see how the high DEET-content sprays as well as any other local wards work for me. I also need to look into when high malaria season is, because the time of year will obviously play a huge role in how prevalent the mosquitoes are. Obviously I don’t want to get sick, but when the prevention has the potential to be as miserable as the disease itself, I suppose one is more amenable to taking some risks!

          Aug. 4 2012 @ 3:34 pm
  6. Hey – great heads up about some of the shots! Also… high five to the CDN medical system 🙂 Don’t get sick!

    Jul. 30 2012 @ 12:25 pm
    1. Dana - Our Wanderlust author

      Yeah, based on my cursory research it did look like the vaccinations would be cheaper up in Canada, but I didn’t realize it would be that dramatic. Not only was the Hep A quite a bit cheaperr, but getting the Tetanus/Polio booster for free made a huge difference! Moments like that REALLY make me love Canada! 😉

      Jul. 30 2012 @ 12:59 pm
  7. This post brings me back to last summer getting ready for six weeks backpacking through Peru. I had to get SIX vaccinations that cost almost $600, and I had an allergic reaction to one that left a huge, itchy, painful welt on my arm for weeks. We never figured out which one it was because I got three in each arm (and subsequently spent the next 2 days in bed whining about my arms hurting). I do know that the yellow fever one is a good investment – several countries won’t let you in without it (I know for sure Ecuador is one) and if you travel to one that is considered a YF-risk country, then Canada won’t let you in without your YF vaccination card!

    Re: malaria, we took Malarone while in the Amazon jungle in Peru but ultimately gave up taking the pills as we were so sick in Peru that the pills never stayed down anyway. We barely used bug spray and were fine. I also have done Roatan twice this year with no malaria pills and very little bug spray (the sandflies just kill me anyway, I’d rather get mosquito bites!) I brought the pills with me though as the treatment for malaria is just high doses of the preventative pills and I figured why not. But other commenters have made good points – malaria pills are relatively cheap (by Western standards) in high-risk countries anyway.

    Aug. 1 2012 @ 4:03 pm
    1. EM | Cubicle Throwdown author

      Although we aren’t planning to visit any YF countries on this trip, I figure that it’s reasonable to assume that we will probably want to visit a place where it is a concern sometime in the next 10 years… so since we’ll be in a place where we can get the shot for so cheap, that seems like a good investment to me!

      And yes, based on my reading, if you’re traveling to malarial areas of Africa, taking pills is non-negotiable, but for SEA it really seems like there are reliable ways to avoid bites and the pills are therefore, unnecessary.

      Aug. 4 2012 @ 3:20 pm
  8. You are very fortunate that you were able to get your shots so cheap. It can really add up and blow a budget before you really get going.

    I find anti-malaria tablets absolutely foul to taste but I once lost someone to malaria so take no risks. I’ve been back 3 weeks after a one week trip but still have another week to finish the course, yuk!

    Nov. 16 2012 @ 3:52 am
    1. The Guy author

      Yes, we are extremely lucky that we were able to get our vaccinations for such a pittance. I know this aspect of trip planning often puts a dent in the travel budget, so I’m doubly pleased we were able to cover our bases without going into the red!

      We haven’t really been anywhere yet that requires serious Malaria consideration (I suppose there are parts of the Philippines where it is a worry, but we’ve not really been in the remote places, and mosquitoes haven’t been much of an issue thus far), but given that we do have the pills and I am a mosquito magnet, I may start taking them before we hit Malaysia/Vietnam (whichever comes first!). I know malaria is a serious illness so we’ll do our best to stay safe!

      Nov. 18 2012 @ 12:29 am

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