When you make the decision to travel to foreign countries long-term, one of the most daunting subjects to figure out is which vaccines you absolutely need, which you should get, and which you may want for additional peace of mind. Navigating the whole system can be a nightmare. The struggle is real.
In a previous post, I wrote about how I didn’t know what I needed, where to go for it, or what it might cost even with help from my health insurance. In this post, I will report back on what I ended up doing. Hopefully this information can help you figure it out too!
A Guide on Getting Vaccinations For Long Term Travel
1. Do Some Background Research
A great free resource is the Centers for Disease Control and Prevention’s website. They have a main section devoted to Traveler’s Health. You can select the countries you intend to visit, select long term travel or study abroad, and see what the recommended vaccinations are. There is enough information to get a rough idea of what you might need.
2. Find a Travel Doctor – Don’t Use Generic Clinics Unless Desperate
I called so many places while trying figure out what I needed and who could give it to me in the most affordable manner. Here is what I learned. If you can find a local Travel medical doctor, go to that person. If they are affiliated with a hospital, they will have more vaccines on hand. In my case, there was a global shortage of Yellow Fever vaccine. Not only did my Travel doctor have a yellow fever vaccine on hand when none of the local travel clinics did. Some of the other urgent care clinics were aware of the global shortage and marked up the cost of their alternative vaccines…. knowing people might have no other option and be forced to pay a premium for it out of desperation.
3. Design An Itinerary to the Best of Your Ability
If you can narrow down the regions you might go to, travel doctors can assist you better. Some regions have strict requirements which you need to be aware of. For example, some countries will not allow you to enter without proof of vaccination if you have previously been to countries in Africa or South America with risk of yellow fever!
This is especially important if you may enter areas with risk of malaria.
4. Obtain Your Vaccination Records
You will need (and want) to know what you have already had. Now I am going to unleash the bio nerd within me and take you on a journey through travel-related microbiology. 😉
But first: a quick story. While traveling on the island of Mykonos in Greece, I trapped my thumb inside a rusty metal locking mechanism on a bathroom door. In that unexpected situation, being aware that I was vaccinated for something as standard as tetanus was extremely important. While I did ultimately remember my vaccinations, I might urge you to locally save or print your records because the best part of the whole Mykonos escapade was when I tried to pull my medical records from the doctor’s office’s website but the website wouldn’t open in Greece due to flawed online security precautions.
Which travel vaccines are available and important to know about?
Spread by coughing or sneezing, diphtheria is a respiratory illness caused by bacteria that has an incubation period of less than 3 day. It can result in death. Diphteria is avoided via the Tdap or DTap vaccine most Americans receive as an infant prior to entering the school system.
Tetanus is a toxin spread via spores. If you get injured, these spores can enter the wound and cause a severe infection. It causes your muscles to become become rigid. Tetanus is painful and in many cases, deadly. Many Americans are vaccinated for this as infants.
Whooping cough is a highly contagious respiratory tract infection. Symptoms include a high-pitched intake of breath that sounds like “whoop!” Before a vaccine was invested, whooping cough was considered a childhood disease.
While you may have thought Polio was eradicated, there are still a few countries with risk of poliovirus! Polio is spread via contaminated food and water. It has an incubation period of 7-14 days and in most cases, there may be no symptoms. A small percentage will experience paralysis, bladder dysfunction, impaired swallowing, breathing, and speech, all of which could be fatal.
Hepatitis A virus is spread person-to-person by contaminated food and water. Countries with less hygienic sanitation practices are at greater risk. Americans may have less exposure and be at greater risk while traveling. This vaccine-preventable disease causes inflammation of the liver. Gay men are among a number groups that this vaccination is also highly advised to regardless of living circumstances.
Hepatitis B is spread person-to-person via infected bodily fluids such as blood. Infected medical equipment and sexual transmission are common means of infection. Symptoms include fever, rash, joint pain, and jaundice.
Yellow Fever is spread by mosquitos. The areas with risk of yellow fever are expanding. Right now, the company that manufactures YF-VAX (the FDA approved vaccine) is rebuilding its factory in the USA. With production at a halt, the USA is temporarily allowing the “experimental vaccine” Stamaril to be administered instead. (It isn’t actually all that “experimental” considering it is what people outside of the USA receive as a vaccine for Yellow Fever. You will need to sugn a waver though.) Vaccination offers lifelong protection.
Typhoid is spread via contaminated food and drinks. The symptoms of typhoid include abdominal pain, constipation, diarrhea, confusion, headache, fever, and a rash. Typhoid is a type of salmonella (salmonella typhi) and it is still common in the developing world.
Rabies is advised for travelers who may spend a lot of time outdoors. Transmission occurs when someone is bitten by an infected animal via the saliva. Symptoms include irritability, depression, convulsions, cardiac arrest, and confusion. There is a pre-exposure and post-exposure vaccine. In either case, if you are bit by an animal, seek help immediately. Rabies is nearly always fatal in humans. Very few exceptions to this have been documented.
Japanese Encephalitis is contracted through a mosquito. These mosquitos are typically found in specific areas in Asia. Some people get Japanese Encephalitis and show no symptoms. In other people, fever, meningitis, encephalitis, and paralysis may occur. Recovery is slow and difficult. The vaccination for this tends to be very expensive.
Tick-borne encephalitis is spread to human by infected ticks and parasites. It can also be spread via milk from infected animals. The TBE Flaviviridae virus causes flu-like illnesses which usually appear within 2 weeks of being bitten. The symptoms may include fever, headache, nausea, photophobia, neck stiffness, convulsions, and an altered mental state. Meningitis, encephalitis, and paralysis may occur as well.
Which vaccines will you need?
Thanks to my doctor, I am more or less aware of exactly what I need given the places I intend to visit. He was able to generate and print these detailed maps for me (via a subscription service called Travax) that showed exactly which areas had risks for illnesses like malaria and yellow fever.
Given that, these statements are vast generalizations but may still prove to be useful:
Tetanus is found worldwide. It survives in soil and is difficult to eradicate.
Diphtheria is found in South East Asia, South America, and parts of Africa.
Pertussis is mostly found throughout Africa and India.
Polio is mainly still found in developing countries in Asia and Africa.
Hepatitis A is present in all countries with poor sanitation & hygiene.
Hepatitis B is found in South East Asia, the Middle East, Africa, and South America.
Yellow Fever is found in Africa and South America.
Typhoid Fever is found worldwide but more common in areas contaminated with sewage.
Rabies is more common in Asia, Africa, and South America.
Japanese Encephalitis is more common following the rainy season in many Asian countries.
Tick Borne Encephalitis is found in parts of Asia and Europe.
Does it matter when you get them?
For some, it does! Make sure you plan early enough. I would say a good rule of thumb is to see a doctor 3 months in advance if you can manage that. Booster shot requirements are common for many of the vaccines on this list. For example, you can get a Hepatitis A vaccine that protects you for 6 months to a year but you need a second shot after that for lifelong protection.
How expensive are the vaccines?
For your convenience, I will share prices from my doctor’s office. These are full price and do not indicate what you might actually pay with insurance coverage. I thought I’d have to pay full price for everything and the truth is, I paid almost nothing for the protection that I got.
I can’t stress the importance of shopping around. For example, it says here the typhoid oral vaccine is $88.00 while the typhoid injectable vaccine is $90.00. I was able to bring a prescription for the oral vaccine to a CVS pharmacy and get my vaccine for $10.00 after insurance. You might even qualify to get some for free depending on your circumstances.
Note: some of them are very expensive. Talk to the doctor about whether or not each vaccination makes sense for your plans, destinations, and health history.
How long does protection last?
Diphtheria/Tetanus/Pertussis/Polio: 10 years.
Hepatitis A: Long term after 2nd booster shot.
Hepatitis B: 10 years.
Yellow Fever: It used to be 10 years but now it is lifelong.
Typhoid: Injectable (2 years) Oral (5 years).
Rabies Pre-Exposure: 1-2 years.
Japanese Encephalitis: 1 year.
Tick Borne Encephalitis: 1-3 years.
Are there any side effects?
Vaccines always carry risks. Redness, pain, and swelling may occur around the injection site. However, it is possible to experience other side effects which are much more rare. With my doctor, we had one discussion that I found particularly interesting.
With typhoid, you can take a series of typhoid pills orally instead of getting a shot for protection. The oral option is also cheaper, usually. So why would anyone opt for a shot if the oral option is cheaper and less painful? Here’s the catch.
Typhoid (injectable) offers just 2 years of protection. The vaccine carries inactivated bacteria so it is relatively risk-free but you will need to get it more often.
Typhoid (oral) offers 5 years of protection. However, the oral vaccine contains an attenuated version of the live bacteria. It literally needs to stay refrigerated because of that. Some people (a small percentage) experience some minor symptoms of typhoid bacteria while taking the course of pills. It is a higher percentage of people than with the injectable variation. Most people are fine though.
Malaria is difficult because it is a parasite spread by mosquitos. Malaria, Dengue, and Zika are all serious and sometimes fatal diseases spread via these insects. When you are bitten, the parasite enters your bloodstreams and attacks red blood cells through its process of multiplication.
Malaria is present in more than 100 countries around the world. 40% of the world’s population is at risk of getting it. In Malaria countries, a trip to a doctor’s office may result in you being given anti-malarial tablets upon arrival before even being inspected. It is the first thing they do to treat you because of how common it is.
The symptoms are similar to the flu: chills, headache, muscle aches, fatigue, fever, nausea, vomiting, diarrhea, loss of red blood cells, jaundice, and anemia. The symptoms can last as long as a year. If you become ill while traveling in malaria areas or up to a year after you get back, you should seek medical attention.
There is no vaccine for malaria but there are anti-malaria tablets that can prevent you from contracting the parasite. Some of the tablets have nasty side effects like nightmare and vivid dreams so talk to your doctor about what he or she recommends.
You can also choose to wear mosquito repellants like DEET. A more effective repellant that you can find at camping stores is something called Permethrin. There are even special clothes you can wear (some manufactured with Permethrin) to repel mosquitos!
How necessary are the vaccines?
The final decision (is most cases) is up to you. It depends on whether or not you want to take the risk. Think about where you are going. Will you be in remote areas? Will you be in touristy areas? If you’re going to the woods for camping you will want to highly consider vaccines that you might not while going to major cities.
If the vaccine is affordable and accessible, I think the obvious decision is to get it. Why would you want to go on a long, amazing trip and find yourself sick for an extended period of time? That sounds awful.
My Next Steps:
The same day of my appointment, I was able to get my Hepatitis A vaccination. I already had most of the shots which turned out to be a great relief.
My doctor recommended buying and bringing allergy medicine, imodium tablets, and other over-the-counter medicine that people sometimes overlook before leaving. He gave me a prescription for an oral typhoid vaccine, yellow fever vaccine, anti-malaria tablets, and a general antibiotic in case I get sick or an upset stomach while traveling.
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