Now that I am getting closer to my Egypt trip, I have started to think about the required vaccinations for visiting the Middle East, and the RTW trip. Luckily, since I am going to require an array of shots for the RTW, they all cover what is recommended for Egypt and Jordan. As a result I thought it was necessary to make a post regarding what to think about when it comes to medication and vaccinations for RTW travel. (Pictured: Typhoid and Hepatitis A vaccine received May 15th)
When traveling to undeveloped countries there is not only a high level of culture shock, but additional precautions need to be taken in order to maintain a high level of health. In some countries we are spoiled by clean tap water and a high degree of sanitation. In other countries the lack of these can cause a wide variety of diseases and impairments. Additionally in some regions the mosquito and other animals can carry a few nasty diseases as well. While bug spray containing DEET will help against the mosquito, it is still highly recommended to get vaccinated for the major diseases they may carry.
Some of the major diseases that the CDC suggests vaccinations/medicine for include:
Hepatitis A, Hepatitis B, Yellow Fever, Typhoid, Rabies, Malaria, Japanese Encephalitis
While majority of this are only recommendations, one, Yellow Fever, is required to enter the infected areas. Countries in these areas will require you to show an international certificate for proof of vaccination or else you will be deported on entry. The following map shows the infected regions of Yellow Fever. Before you travel it is important to check the entry requirements for these countries to see if the vaccination certificate is required.
In most cases, the general consensus is that Hepatitis A, B, and Typhoid are also considered required for travel in many regions since the diseases can be obtained through food or water based sources. Hepatitis A is generally two doses, Hepatatis B is typically three, and Yellow Fever and Typhoid can be covered in one shot each. Some places may offer a combined Hepatitis A & B vaccine which makes it a bit easier for those leary of shots. Additionally, some states in the United States force you to have Hepatitis B while going through high school, it is best to check your immunization record before getting the shots to ensure you are not double dosing. I checked mine and found out I am set on Hepatitis B already, so that is a few dollars of saving!
Of that list, Malaria is the only non-vaccine oriented medicine, which is typically prescribed in a daily or weekly oral dose to be taken in infected regions. Since Malaria is primarily spread by mosquito contact, ample coverage of DEET can produce a great layer of protection. One potential side effect of this medication is delirium and other psychotic affects. Since I will be traveling for a long time in low to medium infected regions, such as South East Asia, I do not want to subject myself to such potential side effects for months at a time, especially since I normally never take concentrated medication in pill form. So instead I am going to load up on bug spray and hope for the best.
Japanese Encephalitis is also passed threw by mosquito, in similar regions, and has a very low infection rate. While this one can be prevented by vaccine, I am going to pass on this as well and hope that DEET bug spray will cover the remaining chances of infection. In the US there is currently a redesign underway of the Japanese Encephalitis vaccine and my local agency does not even carry the vaccine. And as for rabies, well, I am just hoping that the chance of me being bitten by an infected animal is minimal as my agency recommended only getting it if I will spend long periods of time working with animals.
Since these shots are specialized for travelers, your doctor will unlikely carry the vaccine. Instead you will need to find a travelers clinic near you to find a location to get these inoculations. Many sources suggest getting shots at least 6 weeks prior to travel such that the vaccine has enough time to take affect in your system as well. Shots that come in a series, such as Hepatitis A and B, will provide enough protection from the first shot for most major travels, and the subsequent injections will add up to 10-20 years of protection for future travels. Typhoid is typically good for 2 years, and Yellow Fever has a high duration as well.
So the question is, how much do these typically cost? I called my local public vaccination clinic that carries most of these in house to find out the current costs. For shots that require multiple doses, the cost covers the series. General prices for typical travelers vaccines are as follows:
Hepatitis A & B Combined: $46*
Yellow Fever: $75
Typhoid: $46
Doctors Fee: $21 (x2 visits)
Total Cost: $188
*I already have Hepatitis B and do not need this shot, however I wanted to list the typical cost for those who have not.
My local travelers clinic has said that the first round of Hepatitis A will cover me during Egypt and I can get the second shot 6 months later to be covered for the RTW trip. Right now they are having a shortage of the Yellow Fever vaccine and cannot give me the inoculation if I am not traveling soon. Luckily I will be put on the list to get it in 6 months when I go back for my Hepatitis A booster.
Come Friday May 15th my arm will be a pin cushion after the first round of Hepatitis and Typhoid shot. I'll add a new post to this series after I get the first dosage, and another in 6 months when I get the rest to describe how the procedures went.
8 comments:
From getting my shots I remember most of them lasted 5-10 years in duration. Japanese Encephalitis required 3 shots in a row and I just got them because DEET doesn't cover everything. Don't forget to a prescription for cipro when you visit the travel doc for a case of diarrhea.
Dont forget a TB and a tetanus booster.
I forgot that my doctor told me he'd give me super strength anti-diarrhea medicine, can't forget that! I think getting that is almost a guarantee when our bodies don't recognize the foreign bacteria on food very well.
I just had my booster shots a couple months ago, glad to get those out of the way. I am just prepared for a couple days of my arms being dead after getting pricked so many times.
My husband and I go for our jabs this monday. My arm already hurts just thinking about it... doesn't help that both me and him fear needles as well.... yikes!
I called the travel clinic a month ago, told them our tentative departure of sometime in June and our basic itinerary and they said okay your calling a bit early. I thought I was calling late and was worried about those doses that take multiples jabs over a course of time.... maybe we don't need those ones? Guess I will find out very soon!
I am with you Deidra, I am terrified of needles as well. When I had my tetanus booster the injection itself was pretty painless but my arm was a bit sore the next few days. I suspect getting that many shots will have similar side effects. I think getting myself worked up over it is worse than the actual shot.
It is interesting that your doctor said it was ok when you leave in a month. I am guessing they might think it is only necessary for you to get the first shot in the series since its typically required to wait some for the next. I'll be following your trip, it looks like you have a great itinerary!
Have you considered "doxycycline"? I too am weary of the potential psychological side-effects associated with certain prophlaxes (most notably "mefloquine").
I must add however, that the risk of psychosis-related side-effects is LESS than 5% - more likely around 2% or so. To state that delirium is "high probable" may be a slight overstatement :)
Doxycycline's major concern, as far as adverse side-effects go, is a 10% risk of sensitivity to sunlight (running the gamut from mild rashes to serious skin blisters). It is also DIRT cheap - I've calculated about $6.50 US per month.
Personally I'm going to try the doxy....and considering the time I'll be spending in sunny places, hope to hell I'm not among the 1/10!
I guess high probability is a bit of a poor word choice. 2-5% is still too high for me to be willing to take for the side effect itself. I'll definitely check into Doxycycline, $30 for about 5 months is not as bad as the alternatives!
All of the injections are fairly innoccuous - I cant even say I had a sore arm afterwards. You should add meningitis to your list by the way. Hep B is the curious one, you need 3 shots over 6 months and then a blood test to confirm that your body has accepted the vaccine - if not you need to go again. Apparently if you are over 45 (like me) you are less likely to accept it, so I've decided not to get it. With rabies you can contract this from a simple scratch and die within 30 minutes - so I decided to pay the money - even with the vaccine you need to get home fast (within 3 days) as the antidote you require is not readily available in far flung destinations. Scary...but hope this helps your decision making
After weighing the pros and cons and cost of Meningitis and Rabies I decided not to get them. My travel clinic did not argue with me that it would be worth while so I am sticking with what I have. I think death within 30 minutes is a bit of an outrageous claim, most sources indicate that it wont even develop fully over the course of the day so unless there is a major reaction that seems unlikely. I had my series of three Hep B when I was a teenager, but no blood work to see if it took, no one has mentioned it to me as an issue so I hope I am ok now.
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