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Vaccinations for travel

Thinking of taking a 2 month solo “roughing it” retirement trip to Africa or South America and wondering about vaccinations to get over the next 12-18 months. I’m not thinking travel vaccinations like typhoid or yellow fever that aren’t covered by insurance (I will evaluate later with more definitive plans), but the ones that are covered by insurance but not everyone gets, from this list:

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

I’m thinking Hepatitis A and Meningococcal. The way my clinic works there’s no MD involved, you just show up and ask for what you want. Do others get these “fringe” vaccinations for travel?

Posted by
1980 posts

Yes, I got Hep A and B vaccines (and others) when I went to Panama, and they were advised for Russia.

For Panama, I went to a travel clinic that specialized in recommendations for vaccines specific to the countries you were traveling to.

For Russia, I was with Kaiser and they had a travel vaccine specialist who made the recommendations, again specific to countries.

Posted by
31303 posts

Tom,

My usual approach is to check a couple of websites for vaccination information for the places I'll be visiting, including https://travel.gc.ca/ and https://www.iamat.org/ . Once I have a good idea which vaccinations will be required, I make an appointment with the local Travel Medicine clinic (well in advance of departure) and obtain the recommended shots. I also get Dukoral (oral med.) prior to each trip.

Most travel-related vaccinations here aren't covered by the medical plan, so I have to pay for those myself, but they're not usually too expensive. If I need any boosters for routine vaccinations such as tetanus or whatever, I get those at my family doctor or the local health clinic and those are covered by the medical plan.

On the travel.gc.ca website, I also check the "Safety & Security* section to determine what "hazards" I need to be watching for when I arrive in the country.

Posted by
4894 posts

These aren’t “fringe” vaccinations, they are sensible precautions if your government and medical practitioner recommended them. I always get whatever is recommended for a particular trip - who wants to be ill in some remote part of Africa with limited medical facilities? If you think your trip may involve getting close to wild animals, a rabies shot is useful although it’s expensive here in the U.K.

Many vaccinations give 10 years cover, so would cover future trips.

Check which countries you are proposing to visit, as some may ask you to prove what shots you have had. I always take my vaccination log book on any trip where my immunisation maybe challenged.

Posted by
3789 posts

'roughing it' and 'solo'? Consider how remote you will be and where you can get treatment.

Given that people retire earlier in North America, what are your recommendations for Pneumo vaccines or shingles vaccine? They are often age based. Also, if you don't have the paper to prove you had Measles vaccine as a kid, at the very least, get tested to see if you are immune and carry that with you....otherwise, get the booster. Consider there were measles outbreaks in the past few years and it limited travel for people. In fact at least one ship vaccinated each and every passenger who didn't have proof of previous vaccine. I prefer to know who is giving me needles, thank you very much.
There are shortages of Yellow Fever at times, so plan ahead. Also, what are your thoughts about Rabies? I normally wouldn't think to get it, but I spent a month volunteering in a rural area of Tanzania and have a healthy respect for those 'yellow, mangy dogs'. I keep away from them, but neither do I trust them. Rabies vaccine is expensive, and takes 3 shots and also is sometimes in a shortage; but in Africa, you may need to fly to Cape Town from anywhere else to get human gamma globulin if you are bitten so at least the rabies vaccine buys you more time to get there.

At the very least, research where treatment can be had as far as where you want to travel.

Posted by
4947 posts

We had a safari planned for Kenya/Tanzania for this July/August, but had to postpone until 2021 because of COVID-19.

My wife and I went to our local health department and received vaccinations for Hep A and B, Typhoid, MMR, and Tetanus. We had the Yellow Fever vaccination already because of a visit to South America.

You will need Yellow Fever if you visit Tanzania.

Posted by
3250 posts

“Ask my doctor” is a little quaint, I have had the last 3 retire or move on, so now looking at 4 GP doctors in 6 years. I don’t think I’ll ever have a doctor I consider to be mine again. I’ll ask the new one.

I did the Shingrix vaccine already this year, quite a horrendous experience I was not prepared for. Probably ranks in the 5 sickest experiences of my life, both shots. Literally soaked the bed with sweat after the second shot, dripping wet, yuck. I am pretty sure my wife will not get the vaccine after seeing that, as the vaccine seemed to be worse than the disease. I lost 5 days of work: 3 after the first jab and 2 after the second. Not an allergic reaction, just a severe one.

I’m pretty sure even a travel clinic consultation is not covered by insurance, that could be $250 on top of the cost of the jabs.

Was unaware there was a rabies vaccine. Hepatitis B seems overkill but I can ask.

Posted by
280 posts

Check the WHO immunization schedule for the countries you are visiting. Public health departments often offer vaccines at a lower cost than private providers. I would also check the immunization entry requirements for each country you are visiting. Some still require a yellow shot card proving you have been vaccinated. If you're spending thousands to go to Africa or South America and don't want to plunk down a couple hundred dollars to protect yourself from truly unpleasant diseases, at least make sure you have excellent travel insurance that will cover both hospitalizations abroad and medevacs. I've been in two African hospitals. I can assure you that in some ways, they were worse than the diseases. And I was pretty sick.

Posted by
3789 posts

Wanderlust's comment about medivac reminded me about the need to consider registering for this. I think the US has access to an annual medivac plan that is global. When I was in Africa and particularly in safari country, I joined the Flying Doctors organization. I think it was about $40. https://flydoc.org/ It is your medivac from rural areas to the nearest hospital. If you don't use it, they will use the membership to do humanitarian lifts for locals that need it. https://flydoc.org/ There are other similar organizations should you go to South America instead.
A short story - I was on a private bespoke safari in May 2012. May is just after the 'long rains' in Tanzania so grass is 2-3 feet high. Driver and I were in a good new jeep with a pop up roof. I like to stand and watch the world from outside the roof, so this morning we were in the Serengeti on one of the many dirt tracks. It took a sharp left turn but because of the grass, driver didn't see the deep pot hole right after the corner. We hit it straight on and were rocked side to side several times. I became a human ping pong ball losing my grip of the roof rim hitting first the left window, then the right and then the left again. Ultimately, I broke bones at the end of my left collarbone in my shoulder. I didn't abandon the safari, but it was somewhat challenging. We visited a medical type 2 or 3 days later as I had left most of my Advil at the volunteer home. He poked around and said it was just bruised. His RX for pain was one 200mg Advil every 6 hours....not very useful. No xray options. No real pain relief med at the local pharmacy. An xray when I returned to Canada confirmed the bone breaks.
The reason for the story is to outline the challenges in remote places. That was a minor accident but if there is something major, then you want to be able to call services.

Posted by
19214 posts

The hepatitis vaccine is now a combination of A and B. I got mine (2 shots, months apart) at CVS. I also got the typhoid vaccine there. My doctor suggested I check CVS's pricing, because it would probably be less expensive than getting the shots at her medical center. She was right. It would certainly be worthwhile to check Walgreens and other similar providers as well. My (very good) insurance didn't cover the hepatitis vaccine; I don't remember about the typhoid, but the usual situation is that things not needed in the US are not covered.

I believe the Safeway pharmacies may administer some vaccines beyond flu and shingles. My local store gives me a 10%-off supermarket coupon when I get vaccinated there.

You will probably have to order the more unusual vaccines in advance, so this is not something to put off until 30 days before departure (plus that wouldn't allow you to get both doses of the hepatitis vaccine). Actually, the current advice is that hepatitis may require 3 shots. My blood work showed I had the antibodies (?) after just two.

Posted by
3250 posts

acraven: just reading the nitty gritty of my insurance plan not sure if Hep is covered or not, will have to call.

The Pneumo vaccine is only recommended if over 65.

I like the flydoc recommendation.

Posted by
6763 posts

Our MD sent us to a Travel Clinic to assure we would be protected for a trip. Do you have a Travel Clinic near you? The nearby university and medical school has one and that is where we got appropriate inoculations. Some required a follow up shot several months later.

Posted by
6082 posts

Hep A is a common cause of foodborne illness, even here in the US. So no harm in getting that one. Hep B was (probably still) for people like health care workers who might be exposed to human blood or other fluids. Our grocery store pharmacy offers vaccination for shingles, DPT, and pneumococcal pneumonia as well as influenza. County health department does the less common ones.

Posted by
4556 posts

You might check to see if there is a travel medicine specialist/clinic in your area.

When I went to South Africa and Botswana (in 2003), I ended up getting vaccines for Hepatitis A/B, Typhoid, and a Polio Booster. The travel clinic also took care of my prescription for anti-malarial med. Because they were a travel medicine clinic, they did a good job of explaining the potential risks for various illnesses as well as the vaccines themselves. The hepatitis A/B involved 3 shots at 1, 2, and 6 months when I took it. As I recall, they indicated the Hep B was unlikely to be necessary unless I was injured and needed blood products; I decided to go ahead and get it as a precaution and because the combined AB vaccine was just one more dose than the A vaccine.

Posted by
126 posts

Sorry to hear about the bad reaction to the Shingrix shot. My husband and I have both had the older shingles shot, and more recently, the Shingrix, with no ill effects. In checking with all our friends and aquaintances w/in our age group (70s and 80s) none have had what you experienced. I say this so your wife doesn't forgo the shot if she has no contraindications. Shingles, from what I have been told by persons who have had it, is an agonizing and painful disease, which can last for months. I fear that you are in that small percentage who suffered from side effects.
We feel it is unwise to try and skip any immunizations recommended for a particular destination. We have had our Hep A, Yellow Fever, both types of pneumonia (viral and bacterial), and of course we stay up-to-date on our T-Dap and get annual flu shots. We both received the oral polio vaccine when it came out in the 50's (as some of the first recipients). Measles, mumps and rubella vaccines came out when we were adults. We had those three illnesses when we were children, as did all our friends. We also had whooping cough. As a kid, the only vaccine any got was a smallpox vaccine. Many of my generation can still see the small circle on our arm, an artifact from another time.
Get any shots you can to protect you, especially, as others said, when you are visiting someplace far from good medical services. In Africa, at some of the game preserves we visited, it would have taken at least a day to get to a place with a hospital. And don't forget your malaria pills!
(p.s. Be glad you probably won't need cholera or plague shots. When my husband went to Viet Nam, he had those and said they really laid everyone low!)

Posted by
126 posts

Oh yes, We are lucky enough to have Kaiser, so their travel specialist nurse practioner was a one-stop shop and if I remember correctly, the cost for yellow fever shots were minimal ($10.00?) Flu and TDap are free. The other shots were pretty cheap too. Good luck on the trip.

Posted by
2755 posts

I did the Shingrix vaccine already this year, quite a horrendous experience I was not prepared for. Probably ranks in the 5 sickest experiences of my life, both shots.

Yes, me, too. Your reaction was not rare. My doctor warned me that I might have flu like symptoms. Yes, not nice symptoms for a couple of days, but then another symptom for one week, and a third symptom for three months. The next time I went to my doctor, she indicated that they'd had many, many complaints about it, and that she'd been sick as a dog after getting her shots, and they were just getting clued in to the 3rd symptom by others as well. Because she'd been ill as well, she was very empathetic and was also concerned about this 2 shot vaccine. The former one shot did not have these symptoms. This is the problem with new vaccines, I guess.

Posted by
627 posts

I was just about to get my shingles shot the other day but have been somewhat concerned about getting it right now if there is a possibility of a COVID shot on the horizon. I am not quite 55, so still in the younger group, but a young teacher at work (age 40) is dealing with a bad case of shingles right now. I remember my parents dealing with it. Very painful. Everyone I spoke to that has had the shot said the side effects can be quite bad but it is better than actually getting shingles. I'm going to hold out a little longer. COVID is riskier for me right now.

Posted by
1980 posts

I’m pretty sure even a travel clinic consultation is not covered by insurance, that could be $250 on top of the cost of the jabs.

When I went to a California travel clinic in 2015, their consultation fee was $50. Our county also offers the vaccines, at comparable prices to what I paid.

Posted by
223 posts

Since you apparently live in MN, I highly recommend the travel clinic that Healthpartners runs. I have visited them before each of my trips outside Europe and they have the most up-to-date info on immunizations and other health considerations (for instance, will you need to take anti-malaria medication? How do you avoid dengue fever? What antibiotic is best? How to find good care in more remote locations? Etc.) Sometimes the visit has been covered by insurance and sometimes not. I have never figured out why - maybe something with the coding? But whatever the cost, I feel that it is well worth the cost to obtain really good info and advice before heading off the beaten track.

The Healthpartners travel clinic has virtually any immunization in-stock, but it is true that you may have to pay for some yourself. Again, I have felt that this expense was worthwhile to gain some peace of mind. The travel clinic will discuss with you about the pros and cons of getting each shot.

Posted by
3250 posts

Hi renee:

My clinic has been bought out by Healthpartners so I know where one of their travel clinic locations is. Their posted pricing is a little scary, $350 for yellow fever, $400 cholera, $500 rabies.

Adding that the public health clinic I checked doesn't carry travel-type vaccinations, just the ordinary ones.

Posted by
223 posts

Yes, some shots are really expensive! However, you can consult with the clinic and then shop around elsewhere to see if you can get the shots elsewhere ( a public health clinic perhaps) for less. Keep in mind that you might not need these particular expensive shots. I have traveled in such places as Tanzania and Myanmar, but never needed to get the cholera shot. Yellow fever is only required to enter certain countries IF you are entering FROM a country with a yellow fever outbreak (Tanzania is an example). Also, if you have ever had a yellow fever shot ((and have proof of it) you don’t need another one. I had one when I was 16 (I am retired now!) and still had the certificate. So Healthpartners entered it into my record.

I did get the rabies series (3 shots, EACH about $500) because the doctor at the travel clinic, a specialist in SE Asia, really recommended it when I went to Myanmar. Her reasoning was - many rabid dogs and monkeys there combined with a poor health care system (she said - if you have any kind of serious ailment, hop on the first plane back to Bangkok!) Even with the rabies shots, you still need to seek medical care after a bite, but it is much less urgent. I had sticker shock at the time, but now I don’t have to ever get the shots again. If I had only been going to a place like Thailand, where medical care is good, I would not have gotten them. This is the kind of decision-making that a good consultation can help you make based on your own plans and risk-tolerance.

Posted by
19214 posts

I am not a medical person, so this is definitely not medical advice, but: I gather from online reading (and my primary-care doctor agreed) that the cholera shot isn't usually recommended because it's just not very effective. In general, my philosophy is to get every pertinent vaccination, but in the case of the cholera shot, I think I'll pass, even though there's a trip to India in my future.

Posted by
3250 posts

cholera: Formerly treatment did not address the dehydration that made the disease fatal. From the WHO:

"Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day."

Misunderstanding the Dukoral comment above, it's less than $100 at some locations for this oral cholera vaccine. I have had the shot years ago and that was not very effective (and perhaps expensive).

Edit: Dukoral is not available in the USA, but it is in Canada.

Just called and got an OK from insurance that both Hep A and B are 100% covered, so I will start that 6 month journey from first to last injection.

There are special clinics where you can get the vaccines. I'm planning a trip to Aruba ( https://www.africanjacana.com/aruba/ ) later this year, and I'm planning on getting both Hepatitis A and Meningococcal vaccines and a few others. Hepatitis A, hepatitis B, typhoid, yellow fever, rabies, meningitis, polio, measles, MMR, Tdap, chickenpox, shingles, pneumonia, and influenza are the ones they recommend, but as for me, they're too many. I will check with my doctor and make a vaccine plan, but I already have a few from the list, so I won't have to do that many.

Posted by
31303 posts

A few additional comments to add.......

I've found in the past that not all family doctors are well versed in travel medicine, or the specifics of which vaccines would be required for a particular destination. For that reason, I prefer to deal with the physicians at a Travel Medicine Clinic, as they specialize in that sort of thing.

Regarding Dukoral, the travel med doctor said it's not 100% effective, but suggested it would be better to have some protection rather than no protection. For the small cost and ease of an oral med, I figured it's a good idea.

Posted by
6082 posts

I inquired about getting some Dukoral last time I was in Canada. As I recall, part has to be refrigerated, and I think the protection is only for a certain length of time, it wasn't feasible for me to take it as a visitor from the US. That is, you can't just get some there and take it home to be used before your next trip.

Posted by
31303 posts

stan,

That's true, the Dukoral vaccine does have to be refrigerated but that's easy to do as I'm only about a five minute drive from the clinic. As I recall, two doses are required the first time so if one was taken at the travel med. clinic, only the booster would have to be chilled until you get home. I believe the vaccination has to be renewed every year, but only the booster has to be taken.

Travel vaccinations are not covered by the medical plan here, so I have to pay out-of-pocket for that. From what I remember the cost was reasonable.

Posted by
3250 posts

Following advice above I read online that the yellow fever vaccine, which used to require boosters every 10 years, is now considered good for life. It’s been decades but I had a vaccination and then 10 years later a booster, so that one is done. I still have the yellow book documentation which I can carry.

Posted by
1331 posts

with the rabies shots, you still need to seek medical care after a bite, but it is much less urgent. I had sticker shock at the time, but now I don’t have to ever get the shots again

You need to check about rabies vaccine providing lifetime immunity. I’m pretty sure that is incorrect, unless there is a new vaccine that I am unaware of that does so.

Also, I had a short lived reaction to the shingles vaccine. I felt like crap for a day. I still got a mild case of shingles about three months later. This was a few years ago and I still have pain where I had them.

Posted by
223 posts

Here’s what the CDC says about the rabies shot:

“For pre-exposure protection, 3 doses of rabies vaccine are recommended. People who may be repeatedly exposed to rabies virus should receive periodic testing for immunity, and booster doses might be necessary. Your health care provider can give you more details.”

If I ever go somewhere where rabies is likely, I would check my immunity. I believe that the travel clinic told me at the time I got the shots that most people are fine with just the original 3 shots.

Good news, Tom, on the yellow fever shot!

Posted by
246 posts

We get our travel shots a the county health department. Hepatitis A for India. Tetanus shot because we do alot of renovations at home and the cabin. It protects us overseas too. We usually are taking a tour to third world countries where extra protection might be needed. The tour company tells you what they recommend to cover themselves and protect you. Have never felt the need for a Hep B shot as we are an older quieter couple. Have yet to travel in places where you need malaria, yellow fever or cholera protection. Haven’t considered rabies shots. The potential need is even here at home. We have had all the typical childhood diseases that they vaccinate for now. Guess the next vaccine on the list will be Covid 19.

Posted by
5094 posts

Is Malaria a potential concern, too?

Posted by
31303 posts

"Is Malaria a potential concern, too?"

Yes, it will be a concern in some countries or at specific times of the year. Packing a DEET based mosquito repellent as well as Malaria prophylaxis is highly recommended for some destinations. The government websites (ie: travel.gc.ca) provide information on that point for each country.

However, one important caveat to mention. In choosing anti-malarials, I would recommend not using Lariam (mefloquine) as it can have some very severe side effects in some people. There are currently several class action lawsuits pertaining to these side effects being heard by the courts. These were filed by ex-military and police from Canada, Britain and the U.S. (including at least one U.S. Navy SEAL) who served overseas in malaria prone areas and were ordered to take the drug. Refusal to do so in the Canadian Forces was punishable by court martial, according to one of our retired Generals - https://www.ctvnews.ca/w5/romeo-dallaire-joining-lawsuit-against-government-over-anti-malaria-drug-1.4645769 .

Posted by
290 posts

Just a comment, don't forget the basics. DPTP ( Diptheria, polio, tetanus and pertussis) and if you didn't have measles or mumps as a kid, you may want to get a booster of the MMR.

Our daughter had a bunch of vaccines for travel about a year ago, and it turned out no one suggested the tetanus booster that was over 10 years out.

Posted by
31303 posts

Lisa,

That's a good reminder that routine vaccinations should also be checked prior to travel. I had a Tetanus booster along with a Flu shot not too long ago (one in each arm).