For many of us, the allure of the unknown is the root cause of wanderlust. But that unknown can come with plenty of risks — some of which we don’t encounter in our home country, including certain diseases.
While most of us have been vaccinated since early childhood for measles and mumps, for example, we haven’t been inoculated against diseases that aren’t present in the United States unless brought in from abroad, such as yellow fever or typhoid.
Certain diseases are only a risk in specific regions, and within that region risk levels can vary based on climate and season. Also, prevention for these diseases varies drastically. Some are administered as shots or series of shots, others orally, and for some you can only rely on traveling responsibly for prevention.
Where to begin is often the most difficult step when knowing if or what vaccinations and immunizations are needed. For expert guidance, I spoke with Corey McVey, the director of nursing at Passport Health in Chicago and Wisconsin.
McVey said the first stop when considering international travel should be the Centers for Disease Control and Prevention’s (CDC) dedicated Travelers’ Health site — a recommendation echoed by pretty much everyone in the travel health community. The CDC website is easy to navigate, clear and concise.
From the homepage, you can select your destination country. Within each country, recommended vaccines and medications are clearly broken down for all travelers, most travelers and some travelers. These are followed by a more general list of health and safety tips, medical packing lists and specific health notices.
It’s not often that a government website is organized and maintained well enough that a separate organization hasn’t created their own, better version, but that’s the case here. Your first step couldn’t be simpler. But if you’d like a second reliable source, you can also visit the World Health Organization (WHO) website for international travel and health.
“Only 10% of travelers that should seek travel consultation do,” said McVey. Several factors contribute to this alarmingly low number. Here are some common misconceptions that keep people from seeking a travel health consultation:
“I won’t get sick.” McVey believes this is the most common reason people skip travel consultations. “People think they’ll be fine. They won’t come across illness or diseases. But you should get a consultation for the same reason you wear a seat belt. You don’t know about others. You don’t know about the people cooking your food.”
“I saw my primary care physician.” Many travelers consider an appointment with their primary care physician adequate. You definitely should consult your physician first, and often they will recommend a travel clinic — especially if you’ll need vaccinations they don’t carry. However, McVey says sometimes physicians don’t have the most current information. “They may not be aware of an outbreak. Travel clinics are most in tune with international travelers’ needs.”
“I got all the information I need online.” While the CDC website should be your first stop, it shouldn’t be your last. A travel consultation will cater recommendations to the traveler based on health history risks, and the type of travel they expect. “The needs of a backpacker traveling through Thailand are different than a business traveler who will only be in Bangkok a few days.”
“I’ll get sick.” McVey sees many patients who misunderstand how vaccines works. “Some people think the shot gives them the disease, they get sick and then they are immune. Very few people get sick from the vaccines. It’s an antibody build up.”
“Travel consultations are expensive.” Some vaccinations such as rabies are indeed expensive (over $1,000 for the series), but that vaccine is rarely needed and is an extreme example. Travel consultations themselves cost just $50 to $75. Most vaccines are less than $100. And as the name suggests, the visit is merely a consultation. You’ll receive recommendations for medication or vaccinations as needed but are under no obligation to get them.
Some insurance plans cover preventative health for international travel (Medicare notably does not). One travel clinic I visited before an extended trip around the world submitted my bill directly to my insurance, and I had more than 80% of my $800 bill covered. On a visit years later for another extended trip, I paid for the visit myself and submitted the bill to my insurance, getting reimbursed for 60% of the $500 bill.
The reality, though, is that not taking the proper precautions could cost you much more. I know of amazing travelers who died of typhoid fever, and their deaths were largely preventable.
Travel clinics are common in most cities. Passport Health alone has over 270 clinics in North America. The CDC recommends scheduling your travel consultation at least a month before travel. Vaccines take 10 to 14 days to reach full effectiveness, and some need to be administered as a series. For example, Twinrix, which vaccinates against Hepatitis A and B, requires a second shot one month after the first for maximum protection during travel. A third shot can be administered six month later for lifetime protection.
During your consultation, you’ll discuss which countries you will visit and what health risks exist in specific regions of those countries. You will then get recommendations based on your risk of exposure due to your type of travel. If no shot series is necessary and all vaccines can be administered in one day, only one visit is needed. You’ll also get any needed prescriptions such as malaria and antidiarrheal medication.
However, McVey stresses that a late consultation is still far better than no consultation. “We’ll vaccinate even if they are getting on an airplane that day. It’s never too late.”
Not all immunizations work the same way, and the duration for which they last varies, too. For example, the yellow fever vaccine lasts 10 years while the vaccine for typhoid lasts just two years. The typhoid vaccine can also be taken orally, four times over the course of a week (every other day), and lasts for five years.
You should make sure you fully understand the risks and effectiveness associated with any vaccination you are considering. The CDC Vaccine Information Statements (VIS) explain each disease, who is at risk and who should or shouldn’t get the vaccine due to age or health concerns. It also lists potential side effects. The easiest way to find a VIS for a certain disease it to type the disease name followed by “vis” in a search engine. So if you’d like to see the VIS on the Japanese encephalitis vaccine, simply search, “Japanese encephalitis vis.”
Possibly the most complicated and misunderstood vaccine is the rabies vaccine, which I thought I understood until McVey explained the process. First of all, despite being an expensive, three-shot series, it does not actually prevent rabies on its own. It merely affects the treatment after exposure, including eliminating the need for an immediate shot called Human Rabies Immune Globulin (HRIG). This shot can be hard to find, needs refrigeration and expires quickly.
If a patient has received the three-shot pre-exposure vaccine and gets bitten by a potentially infected animal, they still need two doses of the rabies vaccine. One should be administered as soon as possible (within the first day) and the second two days later. HRIG is not needed because the body has already created the ability to produce the needed antibodies.
If a patient hasn’t received any pre-exposure treatment and potentially contracts the disease, they need both a shot of HRIG and a shot of the vaccine within a day. Depending on where the patient is in the world, HRIG can be hard to find. Three more rabies vaccine shots are needed three, seven and 14 days following the bite. And if a dose is missed, the vaccine schedule needs to be started over.
As you can see, vaccines can get complicated. Take the time to fully understand what you are putting in your body and how it works.
While many serious health risks can be prevented through vaccinations, the most common health risks cannot. “The no. 1 health risk for travelers is diarrhea, which can be prevented many different ways,” McVey explained.
So, you’ll need to learn best practices around hygiene and sanitation, and a travel consultation or the CDC website will provide this information.
Other diseases are preventable by prescription. There’s no vaccine for malaria, but taking malaria medication while traveling through at-risk areas can greatly reduce the odds of contracting the disease. But there’s currently no treatment for either dengue fever or the Zika virus, so the only way to avoid contracting these diseases is to prevent mosquito bites.
Overall, the risk of diseases abroad should be taken seriously, but they should never be a deterrent to travel. A travel consultation will prepare you with vaccinations, medications and, most importantly, an education, so you can travel safely, responsibly and in good health to the far corners of the globe.
The Points & Miles Backpacker is a weekly column appearing every Monday. TPG Contributor Brian Biros, who has backpacked the globe for the past 15 years, discusses how to fund this adventurous, budgeted and increasingly popular form of travel with points and miles. He’ll also explore all things backpacking-related. Read his story here and his high-level approach here.
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