When I was about to embark on my first trip overseas, spending a week and a half in France, my dad, who had lived in Thailand as a child, asked what immunizations I would need. He got a confused blink or two before the response, “Um, none… It’s France.”
Much like complicated visa wrangling, getting special shots for my RTW trip will be a new experience, and if I want to move my trip up to this July, I need to get a plan in place now.
The CDC has a pretty comprehensive section of its website dedicated to travel health, but which of their recommendations I follow is a judgment call.
Ensuring vaccinations for measles-mumps-rubella (MMR), diptheria-tetanus-pertussis (TDAP), chicken pox, and flu are all up-to-date is recommended for all travelers before any trip.
Flu vaccines are annual, so therefore non-negotiable, but also definitely covered by health insurance. I received an MMR vaccine and had the chicken pox as a child, so I probably don’t need these as an adult. TDAP boosters are necessary every 10 years, but I’m pretty confident that I this was part of my off-to-college vaccine regimen, so mine is current.
Update: I did receive a flu shot and a TDAP booster at my first clinic visit on February 2. My last TDAP booster was just under 10 years ago, so while not required, it was strongly recommended.
Contaminated food and water is a potential risk in most of the countries on my route, so guarding against Hep A is a must-do. This is a two-part vaccine, with the second shot given six months after the first, so this will be the first vaccine I get. It’s also probably covered by insurance.
Update: Apparently I got one dose of the Hep A vaccine before I went to college, so I only needed one more for lifetime immunity. This was covered by insurance.
According to the CDC, typhoid is also a risk with food and drink in Turkey, India, Nepal, and Southeast Asia. This super helpful blog post at The Girl and Globe about the cost of vaccines estimates $120 for typhoid, which may not be covered by insurance.
Update: Typhoid has an oral vaccine option (Vivotif). It’s four pills and I’ll take one every other day for about a week. My pharmacist quoted the cost at $80, but through an app called Good Rx, I have a coupon to bring that down to $65.
I had a polio vaccine as a kid, but when you travel to an area where polio is still a problem, you need an adult booster. Adding this to my vaccination regimen means I can go to Laos as planned. I don’t know for sure whether an adult polio booster is considered routine preventive care, so if insurance doesn’t cover it, I can expect to spend about $60 on this shot.
Update: My doctor did not recommend a polio vaccine, so I can forget about this.
What I’m Not Getting
Being monogamous and uninterested in tattoos comes in handy – no Hep B vaccine necessary. Besides, I got one before going to college.
The rabies vaccine is a pricey series of three shots. I’m traveling mostly in major cities and I’m not volunteering with animals, so I’ll take the low risk now and cross the animal bite bridge if I come to it.
Update: My doctor recommends I consider the rabies vaccine, but I’m leaning towards still forgoing it.
Another case where I’m taking a risk is Japanese Encephalitis. JE is a mosquito-transmitted disease that the CDC recommends vaccinating for travelers staying longer than a month in Asia. I do fit that bill, but here’s the rub. A JE vaccine costs about $300-500 per dose and the risk of infection seems to be pretty low, and even lower if you’re good about preventing mosquito bites in the first place.
Update: My doctor recommends I get the JE vaccine, and I’m now taking it into consideration despite the high cost.
I very nearly nailed organizing an itinerary that would not require a yellow fever vaccine. Countries that require this vaccine only do so if you’re arriving from a risk area and the only risk countries I’m visiting are at the end of my trip. Within those countries, I’m steering clear of the particular rural areas where I might need that protection. The only hiccup is getting from Peru to Costa Rica. Coming straight from Peru without a proof of vaccination could mean getting denied entry to one of my top bucket list destinations. How to get around this? Flying from Lima to Miami and then on a separate flight to San Jose isn’t any more expensive than a direct flight between Peru and Costa Rica. My hope is that having the most recent stamp in my passport from the U.S. will get me around that requirement and save me from spending $75 to cover just one country on my itinerary.
Update: My doctor confirmed that I will not need a yellow fever vaccine for any part of my trip, and that if I were traveling to South America before visiting Asia, that would not be the case.
Other Medical Needs
All my current prescriptions are fully covered by insurance, so I only need to make sure I’m able to stock up a year’s supply and have a copy of the prescription with me in case of emergency. (And luckily none of my medical needs are life-threatening, so if I did lose my medicine and the prescription, it wouldn’t be the end of the world.)
Malaria, however, is something I should worry about. While the risk factor is relatively low, malaria is not something I’m f-ing around with. India, Thailand, Laos, and Cambodia are all malaria-endemic. Many strains in these countries are immune to chloroquine and mefloquine, according to the CDC, so my cheapest option is the daily pill, doxycycline. I’ll need to start my regimen a day or two before arriving in India, and because you need to continue taking it for four weeks after leaving an infected area, I’ll also have to take it while in Nepal, Vietnam, and Indonesia, even though my risk there won’t be as significant. That’s about 100 days in total, and at $3 a pill, my overall medical budget (pills and vaccines included) now totals around $500-600, or 2.5% of my budget.
Update: My doctor has recommended malarone over doxycycline because of the lower risk of negative side effects and the fewer number of pills needed for malaria prevention, noting that the cost gap between the two has shrunk significantly in recent months. We’ll be working together over the next three months to determine exactly how many malaria pills I need. They are also issuing me prescriptions for diamox, to help with altitude sickness on the Inca Trail, and for azythromycin, rather than cipro for the ailment affectionately known as Traveler’s D.
The clinic I visited recommended the app GoodRx, which can help you find the lowest prescription price at local pharmacies and also has coupons available to bring costs down further.
The cost of my two-hour consultation was $140. The costs of all prescription medications according to GoodRx will be about $260, making my total medical costs without the JE vaccine $400.