The Smart Traveler’s Guide to Vaccinations

Vaccinations! There’s a fun topic. Viruses, diseases, needles… Sounds like a Christmas gift from Pandora herself. A cornucopia of horrors.

With so many of my clients visiting amazing, adventurous, and exotic places, questions around visas and vaccinations come up fairly frequently. What do I need? When do I have to get them? What do they do? All valid, and all important.

So, to help with this, I thought I’d start by putting together some posts to cover topics like this as they come up and kick it off with vaccinations.

Vaccinations can be daunting. There are so many… Some are valid for longer periods than others. Some are perhaps more necessary than others. But which ones do you really need? How much will it cost? What are the risks if you don’t get them? How close to your departure date can you get them?

The CDC Traveler’s Health site is where most people default to checking out when getting ready for a trip, but the info you need can still be difficult to glean from its multitude of pages…especially if you’re heading out on a journey encompassing more than one country in developing nations. For example, if you’re traveling from the US into most African countries, you don’t need a Yellow Fever vaccination. But let’s say you’re planning to hit several countries in Africa, you may need a valid Yellow Fever certificate because of individual country rules when crossing borders there. The CDC site tries to compile this data – and they do a pretty good job – but it can still be easy to miss something.

The other variable is the type of travel you’ll be doing or the activities you’ll be taking part in. Whether you’re planning an urban, rural, jungle, ocean cruise, river cruise, guided luxury tour, or backpacking can play a major role where you fall in the risk scale for certain diseases.

Below is a compilation of the main vaccinations that come up in travel circles and what you may need to know about them.

IMPORTANT:
No matter what, make sure you always check the current vaccination requirements
that fit with your travel plans and be sure to ask your doctor!

Tetanus / Diphtheria / Pertussis

This one falls in the “general must have” category. Tetanus spreads by the spores entering the body at point of an injury. Diphtheria is a air-borne respiratory disease. Pertussis, commonly known as Whooping Cough, is spread primarily through close contact with an infected individual.

Where is it an issue?

Risk for all of these is present in 100% of the world, you should be getting a booster regularly even if you live in the US. These days, Tetanus, Diphtheria, and Pertussis are given together in a booster vaccine known as TDaP.

Approximate cost

$50-65

Hepatitis A

This highly contagious virus is spread through contaminated food and water (even ice). It’s common in places where there are sanitation issues, but I had a friend once who caught it from eating out in NYC once, so it can show up anywhere. Hep A is one that the CDC typically recommends for “Most Travelers” regardless of the country being visited.

Where is it an issue?

Underdeveloped countries have a higher-than-normal risk for Hepatitis A like Africa, Mexico, the Middle East, Central America, South America, Asia, parts of the Caribbean, Eastern Europe, and the Mediterranean.. Hepatitis A virus is also present in the Mediterranean basin and Eastern Europe where the risk of infection is greater for those who visit rural areas, the back country, or those who eat or drink in areas of poor sanitation.

Approximate cost

$70 standalone vaccine, $120 when coupled with Hep B (Twinrix)

Hepatitis B

Transmitted primarily through things like blood transfusions, contact with blood, sexual contact, or exposure to contaminated needles (e.g. tattoos) or even for medical purposes like acupuncture, IV drugs.

Where is it an issue?

Hep B is present everywhere in the world also, but it shows up chronically in Africa, China, Korea, Indonesia, the Philippines, the South Pacific, the Middle East, Haiti, the Dominican Republic, and South America through the Amazon River Basin.

Approximate cost

$80 standalone vaccine, $120 when coupled with Hep A (Twinrix)
Adult travelers are urged to receive at least the first injection before departure and a follow-up booster at 6 months. Twinrix combines Hepatitis A and Hepatitis B into a 3 dose series saving several needle sticks.

Typhoid

Another one that makes its way around through contaminated food or water. The CDC currently recommends this vaccine for most travelers, especially those visiting more rural areas, small towns, jungles, or (my favorite phrase) those who are “adventurous eaters”.

Where is it an issue?

Developing countries like Asia, Africa, Central America, and South America.

Approximate cost

$90

Polio

This highly contagious virus is also spread through personal contact and contaminated food or water.

Where is it an issue?

Afghanistan, Algeria, Benin, Burkina Faso, Cameroon, Central African Republic, Chad, China, Djibouti, Ethiopia, India, Iran, Kenya, Libya, Mali, Niger, Nigeria, Pakistan, Somalia, South Sudan, Sudan, Tajikistan, Tanzania, Turkmenistan, Uganda and Uzbekistan. Polio is endemic in Nigeria, Pakistan and Afghanistan.

Approximate cost

$65

Yellow Fever

Yellow Fever, like Malaria and West Nile Virus, is spread by mosquitoes. It’s fairly rare, but the reason it’s troubling is that it has a really high mortality rate so countries requiring vaccination take it very seriously. It’s one of the only vaccinations that actually has a certificate issued when you receive it and, countries requiring the vaccine, will request to see your certificate upon entry. Failure to produce the certificate and you won’t be permitted to enter.

Where is it an issue?

Mainly sub-Saharan Africa, countries in South America, Panama, Trinidad and Tobago.

Some countries may not require the vaccine for entry, but will require proof if you’re coming from an infected area – even if you’ve only been to the infected area in transit.

For instance, if you’re heading to Tanzania which, when coming from the US, doesn’t require the Yellow Fever vaccine. However, if your flight path were to make a stop in, say, Kenya on a layover, you would need to be vaccinated for Yellow Fever because Kenya is one of the infected “watch list” countries and Tanzania won’t let you enter even if all you did in Kenya was stay in the airport.

Approximate cost

$125

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Resources/References

Passport Health: Passport Health is the largest provider of travel medical services in the US. They have over 220 travel clinics across the nation.

CDC Travelers’ Health: This is the official site of the US government health recommendations for traveling provided by the Centers for Disease Control and Prevention (CDC)