I was sitting in the waiting room of SmarTravel International Health Services yesterday during my lunch break when a bit of trepidation came over me.
The prospect of needles jabbing my arm didn't bother me so much as the feeling that I'm 5 months from leaving my life in the United States behind for the great unknown.
While I spend hours daydreaming for every few minutes I feel anxious, the concern always seems to weigh heavier.
So I filled out the necessary paperwork, as I've done the past two years when getting ready for pre-travel inoculations, and attached my laundry list of countries before handing everything back to the receptionist.
She was a little taken aback, though quite positive about my travel plans.
I then waited patiently for about a half-hour, despite the lack of patients, as I assumed they were querying and printing off the recommendations for each country.
Eventually, one of the nurses called me back, and she was also a bit tickled by the opportunity to tackle such an uncommon case as mine.
She began to go through the list of potential maladies, counting up the number of countries per illness to get a feel for which immunizations would be worth recommending.
A nice benefit of having had a recent trip to Costa Rica was the shots I had already received (covered by my health insurance).
2005 -
- Hepatitis A (x2) @ $80 per dose - good for 20 years
- Oral Typhoid @ $80 - good for 5 years
- Tetanus/Diphtheria @ $50 - good for 10 years
Ultimately, to fill in the blanks on my yellow International Certificate of Vaccination card, she suggested the following:
2007 -
- Yellow Fever @ $98 - good for 10 years (required in some countries on my list, specifically Tanzania, Brazil, Peru, Colombia, and Panama)
- Japanese Encephalitis (x3) @ $148 per dose - good for 2-3 years
- Hepatitis B (x3) @ $80 per dose - good for 20 years
- Meningitis @ $125 - good for 3 years
- Influenza (Flu) @ $0 if offered as usual through my employer - good for 1 year
After looking at the price sheet, and taking the advice of one of my readers to spread the shots out over time, I kept to my plan of starting the course of Hepatitis B shots (only) during the visit.
Researching the wide array of debilitating and deadly diseases in the world is a rather drab affair. Ultimately, deciding which shots to get is about managing risk.
SmarTravel offers an interactive map which highlights parts of the world affected by many of the diseases I've mentioned in this post.
As a result, I'm planning to skip the Japanese Encephalitis given it's limited to eastern Asia, and Meningitis which is prevalent in an even smaller section of central Africa.
At this point, I'm going to do a little more reading on the BootsnAll message boards and CDC, though I'm fairly comfortable with my decision.
In addition to Hep-B, I'm going to get the Yellow Fever, Influenza, and (adult) Polio shots in a few months.
Once I've been stuck like a pincushion, I should only have to worry about tackling Malaria.
I've ruled out Malarone as it's taken daily. I've had no side effects with the weekly Chloroquine, however much of Asia, Africa, and South America is resistant to it.
As a result, I'm left with Mefloquine (Lariam), which carries some nasty potential side effects, such as "nausea, dizziness, insomnia, strange dreams, nightmares, depression, and anxiety."
The Malaria debates are frequent on travel message boards, and I've read many travelers' comments about skipping malaria pills in favor of managing the mosquito risks.
The one question I did ask at the travel clinic nurse was whether there are potential side effects to taking malaria medications long term (say weekly for 2 years).
The response from the clinic director was "no" and that many international volunteers, such as those in the Peace Corps, take them regularly for their full commitments abroad.
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Additional Resources: SmarTravel Profiles on 220 countries. USA Center for Disease Control - Traveler's Health section. Immunization Action Coalition - Vaccination Information for Healthcare Professionals.
Dan says
Wow that is expensive, I imagine it would be even more expensive here too. It's something I haven't thought about too much yet but I'm really going to have to.
On the Malaria, it does depend on the person a lot if they go a daily tablet or injection, but I have heard that countries your most at risk in have the most effective drugs there and given that they are developing countries it could also work out significantly cheaper.
Mike says
I never even stopped to think that some jabs might be covered by my own health insurance. Anyone know if this is fairly common? I had just planned on paying for the full boat out of my own pocket.
Dave, I spent quite a bit of time on the BnA forums researching vaccinations and it seems like about half the people over there reported the side effects you mentioned for Lariam. Sounds like pretty nasty stuff. I'd be interested to hear how you decide to handle the malaria issue.
Dave says
I would recommend you definetly call your health insurance company to find out which immunizations they cover, and how the plan covers them. I work for a rather big insurance company, and can say there is a movement in the industry (and amongst employer clients) toward investing more in preventive medicine, which includes vaccines (both for children and adults).
For example, I'm covered at 100% for certain nationally recommended vaccines, which makes this process a little lighter on my wallet.
Don't be surprised if I wait until my boots are in Australia before deciding how to approach the malaria threat in SE Asia!
Mike says
Awesome! You may have just saved me several hundred dollars, Dave. I'll have to call my insurance company but it sounds like I may be in luck. If so, I'll be happy to give you a testimonial should you ever decide to post a "Testimonials" page. =P
Mike says
I never even stopped to think that some jabs might be covered by my own health insurance. Anyone know if this is fairly common? I had just planned on paying for the full boat out of my own pocket.
Dave, I spent quite a bit of time on the BnA forums researching vaccinations and it seems like about half the people over there reported the side effects you mentioned for Lariam. Sounds like pretty nasty stuff. I'd be interested to hear how you decide to handle the malaria issue.
Dave says
I would recommend you definetly call your health insurance company to find out which immunizations they cover, and how the plan covers them. I work for a rather big insurance company, and can say there is a movement in the industry (and amongst employer clients) toward investing more in preventive medicine, which includes vaccines (both for children and adults).
For example, I'm covered at 100% for certain nationally recommended vaccines, which makes this process a little lighter on my wallet.
Don't be surprised if I wait until my boots are in Australia before deciding how to approach the malaria threat in SE Asia!
Mike says
Awesome! You may have just saved me several hundred dollars, Dave. I'll have to call my insurance company but it sounds like I may be in luck. If so, I'll be happy to give you a testimonial should you ever decide to post a "Testimonials" page. =P
Dan says
Wow that is expensive, I imagine it would be even more expensive here too. It's something I haven't thought about too much yet but I'm really going to have to.
On the Malaria, it does depend on the person a lot if they go a daily tablet or injection, but I have heard that countries your most at risk in have the most effective drugs there and given that they are developing countries it could also work out significantly cheaper.
Stu says
yeah the malaria debates... ive one foot in each camp.met a lot of saffers and zimbers in london and none of them had malaria or took tabs/injections (but its probably different if you grow up there)...
all I know is how sick they make you and how often you have to take them...
if you forgoe malaria treatment, Id be curious to know the helth insurance company position if you come back and try and get treatment...
i thought they attached 'diziness, nausea, etc' to everything these days because if someone somewhere gets dizzy, it applies the warning to everyone...
Dave says
Stu you raise a good question I'll be sure to ask just to be safe. I, unlike some others, intend to get medical insurance once I quit my job, in addition to travel insurance. It'll have a high deductible, however the goal is to have no lapse in medical coverage, which would make it more likely I could get caught in some type of catch-22 tied to pre-existing conditions if I got really ill.
Stu says
yeah the malaria debates... ive one foot in each camp.met a lot of saffers and zimbers in london and none of them had malaria or took tabs/injections (but its probably different if you grow up there)...
all I know is how sick they make you and how often you have to take them...
if you forgoe malaria treatment, Id be curious to know the helth insurance company position if you come back and try and get treatment...
i thought they attached 'diziness, nausea, etc' to everything these days because if someone somewhere gets dizzy, it applies the warning to everyone...
Dave says
Stu you raise a good question I'll be sure to ask just to be safe. I, unlike some others, intend to get medical insurance once I quit my job, in addition to travel insurance. It'll have a high deductible, however the goal is to have no lapse in medical coverage, which would make it more likely I could get caught in some type of catch-22 tied to pre-existing conditions if I got really ill.
Cassie says
I've been thinking about the malaria thing lately too.
This is a great link about vaccines http://travelindependent.info/b4yougo.htm
Its a tough call. There was a woman that was on the Thorn Tree boards forever that wrote a book and travelled all over hitchhiking and was fairly well known...she died a of malaria last year, and it seems the debate is in high gear again.
Nice that your insurance covers some vaccines. I just started the Gardasil series and they told me they'd cover it, then declined in the end. Those are almost $200 a shot and there are three of them...and painful as hell.
Who knew that shots could be so exciting?!!
Cassie says
I've been thinking about the malaria thing lately too.
This is a great link about vaccines http://travelindependent.info/b4yougo.htm
Its a tough call. There was a woman that was on the Thorn Tree boards forever that wrote a book and travelled all over hitchhiking and was fairly well known...she died a of malaria last year, and it seems the debate is in high gear again.
Nice that your insurance covers some vaccines. I just started the Gardasil series and they told me they'd cover it, then declined in the end. Those are almost $200 a shot and there are three of them...and painful as hell.
Who knew that shots could be so exciting?!!
wade says
I am in the process of getting poked and prodded for a trip to South America. Went through it a few years back for a trip to Africa. Malaria medication is a "better safe than sorry" thing for me. I take Malarone. It does make me have some funky, vivid dreams though.
wade says
I am in the process of getting poked and prodded for a trip to South America. Went through it a few years back for a trip to Africa. Malaria medication is a "better safe than sorry" thing for me. I take Malarone. It does make me have some funky, vivid dreams though.
Natalie says
My husband and I are currently receiving the same Japanese Encephalitis (JE) vaccinations that you went through a while back.
Their is a new Japanese Encephalitis vaccination that is coming out either late 2008 or early 2009. This should be less expensive and it can be given in 2 shots instead of the current 3.
Feel free to read about our JE experiences and more on http://www.nomadbackpackers.com
Natalie says
My husband and I are currently receiving the same Japanese Encephalitis (JE) vaccinations that you went through a while back.
Their is a new Japanese Encephalitis vaccination that is coming out either late 2008 or early 2009. This should be less expensive and it can be given in 2 shots instead of the current 3.
Feel free to read about our JE experiences and more on http://www.nomadbackpackers.com
Joanne says
I heard that there is an effective Japanese Encephalitis shot that you can get in Nepal and --was it Korea or Thailand? It was written possibly up by WHO a few years ago. It is one shot, cheap, few side effects and good for life. Anyone know what it is called and how I would get such a shot while visiting Nepal?
Regarding Mefloquin or Lariam, I witnessed the strange side effects in someone close to me: nightmares, anger, and other psychological reactions--and this is someone who showed no prior tendencies.
Joanne
Joanne says
I heard that there is an effective Japanese Encephalitis shot that you can get in Nepal and --was it Korea or Thailand? It was written possibly up by WHO a few years ago. It is one shot, cheap, few side effects and good for life. Anyone know what it is called and how I would get such a shot while visiting Nepal?
Regarding Mefloquin or Lariam, I witnessed the strange side effects in someone close to me: nightmares, anger, and other psychological reactions--and this is someone who showed no prior tendencies.
Joanne
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