Taking a trip outside of the United States is a little bit like going to kindergarten—you have to be sure you have your shots or you might not be admitted. Whether it’s from having a member of the opposite sex touch you on the playground (the formally established way of getting cooties) or having someone poop on their hand and then touch your food (the less established but much more terrifying way of getting cooties), no one wants to get the bug.
So I’ve been doing a bit of research on the Center for Disease Control’s Travel page to determine just how many times Jeff and I need to get stuck in the arm before we set out and what the various concoctions will protect us against. By using their destination list to investigate every possible country we might visit on our round the world trip, I came up with a comprehensive list:
- Tetanus: Also known as lockjaw, tetanus is a disease that causes tightening of the muscles. It enters the body through a break in the skin and leads to death in 10-20% of cases. Though we were immunized against tetanus as a child (as part of the diphtheria, tetanus, and pertussis vaccine), a booster is recommended for adults every ten years.
- Polio: Though eradicated in the United States for decades, polio is still out there, and outbreaks have recently occurred in countries we plan to travel to such as Cambodia, Madagascar, and Indonesia. In extreme cases it can lead to paralysis and death. Though again, we were immunized against this as kids, a booster is recommended for adults traveling to countries with known outbreaks.
- Hepatitis A: A viral infection of the liver, this disease can be spread through fecal matter as so kindly mentioned above, through contaminated water, ice, shellfish, fruits, vegetables, or other uncooked foods. It’s common throughout the world, but easily prevented with the vaccine, which is given to pretty much every traveler. Fortunately, both Jeff and I have already received this vaccine.
- Hepatitis B: This version of hepatitis is spread from blood to blood or sexual contact, so it’s harder to pick up, but it’s still pretty prevalent around the world. Jeff and I have also been vaccinated against this disease.
- Typhoid: Typhoid is a nasty gastrointestinal disease caused by exposure to the bacteria Salmonella enterica, usually through contaminated food and drink, particularly in the developing world. It can be life-threatening if not treated with antibiotics, and though the vaccination is highly effective, it is not 100% effective as there are multiple strains with various resistances.
- Yellow Fever: This virus is transmitted to humans via mosquitoes in South American and sub-Saharan Africa. At its worst it can cause hemorrhagic fever. Areas infested by yellow fever carrying mosquitoes require proof of immunization before you are allowed to enter this country, so this is the one immunization that we absolutely must have. No ifs, ands, or buts about it. The vaccine is good for ten years.
- Japanese Encephalitis: This is another mosquito-spread disease, and it’s similar to West Nile Virus, although the survival rates are much worse. In fact between 1/5 and 1/3 of people who get the disease die, and 50% of survivors have major neurological disorders. The upside, however, is that the disease is rare, with only 50,000 cases a year at most. In general, it’s restricted to rural areas in China, Japan, Korea, and eastern Russia (none of which we plan to travel to), but cases have also been recorded in rural areas of other Southeast Asian nations.
- Rabies: We all know how this one works. Rabid animal bites you and gives you the infection, you start going crazy and foaming at the mouth, you have hydrophobia, delirium, convulsions, and then go into a coma and die. Once symptoms show up, it’s too late. You’re dead. A series of shots given post-bit and pre-symptoms is effective, however, in preventing the onset of rabies. The vaccine for this does not prevent rabies, but is basically the first couple in the series of shots you would need, thus buying you a bit of time to get the rest.
Additionally, we need all the standard immunizations, the ones we had to get as kids—diphtheria, pertussis, measles, mumps, rubella… Fortunately, we didn’t have crazy parents who thought vaccines were evil, so we’re all good here.
So what this breaks down to is eight vaccines. One—yellow fever—is required. Two—hepatitis a and b—we already have. Three—tetanus, typhoid, polio—are recommended and we plan to get. And two—Japanese encephalitis and rabies—we aren’t certain about.
Why not just go ahead and get them all, you ask? Well, for one, I don’t really like getting stabbed in the arm and I don’t want to risk side effects if the vaccines aren’t necessary. Am I actually going to be somewhere where Japanese encephalitis is prevalent and will I be there in the season when the mosquitoes that carry it are active? Since I still have to get all the rest of the rabies shots, will having one really do me any good?
The second issue is simple, money.
Even though Jeff and I are lucky to have fabulous insurance, we’re left high and dry when it comes to adult immunizations. Apparently they’d rather treat the typhoid after we get it. So how much is it going to cost us to get all these immunizations? Well, oddly enough, figuring that out is tough. You’d think one dose of yellow fever vaccine would have a set cost, but you’d be wrong. I called various clinics—public and private—in DC and Maryland and even one in Kentucky, and I got a range of prices—from $90 to $150 for yellow fever. Obviously, go with the cheap one, right? Well, um, not necessarily, because while they might have a low price for yellow fever, their typhoid price could be sky high. And don’t forget that office visit charge. I’ve outlined the price range for each vaccine that we definitely plan to get below:
- Tetanus: $45-$85
- Polio: $30-$65
- Typhoid: $65-$85
- Yellow Fever: $90-$150
- Office Visit: $0-$48
And though it looks like we could get away with it costing $225 each, that’s not the case, since no one place offers all of the shots at the lowest price. If we get vaccinated here in our area, we’ll each be paying a minimum of $310. (I got these price quotes a few months ago, so they may have gone up.) In Louisville, we could get them for $281 (but of course, we’d have to pay to get there, so that’s no savings, unless we’re already in town for some other reason). Ouch! And that’s the cost, not the stab in the arm.
Add in the vaccines we’re not sure about and the cost soars. Japanese encephalitis requires three jabs, at approximately $90 a piece, and the rabies shot also requires three shots, priced at over $150 a poke. So you’re looking at $270 for the Japanese encephalitis and $450 for the rabies! I’m not one to take health concerns lightly, and I do value my life very highly, but you have to wonder where to draw the line. What’s being smart and what’s being paranoid?