International travel 101: What vaccinations do I need?

Getting poked and prodded by a doctor is never fun, but when you’re pondering travel to third-world countries, it could be considered compulsory. That said, vaccinations are a hotly debated topic among world travelers, and not everyone shares the same views.

Read the latest on the much-discussed H1N1 flu.

In my free Tips for Extended World Travel seminars that I offer at Bay Area REI stores, people always want to know more about this subject, and it really boils down to one simple question:

Should I get the shots and pop the pills, or not?

That’s an individual decision that you need to make with the help of a qualified health professional. And just to be clear, I’m not one. But I have traveled to 32 countries around the world and faced this dilemma myself. As someone who prefers to manage her health holistically, and who rarely deals with Western approaches anymore when it comes to health, I wasn’t too thrilled about getting pumped full of stuff. But in the end, after doing a ton of research online and sitting down with travel medicine specialists, I decided it was in my best interest to get vaccinated for a variety of conditions, and to take anti-malarial drugs.

So what basics do you need to know? Here’s an overview of the most common vaccines you’ll want to consider, along with a few helpful tips for getting through the process.

Standard vaccinations:
The following are fairly common no matter where you go outside the developed world:
Hepatitis A and Hepatitis B, Typhoid, Polio, Tetanus, Influenza (flu)

Country- /region-specific vaccinations to consider:
The following are specific to certain countries/regions of the world, and probably the most common that you’ll need to consider in addition to the standard list above:
Yellow fever, Meningitis, Japanese encephalitis, Rabies

Special note about yellow fever:
Even if you decide not to get this vaccine, you might be refused entry to a country if you’ve been in a yellow fever-endemic area and don’t carry an official card to prove you’ve been properly immunized; your health practitioner will give you this card upon completing your vaccine. While no customs officials ever checked my yellow fever card, I felt better knowing I had it.

As always, talk to a medical professional about all of the above.

Other helpful tips and information:

• Allow for plenty of time - 4-6 weeks - if you do decide to immunize. Some vaccinations and medications require a series of shots/treatments that must be administered over the course of several weeks. You’ll need the list of countries where you plan to travel, so your health provider can determine what vaccines and medications you’ll need. Do mention areas you might travel to but aren’t yet sure of; better to be thorough here than not.
• Do not rely on your general practitioner (GP) or family doctor for travel health issues; consult a medical professional who specializes in travel medicine. Many cities’ public health departments have travel clinics (San Francisco's is excellent), or you can search online for private travel clinics in your area.

  Travel medicine specialists are up-to-date on current risks and outbreaks around the world, and have intimate knowledge down to specific in-country locations. On one visit, my nurse pulled out a map of Vietnam and was able to pinpoint exact areas of the country where I might be at risk. This type of detailed knowledge is extremely valuable, and not something to which your GP typically has access.

• It is a good idea to visit your GP to get a physical exam and full blood panel drawn if you’re planning to be overseas for an extended period of time (I was gone 14 months). You never know what type of medical services will be available in, say, Egypt, or Tibet, so uncovering any potential problems before you go is a good thing. If you’re planning to be gone for six months or more, throw in a visit to your dentist and eye doctor as well.
• If you find yourself needing treatment overseas, always use discretion when visiting third-world hospitals or clinics; hygiene standards aren’t typically on par with what we’re used to in the States. Check the U.S. State Department website, which lists resources for finding doctors overseas, as well as suggestions for getting treatment assistance if you become seriously ill or injured.
• Know your personal health history and what vaccinations you might have received as a child. I’ve never had chicken pox, so our travel nurse recommended I get that vaccine (in addition to a host of others). My husband couldn’t remember if he’d been inoculated for measles/mumps/rubella (MMR), so he got that vaccine (again, in addition to a host of others). If your parents are still living, conduct a mini-interview with them to get more details about your health history as a child, as well as any conditions they - or other family members - might have that could affect you down the line.
• Keep in mind that diseases that have been eradicated in the U.S. (e.g., polio, typhoid) are still major problems today in other parts of the world. Educate yourself by reading up on these issues before you go. (See more info below.)
• Some insurance companies don’t cover travel vaccinations; check with your insurance provider before you take any action, so you know what to expect in the form of reimbursement/coverage.
• What’s it going to cost? My bill for the standard group of vaccines listed above ran me about $475; the total cost of all of my immunizations (not including anti-malarial drugs) was about $1,100. (This stuff ain’t cheap!) But many of the vaccines last 10 years or more, and some are good for life. When you consider the peace of mind I got in the process, I think it was worth it.

For more info: Close to home, the San Francisco Department of Public Health (located across from City Hall) runs a first-rate and affordable Adult Immunization and Travel Clinic. (This is where I went.) They can also write prescriptions for other travel-related conditions, including malaria prevention, traveler’s diarrhea, and altitude sickness. In addition, they provide a variety of other travel-related services and products.

Other resources include Passport Health, with clinics around the Bay Area and nationwide, as well as private medical clinics.

Your ultimate online resource is the federally-managed Centers for Disease Control and Prevention (CDC), whose website has an excellent section devoted to travelers' health, including everything you need to know worldwide broken down by country, and the latest on the much-discussed H1N1 flu.

Check back for more on overseas travel health issues. And consider reading my feature about emergency medical evacuation insurance - don't leave home without it!