With our around the world trip approaching, Peter and I both has our travel immunization appointments recently.
My appointment was at the Beth Israel Travel Medicine & Immunization Clinic, and they were wonderful. Between the nurse practitioner and the doctor, they spent 2+ hours with me (when does that ever happen with a doctor anymore?!), and were extremely thorough.
In general, there was not a huge impact on my travel vaccines because of my diabetes. However, if my diabetes was not well controlled, or I was immune-suppressed, there would have been an impact.
In particular, here’s what I learned through researching for the appointment and discussing with my doctor:
- Start the process early. My primary care doctor recommended setting the travel appointment 2-3 months before departure, and I’ve found this to be very helpful. It gives you time to ensure you have no reactions to the vaccines, and fill any necessary prescriptions. For instance, I’m still going back and forth with the nurse about my malaria medication, and I’m glad I have some extra time to do this and fill the script before we leave.
- Research the vaccines needed for your destination(s). It’s a good idea to do this before your appointment so when the doctor mentions something like “Japanese encephalitis” you have some sense of what they’re talking about. A great research for this is the CDC Traveler’s Health site. The search tool allows you to indicate if you have a chronic condition or are immune-suppressed, and offers recommendations based on that.
- Know if you’re up to date on routine vaccinations before your appointment. Routine vaccines are the ones you’d get in the U.S. through your primary care doctor, including the measles-mumps-rubella (MMR) vaccine, the diphtheria-tetanus-pertussis vaccine, the varicella (chickenpox) vaccine, the polio vaccine, and your yearly flu shot.I meant to ask my primary care doctor if I was up-to-date before my travel appointment, and time got away from me. The end result is that the travel clinic had to draw blood and screen it for the vaccines. I hate blood draws. So trust me: find this information out in advance!
- Consider any budgetary concerns beforehand—particularly around the rabies vaccines. Most often travel vaccines are paid out-of-pocket because insurance companies think these vaccines are optional. Budget is a real concern for most, especially considering travel itself can be expensive. Peter and I found we had two decisions to make regarding what we wanted to spend:
- The Typhoid vaccine. The typhoid vaccines comes in a pill form and an injectable. The pill is taken every other day for days (so a total of 4 pills), and you cannot eat for two hours afterwards. The pills are about $100. The injection is given once, and is about $200.The pills are not recommended for immune-suppressed individuals. My diabetes is relatively well controlled and they were not concerned about my immune system; however my doctor still preferred the injection for me. She would have given me the pills but I opted to spend the extra money to follow her suggestion. Plus, what if I had a low and had to eat during that two-hour window after taking a pill? I didn’t want to risk the vaccine not being effective.
- The rabies vaccines. The rabies vaccine is extremely expensive (consisting of three shots that cost about $500 a piece) and it does not eliminate the need for medical care if you are bitten by an animal while traveling. You can read more about how it works here and here.After a few discussions and really considering what was best for our health and our wallets, Peter and I decided not to get the rabies vaccine. If the vaccine completely eliminated our need for further medical care, then I might have had a different opinion. However, we will not be working with animals or in extremely rural settings were we could not seek medical care if bit by an animal. It would be a $3,000 expense between the two of us—one which we would not even contemplate for a week’s vacation. We did not feel that it was justifiable in the end.
- Get a record of the vaccines you did get. Your doctor should give you a card that you can bring on the road with you to show at customs. You may be asked for this when traveling.
- Staying healthy on the road doesn’t stop at the vaccines! Interesting, I spent a lot of time talking to the doctor about avoiding mosquitos (through bug-repellent clothing, bug-repellent spray and nets), avoiding fresh water swimming, especially in Africa (apparently there are parasites in the water that can enter your system – who knew?), and avoiding consuming unfiltered water or uncooked food.
Lastly, the nurse practitioner gave me a TON of new resources related to medication rules while traveling. I’m sorting through them now, but am super excited to share more as I figure things out. Stay tuned!