How to Choose Your Travel Vaccines

  • January 27, 2019

vaccinations are often an afterthought in travel planning.

after all, who wants to think about needles and mosquito-borne illnesses when you could be dreaming about pain au chocolat in Paris?

when we decided to explore 50+ countries back to back, however, we realized it was time to get serious. nobody wants their travels cut short by an easily preventable illness.

here's what we learned.

Trustworthy source for vaccines

there’s a lot of fearmongering out there about travel-related illnesses. and if you read too much of it, you'll convince yourself you’re better off locked in your hotel room.

our preferred source for up-to-date vaccination information is the CDC (US Centers for Disease Control and Prevention). the CDC is a US government agency tasked with protecting public health. you can search the CDC’s recommended vaccinations by country here or by disease here.

most importantly, the CDC is a 3rd party entity that doesn’t profit from your vaccine decisions (travel health clinics, we’re looking at you) and thus is more likely to provide unbiased recommendations.

Sort vaccines based on your plans

Not all vaccines are created equal.

vaccines can be placed into three categories:

  1. required

  2. recommended (by CDC)

  3. excessive

1. required
yes, some countries require proof of vaccination for entry.

for instance, some countries in Africa and South America currently request proof of the yellow fever vaccination. you will need to show your yellow fever certificate at the airport upon arrival.

here's one of ours... we should probably write our name on it.

your physician will hand you a similar vaccination certificate after administering the yellow fever shot.

keep in mind you need to visit a clinic authorized to provide this vaccine in order to obtain the certificate. find an interactive map of authorized yellow-fever vaccine centers here on the CDC website:

2. recommended (by CDC)
the CDC provides vaccine suggestions based on the traveler and the type of trip.

it's not as simple as saying you'll need x vaccines if you're going to y.

location, trip duration, whether you'll visit rural areas, possible contact with needles, amount of time you'll spent outdoors, and more -- all help determine whether a specific vaccine is right for you.

remember, these are recommendations and whether or not you decide to take them is up to you or your doctor. use the CDC website to understand the risks.

3. excessive
this category is for vaccines that are not recommended by the CDC for your travel.

while we generally adopt the "better safe than sorry" mentality, sometimes it's excessive.

here's an example:

the CDC guidelines for Japanese Encephalitis:

  1. transmission occurs in rural agricultural areas (rice paddies) in Asia in the summer and fall

  2. the incidence rate of travelers from non-endemic countries is <1 case per 1 million travelers

  3. <1% of people infected with JE virus develop clinical disease

verdict: since we’re only staying in large urban cities, and we're out of Asia by spring, we skipped the Japanese Encephalitis vaccine. we'll take precautions with bug spray and mosquito netting instead.

Vaccines We Chose For a Year Abroad

here's how we grouped each vaccine based on our specific travel plans.

for the record, we’re planning to visit:

  • East Asia through spring

  • Middle East in the summer

  • Europe through fall

  • South and Central America through winter

... and will be back in North America by Spring 2020.

for this itinerary we took all "Required" and "Recommended" vaccines below, and skipped the "Excessive" ones.

for these shots we spent about $1,000 between the two of us.

should I get every vaccine?

you may be someone who errs on the side of safety. but before you run to the nearest health clinic for every vaccine you can get your hands on, read on to see why this might not be the best idea.

the expense
for one thing, vaccines can be expensive. the Japanese Encephalitis vaccine was $658 at the Walgreens in New York City. and most travel vaccinations are not covered by US health insurance companies.

the side effects
like any medication, there are potential but rare side effects to vaccinations.

however, vaccines have also helped to prevent major epidemics and are widely recognized as a safe medical procedure.

the effectiveness
it's worth mentioning vaccine efficacy and effectiveness varies.

here's some math:
the Japanese Encephalitis vaccine has a 97.5% effectiveness rate. without the vaccine, you have a 0.0001% chance of contracting the disease in rural Asia if you're coming from a nonendemic country. with the vaccine, you have a 0.0000025% chance of contracting the disease.

let's just say both are percentages that wouldn't bat an eye around the poker table.

The risks of not getting vaccinated

at Rickshaw Labs we believe data should drive decisions. if vaccination research feels overwhelming, perhaps this morbid exercise will help put things into perspective.

below we’ve mapped the risk of death from Japanese Encephalitis against other illnesses and common activities.

data is calculated by risk of contracting the illness x fatality rate. other mortality stats are taken from besthealthdegrees and livescience:

takeaway: everything has inherent risks.

a couple years ago in Bali, Indonesia we went scuba diving, which was 2,907x more likely to be life-threatening (0.002907 / 0.000001) than contracting and then dying from Japanese Encephalitis.

between us we've also gone skydiving, ran along major highways, and lived in New York City for 6 years -- a breeding ground for pedestrian accents. even Ryan's jury duty in 2015 was for a pedestrian hit by a yellow cab.

routine vaccinations

make sure you are up to date on your routine vaccinations.

within the US, many routine vaccinations are mandatory by your employer or your school. so there's not much point in discussing the pros and cons.

health insurance may not cover international medical visits, so get vaccinated before your trip.

keep in mind some vaccinations are doled out in multiple doses over a period of time. there's also an incubation period, so don't leave it to the last minute. for instance, the Hepatitis B shot is typically administered in 3 doses, with the third given 4-6 months after the first.

if you are unsure whether you're up to date, ask your doctor for an antibody titer to test your immunization levels. this is a simple blood lab test that measures the amount of antibodies in your system.

where to get vaccines

if cost is important, here’s what you can do:

routine vaccinations: get these from your doctor or even at your local pharmacy through standard health insurance. here's a list of what considers "routine" vaccines:

travel vaccinations: these are typically not covered by insurance and your doctor’s office may not readily have them in stock.

google local travel health clinics, medical practices, and pharmacies that do offer vaccinations.

call to compare prices and make sure to ask if they have the vaccines you need in stock. the CDC has a clinic locator for travel vaccines. some Duane Reade, Walgreen's, and CVS locations also offer travel vaccines.

if cost is not important to you, you can make an appointment at a travel health clinic like Passport Health. note, you'll probably pay $100+ extra for the consultation fee. if you're traveling to Africa or South America, just make sure it's a yellow-fever approved facility.

travel health clinics may offer routine vaccinations but typically do not accept health insurance. save money by getting routine vaccines from a clinic approved by your health insurance.

now it's your turn!

read the CDC website, consult your doctor, and do your research!

Hideko's final tally:

  • $0 - blood titer to verify her immunization levels

  • $305 - yellow fever from Passport Health

  • $142 - typhoid from CVS MinuteClinic

  • $0 - Hep A/B from her primary physician

ultimately, the hours of research that went into this process were just as costly as the shots. hopefully this post will reduce the "time" portion of your costs.