Travel Vaccines

My two oldest teens volunteer with a food bank.  Salmon from our state’s fish hatcheries that would otherwise go to waste is donated to the food bank.  It’s a huge task to clean and can the fish, but obviously worth doing.  The majority of the fish is given out locally, but a portion is shipped around the world.

By now, you’re probably wondering what this has to do with travel vaccines.  A dozen of the food bank volunteers will be going to Guatemala to do some disaster relief work (hurricanes, volcanos), including helping distribute some of the salmon that they’ve helped can.  My kids get to participate, and one of the requirements was for them to get the vaccines needed for travel to Guatemala.

We’ve learned some interesting things.

Where?

Where does one go to get travel vaccines?  I initially called our family doctor, but it turns out that he doesn’t do travel medicine.  It’s not cost-effective for him to stock every possible vaccine, so he suggests that people go to the health department.  That’s one option. 

There are some medical clinics that run a travel clinic; we found one that does travel vaccines two half-days a month.  With such limited access, slots fill up quickly, so it’s important to plan ahead. 

We also learned that some pharmacies give travel vaccines.  Your state’s health department website should have a complete list of places that provide travel vaccines.

Cost?

There will be both consultation fees and vaccine fees.  It’s expensive.  It’s also likely to be out-of-pocket.   Insurers figure that if you have the money for travel, you have the money for your shots.  Just consider it all part of the trip.  Ask before making any appointments, though.  Costs vary widely.

The health department here, I discovered, charges $140 to talk to someone about travel vaccines, plus the cost of the individual vaccines.  They don’t however, volunteer that information over the phone.  A few people in the group made appointments at the health department, and were shocked at the cost.

The family physician I found who holds a travel medicine clinic twice a month charges $215 plus the cost of the vaccines, but offers a discount for additional people in the group seen at the same time (only $125).  This place was up-front about the fees and made it clear that payment was expected at the time of service.

Pharmacies are definitely the least expensive option for a single vaccine.  You just tell them which vaccine you want and pay for the shot; there’s no extra consultation fee.

The vaccine fees vary widely, too.  A typhoid vaccine costs $99 at the health department, $56 at the FP’s travel clinic, and $75 at the pharmacy.

Which Shots Do I Need?

If you pay a travel clinic or the health department for a consultation, they should tell you which vaccines are appropriate.  Should.  Our group has discovered that different people were told different things, and that the shots given at the local health department depend on who happens to be working that day.  Not everyone received all the shots recommended by the CDC.

The Centers for Disease Control and Prevention (CDC) has excellent information online.  Anyone with internet access can learn which shots are recommended for the area to which they’re planning to travel.  In fact, the travel medicine doctor we saw gave the kids handouts that, it turned out, were printouts of the CDC’s website.

What About Prescriptions?

There’s more to travel than getting a few shots before you leave.  My kids will be in an area where malaria is a concern, so they needed a prescription for an anti-malarial.  It depends on which part of the world you’ll be seeing which anti-malarial(s) will be effective – fortunately, the CDC provides that information.

It’s the little things, though, that make me think it might be better to see a travel medicine doctor instead of the less expensive pharmacy-based-travel-vaccines – at least for the first trip or two.  The doctor my kids saw also gave them a prescription for a medication to take in case they get a case of traveler’s stomach, and a lot of good how-to-stay-safe-while-travelling tips.  The people in the group who got their shots at a pharmacy don’t have those just-in-case meds, and they didn’t get the helpful tips.

Contraindications

Check your medications.  Some prescriptions specify that you shouldn’t get vaccinated until you’ve been off the med for a while.  Thus, if I ever need to discontinue my mtx & biologic, I’m planning to get some basic travel vaccines while it’s possible.  The hardest part of seeing my kids go is knowing that if something comes up, I can’t go get a few shots and then hop on a plane to go help them.  Check your current medications carefully to be sure it’s safe to get travel vaccines.

Thanks for reading.  If you’re travelling, enjoy your trip.

Excuses

Why not get a flu shot?  In a comment on yesterday’s post (where I started off trying to convince myself that I didn’t need a flu shot this year, but ended up deciding that it would be a good idea to do it despite getting vaccinated against 2/3 of the components last year), Wren said:

I’ll get the shot when it’s available. I’ve never really understood why someone wouldn’t get it, particularly if it cost them nothing. Personally, I’ve never had any adverse reaction, I’ve never gotten “the flu” after getting the shot, and the injection itself is quick and almost painless. When I compare getting the shot to getting sick with the seasonal flu, particularly while taking meds that lower my immune response, there’s just no argument.

As one who usually comes up with excuses to skip the recommended flu shot, I think I can come up with some reasons to avoid having a needle stuck into my being.

  1. It’s not vaccine specific.  I don’t like any shots.
  2. My arm is sore enough for days afterward that I have to modify my routine.
  3. I and most of my kids are sensitive/allergic to chicken eggs.  Many vaccines are contraindicated for those with egg allergies.  We have to be watched carefully after vaccines.
  4. Last year one of my kids nearly passed out after getting a shot.
  5. One year, one of my kids started puking after getting a shot.  Ewww!  Fortunately, the garbage can was easy to grab.  That child is watched even more carefully now.
  6. I don’t have the time it would take to go get a shot.  It’s not a five-minute jab.  It’s an hour to drive there, time spent waiting in the waiting room, time spent waiting in the exam room, time spent being observed for adverse reaction afterward, then time spent travelling home.  I have to budget a minimum of three hours to go get a shot.
  7. Fuel isn’t cheap.  I don’t just pop in to the doctor’s office – or anywhere else.  I have to carefully plan trips to make sure the gas gauge isn’t sitting on empty.
  8. Skip shots to avoid being harassed by anti-vaccine folks.  Here’s part of the exchange from when I got one of my vaccines last year:

“No way I’m having someone pump that into my children’s veins.  Did you do your homework first?

Then there was my EMT friend wanting to know how I managed to score something that was in such high demand.

I’ve had anti-vaxers in the past criticize my carefully thought-out decision to protect my children from the ravages of childhood diseases.  It’s just not something I feel like dealing with all the time.  We’ll probably not announce it when we finally get our shots this year.

If you don’t want to do something, it’s easy to come up with excuses, so there are sure to be other reasons, too.   If you’ve had a bad experience, it’s even easier.

My experience with flu is worse, though, so in my house, we’ll get the shots.

Flu Shots

Drug stores now have signs up that flu shots are available in the pharmacy.  At my doctor’s office, flu shots are $20 and paid for by my health insurance – but not available yet.  At the pharmacy, flu shots are $30 and not covered by my health insurance – and apparently available now.

My struggle, however, isn’t with whether or not I should spend the $30 now instead of waiting until October when it won’t cost me anything out of pocket.  My struggle is with whether or not to get the vaccine at all, and my quandary has nothing to do with price.  I’ve had the flu before, and would gladly pay $30 to prevent it ever happening again.

When I started reading, though, I discovered that the components of the flu vaccine don’t always change from year to year.  According to the CDC, this year’s trivalent seasonal flu vaccine’s components are:

  1. A/California/7/2009 (H1N1)-like antigen – last year’s swine flu vaccine
  2. A/Perth/16/2009 (H3N2)-like antigen
  3. B/Brisbane/60/2008-like antigen – part of last year’s seasonal flu vaccine

If you got all your flu vaccines last year, you’ve already been vaccinated against 2/3 of the things covered by this year’s vaccine.  So I started wondering, since I’ve already had two-thirds of this vaccine, how long does the flu shot provide immunity?  Maybe I could skip this year.

In the same CDC article linked above, it sounds like a few studies have been done, but we just don’t know how long the vaccine lasts.  There’s no indication that they check every year (and even if they did, it will be next year before we know the results of last year’s shot).  From the studies that have been done in the past, it looks like the flu vaccine is effective for six to eight months.  Months!!!  After that, people start losing immunity to the specific strains contained in the shot.

One study showed 92-100% effectiveness the first year; a different study only showed 75% effectiveness.  That’s the first year.  Up to 55% of people lose immunity after that (depending on the strain of flu and various other unknown factors).  What we don’t know is which people lose immunity.  I’ve had the flu once.  I’m not willing to gamble that last year’s shots gave me immunity this year – for too many people, it doesn’t work that way.

I started out this post looking for a way to rationalize not getting immunized this year.  Instead, I’ve talked myself into getting the shot once again.