How to know if you need vaccines before your next trip

Oct 8, 2019

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Passengers on an American Airlines flight from San Francisco (SFO) to Charlotte (CLT) last month may have been exposed to Hepatitis A. 

Health officials told WCNC the virus is “highly contagious” and can be spread from person to person, or through contaminated food or water.

Fortunately, Hepatitis A — like many other contagious illnesses — is entirely preventable. All the people on the flight who may have come into contact with the contagion have since received the vaccine, WCNC said, and health officials are “urging others to follow suit.”

Certain diseases are only a risk in specific regions, and within that region risk levels can vary based on climate and season. But some viruses present a risk no matter where in the world you are traveling. So, there are many vaccinations and immunizations every traveler should get, whether flying to a far-flung corner of the globe or hopping on a domestic flight.

“Most travel diseases are preventable if you first know what they are,” Dr. Rajiv Narula, MD — founder of the International Travel Health Consultants — told The Points Guy in 2018. “When you start planning a trip, [that’s] when you should start thinking about it.”

Before you board your next flight, make sure you’re protected against some of the most common illnesses that afflict travelers.

Check your immunizations

In 2019, hundreds of cases of measles were reported in the U.S. — many at major airports including Los Angeles International (LAX), Chicago Midway (MDW) and Newark Liberty International (EWR).

Dr. Manisha Patel, team leader for measles epidemiology at the Centers for Disease Control and Prevention (CDC), told TPG that more measles cases were reported in 2018 and 2019 than in years past, and the bulk of recent cases confirmed in the U.S. came from unvaccinated travelers.

Measles may be considered one of the most contagious infectious diseases, but it’s also incredibly preventable. As long as you’ve been vaccinated, your chances of contracting the illness are pretty slim — even if you’re in an airport. Just one dose of the vaccine is 93% effective, though two doses are recommended. But, if you’re unsure of your immunization status, be sure to get the measles, mumps and rubella (MMR) vaccine before you travel.

Travelers should also make sure they are inoculated against typhoid and Hepatitis A, which are both vaccine-preventable. Even if you’ve been vaccinated against tetanus and polio, you may want to talk to your doctor about getting a booster before traveling.

Get the flu shot

A 2007 study of intercontinental air travelers printed in The Journal of Infectious Diseases found that “respiratory infections after air travel are frequent,” and that influenza and parainfluenza viruses were the most prevalent.

In addition to getting the annual flu shot before flying (especially if you’re going to be around kids), travelers may also want to consider wearing an N95 respirator face mask. It’s possible you might even be able to get a flu shot on your next trip through an airport.

Sitting in a window seat, Dr. Narula told TPG, may also minimize your exposure to any microbes.

(Photo courtesy of Shutterstock)
(Photo courtesy of Shutterstock)

Visit the CDC website

Corey McVey, the director of nursing at Passport Health in Chicago and Wisconsin. told TPG the first stop when considering international travel should be the Centers for Disease Control and Prevention’s (CDC) dedicated Travelers’ Health site — a recommendation echoed by pretty much everyone in the travel health community.

When planning an international trip, always consult this website. Image courtesy of the CDC.
When planning an international trip, always consult this website. Image courtesy of the CDC.

From the homepage, you can select your destination country. Within each country, recommended vaccines and medications are clearly broken down for all travelers, most travelers and some travelers. These are followed by a more general list of health and safety tips, medical packing lists and specific health notices.

If you’d like a second reliable source, you can also visit the World Health Organization (WHO) website for international travel and health.

Get a travel consultation

“Only 10% of travelers that should seek travel consultation do,” said McVey. Several factors contribute to this alarmingly low number. Here are some common misconceptions that keep people from seeking a travel health consultation:

“I won’t get sick.” McVey believes this is the most common reason people skip travel consultations. “People think they’ll be fine. They won’t come across illness or diseases. But you should get a consultation for the same reason you wear a seat belt. You don’t know about others. You don’t know about the people cooking your food.”

“I saw my primary care physician.” Many travelers consider an appointment with their primary care physician adequate. You definitely should consult your physician first, and often they will recommend a travel clinic — especially if you’ll need vaccinations they don’t carry. However, McVey says sometimes primary care physicians don’t have the most current information. “They may not be aware of an outbreak. Travel clinics are most in tune with international travelers’ needs.”

“I got all the information I need online.” While the CDC website should be your first stop, it shouldn’t be your last. A travel consultation will cater recommendations to the traveler based on health history risks, and the type of travel they expect. “The needs of a backpacker traveling through Thailand are different than a business traveler who will only be in Bangkok a few days.”

“I’ll get sick.” McVey sees many patients who misunderstand how vaccines works. “Some people think the shot gives them the disease, they get sick and then they are immune. Very few people get sick from the vaccines. It’s an antibody build up.”

“Travel consultations are expensive.” Some vaccinations, such as rabies, are indeed expensive (over $1,000 for the series), but that vaccine is rarely needed and is an extreme example. Travel consultations themselves cost just $50 to $75. Most vaccines are less than $100. And as the name suggests, the visit is merely a consultation. You’ll receive recommendations for medication or vaccinations as needed but are under no obligation to get them.

Some insurance plans cover preventative health for international travel (Medicare notably does not). One travel clinic I visited before an extended trip around the world submitted my bill directly to my insurance, and I had more than 80% of my $800 bill covered. On a visit years later for another extended trip, I paid for the visit myself and submitted the bill to my insurance, getting reimbursed for 60% of the $500 bill.

Find a clinic near you

Travel clinics are common in most cities. Passport Health alone has over 270 clinics in North America. The CDC recommends scheduling your travel consultation at least a month before travel. Vaccines take 10 to 14 days to reach full effectiveness, and some need to be administered as a series. For example, Twinrix, which vaccinates against Hepatitis A and B, requires a second shot one month after the first for maximum protection during travel. A third shot can be administered six month later for lifetime protection.

During your consultation, you’ll discuss which countries you will visit and what health risks exist in specific regions of those countries. You will then get recommendations based on your risk of exposure due to your type of travel. If no shot series is necessary and all vaccines can be administered in one day, only one visit is needed. You’ll also get any needed prescriptions such as malaria and antidiarrheal medication.

However, McVey stresses that a late consultation is still far better than no consultation. “We’ll vaccinate even if they are getting on an airplane that day. It’s never too late.”

Understand your vaccines

Not all immunizations work the same way, and the duration for which they last varies, too. For example, the yellow fever vaccine lasts 10 years while the vaccine for typhoid lasts just two years. The typhoid vaccine can also be taken orally, four times over the course of a week (every other day), and lasts for five years.

You should make sure you fully understand the risks and effectiveness associated with any vaccination you are considering. The CDC Vaccine Information Statements (VIS) explain each disease, who is at risk and who should or shouldn’t get the vaccine due to age or health concerns. It also lists potential side effects. The easiest way to find a VIS for a certain disease it to type the disease name followed by “vis” in a search engine. So if you’d like to see the VIS on the Japanese encephalitis vaccine, simply search, “Japanese encephalitis vis.”

The CDC's Vaccine Information Sheet on the often misunderstood rabies vaccine.
The CDC’s Vaccine Information Sheet on the often misunderstood rabies vaccine.

Possibly the most complicated and misunderstood vaccine is the rabies vaccine, which I thought I understood until McVey explained the process.

First of all, despite being an expensive, three-shot series, it does not actually prevent rabies on its own. It merely affects the treatment after exposure, including eliminating the need for an immediate shot called Human Rabies Immune Globulin (HRIG). This shot can be hard to find, needs refrigeration and expires quickly.

If a patient has received the three-shot pre-exposure vaccine and gets bitten by a potentially infected animal, he or she still needs two doses of the rabies vaccine. One should be administered as soon as possible (within the first day) and the second two days later. HRIG is not needed because the body has already created the ability to produce the needed antibodies.

If a patient hasn’t received any pre-exposure treatment and potentially contracts the disease, they need both a shot of HRIG and a shot of the vaccine within a day. Depending on where the patient is in the world, HRIG can be hard to find. Three more rabies vaccine shots are needed three, seven and 14 days following the bite. And if a dose is missed, the vaccine schedule needs to be started over.

As you can see, vaccines can get complicated. Take the time to fully understand what you are putting in your body and how it works.

Prevention beyond immunization

While many serious health risks can be prevented through vaccinations, the most common health risks cannot. “The no. one health risk for travelers is diarrhea, which can be prevented many different ways,” McVey explained.

So, you’ll need to learn best practices around hygiene and sanitation, and a travel consultation or the CDC website will provide this information.

Other diseases are preventable by prescription. Taking malaria medication while traveling through at-risk areas can greatly reduce the odds of contracting the disease — and in April, a malaria vaccine pilot program launched in Malawi and Ghana. Kenya became the third country to roll out the two-year trial of the groundbreaking vaccine in September.

But there’s currently no treatment for either dengue fever or the Zika virus, so the only way to avoid contracting these diseases is to prevent mosquito bites.

Overall, the risk of diseases abroad should be taken seriously, but they shouldn’t be a deterrent to travel in most cases. A travel consultation will prepare you with vaccinations, medications and, most importantly, an education, so you can travel safely, responsibly and in good health to the far corners of the globe.

Additional reporting by Melanie Lieberman.

Featured image by SDI Productions

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