Vaccinations for India, Thailand, Cambodia, Vietnam - really $2000??
Oct 27th, 2010, 06:55 AM
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Vaccinations for India, Thailand, Cambodia, Vietnam - really $2000??
I am planning a 3-month "wander" through India, Thailand, Cambodia, Vietnam - perhaps Laos, too - and a Bali stop on the way home. I've never been to Asia, but have traveled extensively in Europe, and been to North Africa, Central and South America.
I live in Texas and my job is being outsourced, so it seems like a good time to take advantage of some time off to travel. I'm single and in my 40s - not a 20-year-old-backpacker- but although luxury travel is nice, it's not really my style. I'm kind of a make-it-up-as-you-go-along budget traveler, so I don't have firm plans or a specific itinerary.
I plan to see the big tourist sites, but am also looking forward to volunteering at an elephant sanctuary, and taking needed rest periods at beaches, cabins along rivers, or anyplace beautiful and quiet . To me that sounds like the potential for lengthy non-urban travel (and no Four Seasons Hotels) which puts me at greater risk than in the cities and farther from healthcare if needed.
I've read a lot about vaccines, and realize that the decision is a personal choice, but am really overwhelmed at the potential cost:
Rabies (for India) - $750
Japanese Encephalitis (esp for Thailand) - $800
Malaria/Malerone - $7 per pill.... 90 days plus pre- and post- travel... $650 (doxycyclene is a cheaper alternative, but 4 months on antibiotics sounds like a disaster for the body)
Polio booster $47
Typhoid $60
Tetanus/Diptheria/Pertussis $50
Grand Total = $2,357 (but living to tell stories of your travels = priceless)
People keep telling me that I'm crazy to get all those vaccines - including an Indian doctor I know locally. ("They" never got them...etc.)
After reading lots of posts on Fodor's (very impressed with everyone's adventures!) I figured folks would be able to give me some good advice. I keep reading contradictory opinions..... Please help!
I live in Texas and my job is being outsourced, so it seems like a good time to take advantage of some time off to travel. I'm single and in my 40s - not a 20-year-old-backpacker- but although luxury travel is nice, it's not really my style. I'm kind of a make-it-up-as-you-go-along budget traveler, so I don't have firm plans or a specific itinerary.
I plan to see the big tourist sites, but am also looking forward to volunteering at an elephant sanctuary, and taking needed rest periods at beaches, cabins along rivers, or anyplace beautiful and quiet . To me that sounds like the potential for lengthy non-urban travel (and no Four Seasons Hotels) which puts me at greater risk than in the cities and farther from healthcare if needed.
I've read a lot about vaccines, and realize that the decision is a personal choice, but am really overwhelmed at the potential cost:
Rabies (for India) - $750
Japanese Encephalitis (esp for Thailand) - $800
Malaria/Malerone - $7 per pill.... 90 days plus pre- and post- travel... $650 (doxycyclene is a cheaper alternative, but 4 months on antibiotics sounds like a disaster for the body)
Polio booster $47
Typhoid $60
Tetanus/Diptheria/Pertussis $50
Grand Total = $2,357 (but living to tell stories of your travels = priceless)
People keep telling me that I'm crazy to get all those vaccines - including an Indian doctor I know locally. ("They" never got them...etc.)
After reading lots of posts on Fodor's (very impressed with everyone's adventures!) I figured folks would be able to give me some good advice. I keep reading contradictory opinions..... Please help!
Oct 27th, 2010, 07:11 AM
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As a doctor, I can tell you all of your vaccine costs would be cheaper than one day in a hospital or one ER visit. And your health is priceless. Think about it carefully, don't listen to lay people or anecdotal stories.
Oct 27th, 2010, 07:26 AM
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You can probably get all these vaccinations in the first country you arrive in Asia. If it's Thailand and you don't need the shots or meds before you commence your travel you can probably get it all at a reputable hospital for much, much less. Just a thought!
Oct 27th, 2010, 07:29 AM
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I've traveled to those countries backpacker style and I've never bothered with rabies or Japanese Encephalitis. I had a discussion about the J.E. with the travel clinic I use, and there were some possible side effects from the vaccine I didn't think worth the slight risk of infection.
However, your list is missing Hep A and B which I would recommend. Can't you get your insurance to cover any of this? Mine covers Malarone, for instance. And you should have your tetanus etc up to date whether you're traveling or not.
However, your list is missing Hep A and B which I would recommend. Can't you get your insurance to cover any of this? Mine covers Malarone, for instance. And you should have your tetanus etc up to date whether you're traveling or not.
Oct 27th, 2010, 08:05 AM
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Try to find a "travel clinic" where you live. I know they are at major ports and do these types of vaccinations all the time and thus know there stuff cold and, better, usually have great prices. Even if you need to travel a day to get to one (Sunshine Medical Clinic in Miami and Ft. Lauderdate at the ports are great and walk-in fast) it would be a lot cheaper.
Oct 27th, 2010, 08:10 AM
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Do you still have insurance? If so, some of these should be covered.
Read the info at the cdc website. What you are proposing is really overkill. Here is my take on what you propose, but you do need to discuss all of this with a travel med professional.
You do need to make sure your tetanus is up to date. Insurance should cover this. The polio booster is important, and find out whether you nned a booster for measles/mumps/rubella.
Hep A you didn't mention, but you should have that even if you stay at home. If you haven't had it, consider getting the Hep A/Hep B combination. Insurance will probably cover this.
Typhoid is important.
Japanese Encephalitis is only recommended if you are spending 6 or more weeks in a rural farming area. Unlesss you are doing something unusual for a traveler, it is very unlikely that you need this.
Malaria meds: Many of the places you are going are not malarial risk. Almost none of Thailand is, except for border areas. Much of VN is no longer malarial risk, only parts of India are malarial risk. So if you opt for Malarone, you can start taking it one day before entering the malarila risk area, and continue it for 7 days after, then re-start it for the next area. It is likely you could be off anti-malarials for extended periods during your trip. Take a look at the cdc info on malarial risk areas, and also check out the NHS website, fitfortravel.BTW the cheapest place to buy malarone in the US is at Costco.
Make sure you have plenty of mosquito repellant, as there are a number of diseases carried by mosquitos - not jusr malaria but also dengue and JE. If you can find it, get the microencapsulated type by Sawyers.
Rabies is a consideration mostly for India, which has the highest rate of human rabies in the world. Getting the rabies vaccine gives you more time to get treatment if you are bitten, and you don't need the Ig shot (which is hard to get in India, so they usually use a horse Ig which can cause severe reactions). The rabies vaccine is very expensive in the US, and I'd recommend you wait until you get to Thailand and get the series there. It will be much less expensive.
Read the info at the cdc website. What you are proposing is really overkill. Here is my take on what you propose, but you do need to discuss all of this with a travel med professional.
You do need to make sure your tetanus is up to date. Insurance should cover this. The polio booster is important, and find out whether you nned a booster for measles/mumps/rubella.
Hep A you didn't mention, but you should have that even if you stay at home. If you haven't had it, consider getting the Hep A/Hep B combination. Insurance will probably cover this.
Typhoid is important.
Japanese Encephalitis is only recommended if you are spending 6 or more weeks in a rural farming area. Unlesss you are doing something unusual for a traveler, it is very unlikely that you need this.
Malaria meds: Many of the places you are going are not malarial risk. Almost none of Thailand is, except for border areas. Much of VN is no longer malarial risk, only parts of India are malarial risk. So if you opt for Malarone, you can start taking it one day before entering the malarila risk area, and continue it for 7 days after, then re-start it for the next area. It is likely you could be off anti-malarials for extended periods during your trip. Take a look at the cdc info on malarial risk areas, and also check out the NHS website, fitfortravel.BTW the cheapest place to buy malarone in the US is at Costco.
Make sure you have plenty of mosquito repellant, as there are a number of diseases carried by mosquitos - not jusr malaria but also dengue and JE. If you can find it, get the microencapsulated type by Sawyers.
Rabies is a consideration mostly for India, which has the highest rate of human rabies in the world. Getting the rabies vaccine gives you more time to get treatment if you are bitten, and you don't need the Ig shot (which is hard to get in India, so they usually use a horse Ig which can cause severe reactions). The rabies vaccine is very expensive in the US, and I'd recommend you wait until you get to Thailand and get the series there. It will be much less expensive.
Oct 27th, 2010, 08:55 AM
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Disclaimer: I'm a nurse in a travel clinic, but I'm not suggesting you take my word in lieu of seeing a travel specialist about your specific plans.
It's the Rabies and Japanese Encephalitis that really run the bill up. Do you expect to be in situations with a lot of animal exposure? Rabies risk in most countries is from bats and dogs; needless to say, don't pat any dog or even think of giving them food! (Hard for them to distinguish between food and hand.) These are NOT household pets that have been vaccinated.
The new JE vaccine (called IXIARO in the U.S.) is a 2-shot series; it does NOT have the side effects of the old Biken 3-shot vaccine. The 2 shots have to be at least 28 days apart. The cost should be somewhere in the $600 range (for both), but you might find it for less. We ususally give this only to people who are going to be in rural, agricultural areas (think rice fields and especially pig farms) for 2-4 weeks or more. There is a single-dose oral JE vaccine available in SE Asia, often called the Chengdu vaccine. It's been tested extensively in kids but is also being used for adults in some countries (I know they use it for adults in Nepal); presumably the single dose would cost less?
As for the Doxycycline, this is the exact formula and dose used for teenagers with acne, so plenty of people are taking it long term without ill effects. Do NOT consider weekly Mefloquine for your itinerary, because there is Mefloquine resistance is some areas of Thailand and Cambodia. If you still prefer Malarone, you may not need it for the entire trip; a travel clinic can help you pinpoint risk areas. If would keep costs down if you can group risk areas together.
Take plenty of insect repellant (+ bed net for those riverside cabins) -- Dengue Fever risk is high in all these countries and there are no shots or pills that will prevent it...just insect precautions to prevent being bitten. Perhaps consider some Buzz-Off or Insect Shield clothing? or spray some of your clothes with Premethrin? (more work than you might think; you must saturate the clothes)
Lastly, be sure you have some kind of travel or medical evacuation insurance, in case you become ill or are injured in some of those off-the-beaten-track destinations. Good luck -- it sounds like a wonderful opportunity!
It's the Rabies and Japanese Encephalitis that really run the bill up. Do you expect to be in situations with a lot of animal exposure? Rabies risk in most countries is from bats and dogs; needless to say, don't pat any dog or even think of giving them food! (Hard for them to distinguish between food and hand.) These are NOT household pets that have been vaccinated.
The new JE vaccine (called IXIARO in the U.S.) is a 2-shot series; it does NOT have the side effects of the old Biken 3-shot vaccine. The 2 shots have to be at least 28 days apart. The cost should be somewhere in the $600 range (for both), but you might find it for less. We ususally give this only to people who are going to be in rural, agricultural areas (think rice fields and especially pig farms) for 2-4 weeks or more. There is a single-dose oral JE vaccine available in SE Asia, often called the Chengdu vaccine. It's been tested extensively in kids but is also being used for adults in some countries (I know they use it for adults in Nepal); presumably the single dose would cost less?
As for the Doxycycline, this is the exact formula and dose used for teenagers with acne, so plenty of people are taking it long term without ill effects. Do NOT consider weekly Mefloquine for your itinerary, because there is Mefloquine resistance is some areas of Thailand and Cambodia. If you still prefer Malarone, you may not need it for the entire trip; a travel clinic can help you pinpoint risk areas. If would keep costs down if you can group risk areas together.
Take plenty of insect repellant (+ bed net for those riverside cabins) -- Dengue Fever risk is high in all these countries and there are no shots or pills that will prevent it...just insect precautions to prevent being bitten. Perhaps consider some Buzz-Off or Insect Shield clothing? or spray some of your clothes with Premethrin? (more work than you might think; you must saturate the clothes)
Lastly, be sure you have some kind of travel or medical evacuation insurance, in case you become ill or are injured in some of those off-the-beaten-track destinations. Good luck -- it sounds like a wonderful opportunity!
Oct 27th, 2010, 09:49 AM
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Is there a public health clinic in your area? They often have vaccinations at a much lower cost. Also, remember that it takes several weeks after inoculation before your immune system builds up sufficient antibodies to protect you. Don't wait until the last minute.
I saw a lot of dogs in India, roaming around the monuments, looking for a handout. Monkeys are also an issue to consider. They can be quite aggressive.
I saw a lot of dogs in India, roaming around the monuments, looking for a handout. Monkeys are also an issue to consider. They can be quite aggressive.
Oct 27th, 2010, 12:32 PM
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What a bunch of great responses! Thank you, all!
I got Hep A and B years ago for Egypt (sorry I didn't mention that initially.) Tetanus is probably covered by insurance.
From Kelsey-Seybold Travel Clinic website: "Immunizations for the purpose of foreign travel are not typically covered by health insurance plans. Therefore, Kelsey-Seybold Clinic does not file a claim to your insurance plan." Univ of TX clinic won't file either, and Blue Cross says they don't cover travel vaccines at all.
I compared the Houston public health department's travel clinic prices with the prices at the University of TX travel clinic, and UT was negligibly higher. I also shopped prices around the country (online) and only the JE seems extraordinarily expensive here in Houston.
Thanks for the doxycyclene info, Skibumette!
I don't plan to be in rice paddies, pig farms, or amongst bats particularly - so maybe declining the JE and rabies is an idea. Cumulatively, I hope to be in smaller villages and elephant camps more than a total 4 weeks out of the 12, but if those don't really count as working in rural areas, then I'm probably OK.
I hadn't realized that I could handle malarone on a sub-zone basis... and start it and stop it throughout the trip. Does anyone know if it is readily available over there if I take too small a supply?
On that note, what do you think about the idea of getting some vaccines (and Malerone!) in India or Thailand? I had wondered if they might be significantly cheaper. Any first-hand knowledge about doing that?
Mosquito spray, netting and permethrin-soaked clothes are part of my plan.
Again - thanks everyone for your thoughtful comments!
I got Hep A and B years ago for Egypt (sorry I didn't mention that initially.) Tetanus is probably covered by insurance.
From Kelsey-Seybold Travel Clinic website: "Immunizations for the purpose of foreign travel are not typically covered by health insurance plans. Therefore, Kelsey-Seybold Clinic does not file a claim to your insurance plan." Univ of TX clinic won't file either, and Blue Cross says they don't cover travel vaccines at all.
I compared the Houston public health department's travel clinic prices with the prices at the University of TX travel clinic, and UT was negligibly higher. I also shopped prices around the country (online) and only the JE seems extraordinarily expensive here in Houston.
Thanks for the doxycyclene info, Skibumette!
I don't plan to be in rice paddies, pig farms, or amongst bats particularly - so maybe declining the JE and rabies is an idea. Cumulatively, I hope to be in smaller villages and elephant camps more than a total 4 weeks out of the 12, but if those don't really count as working in rural areas, then I'm probably OK.
I hadn't realized that I could handle malarone on a sub-zone basis... and start it and stop it throughout the trip. Does anyone know if it is readily available over there if I take too small a supply?
On that note, what do you think about the idea of getting some vaccines (and Malerone!) in India or Thailand? I had wondered if they might be significantly cheaper. Any first-hand knowledge about doing that?
Mosquito spray, netting and permethrin-soaked clothes are part of my plan.
Again - thanks everyone for your thoughtful comments!
Oct 27th, 2010, 01:04 PM
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I can tell you that I just got some Malerone & paid about US$1.60 as my insurance covered the rest of it. Also I needed a typhoid booster & can't remember what I paid for that after the insurance but it was very little. P.S I make the choice not to take doxy because I am already ultra sunsensitive & that can increase that & I would prefer not too. Also there is a pretty good risk of yeast infections for women so if you take doxy make sure you have something with you to treat that should it occur. My hubby takes doxy with no probs except having to be extra sun careful.
Oct 27th, 2010, 01:15 PM
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Malarone is not available in either India or Thailand. You'll need to get your malarone here in the US. Your health insurance may cover part of it. I recently got malarone on my Blue Cross insurance, just a $35 co-pay.
If it were me - and it isn't - I'd get my needed vaccines well before my trip with theexception of the rabies vaccine. You could easily wait until Bangkok to get that. And if you get bitten anywhere in SE Asia, Bangkok would be the place I would get to ASAP. I would forego the JE (as I have for years), but I would get the rabies if I was going to be walking a lot or bicycling in India - whether rural or urban.
Have a wonderful trip!
If it were me - and it isn't - I'd get my needed vaccines well before my trip with theexception of the rabies vaccine. You could easily wait until Bangkok to get that. And if you get bitten anywhere in SE Asia, Bangkok would be the place I would get to ASAP. I would forego the JE (as I have for years), but I would get the rabies if I was going to be walking a lot or bicycling in India - whether rural or urban.
Have a wonderful trip!
Oct 27th, 2010, 07:11 PM
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Hi jsm713,
Which country is your first stop? I am asking because, even though your itinerary does not include Singapore, you can get all the vaccinations and prescriptions you need in Singapore at a much lower price. And there are multiple budget airline options from Singapore to any of the countries you mentioned. Maybe you can consider making Singapore a layover stop at the beginning of your adventure? You can also use the stop to pick up some other supplies you may need?
My husband and I live in Singapore now and we have an appointment at a travel clinic in two weeks to get some Malarone for an upcoming trip to South Africa. Just looking at the clinic's website, one dose of IXIARO (for JE) is SGD 240 (about USD 184), which is much less than what you found. I don't know how much the Malarone is, but if you want, I can let you know after my appointment.
When we lived in the U.S., none of the travel-related vaccinations (e.g. yellow fever) was covered by insurance. Mine did not even cover Malarone, while my husband's did. I paid out of pocket myself. While living in Germany, I think Malarone was partly covered by our insurance. But even if it was not, I remember the per-pill price was still less then what I paid in the U.S. I expect the price will also be less here than in the U.S.
This is just a suggestion. Maybe stopping in Singapore doesn't make sense for you, but I thought I'd mention it as Singapore offers better medical facilities than the countries you want to travel to.
Which country is your first stop? I am asking because, even though your itinerary does not include Singapore, you can get all the vaccinations and prescriptions you need in Singapore at a much lower price. And there are multiple budget airline options from Singapore to any of the countries you mentioned. Maybe you can consider making Singapore a layover stop at the beginning of your adventure? You can also use the stop to pick up some other supplies you may need?
My husband and I live in Singapore now and we have an appointment at a travel clinic in two weeks to get some Malarone for an upcoming trip to South Africa. Just looking at the clinic's website, one dose of IXIARO (for JE) is SGD 240 (about USD 184), which is much less than what you found. I don't know how much the Malarone is, but if you want, I can let you know after my appointment.
When we lived in the U.S., none of the travel-related vaccinations (e.g. yellow fever) was covered by insurance. Mine did not even cover Malarone, while my husband's did. I paid out of pocket myself. While living in Germany, I think Malarone was partly covered by our insurance. But even if it was not, I remember the per-pill price was still less then what I paid in the U.S. I expect the price will also be less here than in the U.S.
This is just a suggestion. Maybe stopping in Singapore doesn't make sense for you, but I thought I'd mention it as Singapore offers better medical facilities than the countries you want to travel to.
Oct 27th, 2010, 07:53 PM
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Re: yeast infections and Doxy. If you get yeast infections WHENEVER YOU TAKE ANTIBIOTICS, then it certainly may be an issue. If you've only had an occasional yeast infection, unrelated to antibiotic use, then I wouldn't worry much about it.
Insurance coverage: some companies are good about paying for malaria pills; for others (Cigna and Aetna in our area) don't even waste your breath calling them; they will NOT cover it. But sometimes they pay for Doxy regardless, because it's an antibiotic and it's cheap.
Insurance coverage: some companies are good about paying for malaria pills; for others (Cigna and Aetna in our area) don't even waste your breath calling them; they will NOT cover it. But sometimes they pay for Doxy regardless, because it's an antibiotic and it's cheap.
