Help! What shots for Asia
 

I have read numerous posts and numerous guides and I guess there is no real definitive answer. I'll be in Asia for a little over two months and will be in China, Hong Kong, Thailand, Laos, Cambodia, and Vietnam. Some sites tell you what shots to have for one country but suggest different ones for another. We have a clinic here that my doctor is sending to me as they stock "all regular travel shots", but even he has said that if I ask them they'll be giving me "everything". Is there a current / up-to-date website for this information?

I'm a healthy sort of guy (except for my mild and controlled diabetes), but where can I go for a real definitive list of what immunizations I should really have for my travels there in August and September?

http://wwwnc.cdc.gov/travel/default.aspx

Go to the Yellow Book

Yup, the cdc is the acknowledged expert on this. Read it, print it, and take it with you to your doctor or travel clinic.

I wrote a few summary articles on my blog which might be helpful, http://www.travelindependently.com/c.../travel-health

A good travel doc won't necessarily give you everything. After discussing with you the type of trip you are taking, he or she should be able to make the proper recommendations. Be sure to bring a copy of your complete itinerary and be prepared to discuss the types of accommodations you will be staying in, whether you plan to visit rural areas, have contact with animals etc.

OK, thanks. I did notice that the CDC lists exactly the same things for all the countries I'm visiting.

And I guess I just didn't have high expectations about the ONLY clinic in our town that does travel immunizations really knowing what's what and current. But I did set up an appointment for a "consultation" and the shots -- and was told to bring my intinerary -- maybe they'll know more than I think.

You must admit it's much a guessing game -- like Rabies. Well, I'm not camping or doing a lot of wilderness stuff -- but absolutely anybody COULD be bitten be a rabid animal even in a town.

Talk about rabies - last year in Thailan we were visting the monkey temple and one of the women was bitten by a monkey and she had to go to the hospital and get rabie shots.

I did not get any vaccines or malaria pills for Thailand and Cambodia. This year I'm not getting any malaria pils for Vietam either. They suggest the pills if you plan on being in the rural area or the Mekon Delta, but I will be in the cities and those areas are not malaria prone.

The best plan is to take your itinerary to the travel clinic as they are the experts. However, when I called the travel clinic near me, they wanted to give me every shot known to man, so i thought that they were a rip off, but I'm sure your clinic will be reputable.

Happy Travels

It's a matter of probablities. So for rabies, for instance, you would consider the prevalance of rabies in a country, your activities (bicycling, for instance, puts you at greater risk), and the availability of appropriate medical care (human immune globulin and the rabies vaccine) if you get bitten. If you have received the pre-exposure vacine, you won't need the immune globulin post-bite, but you'll need a course of the post-exposure vaccine.

The issue re: human immune globulin is that some places do not have it available and use an equine immune globulin which can cause serious side effects (but is better than nothing).

So if you were going somewhere with a high incidence of rabies (India has the hiighest incidence of human rabies in the world), if you were trekking or bicycling, and if you would be more than 24 hours from the closest medical care for rabies, I'd opt for the vaccine. I don't believe that is true for your itinerary.

BTW, if you were to get bitten, first aid is throuough cleansing of the wound with soap and water and an antiseptic, if available. Then get to somehwere than can give you both immune globulin and the vaccine.

Hee hee, flgirl, you're more confident in "my local" clinic than I am. Even my doctor said to find out first what I need for my countries as they will probably "sell" me everything they can -- sounds like your experience.

I suspect this would be different in NYC or DC or somewhere where there might be a variety or choice in travel clinics.

Patrick, for all medical care it pays to be an informed consumer. That's why I recommend you take the printed cdc guidelines with you. If they recommend anything you think you may not need, question them about their reasoning. If they are omitting anything you think you might need, question them. We've heard reports here of good travel clinics and bad.

NeoPatrick,

When I called the travel clinic in my area the woman was unbelievable - she was even telling me that I need a yellow fever vaccine, which I got 2 years ago when I went to Africa, so I knew she was ripping me off.

When I went to Africa I took the malaria pills and when I returned home I got such a bad reaction from the drug, that my doctor told me to stop taking them. Since then I have been reluctant to take them. Since my itineray for Vietnam is not in malaria areas, I'm not going to take the pills.

Last year I was surprised that people weren't taking malaia pills in Angkor Wat, but I didn't either.

But, that is me - everyone has to do what is right for them.
If I was going back to Africa or India, that would be a different story.

flygirl, there are apalling examples like yours. As you likely know, there is no yellow fever in SE Asia, but you are not the first person to report being advised to get Yellow Fever vaccine for SE Asia.

BTW, note that there are a number of anti-malarials. The one most likely to cause side effects is Larium, the one you were likely given for Africa. It is not effective in Cambodia. Malarone (which has the fewest side effects) or doxycycline are the two that are effective in SE Asia. As you note, only limited areas of VN are considered malarial risk.

Kathie,

As a matter of fact I took Malarone for Africa and I was lucky that the side effects started when I returned home and not in Africa.

You are absolutely right that there is no yellow fever in SE Asia. I believe in doing a lot of my own research so I am an informed consumer. As they say knowledge is power.

Now, on the other hand, when people say you can drink the water, I say no way - give me the botled water. When I was in Thaiand last year the stop I made everywher was to the 7 Elevn and stocked up on bottled water. I would be more afraid of the water than anything else.

Patrick, it might be worth checking with the US authorities - there are some shots (I forget which) that I need to have in order to re-enter Australia if I've visited some countries; even though they're not strictly necessary according to the Travel Clinic doctors.

also, make sure you take a personal water bottle with a build in filter, or the light pen...well worth it. Katadyn is the best brand, in the Northwest REI has them, but I got mine on line; leaving for China in 2 weeks. No messing around looking for water to buy on trains, etc.
And, make sure you take your shot record with you, or a copy.
Typhoid for sure everywhere.

There is water all over in VN, Thailand and Cambodia. No need for built in filter systems. We took packets of gator aid to add to the water, which were particularly helpful to my husband who sweats profusely.

I don't blame you for wanting to be prepped Patrick. The only nearby clinic that had any relation to travel we had in Memphis wasn't up on much either. Since it's been awhile since we were in these areas, a lot could have changed both in country and in medicine, so the CDC is best to show what you need now. Do make sure you take lots of mosquito repellent, no matter where you're going. Even if you're not worried about malaria due to where you're going, there's still the concern over dengue fever, which hasn't got a vaccine and doesn't sound like much fun either.

Oh, and ask them for come Cipro while you're there. Never a bad idea as an emergency item

Yes, do take along an antibiotic. Cipro is no longer recommended for Thailand (or Nepal, but I don't think you are going there) but is fine for the other places you are going. Azythromycin is currently the antibiotic of choice for Thailand. There is a long, technical article about this on the cdc website. I wish they would put it in the summary, as lots of doctors aren't aware of it, and docs typically don't want to read a long article while you are sitting in the office.

Thanks for the catch Kathie. I did not know that about Thailand and will have to remember that myself.

Phew. So when I called the medical center here they told me to come in two weeks before departure and have a consultation and get the shots. I leave in three weeks, so today I called to make an appointment.

I asked about Hepatitis A & B, as I think I should have both right? Now they say I need a shot one month, the next shot a month later, and a third shot 6 months after that. Four months AFTER I return? So it looks like I go without a hepitatus vaccination which all the sources indicate I should have? What am I missing here?

I fear you were poorly informed by the medical center about when to get your shots. Nonetheless, do get your initial Hep vaccine, as it provides partial immunity. I believe there may be an accelerated schedule, so you might be able to get shot #2 just before you leave. Ask specifically about this. Also, there are places along the way where you may be able to get shot #2. Tell us where you will be when you need shot #2 and we can give you suggestions about getting it in SE Asia. And do get the final shot (there is actually a fairly large window for the third shot) as it assures life-long protection.

There's Hepatitis A and Hepatitis B. You can get individual vaccines or the combined Twinrix which is preferred if you are getting both. The Hepatitis A vaccine needs about two weeks to percolate, the Hepatitis B vaccine needs more time, with a significant increase in effectiveness after later doses. The CDC has approved an accelerated course for the combo vaccine for travelers but I don't think you can get that with three weeks to go. You should be able to get the Hep A vaccine and have it working before you go.

"I fear you were poorly informed by the medical center about when to get your shots."

For sure! And no offense intended but I'm kind of surprised when I asked here, no one said something like " You'd better get on it. You need to get hepatitis vaccines in advance." This is one of those things that I guess you have to know the answer before you ask the question. My intent both here and to the medical center was to get answers, but no one mentioned that the vaccines take a while to "get". If I had known how long it takes to get the vaccinations I need and what they are, then I guess I wouldn't have been asking.

The reception on the phone at the medical center said, "oh you mean you want the hepatitis vaccines? Well. . . " and then told me about the waiting period. She's the same one who before told me to come in two weeks in advance of departure to find out what I need and get them. Duh!

Neo, I admit it never occured to me to mention that you need a series for Hepatitis, as I tend to assume (incorrectly) that people know that. I do always give the cdc website as a reference, so you could have read about the various immunizations, but it if never occured to you that some immunizations are a series or that it takes some time (up to 10 days or so) to develop immunity, you might not have noted that when you read about the immunizations.

Reading the guide books would have told you, also - at least my current Lonely Planets all mention six months ahead of time for Hep B, or an accelerated series for travelers.

Glad you posted, though - reminded me to email the travel clinic I use to check whether I need boosters or anti-malarials for my Sept trip.

Again, not to beat a dead horse, but nearly anything anyone needs to know can be found in a guide book. I suppose if I had read in detail all the guidebooks about immunizations, there really would be no need to post here at all, would there. In fact the same thing could be said about any post here. You can find all the information asked here in guidebooks, but some treat this site as a "shortcut" to information. I admit that I myself often assume that people already know things they don't know.

I have never had or considered a hepatitis vaccine, so I really had no reason to think it would require a period of months.

But as I said earlier, I'm really most put out with the medical center which as I said in one of my original posts may not be as well informed as they are in bigger cities. But as you can tell from this thread it was over a month ago I started called them to ask and they specifically told me to come in two weeks before travel. If I had known better, I would have gone then when I still had over 7 weeks. But why can't one trust the medical center who is going to be "counseling" me to tell me the right time to come in?

So you think this site is a substitute for guidebooks? Your choice, but I've found it works best as a supplement.

That's what I'd call twisting my words. What I'm suggesting is that if "the answer is in a guidebook" then that would be true of about 99% of all questions and posts here.

But yes, I WILL admit to relying on help here a little more than usual as I'm planning a two and a half month trip to 7 countries and I am up to my ears in other activities right now, and getting behind on the usual planning and reading.

I'm going through the same "what jabs to get" dilemma for my India trip.

Three years ago in preparation for China, I googled the few health clinics in my city and called them, one wanted to immunize me for everything including diseases that haven't even been discovered yet. I ended up at a different clinic where they refused to give me any advice - I had to tell them what I wanted. I ended up getting Hep A, B and Typhoid immunizations. I did decide to alter my planned itinerary rather than deal with anti malarials. I stayed healthy in China, even after eating street food and occasionally forgetting not to brush my teeth with the tap water.

I did forget that I was supposed to get a follow-up Hepatitis shot when I returned. Now I'm thinking that means I have to start from square one again for my next trip?...

Good luck NeoP. I know everyone's health situation is different, but these threads are very helpful.

Well, I got back home yesterday so went to the travel clinic. The doctor was very good with my intinerary.
I did Hepatitis A, Typhoid, and a tetanus/diptheria booster.
Total cost including the consultation -- $310.

I also got a prescription for Malaron (?) anti malaria pills -- 30 of them for $197 -- ouch. And some Doxycycline (?) antibiotic.

Neo, what is the doxy for? For travel med, it's typically used only for malaria prophylaxis and you have malarone for that.

"30 of them for $197" - ouch! Time for a new insurance plan - mine will give me 90 for $50.

Insurance plan? What's that? Mine costs $795 a month, has NO drug coverage, and has a $10,000 deductible. If you can find ANY major medical plan that will cover me at 63 being a diabetic, let me know -- so far I think I've checked about 8,794 different companies. LOL

Kathie, I'm not sure what you're asking? I googled Doxycycline just now and it describes it the same way as Cipro and other antibiotics. It does say "also used to treat malaria", but is for all kinds of bacterial infections, etc. The doctor wanted that instead of Cipro or something else I forget which can react with my diabetic meds, while the Doxy should not. At least that's the way I understood it. The best part was that prescription was less than $6.

From Wikpedia (other sites say pretty much the same):

"Doxycycline (INN) (pronounced /ˌdɒksɪˈsaɪkliːn/) is a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections. Doxycycline is a semi-synthetic tetracycline invented and clinically developed in the early 1960s by Pfizer Inc. and marketed under the brand name Vibramycin. Vibramycin received U.S. Food and Drug Administration (FDA) approval in 1967, becoming Pfizer's first once-a-day broad-spectrum antibiotic."

Double ouch! I'm lucky enough to still have retiree medical coverage from my former employer. It was supposed to be free, and of course it isn't, but with premiums like that I'd still be working!

Patrick, for someone like you, prescribing is a matter of compromise given your other meds. I know very well what doxy is, and, as I mentioned, it's used as an antimalarial in SE Asia. But it is not very effective for GI problems. Many of the bacteria in this part of the world have resistance to doxy. Still, it's better than nothing. Cipro is used for GI problems in much of the world, but it is not effective in Thailand and Nepal. For Thailand, the two antibiotics recommended for GI problems are azithromycin and levoquin. Levoquin is likely to interact with your other meds if Cipro does. Ask your pharmacist if azithromycin would interact with your other medications. Azithromycin is available over the counter in Thailand and might be something you could use if the doxy didn't work for you. Also, remember that Thailand has excellent and affordable medical care if you do get sick.

BTW, since you don't have prescription drug coverage, Costco is generally acknowledged to be the least expensive place to fill prescriptions in the US.

And you don't have to be a Costco member to fill prescriptions at the pharmacy!

Thanks for the info, Kathie. And yes -- I get ALL my meds at Costco, including those Malaron. I'm even on their "special" plan for lower rates since I have no coverage.

The good news is that a three month supply of my two diabetic meds plus my allopurinol -- 450 pills in all -- costs me about $30! Thank goodness those are all cheapies, so I shouldn't complain about the expensive anti-Malaria drugs.