Wednesday, January 9, 2013

Clinics and Typhoid and Rabies, Oh my!

Anyone who has needed immunizations for international travel knows they aren't cheap. They are rarely covered by insurance, most of them are only available at designated "travel clinics," and many of them require a series of injections over the course of several weeks or months. Fortunately, there are no "required" vaccines for the areas of the world we are planning to visit, so we could choose to skip this step. But we figure we value our health more than the dollars it would cost, and since we have the means to pay those dollars, we would rather not regret being cheap about it.

Our research started here:

The CDC website offers suggestions for which vaccines you should consider for each country. We compared the lists on the website with our own medical history, and then we visited our regular doctors to update any needed "routine" shots. Those are almost always covered by insurance, and on our plan, that means $0 out of pocket. It's hard to pass that up, especially knowing it might be a while before we have such great health insurance again.

The other suggestions required a little more research. We ultimately decided, in addition to regular inoculations like Hepatitis, to get vaccines for rabies, typhoid, Japanese encephalitis, and malaria.

Rabies: Rabies shots are not only at the high end of preventative care costs, they are also extremely difficult to find in the US. There is a bit of a shortage in this country, so the medication they do have available is reserved for treatment, rather than prevention. With the difficulty of supply and a cost of over $600 per series, this vaccine was initially a big No. Once we started asking around, though, we learned that it's a valuable vaccine to have if you are far from good medical care, and some areas of Asia (like Bali) are having outbreaks of this disease. Rabies is a fatal disease if it's not treated immediately, and we don't want our fear of it to hold us back if the opportunity for adventure arises.

Japanese Encephalitis: This disease is also present in India, so I had already decided against it once. That was five years ago, when the vaccine was an expensive, multi-shot series with a very high risk of side effects. Now, there is a new, single-shot vaccine that is available in a few places, and it has very few side effects. It seems like a much safer option.

Typhoid: This vaccine is an easy one. There is the option of a shot or an oral vaccine, and I much prefer the oral version. It's cheaper, does not involve needles, and it stays effective for five years instead of two. Unfortunately, the last time I took it was more than five years ago, so I'm due for another dose on this trip. Fortunately, it's an easy vaccine to find.

Malaria: After a nightmare of an experience using Mefloquine, I swore off visiting all malaria-affected countries. It just wasn't worth it. So, I was thrilled when I discovered a newer anti-malarial called Malarone that is easier to handle and supposedly has none of Mefloquine's severe side effects. We expect to be visiting areas of Southeast Asia that have a malaria presence, so I am very thankful we have an option other than my old nemesis.

While researching the availability and cost of these vaccines, we came across this:

For a comparison, those rabies shots that cost $200+ per injection in the US? They cost $11 each in Bangkok. Eleven. Seriously. We also priced them in Australia at $125, which is helpful considering the one clinic we found at home that carried them ran out before we could get an appointment.

So now we have a final plan: get as many vaccines in Bangkok as possible. Most of the ones we need will fit well with that plan. The only complication is timing of the rabies series, which means we'll only be able to get the final injection in Bangkok. To round out that series, we've scheduled two visits at a clinic in Sydney, Australia, which will put us right on schedule to finish up when we arrive in Bangkok.