Typhoid, hepatitis and yellow fever, oh my!

by Kim on November 28, 2011 · 48 comments

Vaccinations needed to travel the world

Brian and I spent two hours in the travel clinic today discussing our travel plans and getting vaccinated for our trip. Because we don’t know exactly where we’ll be going, the clinic recommended almost every vaccine known to man. We received some of the recommended vaccinations, turned a few down, and are on the fence about another. Our health is incredibly important, but I am having a hard time distinguishing between perceived and actual risk, and I have always been weary of vaccines.

Vaccinations for travel

These are the vaccinations that we received in preparation of our travels:

Hepatitis A– Hepatitis A is a virus that causes liver disease.  It is found in stool and is usually spread by close personal contact and sometimes by eating food or drinking water.  Countries with high or intermediate prevalence of hepatitis A include Central and South America, Mexico, Asia, Africa and eastern Europe.

Hepatitis B– Hepatitis B is a virus that affects the liver.  It is spread through contact with the blood or body fluids of an infected person.  Hepatitis B is endemic in China and other parts of Asia but is also frequently found in the Amazon and the southern parts of eastern and central Europe.  There is a low rate of Hepatitis B in the middle East, India, western Europe and North America (World Health Organization).

Polio– I thought the last person to get Polio was Tiny Tim, but apparently it is alive and well in some parts of the world.  Polio is a virus that enters the body through the mouth and can cause paralysis and sometimes death.  Brian and I were both vaccinated against Polio as children.  Most adults in the US do not need the polio vaccine unless traveling to areas of the world where polio is common.  As of 2011, only Afghanistan, India, Nigeria and Pakistan remain polio-endemic (World Health Organization).

Typhoid– Typhoid is a bacteria that causes fever, weakness, stomach pains and loss of appetite.  If not treated it can kill up to 30% of people who get it.  Typhoid is contracted through contaminated food or water and affects about 21 million people a year.  The vaccine is recommended to people traveling in northern and western Africa, southern Asia, parts of Indonesia and Peru (World Health Organization).  Unlike the other vaccinations we received, the Typhoid vaccination is taken by mouth as a series of pills (a shot is also available, but the pills were cheaper).

Yellow Fever- Yellow fever is a serious disease caused by a virus.  It is spread through the bite of an infected mosquito and is found in certain parts of Africa and South America. Receiving this vaccination truly freaked me out because 1 person in 55,000 has a severe allergic reaction, 1 in 125,000 has a severe nervous system reaction and 1 in 250,000 develops a life threatening severe illness and organ failure (gulp).  I’m still alive to tell you this so so far, so good.  

An important note: Proof of the Yellow Fever vaccination is required before entering some countries.  Brian and I each received a stamped International Certificate of Vaccination that we must keep with our passports.  

Malaria– Malaria is a parasitic infection transmitted primarily through the bite of a mosquito.  It causes fever, chills, headache, body ache and, in severe cases, seizures, kidney failure, coma and death.  Malaria occurs in parts of Africa, Central and South America, the Caribbean, Asia, Eastern Europe and the South Pacific.  Brian and I will carry anti-malarial medication and take it when necessary.  Anti-malarial meds can cause vivid dreams and hallucinations so we will use sparingly, or sell on the streets to make money (just kidding!).  

 Photo by Gerald Yuvallos, Flickr Creative Commons

The vaccinations we declined

Rabies– Humans get rabies when they are bitten by an infected animal.  Weeks or even years after the bite, rabies can cause pain, fatigue, headache and irritability followed eventually by seizures, hallucinations, paralysis and death.  Brian and I decided against the rabies vaccination for a couple of reasons.  1) We’ve managed to avoid rabid animals this long, 2) The vaccination can be applied after exposure.  The vaccination is also expensive ($600 per person), but we don’t believe that cost alone is a good enough reason to decline a vaccination. 

Meningococcal– Meningococcal disease is a serious bacterial illness not always treatable by antibiotics.  Those that contract the bacteria can lose their arms or legs, have problems with their nervous system, become deaf or mentally retarded, or suffer seizures or strokes.  As serious as Meningitis can be, Brian and I decided to forego the Meningococcal vaccination mainly because we do not plan to travel to the region in Africa known as the meningitis belt.  

The vaccination we can’t decide on

Japanese Encephalitis– Japanese Encephalitis is an infection caused by a virus that spreads through the bite of infected mosquitoes.  The risk of Japanese Encephalitis is very low for most travelers, but higher for people living or traveling for long periods in rural parts of Asia.  Brian and I aren’t sure if we’ll be traveling for long periods in rural Asia, but we don’t want to rule it out as a possibility.  The vaccination costs $800 per person which, again, isn’t ultimately a factor, but ouch.

The cost of travel vaccinations

In the United States, insurance coverage for travel vaccinations varies depending on individual policies.  I’m not sure yet if our policy will cover the cost of our vaccinations, but I’m not holding my breath.

All told, my vaccinations cost $468 (Hep A, Hep B, Polio, Yellow Fever).  Brian’s vaccinations were slightly less because he was able to receive the Hepatitis A/B combined vaccine (not an option for me since I began the Hepatitis sequence in 2007).  This total does not include the Typhoid medicine, Malaria pills or Japanese Encephalitis if we decide to take it.

Next Steps

Slowly but surely we are crossing things off of our massive to-do list.

Next up:

Survive the holidays without breaking the bank.

Find cheap insurance that is HIPPA compliant and will cover us in case of emergency as we travel.

Schedule a litany of doctors appointments to make sure we are in good health before waving goodbye to our employer-provided health insurance (sigh).

Travelers, Help!

If you have any insight about vaccinations, especially the Japanese Encephalitis vaccination, please leave a comment.  

Disclaimer: I’m not a doctor. If I was, I’d already have the money saved to leave on this adventure.  


{ 46 comments… read them below or add one }

Tina November 28, 2011 at 8:33 pm

Japanese Encephalitis- although we didn’t have this living in Xiamen (southern China), I had a friend who caught this, and almost died.

There is a fine line, and at the end of the day, a few dollars saved isn’t worth it.

Your call!


Kim November 28, 2011 at 8:47 pm

Yikes Tina, that is scary. Okay, good to know. A few dollars definitely isn’t worth our health, that’s for sure.


rob November 28, 2011 at 8:38 pm

Are you wary of vaccinations or weary of them? 🙂

I’m always fascinated when I read about people only getting Hep-A, Hep-B, and polio when they get ready to travel. I got Hep-A and the Hep-B series years ago here in Colorado, and I’ve been getting a polio booster every 5-10 years for as long as I can remember.

As for the risks associated with the yellow fever vaccine, it’s *MUCH* safer than giving birth. The death rate for giving birth in the US is 13 per 100,000. That’s 32 women in 250,000 that *will die* from giving birth, compared to 1 in 250,000 people that will develop life-threatening illnesses from the yellow fever vaccination.

Are the typhoid and yellow fever vaccinations “forever” vaccinations or do you need to get boosters?


Kim November 28, 2011 at 8:46 pm

Whoops, I’m wary. I’m weary of being wary.

Typhoid lasts five years and the yellow fever is good for 10 years, so eventually boosters will be necessary.


rob November 28, 2011 at 9:25 pm

Wariness can be wearying!

Thanks (re vaccines). Much like polio then.

Betsy Talbot’s FB comment on your blog brought me hear and I have to say I’m excited on your behalf. Following them has been awesome and inspired me to get back on the frequent travel horse. Since I “met” them online i’ve been to Italy, Croatia, NZ and have booked trips to Turkey (March) & Scandinavia (June/July). And have plans for Chile and Argentina (December 2012) And maybe Peru, although that’ll likely be a separate trip. Apparently reading travel blogs infects one with the travel disease 🙂


rob November 28, 2011 at 9:26 pm



Kim November 29, 2011 at 6:24 pm

Rob! I am impressed with how much traveling you’ve been able to pull of in the past year, way to go! Thanks for the kind words. We are beyond excited, it is honestly a dream come true (actually, more than that, because I never actually believed that I would have the chance to do something like this). I hope you stay infected with the travel disease 🙂


rob November 30, 2011 at 10:55 pm

Thanks, Kim. It really just took thinking about it again. I have been a traveler since 1984 when I moved to Sweden for four years, and backpacked my way around Europe for vacations. I’ve done a fair amount of travel since returning to Canada and then moving to Colorado, but recently got “the bug” again. I’ve actually figured out over the years that I, personally, don’t like to be “traveling” for more than 4-5 weeks at a time without settling down and recharging. I’ll probably take longer and spend more money on airfare than you RTWers, but that’s OK too. It’s always fun to see the high points that people post on their blogs, and I’ve traveled enough to know that some days you just slog through and don’t want to talk about. Not unlike life in general, actually.

Torre – Fearful Adventurer November 28, 2011 at 9:16 pm

I’ve just been getting my vaccinations too. I need everything under the sun, and I’m half way through. I may have organ failure the next time we speak.


Kim November 29, 2011 at 6:21 pm

You and me both Torre.


Gillian @OneGiantStep November 28, 2011 at 9:38 pm

While I think it’s prudent, and important, and your responsibility to make sure you remain healthy while you travel I remember how dizzying it was to try and make sense of it all…and I work in health care! We made all the same decisions you report making but, in the end, didn’t actually take the malaria medication we had with us. Perhaps it was the season we traveled in but we did not see many mosquitoes except for in the witching hour of dusk. We were diligent with coverage and using repellent and were not bitten. However we were not traveling in African countries where the species of malaria is much more serious – I would not hesitate to take it were I going there. We decided against Japanese Encephalitis. The risk of catching it is extremely low and the cost is exhorbitantly high. Just my two cents!


Kim November 29, 2011 at 6:27 pm

Thanks Gillian. We are really on the fence about the Japanese Encephalitis. I think what we might do is receive the vaccine overseas where it is cheaper? Maybe. Or we might just get it here. Or we might not get it at all. Damn! Clearly we haven’t made a decision on that one yet.


Sunee November 28, 2011 at 9:54 pm

Something that you haven’t mentioned and might not be aware of, is that if you have a follow-up injection for Hep-A after 6 months, you have lifelong immunity against the virus. Definitely worth another shot in my opinion.


Kim November 29, 2011 at 6:28 pm

Yes, thanks for mentioning that Sunee. The reason we went and got our vaccinations now, six months before we leave Portland, is because we knew it took that long for the Hep A vaccination. Travelers, take note!


Scott November 28, 2011 at 9:58 pm

Hmm, this is pretty eye-opening as I leave in 10 weeks and have not really looked into all these vaccines yet. I suppose I should get on it.


Kim November 29, 2011 at 6:29 pm

Scott, any travel clinic will be able to tell you what you need. 10 weeks is plenty of time for most vaccinations, as far as I can tell.


Sarah November 29, 2011 at 2:20 am

Thanks for the heads up Kim, you are super organized! We took malaria tablets ( the expensive ones have less side effects, of course!) throughout our trip to India, as I know someone who got it there. Glad you’re taking them with you. I’m with you on the rabies, cross that bridge if you come to it (or run screaming over it pursued by said rabid dog).
I would check the stats on the JE, and figure out if you will be at risk. Do your own research and decide if it’s worth it. Also how much are vaccines overseas? Maybe they could be cheaper?


Kim November 29, 2011 at 6:30 pm

Sarah, did you have crazy dreams and hallucinations??


Julie November 29, 2011 at 5:35 am

Ah, vaccines. I went through this last year at this time, and like you, had trouble deciding on a couple. I spent time mostly in SE Asia, so we opted not to get Japanese Encephalitis. Also, just so you know, the malaria pills I took for my entire trip did not cause any strange side effects (I was kind of looking forward to crazy dreams!), and they were easy and relatively cheap. I’ve heard you can purchase malaria pills in some countries if you don’t want to carry tons of pills with you, but you might want to dig around a little more on that…


Kim November 29, 2011 at 6:33 pm

Thanks Julie. I have heard that too. I don’t know how much the malaria pills cost in the US (I will find out soon) but if they are super expensive, getting them overseas will be what we go for.


Ali November 29, 2011 at 5:43 am

I didn’t get Japanese Encephalitis, but I was also only in SE Asia for about 2 months. I didn’t take anything for malaria since all of the precautionary meds have side effects I wasn’t willing to deal with (I have my own chronic health issues) but I did take meds with me in case I ever started developing symptoms. Like Gillian, I made sure to always put on bug spray and even though I did get bitten some, I didn’t get sick. When I got Hep A, I was told to get a 2nd shot 6 months later and then it would be good for life. But then my doctor in Germany insisted on giving me a booster for that and Hep B (which I also thought was lifetime) anyway. Who knows. It’s all confusing and scary but you have to find the balance between cautious and paranoid.


Kim November 29, 2011 at 6:34 pm

Ali (or anyone else) is it hard to find bug spray overseas? I doubt it’s hard but just wondering…?


Ashley November 29, 2011 at 5:58 am

Sarah has the right idea about checking for some vaccines abroad. My brother has been living in Thailand for nearly 10 years and has found that many medicines are cheaper, and he often goes to a reliable hospital in Bangkok when he needs booster shots etc and gets it taken care of for a fraction of the cost.

For what it’s worth, we didn’t get the JE shot before any of our travel. It wasn’t recommended to us years ago when we went to SE Asia, and we decided against it for this trip as well. Personal preference though…


Kim November 29, 2011 at 6:35 pm

I think the JE vaccination is new and has only been available since 09. Maybe that’s why it is so expensive? Ashley, do you know what hospital your brother goes to in Bangkok?


Ashley November 30, 2011 at 7:50 am

I’m not sure offhand, but I’ll ask him and get back to you.


Ashley November 30, 2011 at 8:29 am

Also, regarding insurance, we have World Nomads, and they changed underwriters for US citizen plans, so we are covered for worldwide or domestic trips that are more than 100 miles from our home. I have no idea if it’s HIPPA compliant, but I’m sure they could tell you if you gave them a call, and then could tell you exactly where to find it in writing (just to be sure!).


Kim November 30, 2011 at 7:09 pm

Awesome, thanks Ashley. I will definitely call them and find out. Thanks for asking about the hospital in Bangkok too.

Carmel November 29, 2011 at 7:21 am

Oh lord…yet another thing to work into the budget. Ok, adding to the list now. Glad YOU’RE so organized! 🙂


Kim November 29, 2011 at 6:36 pm

It’s not cheap! We have definitely budgeted for this as a pretty solid expense… the next big expense will be health insurance. Carmel, you could start getting vaccinated now, one shot at a time!


Kjersti November 29, 2011 at 8:02 am

Oh my God, 800$ for the Japanese Enc (can’t spell the rest of it)?? That’s unbelievable. It was the most expensive one we took as well, but closer to 200$ per person (2 shots). As you say, the risk is relatively low, but is it really treatable if you get it? Good luck weighing the pros and cons, it’s a tough one!


Kim November 29, 2011 at 6:37 pm

Yeah, I’m not sure that it’s treatable after you get it. Scary. Isn’t $800 insane? The rabies vaccination is $600, which I also think is insane. But, I know that it’s a small price to pay in exchange for good health. Sigh. What to do?


Rhonda November 29, 2011 at 12:20 pm

Isn’t all the poking fun? NOT!
We did get rabies, actually – Jim got the rabies vaccine but I had been bitten and actually received the week dose as a child so it wasn’t necessary for me.
We also did the the Japanese encephalitis. We spent months in SE Asia in a few off the beaten track places and since pretty much your BEST scenario if you get it is permanent brain damage we figured better safe than sorry. You may not think you’ll be there long now, however I think once you find how amazing that part of the world is, coupled with the incredible value of traveling there, you may reconsider.

We never did take any malaria medication (and hadn’t on previous trips to Asia or Africa either) We were in & out of malaria zones throughout the course of our trip and long-term doses are horrible for your liver. Also, mosquitoes respond to different malaria medications and so we just carried lots of bug spray and covered up at dawn & dusk.
A lot to deal with now but the good news is that many of the vaccinations are good for quite a few years so you won’t need them again soon:)


Kim November 29, 2011 at 6:40 pm

Thanks Rhonda for this advice. I can’t wait to talk more with you about this stuff (our HH is coming up!). Also want to pick your brain about health insurance. Did you have additional insurance or just World Nomads? We are in a slight bind because we are traveling in the USA for three months and travel insurance doesn’t cover your home country (as far as I can tell). Also, we need to make sure we have continuous coverage and travel insurance isn’t considered continuous coverage? I can’t wait for you to teach me 😉


Rhonda December 1, 2011 at 11:08 am

Looking forward to HH next week as well! Nomads does cover in the US as long as you’re more than 100miles from home so that is ok. Not sure on the continuous coverage part, however. We’ll have to figure it out when we meet up!


Kim December 1, 2011 at 9:32 pm

Yep, I’ll definitely give them a call. Look forward to seeing you soon!


Rhonda November 29, 2011 at 12:22 pm

oh, forgot to say. We used World Nomads insurance and loved them. Good price, easy to work with and they have different levels of coverage depending on what you’re looking for. We’ve found general medical care is so inexpensive in most countries that part of the insurances isn’t too relevant but we did make sure we had good emergency evacuation coverage. It was 3 yrs ago but I believe we paid $460/couple every 6 months.


Alien Traveller December 7, 2011 at 10:51 am

I was browsing website to find the reason why “Dog Mtn” in the gorge is called so and I stumbled on this website. I like this website. The aventure and outdoors in NW, RTW, trip details and pictures are amazing. I like people who share their thoughts on travelling and adventures. It’s fun to read such blogs. Keep it up and Thanks!



Kim December 7, 2011 at 6:24 pm

Hi Mandhu, thanks so much for your nice comment and for stopping by!


For 91 Days Travel Blog December 26, 2011 at 10:39 am

Good post – we are about to head to Sri Lanka and we decided on the shots you are getting but don’t really bother with Malaria. If we get a fever … straight to the doctor!

Everything else we are scrapping as well.

The vaccination thing is really freaking us out!

Of course we don’t want to get sick but on the other hand vaccinations are kind of scary as well.


Kim December 26, 2011 at 3:48 pm

I agree that vaccinations are totally freaky. But, since we’ve survived the first round of them I think we’ve decided to get the Japanese Encephilitis vaccination after all. I don’t want to worry about it while we travel…

Have fun in Sri Lanka!


Jessica March 12, 2012 at 10:37 am

Hi Kim! Just wondering if you did indeed get the Japanese Encephalitis shots? I think we’re going to because I am paranoid AND a mosquito magnet.

I’m so excited for you!


Kim March 12, 2012 at 5:53 pm

Hi Jessica. We have not gotten the Japanese Encephalitis shots- yet. We’re actually still considering it and I have it on my to-do list to call the insurance company and find out how much we’d pay out of pocket. The travel clinic quoted us $700-$800 each which makes me wonder if it’s worth it. My general practitioner told me she didn’t think it was necessary at all. HOWEVER, I too am paranoid and can just imagine myself on my death bed wondering why I just didn’t get the damn shot. So, sorry I can’t help much, I still haven’t figured it out for myself.


Archana October 10, 2014 at 10:50 am

I was born and brought in India but have been living in the US for the past 7 years. I am sure I had gotten the polio vaccine as a child, but never bothered about any other vaccines ever and have generally been a healthy person so far. But I have also been noticing common seasonal/pollen allergies for the first time this year (bidding goodbye to good ol’ south asian immunity I guess!). I did get midly sick in my previous trips to India, but I always thought that was because of the street food that I gorge as soon as I land there. Have never thought about vaccinating before those smaller trips home.

Now, I am just about a year away from my travel plans (winter 2015) and I will be spending few months in SE Asia. So am wondering if I should follow suit and better take all the vaccines you listed here or rely on the flimsy immunity of my brown blood :D. I do plan to take the Hep A/B atleast.



Kim October 10, 2014 at 12:04 pm

Hi Archana,

I think the choice is up to you!! You can always wait and get vaccinations in SE Asia as well. For instance, we didn’t get the Japanese Encephalitis vaccination because it was super expensive in the states but I’ve read that you can get it inexpensively in Bangkok. Have a great time!!


Rafi Ullah October 16, 2015 at 9:40 pm

salam Sir , I have typhoid since 7 to 8 months and their is pian (very hot) in my stomach and tistatain what I do.


Kim December 1, 2011 at 9:30 pm

Sounds like you’re an expert, Rob. I’m certainly not there yet but look forward to the time when I can really peg what kind of traveler I actually I am. I believe I will want to travel slowly and settle down from time to time. We shall see.


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