I do a lot of traveling, and even though I spend time in 1st world nations with high quality medical care, I also spend time in 3rd world nations where sometimes the nearest hospital is an airplane ride away. That’s why I make sure to always have my travel vaccinations / vaccines up to date. Since I travel almost full-time, I should stop calling them travel vaccinations, I guess.
Disclaimer: I am not a doctor or medical professional. This is not medical advice. Please do your own research and consult with a doctor before taking any medicine / vaccine.
How Vaccine Guidelines are Decided
Let me first tell you how vaccine guidelines are made:
- Drug company develops vaccine
- Vaccine goes through multiple rounds of testing in a large population to see if it works (efficacy) paid for by drug companies. They test different time periods between shots and different doses. They measure level of protection at each time period.
- Governments approve Vaccine based on the results of the tests.
Governments decide on these guidelines based on a cost/benefit analysis. For example, they assume not everyone will be compliant (i.e. get the shots) on time. So they try to come up with a schedule that gets most people protected most of the time. All vaccine protections fade over time. It’s just a matter of time. Some vaccines last so long that they call it lifetime because you’re not likely to get it before you die of something else.
It’s All About the Money – Vaccine Costs
Governments also base the injection schedule on cost. If you’re going to vaccine the entire population, you don’t do it unless it’s worth it. The HPV vaccine is only covered up to age 26 in the US, even though it’s been shown in Australia to be recommended up to age 45. This is due to the high cost of the vaccine alone. Some vaccines, especially new ones, are very expensive because they are still under patent, and/or most people in that country don’t receive it so your insurance doesn’t cover it. The Japanese Encephalitis or Rabies Pre-Exposure vaccines are some examples. If you try to get the vaccines in the US, you’re most likely going to pay full price ($250+injection and DR fees PER SHOT). But that also means if you travel to a country with a cheaper cost of living and/or where the vaccines are on the national schedule, the cost is much lower. E.g. $16 for JE vaccine in Bangkok, Thailand vs $250+ in US.
Some clinic in SE Asia that are cheap and I recommend:
Bangkok: https://www.thaitravelclinic.com/
Kuala Lumpur: Twin Towers Medical Centre
My Chosen Vaccines
You can do a search online for what vaccinations you need for which countries. The list that I’ve compiled works for me because it covers almost all of the preventable diseases in countries that I tend to live/visit. The duration of immunity is based on conservative estimates that I pulled from medical studies. The duration that I use is less that what many governments use, because I want maximum protection. If you want to search for which vaccines you need for specific countries, you can find it from US CDC Travel or UK NHS.
Remember: all vaccine protection fades with time. If I wrote 3-5 years, that means that the immunity starts to fade on year 3, then you aren’t protected after year 5.
| Disease | Vaccine brand | Duration of immunity |
| Yellow Fever (live) | YF-VAX | lifelong but every 10 yrs for entry to countries |
| Polio | Many brands | >99% for 18+ years |
| Meningitis / Meninggococcal ACWY | Many | 3 years |
| Meningitis / Meninggococcal B | Bexsero, Trumenba | 2 years (new, not enough data) |
| Rabies | Many | Maybe 10+ yrs, no guidelines (protection tested before boosters) |
| Tetanus | TDAP | 96% 13-14 yrs, 72% >25 yrs |
| Diptheria | TDAP | 10 yrs |
| Pertussis | TDAP | 4 yrs |
| HPV – Gardasil9 | Gardasil9 (men) | 5-8 years |
| Measles | MMR | 30 yrs |
| Mumps | MMR | >90% for >15-20 yrs |
| Rubella | MMR | 90% >10 years, then wanes |
| Pneumococcal | Different varients | 5-8 years |
| Typhoid – injection (inactivated) | 2 years | |
| Typhoid – Oral (live) | 3-4 years | |
| Hepatitis A | 20 years | |
| Hepatitis B | Lifelong | |
| Japanese Encephalitis (live) | IMOJEV | 3 yrs, 85% @ 5 years |
| Japanese Encephalitis (inactivated) | IXIARO/JESPECT | 3 years |
I’ve chosen against the cholera vaccine because the inactivated (dead) one approved by the WHO only helps 52% of the time, and the attenuated (live) one (only available in the US), goes down to 80% effectiveness in 3 months.
For those considering the new Dengue vaccine, DO NOT GET THE DENGUE VACCINE unless you’ve had Dengue Fever before. The maker of the vaccine has issued a warning that you will increase the risk of the severe (life threatening) version of the disease with the vaccine if you’ve never had Dengue Fever.
Mosquitoe Bite Avoidance
Most of the nasty diseases are transmitted via mosquitoes. So you can prevent most of those by just taking some basic precautions. Always wear mosquito repellent with DEET/Picaridin (none of that herbal crap – it doesn’t work). I don’t recommend the 100% DEET you can buy in the States. It burns. 25% DEET is more than enough. Wear long pants and long sleeves if possible. You can buy very light travel trousers / shirts made of synthetic wet-dry material that keeps cool. Before I know I’m going into the jungle, I treat them with Permethrin which seems to work well. Click for more info on DEET/Permethrin/Picaridin.
Malaria Prevention with Drugs (Prophylaxis)
If you are staying in urban areas, and unless you are hiking in very rural areas, you aren’t going to get Malaria especially if you cover yourself up and use repellent. You are more likely to catch Dengue than Malaria. But if you want to be extra safe, there are many medications for malaria that prevent it.
However, the malaria parasite is becoming more resistant to the medications. Also, the medication’s side effects are pretty bad. Doxycycline is cheap and available anywhere, but I hate the side effects (nausea). The exception to bad side effects is Malarone (Atovaquone/proguanil). I’ve taken it before (1 pill/day) with no side effects. But it is expensive! You can’t buy cheaper Malarone abroad. It costs about $4/pill abroad. If it’s cheaper than that, it’s probably fake. Just buy it in your home country before leaving and try to get your insurance to cover it. In the UK, you can get it for 1.45GBP from TravelPharm. Here’s the US CDC site for which Malaria drugs work in which country.
Malaria Standby Emergency Treatment (SBET)
To cut down on costs, rather than taking Malarone everyday, you could just buy an emergency treatment amount of Malarone – 12 pills. I had a friend who got Malaria while climbing Mt. Kilimanjaro. She was super glad she had them. For treatment, you take 4 pills/day for 3 days. This will last you long enough to get yourself to a proper hospital.
The Bottom Line
It’s worth it to do the research and get the right vaccines. The odds of you contracting one of these diseases is unlikely, but many of these diseases are fatal. So just get the vaccine!
