I know that when I first started to plan my travels around the world, working out which vaccines I needed to get and where to get them was one of the most daunting tasks. I struggled to find one single website that could explain which vaccines I needed for which country, what the diseases actually were, what sort of risk I’d be taking by not getting them.
I’ve been researching solidly for the past three months and have combined everything I’ve learned in this post.
There are so many vaccinations. Which ones do you need and which ones don’t you? How expensive will they be? Can you get some for free? Is it possible to have lots together or do they need to be spread out? How soon before your departure date should you start getting them?
In this post, I will attempt to answer the majority of questions you may have about vaccines and long-term travel. If I miss anything out then please leave a question in the comments below and I will do my best to try and answer it there.
Note: I do live in London, so this information regarding prices will be different if you live elsewhere, but everything else is relevant.
Be sure to get your yellow fever vaccine if you want to visit Africa!
What vaccinations are available to me, and what are they to prevent?
Tetanus is a toxin that is distributed via spores. The disease can be contracted by the spores entering a wound that you may have if you are injured. Tetanus has an incubation period of 3-21 days. During this time, your muscles start to become rigid, until eventually you will not be able to open your mouth, and your spine and abdominal muscles also become rigid. Tetanus can eventually prove to be fatal.
Polio is mainly contracted through contaminated food and water. Polio has an incubation period of 7-14 days. In 90% of cases, there will be no symptoms. 8% of cases will experience mild flu-like symptoms, and the remaining 2% will experience paralysis, bladder dysfunction, impaired swallowing, breathing and speech, which could be fatal.
Diphtheria is a respiratory illness contracted by water vapour in the air and from contact with infected people. Diphtheria has an incubation period of 2.5 days. It can possibly cause death.
Hepatitis A is spread via contaminated food and water, mainly from shellfish, or from person-to-person contact. Travellers that are coming from modern countries that have good hygiene are more at risk, as they will not have developed immunisation from pre-exposure.
Hepatitis A has an incubation period of 3-6 weeks. Over 90% of people infected will not show any symptoms. The symptoms that are experienced by the other 10% include fever, upset stomach, rash, nausea/vomiting and diarrhoea. These symptoms are following by jaundice and itching.
Hepatitis B is spread from person to person via infected bodily fluid, such as blood/blood contact, infected medical equipment and via sexual transmission.
Symptoms can include: fever, joint pain, rash and jaundice. Hepatitis B can lead to permanent liver damage and cancer.
Japanese B Encephalitis
Japanese B Encephalitis is contracted through the bite of a mosquito. These mosquitoes are normally found in rice paddles, as well as on pigs, birds and the Siberian stork. Japanese B Encephalitis sometimes will exhibit no symptoms, although some people experience fever, encephalitis, meningitis and paralysis. Recovery is slow and long-term debility is common. There is a mortality rate of 30% in children.
Rabies infects animals mainly, but the risk for humans occurs animal contact. Transmission occurs from a traveler being bitten by the infected animal, and the virus will then transfer through the animal’s saliva. The virus will move into the infected person’s nervous system and results in either irritable (furious rabies), or depressed (dumb rabies) symptoms. The incubation period is between 20-90 days. Spasms involving the breathing muscles, generalised convulsions and cardiac or respiratory arrest follows, usually within a week, resulting in death.
Tick-Borne Encephalitis is transferred to humans via the bite of an infected Tick. It can also be transmitted via milk from infected animals. Tick-Borne Encephalitis is a flu-like illness, with symptoms appearing within 7-14 days of being bitten. The symptoms can include fever, headache, nausea and photophobia, which could lead to neck stiffness, convulsions and an altered mental state. It could also lead to meningitis, encephalitis and muscular paralysis.
Typhoid is transmitted via contaminated food and drink. The symptoms include fever, headache, confusion, abdominal pain and constipation, as well as a rash.
Yellow Fever is spread via infected mosquitoes. The main symptoms are fever, jaundice, haemorrhage and renal fever.
What vaccines do I need for where I am going?
This is a list of where each of the above diseases are found in the world.
Tetanus is present worldwide.
Polio is mainly found in developing countries in Asia and Africa.
Diphtheria is in most of sub-Saharan Africa, parts of South East Asia and South America.
Hepatitis A is present in all countries with poor sanitation and public hygiene.
Hepatitis B is found in South East Asia, the Middle East, South and Western Pacific and parts of the Caribbean.
Japanese B Encephalitis can occur following the rainy season in China, regions of Nepal, northern Burma, eastern and southern states of India, northern Sri Lanka, northern Thailand, Laos and Vietnam. Occasional outbreaks have been reported in Malaysia, Indonesia, Korea, Singapore, southern parts of Thailand, southern Sri Lanka and all of India.
Rabies has a greater risk in Asia, Africa and South America.
Tick Borne Encephalitis is found in European Russia, Austria, Hungary, the Balkans, Czech Republic, Slovakia and Scandinavia. It can also be found in eastern parts of China.
Typhoid is present worldwide, however it is worse where food and water may be contaminated with sewage — in Africa, Far East and South America.
Yellow Fever is present in tropical Africa and South America. You may be required to show a Yellow Fever vaccination certificate to enter certain countries if you are traveling from an infected area.
How soon should I get my vaccinations?
Hepatitis A and B - The vaccine requires two doses, 30 days apart, which will provide you with one year of protection. You can then have a booster vaccination 6 to 12 months later which will give you 20 or more years of protection. It is best to have the first shot 6 months before your departure date so you can complete the full course before leaving. If this is not possible then you can have the first two shots before you leave, and have the booster shot whilst you are on the road.
Japanese B Encephalitis – three doses on days 0, 7-14 and 28. You will be immune one month after your final dose.
Rabies – days 0, 7, 21-28. You can then have a booster every 2-3 years.
Tick-Borne Encephalitis – Take two does. One at 0 days and the other 4-12 weeks before that.
Typhoid – One dose will protect you for three years, so you can get it earlier than the others.
Yellow Fever – Must be given 10 days before leaving. As this is a live vaccine it has to be given on the same day as other live vaccines (Polio), or 3 weeks apart.
I have been told that if you have left it very late before sorting out your vaccinations, it is is possible ALL of them can be administered at once at different locations on your body – But that sounds awful, so get planning early on!
How expensive are the vaccines?
The most important thing is to shop around. Don’t settle for the first quote you are given, look at lots of different companies and try to find the best prices. I started with my doctor’s surgery and found them to be extremely expensive, and after looking around for a bit, I managed to find the same vaccinations – for half the price!! Prices obviously will vary from place to place, and this is only speaking for the UK. The following will give you some rough averages of prices I’ve found from my research.
It is possible for you to be able to obtain some vaccinations for free from the NHS in the UK, and the three main ones that are normally covered are:
Depending on which borough you live in, you may be able to get even more for free – I have a friend that even managed to get the rabies vaccination for free. Call your doctor’s surgery and find out what’s on offer.
I looked around and this is a list of the cheapest and most expensive prices I found for each of the vaccines:
Cheapest Price: £25.00
Most Expensive Price: £50.00
Cheapest Price: £45.00
Most Expensive Price: £85.00
Cheapest Price: £30.00
Most Expensive Price: £95.00
Japanese B Encephalitis:
Cheapest Price: £50.00
Most Expensive Price: £100.00
Cheapest Price: £17.50
Most Expensive Price: £40.00
Tick Borne Encephalitis:
Cheapest Price: £70.00
Most Expensive Price: £110.00
Cheapest Price: £25.00
Most Expensive Price: £40.00
Cheapest Price: £45.00
Most Expensive Price: £80.00
How long do the vaccinations last?
Dipheria/Tetanus/Polio: 10 years
Hepatitis A: – Long Term.
Hepatitis B: – 10 years
Japanese B Encephalitis: 1 year
Rabies: 1-2 years
Tick Borne Encephalitis: 1-3 years
Typhoid: 3 years
Yellow Fever: 10 years.
Any side effects to the vaccines?
All vaccines are likely to cause redness, pain or swelling around the injection site. However, it is possible to experience other side effects which are listed below, and are quite rare:
Dipheria/Tetanus/Polio – Mild headaches, aching of muscles and a mild fever. Severe reactions are rare.
Hepatitis A – Fever and a headache. Less common side effects are bruising, stiffness in the neck, sore throat, tiredness, nausea, stomach cramps and agitation.
Hepatitis B – Fatigue, headache, irritability, sore throat, tiredness, weakness.
Japanese B Encephalitis – Little adverse effects.
Rabies – Swollen glands, headache, nausea, diarrhea, muscle aches, chills.
Tick-Borne Encephalitis - Apparently it is manufactured using chicken eggs so if you have an allergy to chicken or eggs you should avoid this vaccine. Side effects include joint pain, nausea, tiredness, fever, vertigo, vomiting, hypersensitivity.
Typhoid - Headache, muscle or joint pain, nausea, vomiting, fatigue, abdominal pain and mild fever. Some individuals can develop diarrhea, and allergic reactions like, skin rash, hives, itching and swelling of the eyes or face after taking the oral typhoid vaccine.
Yellow Fever – Tiredness, muscle aches. There are more serious side effects associated with the vaccine so you will have to wait at the clinic for 30 minutes after having had the vaccine to check that you are ok, and not about to have a serious allergic reaction – anaphylaxis. Also rare is encephalitis and inflammation of the liver or kidney. Complications are more likely in the over 70s.
I saved the most important disease until last. Malaria is a serious and sometimes fatal disease that is spread via mosquitos. When you are bitten by an infected mosquito, a parasite enters the bloodstream and travels to the liver, where they multiply before returning back into the bloodstream to attack the red blood cells. These parasites continue to multiply inside the red blood cells until they burst, releasing even more parasites into the plasma. Nice!
Malaria is present in over 100 countries of 40% of the World’s population is at risk. Large areas of Central and Southern America, Africa, the Middle East, India, Southeast Asia and Oceania are considered malaria risk areas.
Common symptoms of malaria consist of flu-like symptoms – The chills, headache, muscle aches and fatigue. Symptoms can also include nausea, vomiting, diarrhea, loss of red blood cells, as well as jaundice and anemia symptoms.
The symptoms normally occur between 10 days and 4 weeks after exposure being bitten by the infected mosquito, with it sometimes being as late as a year.
Any traveler that becomes ill with a fever or flu-like illness whilst traveling, and up to a year after returning from the trip should immediately seek medical attention.
There is not a vaccine available for malaria, but you can take anti-malaria tablets to prevent contraction. As well as taking the tablets you should be vigilant and try to avoid getting bitten as much as possible. You can do this by wearing insect repellent, especially at dawn and dusk where the mosquitoes are most prevalent. Wearing clothes that cover a lot of your skin will also help to prevent bites.
Due to growing immunity from mosquitos, different tablets work best in different areas of the world. These are the five main anti-malarial tablets that you’ll be likely to be prescribed.
Chloroquine – Start one week before travel and continue for 4 weeks after you return. Can be taken for periods exceeding 5 years. Can cause nausea and mouth ulcers.
Paludrine – Start one week before travel and continue for 4 weeks after you return. Can be taken for periods exceeding 5 years.
Mefloquine – Start 2.5 weeks before travel and continue for 4 weeks after you return. Can be taken for up to one year.
Doxycycline — Doxycycline is recommended to be used in Southeast Asia and in chloroquine-resistant areas. You should start taking the tablets (100mg a day) 2 days before you arrive and continue taking them for 4 weeks after you leave the area. Doxycycline can be taken up to 6 months and usually have very few side-effects. It can make you very prone to sunburn and it’s recommended you don’t sunbathe whilst taking these.
Malarone – Start 2 days before travel and continue for one week after your return. Can be taken for up to one year.
Are the vaccines really necessary?
Obviously it’s up to you if you want to take that risk but, in my opinion, they are. It’s always better to be safe than sorry. Do you really want some crazy tropical disease ruining the trip you’ve been planning for months/years?
Yes, it’s true, you could not have any vaccinations, and be absolutely fine, but that’s definitely not a risk I’m willing to take, and for the sake of a few hundred pounds, I’d rather be safe…
Fortunately, these aren’t mosquito bites… I was attacked by sand flies in Cambodia!
As for me…
Today, I visited 1st Contact Travel Clinic in London for my first consultation about vaccinations. If you live in the London area I would definitely recommend this company. They are extremely helpful, have the lowest prices I’ve managed to find anywhere. They also don’t charge for consultations or to get vaccination certificates.
My doctor’s surgery offer Hepatitis A and Typhoid vaccinations for free on the NHS, so I will be getting those from there. I will be getting my hepatitis B vaccine from 1st Contact Travel Clinic in London. I’m also bringing 6 months worth of doxycycline as a malaria preventative.
An update: two years later
I’ve now been travelling for two years so I thought it was time for an update!
Before I left I got my Hepatitis A, Hepatitis B and Typhoid vaccines. My Hepatitis A and B needed a top-up after a year and fortunately I happened to time it so I was back in London for this time. I travelled to 1st Contact Travel Clinic once more to get my vaccines.
I am planning on spending a significant amount of 2013 and 2014 in Central and South America and for this countries I’m going to need the yellow fever vaccine. I won’t be back in London and so I’m going to get this in Chiang Mai, Thailand. I could wait until I reach the US (a few months before my time in C/S America) but given how expensive their vaccines are, I’m going to stick with getting them done in Thailand.
Despite insisting that I will take malaria tablets while travelling, I’m afraid to say that I have yet to take a single one. After weighing up the pros and cons, I decided that there wasn’t enough of a risk in Southeast Asia to warrant taking the tablets. I’ve spent almost 12 months of the last 24 in Southeast Asia and taking anti-malaria tablets for that amount of time would be horrible for my liver.
I plan on taking anti-malaria tablets in South America and Africa, but I won’t be doing so in Southeast Asia. Instead, I smother myself in insect-repellent, cover up at night and use mosquito nets to keep safe.
Other useful resources
1st Contact Travel Clinic, London — I’ve used 1st Contact for every single travel vaccine I’ve needed and found them to be professional, helpful and reasonably priced. I can fully recommend using them if you’re in London.
Fit For Travel — A travel resource site from the NHS, which features up-to-date travel information and advises you on which vaccines you need for which regions of the world.
I hope you’ve found this post to be useful and it cleared up any questions you may have had about vaccinations. If you do still have any questions, or would like to offer advice for any other parts of the world please leave a comment below!