Originally published September 2019; this article recounts our earlier family travel.Last updated: . Our choices and experiences are personal history. Current vaccine and medicine recommendations depend on destination, itinerary, age, and health; check current official guidance with a travel-health professional.
You’ve booked your flights, you’ve booked your Airbnb, you’ve even started to pack. Before traveling internationally, include travel-health planning in your checklist and ask whether any travel vaccinations are appropriate for your itinerary.
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Let’s back up!
Travel health recommendations depend on your destination, activities, and personal health. Start with the CDC Travelers’ Health website and discuss your plans with a healthcare professional. The CDC Think Travel Vaccine Guide is another resource to review with your provider.
This caught me a little bit by surprise as we were planning to travel to Asia, but not totally. My mom is a seasoned traveler and mentioned it to me a few times, so travel vaccinations always lingered at the back of my mind.
A few things that DID surprise me, however, and these are things I wanted to share so you also can keep in mind:
First of all, let’s just put it out there that this is a sensitive topic and very personal. Some moms are WAY fired up about vaccines in general. Coming from a biology major background, I’m all behind the science of vaccines and will always opt for them. If that’s not your thing, we disagree, but it’s your choice. That is my personal view, not a recommendation for every traveler; talk through your own questions with a healthcare professional.
A disease’s presence somewhere in a country does not tell you the risk at every stop. A touristy or developed area is not, by itself, a reason to assume there is no risk. Recommendations and precautions can vary by location, activities, season, trip length, and personal health. Check current destination guidance and discuss your itinerary with a travel-health professional.
Chris and I received hepatitis A vaccinations in Utah and Hawaii. For us, this involved two doses at least six months apart. We received one dose in Utah and a later dose in Hawaii before traveling internationally; I worried about finding follow-up if we had left sooner. A clinician can advise whether to start before travel and how to complete the series based on your age, prior doses, product, departure date, and health. Our children’s vaccination timing was specific to our family. CDC hepatitis A guidance covers travel doses and series completion.
Age limits differ by vaccine and product. When Grace was one year old, we were told she was too young for the typhoid vaccine product discussed at that visit; that memory should not be read as a blanket statement about meningococcal vaccines. We were also given food-and-water precautions for her on that trip. The precautions we followed were advice for our family then, not universal rules for every child or destination. Review CDC travel-vaccine guidance for children and CDC food and water guidance with a clinician for your plans.
Typhoid vaccines have product-specific age limits and schedules. In the United States, the injectable product is licensed from age 2, and the live oral product from age 6; the oral product is four capsules taken every other day, swallowed whole. Booster intervals differ by product, and product guidance can change or differ outside the United States. Our younger boys were too young for the oral product we discussed, so they received the shot in Hawaii before our Asia trip. We expected future boosters might be needed, but follow current product instructions and a clinician’s advice. See CDC typhoid guidance.
Our family’s experience with the oral typhoid vaccine varied. Lucy accidentally started chewing a capsule instead of swallowing it whole. We had to request an additional pill and go longer for her. Chris and Lucy felt terrible: Lucy was nauseous, had severe stomach cramps, curled up on the floor for hours the next day, and missed school; Chris felt terrible too. Grant and I did not notice symptoms. These are our family’s reported experiences, not a prediction of how someone else will feel. CDC says the U.S. oral product should be swallowed whole. If a dose is missed, delayed, or chewed, ask the vaccine provider what to do rather than improvising a replacement dose. CDC typhoid vaccine information has current product details.
For our family of seven, the remaining vaccines cost more than $1,000 in Hawaii at the time. It was painful. I felt the protection was worth the expense for our family, but that was our decision, not a calculation for another traveler. A few shots were covered by insurance and some of Grace’s well-child shots were subsidized in Hawaii while we were technically uninsured. Those are historical costs and coverage details, not current prices or a promise of coverage; check with your provider, insurer, and local programs.
When I wrote this, I was hoping we could travel to Tanzania in a few months. I understood that Yellow Fever entry rules could depend on where we traveled from and was checking our route. A vaccine recommendation and an entry requirement are different questions. CDC’s current Tanzania page says the requirement depends on the itinerary, including qualifying transit through countries with Yellow Fever transmission risk, and the traveler’s age. Check current requirements for your exact route with CDC Tanzania travel guidance and official entry information before departure.
Planning for a future trip
Our family used health clinics for travel vaccines. Check whether your local health office, doctor, pediatrician, or travel clinic offers the services you need; services and appointment availability vary.
You can also ask your doctor or pediatrician whether they provide travel-health advice or vaccines, or can refer you to a clinic. I did not choose that route because I did not want to coordinate two doctors for the adults and kids, and we did not have a primary-care doctor we loved. I was not sure if all doctors had or administered travel vaccines, so I really do recommend checking what a local health clinic can offer.
Come to the clinic or doctor with the countries and areas or cities you plan to visit, and when and for how long. This was a bit challenging for us as an open-ended travel family. I was grateful we had our stops mapped out for Asia; I did not want to deal with that while on the road.
Know what vaccines you have already had. For kids, bring their vaccination records. For adults, do your best to gather what you have had. If you have had a baby in the United States, you may have had Tdap; I had it with two different babies. You may or may not have had hepatitis A. Our records helped us discuss our family’s history with the clinic.
The nurses helped us look up recommendations for the areas we planned to visit and work through timing for our family. A travel-health professional can review current destination-specific guidance with you; ask what they can help with for your itinerary and schedule.
If possible, check in advance with your health insurance about what it may or may not cover. I like calling my health insurance about as much as stepping on a nail, so I did not do this and expected to pay out of pocket. We had a massive deductible anyway and were used to paying out of pocket for everything. We were pleasantly surprised that a few shots at the health clinic were covered while others were not. There can also be subsidized payments depending on where you are. In Hawaii, some of Grace’s well-child shots were subsidized while we were technically uninsured. This is our past experience; confirm current coverage and eligibility directly.
If you need a vaccine while traveling, plan when and where to seek care with a healthcare professional. For our family, I knew the kids would need well-checks and vaccines in Japan, so we booked an appointment at an international clinic when we arrived. We had time to return when one vaccine was not in stock for Lucy. That is what happened to us then; clinic services and stock vary.
What our family did for our Asia trip
This is a record of the vaccines our family received then, not a recommended list for other travelers. Current recommendations depend on your destination, itinerary, age, health, and prior vaccination history.
• Meningitis
• Hep A
• Japanese Encephalitis
• Typhoid
What we chose not to get for that trip
Malaria. For that trip, we opted out of malaria-prevention medicine. I had read reviews and formed the impression that there were few cases where we planned to go; that was my informal impression, not current evidence. CDC’s Indonesia guidance is location-specific: it identifies no malaria transmission in Bali resort areas and malaria transmission in some other Indonesian regions. Medicines, dosing schedules, and possible side effects vary, so the choice depends on exact itinerary and traveler health. Check current CDC Indonesia guidance with a clinician. We tried our best to prevent mosquito bites.
Rabies. For that trip, we declined pre-exposure rabies vaccination. At the time, I understood it could cost around $300 per person; that was an old estimate, not a current price. I had thought, “you still need to get a shot right away if bitten,” but that phrasing missed an important benefit: pre-exposure vaccination does not remove the need for urgent care after a possible exposure, but it changes the post-exposure treatment. For people previously vaccinated, CDC guidance uses fewer vaccine doses and no rabies immune globulin. Wash a wound promptly and seek urgent medical assessment after a bite, scratch, or possible exposure. CDC says the decision about pre-exposure vaccination depends in part on exposure activities and access to prompt, safe post-exposure care. Our family declined; that was our choice, not advice for another traveler. Review CDC Indonesia guidance and CDC rabies guidance, including its post-exposure guidance, with a travel-health professional.
I hope this gets you started. Don’t let travel-health planning scare you, but do check current destination guidance and talk with a qualified travel-health professional about your own itinerary, age, health, and questions. The choices described here are our family’s experience from an earlier trip.
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