Do you really need travel vaccinations on your gap year? Are you confused as to how the risk and recommendations are assessed? Not sure if a recommendation is right for you? Let me take you through the professional process of risk assessing your travel vaccination programme so you can decide for yourself and make a fully informed decision on whether travel vaccinations are right for you.
Travel vaccinations are an essential part of keeping yourself healthy on your gap year, but how do you know which ones you really need to have? Going beyond the country specific vaccination recommendations which will be determined by what risks are present in specific countries, I will take you through the questions a travel nurse will consider so that you can ask them yourself and make an informed decision on which travel vaccines you should get and which you can safely leave for any given trip.
I am taking you through this process not as a replacement for one to one medical advice – in fact I am stating very categorically you will still need to speak to a qualified medical professional – but instead just to give you an idea of the risk assessment process so you can have more of an understanding of why vaccinnes are recommended or not.
Low Uptake Of Travel Vaccines.
In very general terms there is a large percentage of travellers who seek advice on travel vaccines and then don’t listen to that advice, and this is for a wide variety of reasons, from cost to actual mistrust of the advice – which is one of the main reasons I am writing this – to a sense of ‘it won’t happen to me’ and everything in between.
I get it. I really do.
A lot of travel advice does err on the side of caution, but that doesn’t mean that it is overblown or is there just to make money for big pharma, and yes that is a common misconception I hear quite a lot. The recommendations are there to reduce risk, it really is that simple. Even if the risk is relatively low, if there are no other reasons not to get a vaccine then a recomendation will still generally be made because low risk is good, lower risk is even better, right?
The next big excuse for not listening to recommendations is cost. Specific travel vaccines, when they aren’t subsidised by governmental public health programmes, can be expensive, and that fact alone is often enough to put a lot of travellers off getting them. I can understand why to an extent, the cost can be significant, especially if you need a lot of them, and just as with the cost of travel insurance you would much rather spend that money on an extra week on that tropical island or that awesome once in a lifetime adventure. I get it. But just as with travel insurance, sometimes the risk outweighs the cost, and the cost should never be the sole deciding factor.
Saying that though, I have to stress that even with the strongest recommendation I can give you to get any given travel vaccine, that is still all it is, a recommendation. My personal belief is that vaccines are great, but that has zero bearing on any recomendation at all because at the end of the day it is down to you and only you can make the decision of what is right for you. I can give you the facts, tell you all about the risks and the pros and cons, tell you all about side effects and the disease it is protecting you from but I can never – and will never – force, compel or coerce you into taking a vaccine and I will never judge you either way for your decision.
This is what informed consent is all about and is a fundemental part of medical ethics and human rights legislation. It underpins every single thing we do as medical and health practitioners. So when I say I recommend something, or say that I think you should take X, Y or Z if you are heading to any given country, this principle is always behind that.
First Things First.
So with that in mind, first of all before even considering travel vaccinations you should always make sure your routine vaccinations are up to date. These are not travel vaccinations, they are vaccinations that have been deemed essential enough for every day life that they are on many governmental routine vaccination programmes and are your first line of defence against everyday common diseases you will encounter all over the world, even at home.
Routine vaccinations are not forcibly mandatory, despite a common misconception, and there are still a lot of people who may not have had routine vaccinations as a child, an many more who may not have had their boosters, so it is always a good idea to check if you are up to date.
Speaking with a travel health professional before you go is still always essential, as these are specialists in this field and can tailor this advice to your own individual needs and take into account things like your past medical history to give you very specific advice just for you.
It is still extremely important to take these professional recommendations seriously, and they will include the most up to date recommendations for which vaccinations are strongly recommended for specific destinations from sources such as the CDC and the World Health Organisation.
Once this is done you will then need to look at what is recommended for your specific destinations and what risks are present, so when deciding for yourself whether you need specific travelvaccines or not, these are the main points you should consider.
How To Prioritise Travel Vaccinations.
Again, I want to stress that it is still important to speak with a qualified nurse or doctor when making these decisions, these points are only here to let you make an informed decision and a reliable risk assessment after that, because remember, as health professionals we can only give recommendations. Sometimes those recommendations are very, very strong, sometimes they are more like vague suggestions, but ultimately it is up to you.
So what questions do you need to ask yourself?
What Is The Actual Risk?
The most important thing you can do is try and determine what the actual risk of getting a vaccine preventable disease is and what are the potential consequences of you getting that disease even if the risk is low.
Are there lots of cases of travellers getting these diseases in the places you are going? Are there local warnings? Is there a current epidemic of the disease in any particular area or are cases extremely rare? Are there other contributing factors such as envioronmental conditions (ie poor sanitation) or high risk factors such as volunteering with animals or a lack of nearby medical facilities which may affect your risk assessment? If the actual risk of you getting the disease is high, then it is far more likely you will need the vaccination.
This is of course also dependent on the veracity and fatality rate of the specific disease too. If there is an extremely high chance of you becoming extremely ill or even dying from a specific disease, then the risk becomes higher and therefore the recomendation gets stronger. The opposite is true too, if the biggest risk to your health is mild symptomatic illness at absolute worst, then the recomendation won’t be as strong. Of course this is also contigent on other factors such as public health issues.
Where Are You Going?
Certain diseases are more prevalent in some countries than others, and current outbreaks and long term epidemics can all increase or decrease your chances of catching any given disease. Your chances of getting a specific disease such as rabies for example, will increase drastically in a country where that disease is prevalent or there is a sudden outbreak, and obviously decrease in countries where it is not. Therefore a recommendation for the rabies vaccine will be much stronger if you plan to spend months travelling through say Indonesia and Bali for example than it will be if you are spending a year in Europe.
Your own research from official websites such as the Travel Health Pro Website, formerly known as the National Travel Health Network And Centre (NaTHNaC), the CDC and obviously the World Health Organisation is essential.
The Personal Risk To You.
Again, when you look at what your chances are of getting a disease, you also have to look at the risk of what will happen if you get it. What is the fatality rate of the disease? What are the chances of death if you contract it? What are the symptoms? Do you have a past medical history that puts you at risk or are you in an at risk category such as over a certain age, pregnant or somehow immunocompromised? All of these factors play a part in the recommendation. The higher both risk factors are, the higher the recommendation.
How Long Are You Travelling For?
This is an important one. Basically the longer you are in any given destination, the higher your chances of getting a travel related disease.
If you are trekking through the whole of south east Asia for 6 months, then you are far more likely to catch a travel related illness or disease than if you are simply staying in Singapore on an extended layover. So therefore the chances of you needing vaccinations for the longer trip are much higher.
What Is The Weather Like?
Climate can also be a pretty big factor in disease risk assessment, and to some extent the time of year you are going as well.
Mosquito borne diseases such as Japanese encephalitis for example are often not considered a high risk in many areas despite the potential severity of the disease, but the risk does increase in lowland tropical areas in the wet or rainy season because those are the conditions that mosquitoes love, and the risk will decrease in cooler, temperate areas in the mountains, because mosquitoes aren’t as prevalent.
Meningococcal Meningitis outbreaks on the other hand usually occur during the dry season in the African Meningitis Belt, so if you are travelling during that time, your risk will increase and so will your chances of needing the vaccine.
Independent travel is all about spontenaity, I know, but you should have a rough idea of what regions you will be travelling through and when, and a good travel health specialist will be able to factor in all of these envioronmental issues into your risk assessment.
How Will You Be Travelling?
That’s right, even the way you travel can have a significant impact on your chances of contracting a vaccine preventable disease or not. Backpacking on a budget and sleeping in campsites through the far reaches of Mali and Burkina Faso will greatly increase your exposure to certain illnesses than you would get staying in a luxury hotel in the Canary islands for a week.
How Long Do You Have Before You Fly?
Have you gone to see a travel nurse months in advance or like many travellers have you left everything until three days before you travel?
Many vaccines are administered in multiple doses timed days or weeks apart, and sometimes you may need to get multiple vaccines if you need a lot of boosters or have never had any. It is always best to do this separately and timed apart, but it is possible to get a lot of them together at the same time if you really need to. This is rarely a wholly pleasant experience though.
How long you have before you travel is not a determining factor in whether you should get the vaccine or not, but it is definitely something to consider if you do decide you need them.
What Are The Vaccine Side Effects?
All drugs and vaccines have side effects, what we call contraindications. All of them. The difference is that every individual is unique and some will experience no side effects at all, many will experience a sliding scale of a few mild side effects which quickly pass, and a rare few will be hit really hard.
This is a huge consideration for anyone prescribing any medication as we need to carefully balance the risk and reward, and if the risk of giving you a vaccine outweighs the benefits of you having one or even in some cases the risk of the disease, then obviously it won’t be recommended.
It is generally impossible to know which will happen to you until it happens to you, but serious allergies to vaccinnes or other health complications that affect the decision do happen, so if you suspect that you may suffer from serious side effects from past experience or are concerned about it, then you will need to discuss this with a professional.
If the likelihood of you getting serious side effects is high, but the actual risk of you getting any given disease is extremely low, then that is something you need to weigh up for yourself and obviously vice versa.
What Is Your Past Medical History?
Similar to considering the side effects of the vaccines, your own health history needs to be carefully looked at.
Everyone’s past medical history will obviously be very different, and any competent risk assessment on which vaccinations you should get or not should include this. If you have an allergy to a specific component within a vaccine, a compromised autoimmune system or you are taking specific medication that the vaccine may interfere with, then these are all extremely important points when risk assessing the importance of getting a vaccine.
Talk with your GP or a specialist nurse about this as they will have access to your medical records and will be able to answer any specific questions or concerns.
Other Preventative Measures.
With many of the vaccine preventable diseases, the vaccine is only part of the solution and other factors will also determine your risk of becoming ill. Alongside some of the options given above, if you know you are likely to avoid any type of animal at all throughout your entire trip, that will severely reduce your risk of getting rabies. If you are extremely careful about personal hygiene, washing your hands before eating or drinking and drink purified water at all times, that will decrease your chances of getting Hepatitis A, if you know you definitely won’t have sex or exchange bodily fluids with anyone, then it is highly unlikely you will get Hepatitis B. You get my point.
All of these will help reduce your chance of getting ill, and for vaccines that are not strongly recommended or are not really necessary for a specific destination because of an already existing low risk, then these factors may be enough. Or they may not.
Only you can decide that.
But remember, whilst the risk may be low it can only take one infected insect bite, one time of forgetting to wash your hands properly, one quick scratch from a dog, and you can contract a disease that can not only ruin your trip but have long term health consequences too.
This is not meant to scare you or escalate the fear mongering, it is simply meant to remind you that sometimes that is all it can take and hopefully make you think if the is risk worth it.
No vaccine is 100% effective, but they do give you that extra line of defence against preventable diseases, and if the protection is there, why would you not take advantage of it?
Assessing whether you need a travel vaccine or not is often far more complicated than simply looking at the latest chart from the CDC, and it is infinitely more complicated than listening to that bloke in the hostel common room who boasts that he has never had any and he is fine!
Hopefully these questions will help you understand the risk assessment procedure a little more and whilst still not a replacement for qualified medical advice, will hopefully help inform your thought processes and decisions so you can make an informed choice about your travel health.
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Have you read all the information but still need a little more specific advice? Is there a travel health issue that you are worried about and need a little reassurance on? Need some information on malaria, or which vaccinations you will need? Is there a travel health issue you would like to ask about in complete confidence?
Well I am here to help.
Apart from being an experienced backpacker with over 20 years travel experience, I am also a qualified nurse who specialises in emergency nursing and travel medicine.
The Bemused Backpacker Travel Clinic is an indispensable online resource for you to gain a one on one consultation with a medical professional giving you personal reassurance, expert information and qualified advice for any and all of your travel health related questions. To head into the Travel Clinic, click here