American families traveling outside of the country this summer for a vacation, heads up, you might want to see your doctor before your trip. Whether you’re driving an hour to Canada or Mexico or flying across an ocean, there are two key things you want to consider, even if you’ve done your particular journey many times before:

  1. What vaccinations are recommended for the areas that you’re traveling to?
  2. What extra medications might you need to bring with you in the event that you or your children do get sick, and can’t quickly access familiar healthcare options (pharmacies, drugstores, physicians)?

I’m going to focus on travelers’ vaccines in this post, because it’s not the first thing that parents typically think about when going abroad.  To be clear there’s no law or mandate requiring you to get certain vaccines in order to travel abroad, in fact it’s just the opposite.  The State Department and CDC make recommendations, but it’s up to each individual and each parent to make those decisions for themselves based on the risk they perceive.

We all judge risk differently, and depending on the disease, the risk of contracting it may seem small enough to skip the recommended vaccines. But many of the worst infectious diseases you’d contract both here and abroad are actively avoidable, and the so-called “best case” scenarios of catching and recovering from those diseases with little impact are rare, exceptional, and statistically unlikely. After all, deadly infectious diseases, as they’re named, can kill you. They can permanently harm you. And they can leave you and your kids incredibly ill, suffering, and in quarantine, much like the recent case of the 6-year-old boy in Spain whose parents refused to vaccinate for diphtheria. After being in treatment for weeks with that deadly illness, that boy recently died.

Staying unvaccinated in the face of risk is a gamble with what is most precious – our lives.  I don’t feel comfortable taking that gamble because I’ve seen the statistics and science, and they’re stacked against any other decision. This issue came up recently as my soon-to-be stepsons are heading off to Mexico on vacation in a few weeks, a place that they frequent with their other half of the family since it’s literally an hour south of our collective homes in San Diego, California.

My fiance ran across the CDC traveler’s vaccine recommendations for Mexico via the State Department’s website as he was renewing his Passport two weeks ago, and found a recommendation for travelers to get both the Typhoid Fever and Hepatitis A vaccines for trips to Mexico, in addition the standard vaccines that most of us already have. When he spoke to the boys’ pediatrician about it, the physician seconded that recommendation. Though they hadn’t had the shots before, to be fair, travel to Mexico isn’t really a huge deal here. It’s a pretty acceptable and normalized option for many people for their day trips, family visits, and cross-border commutes to work. But during an informal poll of mine, I found that there seems to be a misconception that going to Mexico is really not like visiting a typical “foreign country,” and there are no needed travelers’ vaccines. That’s actually incorrect.

The oral Typhoid Fever vaccine - taken as 4 pills over 1 week

The oral Typhoid Fever vaccine – taken as 4 pills over 1 week

Despite its familiarity and its proximity, Mexico resides outside of the bounds of the U.S. public health bubble. That means that nation’s population doesn’t have the same vaccination requirements, statistical herd immunity, or public health rules and regulations for food handling, hospitals, etc. Many locals here might be surprised to learn that despite its proximity to San Diego, Mexico is actually considered a “developing” country, which is a fancy-shmancy term that captures a wide range of development, economic, and human factors. The designation also means that you as a traveler need to be cognizant of where corners may be cut in public funding (specifically for the purposes of this post, healthcare, and cheap/free vaccination availability), and take the appropriate precautions to safeguard your health. For my fiance, that meant he realized the boys needed to get their Typhoid vaccinations ASAP if they hadn’t already.

One of the many things the boys are excited about for this trip is that they’re staying at a resort location; but it’s also a reason given for why they might not need these vaccines, after all, it’s in a well-developed part of the country.  But just because they’re staying at a high-end resort, doesn’t mean they’re any safer from these diseases. I’m here to tell you that you don’t need to roll around in garbage and poop (yes, I said poop) in the jungle with no doctors for miles to get sick from something abroad. Sometimes it’s as easy as touching our faces after touching something contaminated that we were completely unaware of. Otherwise, we wouldn’t be taught to wash our hands the way that we do after we go to the restroom – after all, germs are invisible.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Vivotif, the live oral vaccine for Typhoid Fever that lasts up to 5 years.

Typhoid Fever is definitely something along those lines, something that spreads largely through poor hygiene practices, since it comes from Salmonella Typhi, a bacteria that only lives in humans’ bloodstreams and intestinal tract, and gets transmitted easily, typically through contaminated food or drink (contaminated by, you guessed it, fecal matter). It’s not common in the U.S. with an estimated 6,000 cases per year, with 75% of those coming from international travelers. In developing countries, it affects a staggering 21. 5 million people a year – and it killed an estimated 161,000 people worldwide in 2013. Per the reports (and the one man I know who has had it, and got it from a 5-star resort abroad!), it takes 1-2 weeks to fully show up in an infected individual, it lasts around a month with treatment, and it’s awful: high fevers of up to 104 degrees Fahrenheit, a rash, exhaustion, delirium, swollen organs, and in worst case scenarios, internal bleeding and death.

So this was an issue easily remedied. Fortunately, these days, 4 simple pills taken over the course of a week can prevent all of that. A small copay, a series of pills, and the boys are now ready to go, teenage hygiene and poop threats be darned! Even better, they’ll be protected against the majority of cases for the next 5 years.

As Americans (and I’m talking generalities, of course), we tend to have an oblivious attitude toward how different things can be in other cultures and countries. And things are not always what we assume they are (read: the same as we are accustomed to), no matter how similar they may look. When confronted with this reality, we can fight it, avoid it, or we can just get over it, already, and adjust our behaviors in a way that best serves us and our children. So, adjust, protect, and avoid the awful things you can. There’s plenty of time to catch Monteczuma’s revenge in the meantime, if you really want to get sick while you’re abroad. Just remember to get a prescription of traveler’s antibiotics and some Pepto before you go.


Resources:

Centers For Disease Control Travel Center Accessed: 06/29/15

 US Passports and International Travel Country Information State Department. Accessed:  06/29/15

 Boy Dies Diphtheria Spain, Parents Rejected Vaccine ABC News/AP News. 06/27/15. Accessed: 06/29/15

 Country and Lending Groups .World Bank Data. Accessed: 06/29/15

 Community Immunity. Vaccines.gov. Accessed: 06/29/15

Germs. Communicable Disease Control and Prevention. San Francisco Department of Public Health  Accessed: 06/29/15

Typhoid Fever National Center for Emerging and Zoonotic Infectious Diseases. CDC.Gov. Accessed: 06/29/15

GBD 2013 Mortality and Causes of Death Collaborators. (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963), 117–171. doi:10.1016/S0140-6736(14)61682-2

The New York Times Health Guide: Typhoid Fever. Accessed: 06/29/15

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Categories: Infectious Disease + Vaccines, Policy, Politics, + Pop Health