Vaccinations: The Other Side of Exotic Travel

I’ve been thinking about traveling to Southeast Asia for some time, though I couldn’t yet tell you when exactly, and it will be for some undetermined amount of time. This just throws the Kaiser nurses into disarray.

When I’d gone in to have my travel consultation with the injection clinic before I left for Australia, I wanted to also do some research on my future venture to Southeast Asia. It was difficult, because Kaiser won’t consult for more than anything 90 days out (“Well what if I’ll be gone for more than three months?” is of course the question it begs), so I fudged the truth a bit and wrote down some start date. I also listed all the countries I might possibly travel through, which did not fit on the few lines they give you.

The nurse at the time had told me I’d listed too many countries and that she couldn’t possibly print out information on all of those. She said, “Can’t you just pick five?”

So I said, “Fine,” in that passively pissy tone that is so familiar to my Kaiser visits, and I listed off China, Cambodia, Vietnam, Mongolia and something else. I wanted to say, just throw a dart at a dartboard. Who travels with a plan?

“Well, you might need the rabies vaccine,” she said. “It depends. Are you an adventurous traveler?”

I raised my eyebrows. “I’m not sure what you mean.”

“Will you, say, be out in the jungle where you can’t get medical help for more than twenty-four hours?”

I had shrugged. “Maybe.”

Maybe was my response to everything they asked, which only served to annoy her. She reminded me I had more countries on my list than fit into my ten-minute appointment. I smiled limply. I wondered if perhaps that wasn’t a problem with the appointment system rather than with me.

Anyway, that was four months ago, before I went to Australia. I ended up back at the injection clinic recently to get serious about Southeast Asia. In the intervening time, I had done little online research (because the surest way to freak yourself out is to Google anything medically-related), but I had talked to several people about vaccines, particularly a couple doctors and a veterinarian in Western Australia.

These conversations, hardly formal medical consults – they were conducted on a sailboat, at a campfire, and in other equally unprofessional locales – did reduce my fear of autism and the other awful things we hear might result from injections.

I had also polled my friends and fellow travelers about the injections they’d gotten before scuba diving in Borneo or volunteering in Cambodia. Half of them couldn’t remember, which made a good case for how untraumatic the shots had been, and the other half said, “Everything. I got ‘em all.”

Nope, didn’t seem like their injections had resulted in anything bad.

Still, the only injection I could remember submitting myself to was a tetanus shot 6 years before, which left me shivering in bed later that evening, singing songs from the Little Mermaid for no particular sane or rational reason.  Other than that, I couldn’t even remember my preceding vaccinations, which were probably for meningitis and hepatitis the year I went away to college.

So, resolved to be an adventurous traveler and get whatever vaccinations were recommended for where I thought I wanted to go, I scheduled my appointment with the travel injection clinic at Kaiser.

No matter how much you’ve psyched yourself up for myriad inoculations, after a visit to the travel clinic, it’s a wonder anyone would still want to travel at all. A visit there makes you feel terribly, humanly fragile in the world, and unsure you even want to leave the confines of your known city.

To compound matters, after the injection clinic, while I observed myself closely for chills, headache, muscle soreness, fatigue or fever resulting from the vaccines, I decided to do further research on the diseases for which I was being vaccinated. A web search took me to the CDC website.

Talk about something that makes you want to curl up on the couch and never leave home! It makes everywhere look like an infection risk. Interested in what could befall you during the Olympic Games in London? Just download the “Digital Press Kit: Travelers’ Health 2012 London Olympics”. Thought cruises, at the very least, would keep you healthy? No way. But arm yourself with the “CDC Feature: Staying Healthy on a Cruise.”

There’s even a bright red “NEW!” next to recent announcements and items on the CDC site, just in case this makes up part of your leisure reading. To me, it felt as though I were shopping for shoes. As in, check out our newest imports, right here, right now! We’ve got the 2012 edition of hand, foot and mouth disease up on the top shelf, next to the very fashionable cholera outbreak in the Dominican Republic.

I make fun of it, but it’s mostly to alleviate the heavy weight it brings to light-hearted and plan-less travel plans.

It’s one thing when the danger is a saltwater crocodile or great white shark – it is reasonable to think these are predators. They are visible, their infliction large and dramatic.

It is another thing entirely to consider the much greater risk in the minutiae of the world: the downright creepy threat of the mosquito, of water-borne illnesses, of things that are too numerous or too small to warrant front-page news like a great white attack would.

Disease and prevention don’t figure into the tropical vacation narrative either. No travel writer writes about the typhoid shot they had to get before their Balinese beach vacation; no one mentions the rabid dogs in Mongolia when they film beautiful, horse-driven documentaries.

Disease prevention is a risk of the road, I suppose, but often enough left out of the narrative that I was amply shocked by the infectious disease posters and recommended vaccines at the travel clinic.

Here are the things that could happen to me just in Western China and Mongolia: polio (thought we eradicated that one, huh?), typhoid (which, along with cholera, I always thought of as a disease from the “Oregon Trail Game”) and rabies (every country has its wild dogs, but apparently Mongolia has a rabies problem amongst them).

I talk a lot about Bill Bryson’s Australia schtick. That is, how In A Sunburned Country relies heavily on the dangerous animals in Australia for its humor.

There’s usually something darkly humorous about a croc attack – like, silly human trying to go adventuring where there are known predators. Silly human, forgot to take the proper precautions, went swimming in open water in Darwin. Shoulda known better. And crocs are usually socio-economically indiscriminate; they attack anyone silly enough to get in their way, and the first world doesn’t benefit from greater prevention than the third.

Bryson never touches on the mosquito-borne tropical diseases reported in some areas of Australia’s top-end. He doesn’t talk about the equine encephalitis, or the dengue fever.  I tried my hand at dangerous animal humor with the mosquito variant:

So-and-so Silly Tourist was laying on a beach in Bali in the middle of the afternoon one July day. She was traveling at the beginning of the wet season, and maybe had read some information advising her to wear mosquito repellent. Not wanting to interfere with her suntan, she hadn’t applied since the early morning. Along came a mosquito, just like all the others, got her on the arm. She only noticed hours later and sometime, days later, she began to feel a fever…

I mean, let’s just stop there. It’s not funny, and not simply because I’m not a comedy writer.

Talking about diseases, or even talking about vaccinations, isn’t good for the travel industry and it’s not good for our morale in the world. Thought we’d licked polio? Ha, think again. Apparently some countries still have a polio epidemic. Like, really think about that one. I bet that if you know anyone in America who actually laid in an iron lung, they’re somewhere around the age of 90 now.

Polio’s the one that really gets me. I mean, you talk about dengue fever, and that’s like, Well, it’s a tropical thing. But polio has a very western parallel, and that parallel got eradicated some 40 years ago (more or less – there have been a few reported cases over the years, mostly in populations that don’t vaccinate their children or in kids with immune deficient syndromes. Interestingly, most polio cases don’t result in paralysis – only 1 in 200 or something like that).

Anyway, the travel clinic advised me to get an adult polio booster shot if I plan to travel to India or Western China, which wigged me out. That’s when I asked, Is polio really still a problem?

So I started reading a bit more, and it turns out that polio is still a problem in a few places, and because it is so easily transmitted, if it’s a problem in a few countries, all surrounding countries are considered at risk.

Polio has widely been stopped through oral vaccination programs, but it is still endemic (i.e. alive and spreading) in three countries: Pakistan, Afghanistan, and Nigeria. In recent years, small outbreaks have occurred in countries neighboring Nigeria, and in Western China (to where it spread from Pakistan).

Part of the issue with stopping it is actually being able to vaccinate everyone against it – no small task. Some sources I’ve read say that vaccination rates in some countries have dropped because of rumors that the polio vaccination program was really a US-driven plot to sterilize Muslim populations. Safety was also cited as an issue, though apparently vaccination programs in Taliban-controlled regions have been fairly safe: health workers carry letters signed by the Taliban leader giving them safe passage. It’s suspected that Afghanistan’s increases in polio are from people crossing the porous Pashtun border from Pakistan.

It’s not all bad on the eradication front: India recently celebrated one year of having no new polio cases reported. The country was long on the endemic list but an intense public health and vaccination campaign resulted this year in the World Health Organization removing it from the list. It needs another two years without new reports before it is declared polio-free, and hence probably the reason they still recommend you get your polio booster before traveling there (that and its shared border with Pakistan).

Croc and shark attacks make the headlines, mosquito bites don’t, infectious diseases rarely do. And so, crocs are the things travelers worry about. But, funny enough, you could count the incidents each year on your own set of fingers. Shark attacks get counted in the ones digits as well.

Mosquito-borne illnesses and water-borne illnesses, those things so little you almost can’t avoid them, certainly can’t shoot-to-kill them, those things that require constant prevention rather than sometimes attention, the ones that come in sums in the tens of thousands on a CDC website and fact sheet, never make the headlines, the travel articles or the humor books.

And it’s no wonder. After the travel injection clinic, I found myself asking, Do I really want to leave this rather marvelously healthy first-world state I live in? Despite its budget problems and despite the factory-like feel of Kaiser, I’m taken care of, pretty safe, and I’ve got a functioning public health department that’s clearly doing a very good job because I never hear about it, and I never hear about disease outbreaks either. I mean, for goodness sake, I thought polio was just an artifact of world history, like smallpox, which apparently really is eradicated, and like the plague, which actually isn’t.