Journey Jotters

Bitten by the travel bug


For our winter break, the JJ family took a trip to South Africa. It was our first foray into Africa. The way our flights were booked (on miles), we had an 11-hour stopover in Cairo, en route to Johannesburg. Our thoughts immediately turned to vaccines that we might need. If you remember, we could not complete our trip to Nicaragua from Panama due to yellow fever vaccine restrictions. We did not need a repeat of that scenario.

After completing our research, it became clear that we did not need any vaccinations while traveling from the US, including if we did a stopover in Egypt. However, I felt we should get the yellow fever vaccination if we had a chance. We hope to continue to travel for at least a few years to come and do not wish to be restricted by the lack of this immunization.

I have referred many people in the past to Passport Health for all things travel-related and it seemed a good time to visit them. My original plan was to get the three of us (Mr. JJ, sonny JJ and myself) to our local Passport office and help Missy JJ get hers when we visited her at college. But then I was a little worried about potential side effects from vaccines and didn’t wish for her to experience them on her own, away from us.

Additionally, I tried to schedule an appointment online for the three of us but no weekends were not an option and the only available weekday timings meant we had to take time off from school or work. We had plans to visit our niece in Atlanta for Thanksgiving. this gave me an idea to look for an appointment while all four of us were together and on vacation.

Luckily for us, we were able to locate a Passport health office just 15 minutes from our niece’s home and they were wide open for the Friday after Thanksgiving. I booked appointments for all four. Then, I received an email asking to fill out a medical questionnaire for each of us. There’s a $10 discount per person for filling this ahead of time. It took under 30 minutes to fill the requisite information for all of us.

For the appointment, we were asked to bring:

  • Vaccination records
  • International Vaccine Certificate or yellow book for the vaccine, if we had it
  • PCP name, address, phone, and fax numbers
  • Preferred pharmacy name and phone number
  • Travel itinerary, if available

The day of the appointment turned out to be a fair one. We reached the office on time and found two other people waiting. Shortly, we were called in by nurse Blair. She was pleasant and ushered us all into her office. She had already reviewed our information and had printed out a list of recommended vaccines.

We discussed Hepatitis A and B, typhoid vaccine, yellow fever, rabies, and polio. We went over malaria prophylaxis since the Kruger area is not a mosquito-free zone. Eventually, we narrowed down the list to typhoid, malaria and yellow fever.

The typhoid vaccine is available as Vivotif, taken as capsules every other day for four days and completed one week before travel. It would render protection for five years. There is a shot available also but is more expensive and would confer immunity for two years only. We chose to take the oral vaccine.

We chose to take malaria prophylaxis, even though we knew mosquitoes would not be an issue other than on the first four days of the trip. Based on CDC guidelines, the recommended medicine was Malarone (atovaquone-proguanil) to be taken once daily starting two days before the trip, during and for one week after the trip.

The last discussion was about the yellow fever vaccine. The main US manufacturing plant for yellow fever is located in Puerto Rico and was destroyed during Hurricane Maria. Since then, all yellow fever vaccines across the world have been delivered from a separate facility in France. Hence, the supply of this vaccine has reduced drastically. The office we visited was the only one in the area that stocked the vaccine. Unlike in the past when yellow fever vaccination had to be renewed every ten years, it is now considered a lifetime vaccine.

After some discussion, Mr. JJ and I decided we should get the vaccine while we could. We offered the children a choice but they decided to take them too. The vaccines were, by no means, cheap at $279 apiece.

We also decided to take the nurse’s advice to get Azithromycin tablets for the traveler’s diarrhea. We got a box of Travelan as well. According to the Travelers supply website, “the active ingredient in Travelan® is hyperimmune bovine colostrum enriched with anti-ecoli antibodies. These antibodies bind to E.coli in the gastrointestinal tract preventing them from attaching to the intestinal wall and thereby neutralizing their ability to cause diarrhea and its associated symptoms”. We could use the Travelan to prevent diarrhea before it worsened to the point of needing antibiotics.

The nurse administered the vaccine one by one and asked us to wait for about 15 to 20 minutes to ensure no allergic reactions occurred. She was not allowed to call in the medications (typhoid vaccine capsules, antimalaria and antibiotics) since we lived in a different state.

We were each charged $55 (original $65 minus $10 for filling form ahead) for the visit and advice. We were each provided with the International Vaccine Certificate or yellow book for yellow fever documentation.

Once home from Atlanta, we called our physicians and had the medications prescribed. Predictably, our insurance did not cover the cost of typhoid vaccine nor malaria prophylaxis. But we felt it was worth it to pay for them, out of pocket.

We did not experience any side effects from typhoid and yellow fever vaccines. Sonny JJ developed loose stools from the malaria medications, which resolved after we stopped them.

This was our first time using Passport Health for our vaccination needs. The service was provided on time, professionally, with adequate time to address our questions and did not feel rushed. Nor was there any pressure to take/buy any vaccines/other products for travel. In addition to travel-related health advice, vaccines, and medications, Passport health also provides visa and passport services to various countries. I would certainly consider using them for all our future needs.

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