A very frequently asked question that I run across is this:
“I’m going to a warm weather resort. Why should I bother getting Twinrix? I know lots of people who gone to resorts, have never gotten shots and they haven’t been sick.”
This is a reasonable question. I also know many people who have gone on trips like this and even more exotic locations and have never received any travel vaccines. So why bother?
My best answer to this would be that it’s good preventative medicine, just like wearing a seat belt or bike helmet. Let’s talk about bike helmets. When I was a child, nobody wore a bike helmet. I spent countless hours on my bike, and so did my friends and other schoolmates. Throughout my childhood, I can’t recall anyone getting severely injured on their bikes where a helmet would’ve mattered. But even though I’ve never known anyone to get badly hurt on a bicycle, I wouldn’t dream of letting my kids ride their bikes without helmets, and I wear one now too. But I still see people riding bikes without helmets. It’s statistically unlikely they will get into a bad crash, and as long as they don’t, not having a helmet won’t matter. But if they do crash, that lack of a helmet could make a huge difference. I’d hate knowing that there was something I could’ve done preventatively and didn’t do it.
So while the risk of getting hepatitis A or B may be relatively low (226 reported cases of Hepatitis A in Albertans between 2007 and 2012, 127 of which were known to be directly related to travel or immigration), the risk is still there. If there is something I can do preventatively to reduce that to almost zero, I think it’s worth thinking about.
Think of vaccines like seat belts, helmets or any other preventative device. You will probably be fortunate enough to never need these things to save you, but I think it’s nice to have these protective measures in place just in case.
Ultimately, it’s about how you want to manage risk in your life whether it’s deciding to wear a bike helmet or getting a vaccine before you travel. So after reading this, you may judge the risk to be not worth getting vaccines. You have that option. There is no country in the world requires you to have any hepatitis vaccines to be admitted. But if you think this might be something worth thinking about, I’ll mention some additional things you should consider.
These vaccines are prescription medicines, so you will need someone to prescribe them for you. You have many options including your family doctor, a travel clinic, public health, and a walk in clinic doctor for example. Where ever you end up going, make sure you think about these things first.
Is it possible that I might have received a hepatitis vaccine before?
Hepatitis A vaccine has not given through the childhood vaccine program, but Hepatitis B vaccine has been part of the Alberta public vaccine program for many years. If you are under 30 years old and grew up in Alberta, you probably already received your hepatitis B vaccines in Grade 5. Children who have lived in different provinces may have received Hepatitis B vaccines at different ages. For example, British Columbia currently give Hep B as part of the first year baby shots. So if your 4 year old was born in Kelowna and you moved to Alberta last year, they might already have Hep B vaccines done. Every province is different. If you can access your vaccine records that is your best option to find out. If you can’t, make sure whoever you see (doctor, travel clinic, public health) is knowledgeable about these schedules and when they have last changed, so they can give you the best recommendation.
Which hepatitis vaccine do I need?
Many people instantly think of Twinrix, the combined Hepatitis A and B vaccine. This is definitely a good option for some people, but it’s not the only option for a traveller. As mentioned above, some people have received Hep B vaccines in school, and they should have long term immunity. For those with Hep B done, you only really need to consider Hepatitis A, which requires only 2 doses and costs less.
If you don’t have either, think about whether you should get both A and B, or perhaps just A or B. For most resort destinations, Hepatitis A is recommended for all travellers as it can be spread very incidentally through contaminated food and water. The risk of getting Hepatitis B is highest for those being exposed to blood or body fluids through sexual contact, medical treatment, sharing needles, tattooing, acupuncture, occupational exposure, or spa treatments like pedicures. If you don’t plan on being involved in these activities, you may want to factor that into your decision. Ask your prescriber to explain these risks in more detail.
When are you leaving on your trip?
If you are leaving more than a month from your first vaccination appointment, you have several options and schedules. If you are leaving in less than a month, it gets more complicated. It would be difficult to get into all of the possibilities here, but I will mention this: one dose of Twinrix will not provide you with enough immunity to protect you for your trip. But don’t worry, you still have several options that can protect you. There are alternative dosing directions for Twinrix for those leaving in less than a month which usually involves an additional fourth dose. There are also vaccines that can protect you against Hepatitis A even if you only get one shot the day before you leave. Ask your prescriber to explain your options.
What about cost?
Vaccines can get expensive, especially if you don’t have any drug coverage. If your budget is limited, ask your prescriber to explain the risks, costs, and benefits for each potential vaccine. For example, most health care providers consider Hepatitis A as the single most important vaccine to get for resort destinations. All travellers are potentially at risk of being exposed to contaminated food or water. Getting Hepatitis A vaccination by itself ($65+65=$130 at Polaris for example) is potentially a lower priced option that only requires 2 doses. Your prescriber should help you prioritize what’s most highly recommended and what might not be quite as urgently needed. Then you can decide what you can fit into your budget.
Who will prescribe and administer the vaccines for me?
You have many options here. You can possibly go to your doctor’s office, your pharmacy, a travel clinic, or public health. Are they knowledgeable and can they answer my questions about the latest travel health and vaccine information? Can they prescribe and administer in the same appointment or do you have to come back another day? Do they have the vaccine in stock or do they have to order it or send you to the pharmacy? What about vaccine prices, consultation and/or injection fees? Do you have to pay more fees at your booster doses? Some places don’t charge much for fees but I’d make sure to ask for vaccine prices as they may cost more to compensate. If the vaccine prices are low, make sure to ask about additional fees. If you have a drug plan, can they directly bill it or do you have to pay and submit your receipts? Deciding where you want to go should be based on the kind of experience you want to have and what’s important to you. Expertise, convenience, price, and quality of customer service are possible factors to look at. Also, if you have a child under 5, keep in mind that only registered nurses and doctors can administer injections. Pharmacists can only inject 5 years and older. At Polaris, we have registered nurses scheduled regularly to make sure we can accommodate younger children.
There’s a lot of information here but there really is so much more that could be said. The info above should not be taken as specific individual medical advice. It’s written to help you think about what kinds of questions you should ask your health care providers about these vaccines.
For more information, book an appointment with us. We now have video conference appointments to provide our services around the world. For more information, check www.polaristravelclinic.ca/telehealth
Click here for our online appointment request form or call us at 403-980-TRIP (8747).
When I have a chance, I think I’ll write another one of these. The topic will be “Should I consider getting Dukoral?” as I get asked that question almost as much as this one. Like us on Facebook at facebook.com/PolarisTravelClinicAndPharmacy or follow us on Twitter @polaristravelrx to find out when I’ve updated this blog with a new post.