Another Shot in the Arm
11/06/08 03:37
Well, the travel clinic nurse said as I rolled my sleeve back up. There’s not much else I can give you any more. You’re a walking advertisement for immunizations.
She had just injected me with the second in the series of three rabies vaccine shots. Given that I had recently taken both of my dogs to the vet for their rabies shots, it seemed like the first real evidence I’d had in a long time for ultimate justice in the world. Rabies vaccine is purple, and there’s a lot of it in each shot — even with three different injections. A distinctly large bump began forming as I rolled my sleeve back down over my arm.
My yellow card with my vaccine record is almost full. If you’ve seen these yellow cards, that’s really saying something. Each “card” is a passport-sized bright yellow document. One side has your name, some basic residency details, and emergency contacts. The other side looks like a small-print spreadsheet: lots of lines and columns. Each time I get a vaccine, the vaccine-administering person writes the type of vaccine (Japanese Enceph, liquid oral), the date (November 2007), and the place (San Franc Trav Cl), plus his or her initials. Actually, travel clinic nurses always seem to be female, and almost uniformly very interesting people in themselves as well. Most travel clinics are run by cities or counties in this country.
My card has something like 25 different lines filled out, spanning a 10 year period. There was a burst of vaccinations just before I went to Nicaraugua in the late 90s, a few updates like tetanus, and then a large number of shots since I started this job last fall. Yellow fever requires a new, separate card, so I have a second almost-identical (and largely empty) yellow card for my yellow fever documentation. Some countries in South America ask that you bring these along. And on my last trip to Brazil I was actually stopped at the gate of a national park before entering the cerrado outside of Brasilia and asked in a blurry mix of Spanish and Portuguese by two women with dengue fever t-shirts if I had my “carta amarilla.” I only had the longer, more complete one with me, though of course it didn’t have yellow fever on it. “Tuve lo mes pasado,” I said. I had that shot last month. They smiled and waved me in.
You often have to spend 30 or 40 minutes in a “consultation” with a travel clinic, especially if you haven’t been there before. You need to explain where you’re going, what season, how far in the future (for multi-sequence vaccinations), and potential risk factors, such as rural versus urban travel. Vaccines must not be a very lucrative part of the pharmaceutical industry becase there often seem to be shortages. Yellow fever was very difficult to arrange. Oregon seemed to lack all Japanese encephalitis last fall just before a trip to China (a major risk area for the disease), and I had to run to San Francisco to get a rush visa to India anyway, so I thought as I waited around for my visa I’d try the San Francisco Travel Clinic.
It was as thoroughly international as you’d expect, even in such an international city. The travel nurse helping me was very patient and thorough, and became very concerned about my not finding any Japanese encephalitis vaccine. She leaned back, frowned, and said, Just a second. I’ll be right back. She came back with a small vial. A guy was supposed to come in yesterday to get our lost dose. He never showed. But I think you need it more. And she shot me up immediately.
Rabies is one of those vaccines for people that spend a lot of time far from major western-style hospitals. It is not a vaccine in the same sense as yellow fever, theoretically preventing all infection. But in case of a bite, you have a little more time and the hospital response is somewhat less rushed and critical. The immunization is also expensive — the three-shot sequence costs almost $500 USD.
Of course, most of the really scary things you can catch abroad don’t have vaccines: dengue is a huge worry, and I have a few friends that have been infected. It’s present in many of the places I visit. Malaria is also a major risk, though I take anti-malarials in pill form. Dreams while taking anti-malarials for a few weeks are always pretty trippy. I have not yet been to a place where drug-resistant malaria is common, like sub-Saharan Africa.
So far, I’ve been very lucky. I purify my drinking water while traveling in many areas and follow many of the usual advisories: avoiding uncooked and unpealed fruits and vegetables, ice, and salads. I have had a little Delhi belly here and a brief allergy there. On my last big trip, I suspect I caught some Asian influenza on a 15 hour flight from Delhi to Chicago and was brought low for a week afterwards. But all in all, no real worries. My local travel clinic nurse looked down my yellow card thoughtfully on this last trip. I hear they’ve making an avian flu H5N1 vaccine soon, and there’s an E. coli vaccine that’s in the works as well. I’ll give you a call, John.
My yellow card with my vaccine record is almost full. If you’ve seen these yellow cards, that’s really saying something. Each “card” is a passport-sized bright yellow document. One side has your name, some basic residency details, and emergency contacts. The other side looks like a small-print spreadsheet: lots of lines and columns. Each time I get a vaccine, the vaccine-administering person writes the type of vaccine (Japanese Enceph, liquid oral), the date (November 2007), and the place (San Franc Trav Cl), plus his or her initials. Actually, travel clinic nurses always seem to be female, and almost uniformly very interesting people in themselves as well. Most travel clinics are run by cities or counties in this country.
My card has something like 25 different lines filled out, spanning a 10 year period. There was a burst of vaccinations just before I went to Nicaraugua in the late 90s, a few updates like tetanus, and then a large number of shots since I started this job last fall. Yellow fever requires a new, separate card, so I have a second almost-identical (and largely empty) yellow card for my yellow fever documentation. Some countries in South America ask that you bring these along. And on my last trip to Brazil I was actually stopped at the gate of a national park before entering the cerrado outside of Brasilia and asked in a blurry mix of Spanish and Portuguese by two women with dengue fever t-shirts if I had my “carta amarilla.” I only had the longer, more complete one with me, though of course it didn’t have yellow fever on it. “Tuve lo mes pasado,” I said. I had that shot last month. They smiled and waved me in.
You often have to spend 30 or 40 minutes in a “consultation” with a travel clinic, especially if you haven’t been there before. You need to explain where you’re going, what season, how far in the future (for multi-sequence vaccinations), and potential risk factors, such as rural versus urban travel. Vaccines must not be a very lucrative part of the pharmaceutical industry becase there often seem to be shortages. Yellow fever was very difficult to arrange. Oregon seemed to lack all Japanese encephalitis last fall just before a trip to China (a major risk area for the disease), and I had to run to San Francisco to get a rush visa to India anyway, so I thought as I waited around for my visa I’d try the San Francisco Travel Clinic.
It was as thoroughly international as you’d expect, even in such an international city. The travel nurse helping me was very patient and thorough, and became very concerned about my not finding any Japanese encephalitis vaccine. She leaned back, frowned, and said, Just a second. I’ll be right back. She came back with a small vial. A guy was supposed to come in yesterday to get our lost dose. He never showed. But I think you need it more. And she shot me up immediately.
Rabies is one of those vaccines for people that spend a lot of time far from major western-style hospitals. It is not a vaccine in the same sense as yellow fever, theoretically preventing all infection. But in case of a bite, you have a little more time and the hospital response is somewhat less rushed and critical. The immunization is also expensive — the three-shot sequence costs almost $500 USD.
Of course, most of the really scary things you can catch abroad don’t have vaccines: dengue is a huge worry, and I have a few friends that have been infected. It’s present in many of the places I visit. Malaria is also a major risk, though I take anti-malarials in pill form. Dreams while taking anti-malarials for a few weeks are always pretty trippy. I have not yet been to a place where drug-resistant malaria is common, like sub-Saharan Africa.
So far, I’ve been very lucky. I purify my drinking water while traveling in many areas and follow many of the usual advisories: avoiding uncooked and unpealed fruits and vegetables, ice, and salads. I have had a little Delhi belly here and a brief allergy there. On my last big trip, I suspect I caught some Asian influenza on a 15 hour flight from Delhi to Chicago and was brought low for a week afterwards. But all in all, no real worries. My local travel clinic nurse looked down my yellow card thoughtfully on this last trip. I hear they’ve making an avian flu H5N1 vaccine soon, and there’s an E. coli vaccine that’s in the works as well. I’ll give you a call, John.
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