Vaccinations

[resjes]

Sorry if this is not in the right area..I presume the moderator will move it if not..

 

So an interesting topic was brought up on my cruise's Facebook page. What vaccinations are required?

 

I know that the cruise line can't force anyone to get a vaccination. However, with all these anti-vaxxer parents out there, should we be worried about them bringing children who are not vaccinated?? Does the cruise have contingencies in place for such breakouts? I've read horror stories about people being quarantined to their cabins (for stomach viruses, etc). It is not as simple as bringing flu shots on board when it comes to things like meningitis, etc. Does anyone have any statistics on how frequently the cruises get plagued with viruses/etc? I'm going to take a wild guess and say that ships that embark from a USA port probably have fewer occurrences?

 

If this is too political, please feel free to delete.

[GeezerCouple]

1 minute ago, resjes said:

Sorry if this is not in the right area..I presume the moderator will move it if not..

 

So an interesting topic was brought up on my cruise's Facebook page. What vaccinations are required?

 

I know that the cruise line can't force anyone to get a vaccination. However, with all these anti-vaxxer parents out there, should we be worried about them bringing children who are not vaccinated?? Does the cruise have contingencies in place for such breakouts? I've read horror stories about people being quarantined to their cabins (for stomach viruses, etc). It is not as simple as bringing flu shots on board when it comes to things like meningitis, etc. Does anyone have any statistics on how frequently the cruises get plagued with viruses/etc? I'm going to take a wild guess and say that ships that embark from a USA port probably have fewer occurrences?

 

If this is too political, please feel free to delete.

 

You can check official websites (State Department, CDC, etc.) to search for vaccination recommendations (or requirements) to visit various destinations.  Also check the destination countries for entry requirements.

The cruise line cannot force you to get a vaccination, correct.  But they can refuse to let you board if you do not have proof of a *required* vaccination, which is the passenger's responsibility.

 

You also seem to be combining things like "meningitis" with things like "stomach viruses" or "flu".  Most common "stomach viruses" (e..g., Norovirus) do not have vaccinations anyway.

 

If you are concerned with the "anti-vaxxer parents", why is your family not vaccinated?  If it is for medical reasons (physician advises NOT to get vaccination), that would affect you in any public area, especially crowded areas such as movie theatres, shopping centers, airplanes, buses, etc.

 

I'm not sure just what you are asking, actually.

 

GC

[Hlitner]

The bottom line is  that cruise lines do not require any vaccinations except what might  be required by a country visited on a cruise.   Having spent over 1000 days on many cruises over the past 40+ years (to 6 continents) the only time we were ever "required" to get a vaccination was on a Princess cruise that stopped at Devils Island and then later went over to Dakar, Senegal.  The Senegal government required everyone to have a valid Yellow Fever Vaccination because of that visit to Devil's Island.  So over 3000 passengers (and crew) had to go through the trouble (and expense) of getting that vaccination.  We were unable to stop at Devil's Island because of high seas!

 

As to viruses aboard, we have never seen statistics other then the CDCs own reports which keep track of cruises where more then 3% get Norovirus or other GI bugs.  But there is no vaccination for those bugs.  We have been on a few cruises where there were some verified Flu cases, but getting a flu vaccination is a personal decision.

 

Hank

[resjes]

My apologies for not being clear. What I meant to say is, what if something serious (e.g. meningitis) does break out on board or someone has it? Will they evac the person or? I don't believe quarantining everyone would be enough, is what I mean.

 

And yes, I was also asking about the Norovirus, which does not have the vaccination. The only option the cruise has is to quarantine everyone to their rooms?

 

FYI - I am vaccinated but got most of these vaccinations as a teenager/child. I have no knowledge if these vaccinations "expired" or if I need to get them redone. I get a flu shot every year. Also, thank you for the CDC website information, I didn't know they had recommended vaccinations listed for other countries than the USA. So my next question would be - since the cruise cannot force you to obtain a vaccination, will customs just not allow you to get off the port if you don't have the documentation showing proof of vaccination?

 

13 minutes ago, Hlitner said:

The Senegal government required everyone to have a valid Yellow Fever Vaccination because of that visit to Devil's Island.  So over 3000 passengers (and crew) had to go through the trouble (and expense) of getting that vaccination.  We were unable to stop at Devil's Island because of high seas!

 

I have never heard of this vaccination. Will the cruise line alert everyone months in advance if certain vaccinations will be required? I can easily get proof of vaccinations I had 10+ years ago but like I said above..I don't know if I need to get them redone?

[GeezerCouple]

2 minutes ago, resjes said:

My apologies for not being clear. What I meant to say is, what if something serious (e.g. meningitis) does break out on board or someone has it? Will they evac the person or? I don't believe quarantining everyone would be enough, is what I mean.

 

And yes, I was also asking about the Norovirus, which does not have the vaccination. The only option the cruise has is to quarantine everyone to their rooms?

 

FYI - I am vaccinated but got most of these vaccinations as a teenager/child. I have no knowledge if these vaccinations "expired" or if I need to get them redone. I get a flu shot every year. Also, thank you for the CDC website information, I didn't know they had recommended vaccinations listed for other countries than the USA. So my next question would be - since the cruise cannot force you to obtain a vaccination, will customs just not allow you to get off the port if you don't have the documentation showing proof of vaccination?

 

 

I have never heard of this vaccination. Will the cruise line alert everyone months in advance if certain vaccinations will be required? I can easily get proof of vaccinations I had 10+ years ago but like I said above..I don't know if I need to get them redone?

 

It is the passenger's responsibility, as already mentioned, to be aware of any vaccination requirements, be they from the cruise line or some country (for entry).

If you do not have a *required* vaccination, it is possible that you will not be allowed to board the cruise ship when you arrive on the sailing date.  (I'm not sure if some cruise lines would allow you on, but refuse to let you get off the ship in "that" country.  The country may require that the ship certify all pax have proof of vaccination, etc.

 

You wrote that you are "vaccinated", but yet have not heard of at least one of the vaccinations that might be required??

You need to be more proactive about all of this, in terms of 'optional' vaccinations (your preference) but especially any that would be required.

 

GC

[wheezedr]

As a physician I would suggest you contact your own physician to determine whether you are current on the routine vaccinations that one should maintain.  This is true whether or not you are planning to travel.  As others have noted only very specific itineraries require vaccines above and beyond the ordinary.  

[resjes]

1 minute ago, wheezedr said:

As a physician I would suggest you contact your own physician to determine whether you are current on the routine vaccinations that one should maintain.  This is true whether or not you are planning to travel.  As others have noted only very specific itineraries require vaccines above and beyond the ordinary.  

 

I am emailing my internist now - as she has all of my vaccinations on record. I have a list of them and it includes vaccinations such as Hep A and B..tdap/tetanus. Meningococcal/pneumococcal and then polio as  baby. I apparently even had the measles vaccine. I'm also doing as one person suggested and checking each port's recommended vaccinations..so far, I have what they recommend.

 

Also, again, I haven't been vaccinated for over 10 years and only get a flu shot once a year. I am not well versed on vaccinations and I would imagine most people I know personally don't know what is required each year for vaccinations.

 

Thanks everyone for your input!! Super useful!

[resjes]

Also, this is what the CDC says regarding yellow fever..since I am from the USA, I suppose this won't be an issue.

 

"There is no risk of yellow fever in Sint Maarten. The government of Sint Maarten requires proof of yellow fever vaccination only if you are arriving from a country with risk of yellow fever. This does not include the US. If you are traveling from a country other than the US, check this list to see if you may be required to get the yellow fever vaccine: Countries with risk of yellow fever virus (YFV) transmission. For more information on recommendations and requirements, see yellow fever recommendations and requirements for Sint Maarten. Your doctor can help you decide if this vaccine is right for you based on your travel plans. Note: Yellow fever vaccine availability in the United States is currently limited. If you need to be vaccinated before your trip, you may need to travel some distance and schedule your appointment well in advance. Find the clinic nearest you."

[wheezedr]

If it has been over 10 years since your last vaccination then you are by definition out of date since the Tetanus vaccine is recommended every 10 years.  In addition a number of other vaccines for adults have been modified in that time period and most adults are advised to have the newer versions.  As Hank mentioned the one vaccine with very specific guidelines is yellow fever but the countries requiring it are quite limited and not common ports for routine cruisers.

[Hlitner]

Just a word about Yellow Fever vaccinations (since somebody mentioned they had never heard of it).  The vaccine is somewhat controversial and has been around for decades.  It is only required by a few countries if you have recently been to one of the few countries in the world that have reported cases of Yellow Fever.   Most cruisers/travelers will spend a lifetime and not be in an area with such requirements.  The vaccine is quite expensive and is often given only at specific places (often hospital clinics) because the vaccine has a very short shelf life once activated.   It is also somewhat unique in that there is an Internationally recognized Yellow Fever Vaccination Certificate.   In my previous post I mentioned that we had to get that vaccine when we were scheduled to visit Devil's Island.  Ironically, there has never been a reported case of Yellow Fever on Devil's Island, but it is technically part of French Guiana which is a country that has reported some cases.  So at the time (a few years ago) the Government of Senegal was simply being very cautious in requiring everyone on our ship to have the vaccination (or a waiver).

 

Hank

[resjes]

Someone told me that Labadee Haiti could have contaminated water but another poster said the food comes off the cruise ship. According to the CDC...

Malaria

You will need to take prescription medicine before, during, and after your trip to prevent malaria. Your doctor can help you decide which medicine is right for you, and also talk to you about other steps you can take to prevent malaria. Areas of Haiti with risk of malaria: All (including Port Labadee). See more detailed information about malaria in Haiti.

Cholera

CDC recommends this vaccine for adults who are traveling to areas of active cholera transmission. Cholera is found in most parts of Haiti. Cholera is rare in travelers but can be severe. Certain factors may increase the risk of getting cholera or having severe disease (more information). Avoiding unsafe food and water and washing your hands can also prevent cholera.

 

[resjes]

Does anyone actually take medication/get vaccinated for malaria and cholera? Or am I just being super worried for nothing? I don't have the best immune system. I also just emailed the doctor about getting the malaria and cholera stuff straightened out.

[resjes]

5 minutes ago, wheezedr said:

If it has been over 10 years since your last vaccination then you are by definition out of date since the Tetanus vaccine is recommended every 10 years. 

 

According to my list..I had the tetanus shot in 2001 (it says td adult) but the tetanus/pertussis shot (says Tdap) in 2011..don't know the differences. Waiting for internist.

[nascarcruiser]

Honestly any of the conditions you are referring to cAn happen at home not just in other countries.  I think to be honest you are worrying about things that likely won't happen.  Yes you should check to see if you vaccines are up to date.  As far as mengitis how do you know that the person next to you in a restraunt or store or plane doesn't have it?

[GeezerCouple]

2 minutes ago, resjes said:

Does anyone actually take medication/get vaccinated for malaria and cholera? Or am I just being super worried for nothing? I don't have the best immune system. I also just emailed the doctor about getting the malaria and cholera stuff straightened out.

 

If you have a Travel Clinic at your medical center or hospital, and are going to these types of locations, you might want to make an appointment there.  Not only will they be more up to date (our PCP referred us to the Travel Clinic), but they are more likely to have some of these less common vaccines, etc.

 

You need to determine what you should take, with your medical providers (and get certifications where required or find out if medical waivers are acceptable).

 

But yes, people can get these diseases, and they can also die.

A very close colleague of mine died of malaria.  We'll never know if he refused to take the preventive meds then available or what.  He was evacuated to London, where he died not long thereafter.  That's not common, of course, but it was definitely both very sad (especially since I knew him so well) and also sobering in terms of getting appropriate meds/vaccines/etc.

 

GC

[wheezedr]

Then your Tetanus is current as 2011 is less than 10 years ago.  Speak to your internist but practically speaking, no one I know would consider either cholera vaccine or malarial prophylaxis for the brief window you will be off the ship in Labadee.   If you have such great concerns you can always just stay aboard and avail yourself of the empty facilities.

[resjes]

16 minutes ago, wheezedr said:

Then your Tetanus is current as 2011 is less than 10 years ago.  Speak to your internist but practically speaking, no one I know would consider either cholera vaccine or malarial prophylaxis for the brief window you will be off the ship in Labadee.   If you have such great concerns you can always just stay aboard and avail yourself of the empty facilities.

That is what I am thinking .. It is such a brief window. I have an appointment with a travel medicine doctor to go over what she thinks I should get or not get.

[pacruise804]

38 minutes ago, resjes said:

My apologies for not being clear. What I meant to say is, what if something serious (e.g. meningitis) does break out on board or someone has it? Will they evac the person or? I don't believe quarantining everyone would be enough, is what I mean.

 

And yes, I was also asking about the Norovirus, which does not have the vaccination. The only option the cruise has is to quarantine everyone to their rooms?

 

snip

 

I can address the Norovirus concern having sailed on a ship that had a reportable level and reading of similar practices on other ships.  Norovirus will be reported at either 2 or 3% (sorry, too lazy to look up) so there are likely cruises where Noro has been present but at lower levels.  Only those with active symptoms will be quarantined - we were not affected and had normal usage of the ship.  We even met people who had family members quarantined but they were not.

 

Proper handwashing is your biggest protection.  Use caution and possibly avoid buffets, but it really isn't that scary for an unaffected passenger.

 

24 minutes ago, resjes said:

 

I am emailing my internist now - as she has all of my vaccinations on record. I have a list of them and it includes vaccinations such as Hep A and B..tdap/tetanus. Meningococcal/pneumococcal and then polio as  baby. I apparently even had the measles vaccine. I'm also doing as one person suggested and checking each port's recommended vaccinations..so far, I have what they recommend.

 

Also, again, I haven't been vaccinated for over 10 years and only get a flu shot once a year. I am not well versed on vaccinations and I would imagine most people I know personally don't know what is required each year for vaccinations.

 

Thanks everyone for your input!! Super useful!

 I thought measles was part of the MMR vaccine (measles, mumps, rubella) and a standard vaccine in the US?  Another vote for verifying everything with your doctor and not relying on an internet community.  Another advice I can offer is that some vaccines may require a trip to your state health department (travel clinic) as vaccinations solely for travel may not be covered by insurance.  My son went on a mission trip to Guatemala last year and needed one of the Hep vaccines, since this is not a local health concern (or he would already be immunized) we had to go to the local PA Dept of Health office.  Very easy to scheduled and covered by tax dollars, but something to keep in mind.

 

Another thing you may want to discuss with your doctor if you plan to spend time ashore away from the touristy areas is use of probiotics.  The mission team leader strongly encouraged use of them for my son's trip, along with only using bottled water (including for brushing teeth) and people who used the probiotics tended to be fine while those who didn't on previous trips often suffered from intestinal issues.  Your physician knows your health situation and can best advise.

[txflood33]

Whenever I travel, I plan for the worst and then follow my doctor's advice.

 

I always do research as to what vaccines may be needed for the countries I'm visiting and then look at any additional info for said vaccines or diseases. 

 

For example, I will be cruising next year and visiting multiple cities in China. 

The CDC and WHO recommend the following vaccinations for China: hepatitis A, hepatitis B, typhoid, cholera, yellow fever, Japanese encephalitis, rabies, meningitis, polio, measles, mumps and rubella (MMR), Tdap (tetanus, diphtheria and pertussis), chickenpox, shingles, pneumonia and influenza.

 

Some of those are pretty standard and I have already had. However, from what I understand, their effectiveness can wear off after about 20 years, so I may as well go ahead and re-up those common ones. The one that stands out is rabies. Evidently, China is considered a high risk country for rabies. I would assume where you are traveling in the country could raise or lower the risk. If the decision were solely up to me I would get the vaccine before travel, because rabies. The doc may say visit the great wall and don't wander off into the jungle and don't pet stray dogs and you'll be fine.

 

I treat this like the 'don't drink the water' warning for Mexico, but on a larger scale.

[sanger727]

No, I have never gotten a vaccine or taken an anti malarial for a Caribbean cruise. I have taken an anti malarial for a land trip in Africa. It really is just about balancing the side effects and cost of the preventative medications with the likelihood of being exposed to an illness. I think in general, on a cruise, it’s unlikely you’ll be exposed to malaria. It’s spread by misquotoes which mostly come out in the evening/night and I don’t think are common near the ocean (I am a mosquito magnet and don’t recall ever getting a bite on a cruise). As far as the measles and similar, not sure why those are any more likely on a cruise than at home. I’m vaccinated to the current CDC standards and not particularly concerned. I have never had to show vaccination records to anyone related to traveling.

[SRF]

21 hours ago, Hlitner said:

Just a word about Yellow Fever vaccinations (since somebody mentioned they had never heard of it).  The vaccine is somewhat controversial and has been around for decades.  It is only required by a few countries if you have recently been to one of the few countries in the world that have reported cases of Yellow Fever.   Most cruisers/travelers will spend a lifetime and not be in an area with such requirements. 

 

I sort of disagree with that statement.

 

It is required in a lot of countries, no matter where you have been.  But they are not normal cruise destinations.

 

So the next sentence is partially correct, as most cruisers will not need them, but many travelers will.

 

 

[SRF]

As for whether or not vaccinations you had a long time ago are still effective, best to talk to a travel medicine doctor.

 

And this changes.  When I was growing up, the polio vaccine came out.  Once, and you were protected for lift.

 

Later, this was changed to once as a child and one adult (over 18) booster.   Now for some countries, they are recommending a RECENT booster.

 

Overall, I am not a big believer in lifetime vaccines (vaccination once or one series, good for life), as the immune system does not work that way.

[resjes]

I have an appointment with a travel medicine/infectious disease doctor a month before the cruise embarks. Her office says I will most likely have to get a typhoid vaccination, and since I had a HEP A vaccination, I don't have to do it again. I'm hoping to avoid the cholera/malaria drugs as those are expensive (they are not vaccinations apparently). Also, from what I've read, they are not great for those who are already on a lot of medications. I guess I'm worrying because I was hospitalized a year ago for a bad stomach infection, and I already have "pre-exisiting" conditions. I don't know if I'm considered "immuno-compromised" or not but it feels like it sometimes. I'm erring on the side of caution I suppose. Thanks all for your feedback. I have enough information now.

[Hlitner]

53 minutes ago, SRF said:

 

I sort of disagree with that statement.

 

It is required in a lot of countries, no matter where you have been.  But they are not normal cruise destinations.

 

So the next sentence is partially correct, as most cruisers will not need them, but many travelers will.

 

 

You got my interest so I did a quick check.  For those of us with US Passports there are currently 16 countries (out of 196) that require a Yellow Fever vaccination.  With the exception of French Guiana, all of those countries are located in Africa.  We have been to Africa a few times, but somehow managed to avoid all of those listed countries (some of which are not considered very safe places for tourism).

 

When DW and I got our last Yellow Fever vaccinations it turned out to be quite difficult.  It is such a "popular" vaccine for "many travelers" that none of the listed centers (all hospital related) in Central PA even had the vaccine.  One major hospital told us if we could wait a few weeks they might be able to find a few others that also want the shot.  Since the vaccine came in a vial that held 10 doses this created a major issue.  The vial is very expensive (over $1000) and must be used within 6 hours of being activated.  Ideally you want to be at a center that has 10 recipients (the same half day) so that the cost can be split.  Otherwise, one can pay hundreds of dollars for a single dose :(.  We got lucky and they had a few other inquiries about the vaccine and were able to get a few of us together on the same morning (I think there was a total of 6 persons).  The nurse who gave us the shot said it was the first time they had given that vaccine to anyone in over 6 months.  

 

When we were on that Princess cruise where we needed the vaccine, we met others who shared their stories of woe about getting that shot.  Some had to drive many hours to get to clinic that offered the vaccine.  Others told us they paid a "fortune" because they were the only one's in their region who requested the vaccine.  There are also other times when its nearly impossible for the designated centers to even get the vaccine (I think it is only manufactured by a single French company and there are often shortages).  

 

I have heard that the CDC has changed their own standards and now says that a single YF vaccination gives lifetime protection (they used to say it gave 10 years of protection).  I am not sure if the African countries have accepted this lifetime thing.....or if they are still insisting on a 10 year cycle.  

 

There are still a few cruises (Seabourn, Princess and HAL) that stop at Devil's Island.  If that YF vaccine is still mandated folks might want to reconsider their decision to take one of those cruises :).

 

Hank

[wheezedr]

I wish I could gather all of you together in a room for a couple of hours to repeat the lecture that I used to deliver to medical students and medical residents regarding vaccination, immunity and the risks, benefits associated with them.  It changed as new agents were added to the armanterium and as our and others research better defined how and where the immune response was maintained in the body.  It looked at how and why some vaccinations confer long (perhaps lifetime) immunity while others are short term at best.  

It hopefully would have addressed much of the misinformation which has been written here as well as by the anti-Vaxer community. Short of that your best bet is to seek available local medical advice and not advice from friends, family and online cruise blogs.