Vaccinations Week 7: Hepatitis A, Rabies, & MMR

The vaccine misinformation continues. Summer has been going back and forth with our health insurance to get them to pay for our vaccines. They tell us that they are covered under our plan, but we have yet to see a dime of reimbursement. On the last call she had with them, she was told that it would be less of a hassle if we got the vaccines at Walgreens instead of Costco. This is due to the fact that Costco only bills prescription insurance and not health (or major medical) insurance. If we get them at Walgreens there would be no upfront cost for us, Walgreens would bill our health insurance and bill us any difference.

When we went to Costco for our first Hepatitis A shot we were told it was a 3 round vaccine. Summer decided to go to Walgreens to make sure they would bill our health insurance, and to get us all setup for round 2 of our Hepatitis A shot. The pharmacist told her that Hepatitis A was a 2 round vaccine not 3 rounds. When Summer questioned him on this, he decided to investigate further. He called a couple other Walgreens that deal with travel vaccines more frequently to check his facts and basically got a shoulder shrug. He then decided to call the CDC to get the real story. It turns out that the Hepatitis A vaccine is only 3 rounds if the country(s) you are going to visit require the vaccine. If like us, all of the countries you are visiting only recommend the vaccine, then it is only 2 rounds. We have already had round 1, and round 2 needs to be a minimum of 6 months after round 1. That means we do not need the 2nd shot until we return from our trip.

The CDC also recommends the rabies vaccine for some of the countries that we are looking at visiting. Based on our research this is only recommended if you will not be near adequate medical facilities. Depending on where you are in some of these countries, it could take a day or more to get to a medical facility that can administer the post exposure prophylaxis. Even if you get the vaccine, you still have to get the post exposure prophylaxis, just fewer rounds. Our insurance also will not cover the vaccine which means it would be $1,111.50 each out of pocket for all 3 rounds. We are also still concerned with overwhelming Summer’s immune system with all of these vaccines. Based on all of this, we have decided to forgo the rabies vaccine. In the event that we are in a remote area and need to get the post exposure prophylaxis, our travel insurance will pay for a medical evacuation for us to a facility that can administer it.

We went to get our MMR booster shot from Walgreens on Wednesday. Since MMR is a live vaccine, it is recommended that it not be administered within 28 days of another live vaccine, unless it is administered simultaneously. One of the questions on the vaccine questionnaire that they gave us asks if we have received any other live vaccines (including Oral Typhoid) within the last 28 days. Our answer was yes, we had Oral Typhoid. The Walgreens pharmacist, unfortunately not the one who worked with Summer on the Hepatitis A vaccine, would not administer MMR to us based on our answer. Now keep in mind that I have done a fair amount of research on live vaccines, and have found that Oral Typhoid is not one of the vaccines that has the 28 day waiting period. Even though I told the pharmacist that the information I had was from the CDC website, they would not budge on their position. They told us that even though the CDC says it is fine, they have to follow Oregon state law. They told us we could try going to a travel clinic or to a Walgreens pharmacy that has a travel pharmacist. So, yesterday Summer called a travel clinic to ask them if they would administer MMR, and was told that they could not give medical advice, and that we should call our primary care physician. I am so tired of the lack of knowledge we encounter when dealing with “professionals” at pharmacies, clinics, and insurance companies. The ignorance they spew from their mouths, and the lack of ambition to seek the actual facts is repulsive. It is no wonder our country has so many medical issues. Ok, off my soap box and back on track. Summer called a Walgreens pharmacy with a travel pharmacist, and after talking to a few different people was told that even though the CDC says that it does not matter, they must follow Oregon state law and cannot administer MMR since we have taken Oral Typhoid in the last 28 days. Summer asked the question that we should have asked at the first Walgreens pharmacy, “can you show us where we can read this law?” At this point Summer had to go to an appointment and she sent me the website that the Walgreens pharmacist gave her for the Oregon Health Authority. I went on and started reading all of the information that they had related to live vaccines. After about 5 minutes of looking I found where this website showed the same information that I found on the CDC website stating that Oral Typhoid would not interfere with MMR. Based on the ignorance and stubbornness of the Walgreens pharmacists, I knew this would not be good enough. I decided to call the Oregon Health Authority to see what they could do for me. I was able to get ahold of the public health nurse who writes the immunization protocol for pharmacists for the Oregon Immunization Program. The nurse confirmed what I have been telling Walgreens, and she emailed me the supporting documentation with the pertinent sections highlighted in yellow. After some coaxing, she gave me her direct line that the pharmacist could call if they had any questions. Armed with this, I headed off to the Walgreens pharmacy with the travel pharmacist to wage war with them. I was able to get past the person at the counter, and the person she called over to help her, and was told I needed to talk directly to the pharmacist. I made my case to the pharmacist who would not believe the CDC website or the Oregon Health Authority website and said she had to call the public health nurse. After 5 or 10 minutes she came back and said they would be happy to administer MMR to us. Do you smell that? That is the sweet smell of victory. Summer was not with me, so we would have to come back later to get the shots. Once Summer was done with her appointment we made our way back to Walgreens and finally got our shots.

With the MMR booster shot behind us, we are now done with all of our vaccines. That is at least until we start taking the malaria vaccine orally in Peru. Summer, due to her needle phobia, was bouncing off the walls when she realized this. Now we have 15 days to get all of the medical insurance claims worked out before we leave for Peru. We do not want to be fighting insurance claims while traveling.

prices below are per person

  1. TDaP (Tetanus, Diphtheria, & Pertussis) $64 08/22/2016
  2. MMR (Measles, Mumps, & Rubella) $0 10/07/2016
  3. Hepatitis A (Round 1)  $71.09 08/29/2016
  4. Hepatitis A (Round 2) $71.09
  5. Malaria * (6 month supply) $94.08 post insurance
  6. Typhoid* (Oral, every other day for 7 days) $63.34 09/14/2016 – 09/20/2016
  7. Yellow Fever* $159.09 09/06/2016

Total paid out of pocket per person so far, $451.60

* prescription required

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