Hepatitis A

[stacey05]

I will be travelling to Ethiopia in a few months (we are adopting) and I had a question about hep A vaccine atlernative. I am opposed to hep A vaccine for religious/moral reasons, so I was wondering if anyone knew anything about the hep a immunoglobulin? I am having a hard time finding out the side effects of this. I know it is supposed to protect you for short term...we will only be in ET for one week.

Also, I originally thought I wouldn't worry about it, but on my adoption yahoo group they are telling stories of loved ones getting hep a and it is not pretty. I knew it could be harder on adults, but a few are saying someone they knew almost died and another said her mom got hep A and then developed auto immune hep A and will be on medication the rest of her life.

Anyone have any info regarding hep A/hep A immunoglobulin? Travel to Africa w/out hep A vaccine?

Thanks,

Stacey

[Addy's Mom]

I've traveled to Egypt four times over the past 5 years, staying weeks at a time, with no Hep A vaccine and have never contracted it. Same with my son, who was pretty young when he first went (16 months).

I followed pretty strict eating/drinking/brushing teeth guidelines (eating nothing raw unless I could peel it, drinking only bottled water, and brushing my teeth with bottled water. That was a preventive against traveler's diarrhea, typhoid, Hep A, and various other germs. It makes eating kind of boring, but I didn't get sick.

I also (and this may be TMI) carried wipes with me because toilet paper is in short supply in Egypt. They use a water pipe instead (almost like a bidet). Using these decreased my touching bathroom facilities a great deal. And hand sanitizer was my best friend.

I don't have experience with the immunoglobulin, however.

Edit: I forgot to say congrats on adopting, that's really great!

[stacey05]

Thank you, Addy's Mom! That helps alot! I guess I need to research how Hep A is spread more. We are adopting older siblings, so I will not be changing diapers or anything. The big thing I am concerned about is eating at the orphanage. The kids like to feed you with their hands and I have heard their kitchen (at the orphanage) is not very clean. It is a sign of affection for them to feed you and for your kids that your adopting to feed you with their hands. I am not sure how to get around that, except maybe not be there at meal times!

Also, what about eating in restaraunts where you have no control on how your food was prepared? Any suggestions?

Thanks,

Stacey

[Addy's Mom]

Yeah, that type of feeding behavior, especially directly in the orphanage, would concern me a little. I travel to visit family and they live in very Westernized parts of Egypt. It's not risk free, but sounds like it's likely cleaner than orphanages (or any child facility) may be.

I'm not sure what Ethiopian food is like, but I ate hot foods like kebab or kofta and rice, no salads unless my MIL made them. I did eat hummus and pita bread a lot. Only drank bottled water, nothing else (other than some wine). Restaurants are much safer in general than road side stands.

I don't know if it's good enough, but Egyptians, because of the heat, use ingredients (like lots of lemon or vinegar) that kill a lot of germs in general. And they cook meat to death over there.

I ate a lot of packaged goods that I bought in a supermarket, too, like European yogurts, etc. And I also took a stash of protein/energy bars with me, for when I didn't like the looks of a restaurant's menu or we just weren't anywhere I could eat. I packed a lot of my son's food too, when he was much younger. Don't do that much anymore, because I know where to get the packaged foods and/or MIL is cooking and I trust her.

[amnesiac]

Personally, I wouldn't have a preference for Ig over vaccine.

http://www.ctint.org/inserts/BayGam_insert.pdf
http://www.talecris-pi.info/inserts/gamastans-d.pdf

[stacey05]

Amnesiac,

I am religiously/morally opposed to the hep A vaccine, that is why I am researching this and looking for an alternative. The IG doesn't look that bad to me in terms of side effects, really. I know there are risks with a blood product, but I have had so many rhogam shots it isn't even funny. I was hoping if I did well with rhogam shots, maybe I would be ok with the hep A IG too.

Stacey

[Marnica]

I have also traveled in Africa (Kenya and Tanzania) and was not vaxed for Hep A. I was cautious about what I ate/drank ect.

Personally I would not get this vax or Ig injection in your shoes. I hear your concern about eating at the orpanage, but really all you have to say is no thank you. It may seem rude and/or they may be offended, but this is your health. You could make up something and tell them you are allergic to multiple foods and are on a strict diet.

[amnesiac]

Originally Posted by stacey05

Amnesiac,

I am religiously/morally opposed to the hep A vaccine, that is why I am researching this and looking for an alternative. The IG doesn't look that bad to me in terms of side effects, really. I know there are risks with a blood product, but I have had so many rhogam shots it isn't even funny. I was hoping if I did well with rhogam shots, maybe I would be ok with the hep A IG too.

Stacey

That could be the case for you. You might check around to see what availability is like where you are before you get your heart set on that option though. In my area some places that normally offer travel vaccines & used to offer Ig are not stocking Ig right now. I think it's partially because of the changes made to CDC recommendations, plus I think one manufacturer stopped providing it & Talecris is/was having supply issues. Some adults actually have protective antibody titers & don't realize it so that's another thought.

[carriebft]

I just want to second that and mention that I talked with the clinic here about Hep A options and their thoughts on the vaccine and whatnot and, in the course of that conversation, learned that they do not stock the Ig.

[stacey05]

I wonder why they are not stocking it? I have read it is better than the vaccine in preventing hep A once you have already been exposed. I think of it like the Tetanus IG which is what you would want if you are not vaccinated and get a wound that could cause tetanus. Many people get the tetanus shot in that case, but from my research, that will not help and you should get the IG. That is what I thought about the hep a IG too. I have also read you can get it BEFORE you travel somewhere if you only need shorter term protection. I will have to check and see if we have it in our area. Thanks for mentioning checking titers, I am going to do that first. I was thinking that since hep a in children can be asymptomatic, it might worth a shot. (no pun intended) ;o)

Thanks,
Stacey

[FernG]

were we not exposed as children in the US?

I've read over and over that Hep A is very minor in children. I'm just wondering if we weren't exposed as children in the US? The first time I was offered the vaccine was when I was in 1996. The NP said that it was recommended because I worked with children. I had never heard of Hep A, so I declined.

Was Hep A not endemic in the '70s and '80s in the US?

[kashka]

I had hep. A in the late 60's and no one else in my family got the disease. No one quite knows why I picked it up and the others didn't. It is my opinion that there has to be other factors to get the disease rather than just exposure (run down immune system etc.) I think the previous suggestions are good if you want to avoid the vaccination.

[tanyalynn]

Originally Posted by FernG

I've read over and over that Hep A is very minor in children. I'm just wondering if we weren't exposed as children in the US? The first time I was offered the vaccine was when I was in 1996. The NP said that it was recommended because I worked with children. I had never heard of Hep A, so I declined.

Was Hep A not endemic in the '70s and '80s in the US?

IIRC, about a third of adults in the US have already had HepA.

[bbrandonsmom]

http://www.cdc.gov/vaccines/recs/sch...d-schedule.htm

Here's the current schedule for the US. So, Hep A was added in 2007? That would explain why I didn't know it was on the schedule. Honestly, after looking at it, it seems like a lot of vaccines to me. Seems like they added more since 2005. shrug.
Anyhow, a friend of mine got the Hep A for her daughter a few weeks back through her ped pushing it. That's when I realized they wanted some kids to get it, but I didn't look into it yet. I remember reading something awhile back that it had been pulled from the US market due to some ingredient-I guess they changed what is in it?

[Otto]

Originally Posted by stacey05

The kids like to feed you with their hands and I have heard their kitchen (at the orphanage) is not very clean. It is a sign of affection for them to feed you and for your kids that your adopting to feed you with their hands.

This is gursha. It's traditional, not just for kids. If you eat Ethiopian food with Ethiopians, everyone's going to be eating with their hands off a communal plate in any event.

[stacey05]

I'm bumping this up because I have another question!

I got my titers checked to see if I am immune (naturally) to hep A and I am not. Darn! We might be traveling next month to Ethiopia and we are thinking of taking our 17 yo with us.

I really don't want the hep A vaccine. I know about bottled water and I am planning on taking my own food! I have already decided not to be at the orphanage at mealtimes so I don't have to worry about the children feeding us with their hands! The children we are adopting are older, so changing diapers will not be a concern for us.

My question is about coffee ceremonies. It seems this is big in Ethiopia and every visitor is expected to participate in the coffee ceremonies. Would this pose a risk for hep a? I know it might have some of their water in the coffee, but it is hot, so would that be ok? Also, would you feel comfortable taking your 17..soon to be 18yo... with you without the Hep A vaccine too?

Thanks for your help!

Stacey

[Marnica]

Originally Posted by stacey05

I'm bumping this up because I have another question!

I got my titers checked to see if I am immune (naturally) to hep A and I am not. Darn! We might be traveling next month to Ethiopia and we are thinking of taking our 17 yo with us.

I really don't want the hep A vaccine. I know about bottled water and I am planning on taking my own food! I have already decided not to be at the orphanage at mealtimes so I don't have to worry about the children feeding us with their hands! The children we are adopting are older, so changing diapers will not be a concern for us.

My question is about coffee ceremonies. It seems this is big in Ethiopia and every visitor is expected to participate in the coffee ceremonies. Would this pose a risk for hep a? I know it might have some of their water in the coffee, but it is hot, so would that be ok? Also, would you feel comfortable taking your 17..soon to be 18yo... with you without the Hep A vaccine too?

Thanks for your help!

Stacey

I would assume that the water will have been boiled to make the coffee, so I really wouldn't be worried about that. From what I have read about these ceremonies, the coffee is often accomapned by a snack, such as popcorn, peanuts or cooked barley. I would be more concerned about this. I know it would be considered rude to refuse, but frankly when one's health is on the line, I would be willing to be seen as a rude forieigner quite frankly. I would be no more worried about taking an unvaxed 18 yo than I would about my unvaxed self.

[Otto]

Originally Posted by Marnica

I know it would be considered rude to refuse, but frankly when one's health is on the line, I would be willing to be seen as a rude forieigner quite frankly.

In the context of a foreign adoption?

[Marnica]

Originally Posted by Otto

In the context of a foreign adoption?

to protect my health...yes. Or I would just tell them that I am sorry, I do not wish to offend, but that I have severe food allergies that are life threatening and I cannot take any chances.