Africa Travel

[ariahsmum]

Hi mamas...

It has been *forever* since I have posted here... anywhere on MDC, actually. But now I really need the expertise of the people here.

I have the opportunity to travel to Africa. Probably have to go by way of Kenya, but will be ending up in Burundi or Rwanda. One of the options is taking 5 year old dd and staying for an extended time.

here's the clincher... no one in my family has ever been vaxed. Soooo...How do I go about finding out what I *really* need for vax to be safe in these countries? How do I figure this out? How much time would i have to do it in... heck I don't even know if I would need a series or just one...

I am so totally against feeding these medicines to our bodies, and honestly I am looking at the choice between not going in order to remain vax free or going and having the risks of vax. I lost my son last year, and I only have dd and no more bio kids, and now you can imagine how terrified I am of putting poisons in her blood stream.

Thank you for any help you can provide. I need someone that really knows their stuff on this.

[rabrog]

A couple of things:
- where are you going to be in Kenya? Metro (Nairobi) or rural? I have a group of friends traveling there in Jan. and they were told they have to have the yellow fever card (I think that's it) or they will not be allowed in country at all. This is new since I was there in '01.
- what vax's are suggested for Burundi and Rwanda? I think depending on where you'd be in those countries, I'd worry more about them than Kenya.

I would have skipped all of my vax's for Kenya if I had known then what I know now and had known more about where we would be (Nairobi, Arsim, Kor, Maralal and in the Maasai region) and how we would be cared for. But your situation may be different.

Give me some more info and I'll see what I can dig up for you. I'd be wary of Rwanda because of the political issues there in the last 10 years..what that's potentially done to their healthcare, water supply, etc. and what rebuilding has been done there.

Jenn

[Gitti]

I will tell you what I personally would do without one twinge of reservations:

Stay vaccine free and take my vaccine free dd with me.

[wannabe]

According to http://www.netdoctor.co.uk/travel/africa.shtml

You MUST have yellow fever for Rwanda (and the CDC says you need it for Burundi, too), and you'll need typhoid, hep A, diptheria, tetanus, MMR and polio as well. Hep B would be a good idea. Kenya's in the meningococcal zone, so depending what time of year you're going you might want to get that. I'd consider rabies if you'll be remote and couldn't get to a place with the vaccine within a few hours of a bite. Don't forget to get antimalarials, too. You can also get these traveller's needle packages with all they'll need if you're admitted to a hospital, so you know they've used clean needles.

Skip TB (you'll always test +ve, and it's not very effective), and typhoid (not very effective).

One concern is if you get sick and are treated you could get a far worse disease than you started with from the hospital or clinic.

I will tell you what I personally would do without one twinge of reservations:

Stay vaccine free and take my vaccine free dd with me.

And what would you tell the border guards when they ask to see your yellow fever certificate?

[roxyrox]

You can look here at disease incidence in the countries you will be visiting and make a decision from there.

http://www.who.int/vaccines/globalsu...cidencemea.htm

[bczmama]

What about malaria? If you're planning on going to a malaria zone, I think you need to consider the fairness of exposing your child to a disease with long-term effects without her being able to give (at age 5) "informed consent" -- especially as malaria hits little children terribly hard, and as the malaria preventatives are not recommended for them either.

[ariahsmum]

Thank you thank you thank you everyone! I will be hopefully only going to Nairobi to *get* a visa unless I find that things have changed and I can get one at the US consulate in Rwanda. So, not really traveling in Kenya, just going on business jaunt to get visa for child.

Yes, I need to definitely consider this all VERY carefully. Obviously I am unvaxed, dh is unvaxed, and dd is now unvaxed due to our beliefs and hard work at keeping things that way. Yes, I know I will need yellow fever, and also anti-malarial stuff. We are strongly considering leaving dd here (which will not be any picnic either) due to the issue.

So some say do yellow fever and malaria for sure, but suggest I can skip the rest- MMR, diptheria, tetnus, polio, HebA, HepB. How do I sort that out? I guess by looking at the CDC and figuring out how much of each thing is in Rwanda and Kenya, eh?

HepA is contractable through water, but someone suggested I get HepB... may I ask why? In case I end up at a hospital there?

Rabrog, can you tell me a bit more about "what you know now" that contributes to your feelings of what you wouldn't do for Kenya?

And Gitti, at the risk of sounding snarky, was there something specific you had to say that would be helpful to my request and consideration? or did you just want to hear yourself talk? Pretend you were in a debate... "I will tell you what I personally would do without one twinge of reservations:Stay vaccine free and take my vaccine free dd with me" does not actually provide and information whatsoever. I am asking you to clarify though, in case you have some actual information that may be helpful to me in this decision.

Thanks again,

[Gitti]

And Gitti,
Thanks again,

You are welcome!

[bczmama]

I should have mentioned as well that I think the best thing you can do in this situation is find the nearest "traveler's clinic". They will have very specific, current information about which vaxes and preventatives they recommend for where you are going (which may frequently vary depending even on which part of a particular country you're going too). As they "specialize" in vaxes, they (in my experience) are usually very helpful in discussing the details of each of the shots.

[rabrog]

If I had known that we would have clean drinking water without a problem, not been handling animals without immediate facilities to wash, etc. I would have skipped the MMR and typhoid at least. Probably would have skipped yellow fever, too.

We were around camels, elephants, etc. but had access to washing facilities with clean water immediately afterwards. We boiled our drinking water or purchased it at the store in Nairobi (mainly boiled) and were careful about what we ate and drank. Eating was done at roadside stands (BEST french fries...omg...and chicken... ) that was a "known" to the gal we were visiting. Other food we prepared ourselves or ate at a restaraunt. We weren't in danger of any of those diseases.

Jenn

[cristinaoketch]

I have been to Africa several times, I do not vax my daughter, and returned from Uganda this past summer after 1 month, during rainy season...both rural and metro.

As far as REQUIRED vax, there are non...the same way they are REQUIRED here, is the same way they are REQUIRED in Africa...if you offer a reason why you do not vaccinate, you can receive a waiver which is exactly what I did for Yellow Fever to Uganda. I simply called the embassy, asked with whom i should speak regarding required documents, and was told to simply include a note stating why I dont vax...religious excemption would work best here.

Wannabe, posted something about a bunch of vax, as well as the "boarder agent", LOL, this is posted as if what happens in Africa happens, here...its just so funny to think that the beaurocratic practices that we take for granted here would just be assumed to be present abroad. Not to say someone might now ask, but simply saying why you dont, or saying that you received an excemption should do the trick....a bribe would also work well in this case too

And as far as rural and metro, these are things you might come in contact with regardless of your location, especially with rural villagers moving in and out of the city...

Please dont be scared into vaxing...if you have a belief that they are toxic to your body and your childrens bodies, remember that the chances of them getting these diseases are still VERY low, and if they did contract measles of polio, what are the chances that that contraction would be serious??

Your questions are ones i asked my self many times as I flew my 21 month old for 20 hours in to Sub Saharan Africa...and once i arrived i just laughed at how I had forgotten how safe and "americanized" many parts of Africa are, and the same way I bring my daughter outside here and never think twice about vaxing, is the same way I felt there.

If you have any other questions about the malaria meds, or the vaxs, send me a PM. I worked in the Permanant Mission to the United Nations for Kenya for a short time, so I may have some contact info that might be helpful.

here are some pix of our trip....

http://i199.photobucket.com/albums/a...sinTimothy.jpg
http://i199.photobucket.com/albums/a...inscousins.jpg
http://i199.photobucket.com/albums/a...hinPakwach.jpg
http://i199.photobucket.com/albums/a...phinasgoat.jpg

[wannabe]

Ariahsmum, I'd get Hep B in case of a crisis of some sort that would see you needing rehydration, or god knows what. It's present in over 8% of the population in that part of Africa, which is pretty scary.

Hep A - you need to be aware that when it's endemic somewhere, it's not just in the water, it's on the food, and roadside stands and even great restaurants can give it to you. We had the pre-opened pepsi scam pulled on us in a very nice restaurant in India.


[QUOTE=cristinaoketch;9755680]

Wannabe, posted something about a bunch of vax, as well as the "boarder agent", LOL, this is posted as if what happens in Africa happens, here...its just so funny to think that the beaurocratic practices that we take for granted here would just be assumed to be present abroad.
[quote]

What, a group of men with guns who'll accept bribes leering at your breasts? That doesn't make you nervous? I can sure as hell tell you I wouldn't be handing over a religious exemption and telling them more handwashing will save their continent from AIDS. Or did you think I meant a nice man in a suit in an airconditioned office with a stamp for your passport?

[harmonymama]

I just returned from Rwanda

I just returned from a year of international work in Rwanda (we were planning to stay even longer) with my DH and two sons. My sons were entirely unvaxed before we made the decision to go to Rwanda. I think its a very challenging decision! I would concur with the PPs that you should look carefully at the CDC recommendations and the WTO disease incidence.

After a lot of research, here's what we did for our DS's:
Dtap (Diptheria is deadly and is possible to contract in Africa)
IPV (also some recent polio outbreaks on the continent)
Yellow Fever
Typhoid
Meningococcal (frequent outbreaks in recent years in Rwanda)

We did not do Measles, Hep A (usually mild in young children), Hep B (although I can see the reason for this, sometimes blood transfusions are required in serious cases of Malaria).

Measles is also deadly in Africa, but this is mostly due to malnutrition and overcrowding not the disease itself.

In hindsight, I would not have done Typhoid (you can get it anyway), and no one ever asked to look at record of our Yellow Fever vax. I suspect that is an outdated law that is no longer enforced, but you never know.

The most serious concern in Rwanda is malaria. I knew many expat families with young children who live there long-term. Some did prophylaxis; some didn't. The funny thing is the only expat kids I knew who actually got malaria were the one's who were on long-term prophylaxis. Malaria preventatives are really not recommended for than a few weeks, and I don't think they are worth it at all except perhaps for short trips to very infested areas. They are not all that effective at preventing malaria and wreak havoc on the liver. The best prevention are mosquito nets and mosquito repellent (malarial mosquitos only come out at night). We were there a year and never got malaria. Many of my expat friends lived there many, many years without ever suffering from malaria. Mosquito nets really do make all the difference. That said, most Rwandans do live with periodic malaria throughout their lives and it can be deadly in young children (though very rarely). As long as you stay on top of any fever, there are very good treatments these days and any serious complications can be prevented. Malaria can be a big deal (it is for the population at large), but in my experience its not that big a deal for expats once you're living there.

Also, its important to think about the most likely health issues you and especially your child will face are digestive bugs: amoebas, giardia, worms... Most everybody gets them at some point or another. Our 3-yr-old got them quite often and they can be pretty nasty. We are still suffering from some digestive issues. THE MOST IMPORTANT THING YOU CAN DO FOR YOUR HEALTH IN AFRICA IS USE THE HIGHEST QUALITY WATER FILTER-- A KATADYN. NOTHING ELSE WILL DO FOR A LONG-TERM STAY.

Hope my experience helps. I think it is a very personal decision. In hindsight I'm not sure I would have done any vaxing, in fact I believe that my oldest son has suffered from a (relatively mild) reaction (even though he was 5 at the first vax), and we've had to return to the US to treat his learning/behavioral issues that may have some connection with the vaxing.

Good luck! Our time in Rwanda was a wonderful experience despite the challenges. I hope yours will be to. Feel free to PM me with any further questions about Rwanda. BTW, what are you thinking of doing in Rwanda?

[kaspar]

Originally Posted by harmonymama

The most serious concern in Rwanda is malaria. I knew many expat families with young children who live there long-term. Some did prophylaxis; some didn't. The funny thing is the only expat kids I knew who actually got malaria were the one's who were on long-term prophylaxis. Malaria preventatives are really not recommended for than a few weeks, and I don't think they are worth it at all except perhaps for short trips to very infested areas. They are not all that effective at preventing malaria and wreak havoc on the liver. The best prevention are mosquito nets and mosquito repellent (malarial mosquitos only come out at night).

please, please get anti-malarials... the key is to get the *right* anti-malarial for the regions you will be visiting. there are different strains of malaria in different parts of the world. even if you are sleeping under an itn, those nasty skeeters can still get underneath - i think i got at least 6 bites during our month in zambia despite taking all the recommended precautions! so i was very glad to be taking antimalarials. i know a number of people who have had malaria (some multiple times), both africans & ex-pats, in africa and india/sri lanka. it is a pretty horrible disease.

diptheria is definitely necessary as well - it is endemic in some parts of africa. i'll see if i can find my inocculation records to see what else was recommended. but i would definitely go to a good travel clinic in your area and have a frank talk about what is exactly needed and why, and go with a detailed itinerary of where you will be.

the last thing you want to do in africa is get sick. unless you are in sa, their hospitals are pretty good! but most other countries have pretty dire health care situations... my bil was in hospital for 3 weeks this summer and it was awful. one nurse to do the overnight shift for two wards of 25 people each. you had to have a relative or hired nurse stay with you if you wanted any attention (the nurse locked herself in her office every night). people dying right next to you. i think my husband is scarred by his experience takig care of his brother overnight while people died around him.

[ariahsmum]

Thanks so much, Kaspar... it is good to hear your experiences with Malaria.. I was just talking to a doctor friend who pretty much said the same thing... she knows people with Malaria... told me a lot about the disease, etc. Pretty scary. I don't really need any of these diseases... and i don't need to spend any time in a hospital when I am there! It makes sense to use wisdom and protect ourselves with medicine in prudent cases.

One question I have now though is about DTaP and DT. Apparently, the clinic where I am going can give me either. The DTaP does not have thimerisol (sorry for spelling errors, I am not taking time to look it up) but the DT does. WWYD?

I personally am not really worried about pertussis and would rather have the lesser vaccines, but I guess I would not want to pass this to a baby, where it is indeed more dangerous. I also would like to avoid mercury, even though it is "in such minute amounts" Grrr....

[kaylee18]

If you're getting vaccinated, be sure to have immunity titers run first. You are very likely not to need a booster if you've had the shots in the past (even if it was more than 10 years ago in the case of DT), and there's a good chance of a protective titer even for never-vaccinated individuals. They're expensive and take a few days to run, so the doc's not likely to suggest them, but insurance paid for all the ones I had prescribed (while I've had insurance, that is).

[ariahsmum]

kaylee, I am unvaxed. Never had anything at all... so I should still get titers in your opinion? For everything or just certain things?

Any advice welcome.

Also, these clinics want to vax me all at once... everything in one sitting. Is there reason to split things up, stagger them for an adult? And still figuring out the DT vs. The DTaP due to the mercury issue.

Thanks so much everyone!

[janellesmommy]

My advice is to find out if there are any vaccines that are legally required with no exemptions. Someone mentioned yellow fever?

If there are one or a few vaccines that are non-negotiable, then those diseases must be the ones that the government believes are a big risk, and the others they must believe are not such a big risk.

I guess if you are even considering MMR and certain others that means the only reason you feel comfortable not vaccinating in the United States is because of your belief in herd immunity? That is different belief than many of us on the vaccination forum, who are not afraid of the diseases, especially MMR.

Tetanus spores are no more prevalent in Africa than anywhere else in the world. Diphtheria can be treated with antibiotics, and are the rates actually high where you're going? Pertussis is an annoyance for an adult or 5 year old. Not worth vaccinating for. Hepatitis A usually doesn't even show symptoms in children, so you can easily scratch that off the list for your daughter.

[kaylee18]

I would get titers for everything meeting the following two conditions: (1) insurance would cover the cost; (2) a disease for which I was seriously considering immunization. Also, for titers meeting the second condition but not the first, I'd get a cost estimate and consider running it anyway.

Some vaccines involve live viruses that you can "catch" from other people, effectively raising your titer without a shot; some natural infections might not have been noticed; some pathogens (such as the one that causes diphtheria) are close relatives of other, more common, less severe pathogens that can also induce immunity; and for tetanus there's often environmental immunity.

I'd also check what titers might have been run at previous times. For example, the rubella titer is a standard prenatal test.

[bczmama]

"I guess if you are even considering MMR and certain others that means the only reason you feel comfortable not vaccinating in the United States is because of your belief in herd immunity? That is different belief than many of us on the vaccination forum, who are not afraid of the diseases, especially MMR."

Or it could be that she realizes that people do on occasion need hospitalization for Measles, Mumps and Rubella and while she is fine with taking the risk of the disease due to the medical care available in the US, she weighs the risk/medical care differently if the medical treatment will be obtained in Africa.