Africa Travel - Page 2

[kaylee18]

I'd also look at the actual incidences of disease in the particular areas to which travel is planned. roxyrox gave a great link for doing that, but also investigate whether the reported cases were imported or acquired within the country (gives a much better idea of which diseases actually exist within the country than just the total cases).

[ariahsmum]

Thanks you guys, soooo sooo much. Really. I am usually research queen, especially on this, and honestly I know a lot about "diseases" and vaccines in *this* country, but never thought about other countries as I never figured we'd be traveling there. This is throwing me all off, especially since right now I am literally up to my eyeballs in paperwork for a homestudy, figuring out how to induce lactation, finding someone to take over my household when I am gone as well as trying to find contacts in Rwanda itself that will house me and support me. They are telling me travel time is fast approaching and we quite literally only opened to this as an idea 3 weeks ago, so it is fast. We are also starting fundraising all while trying to keep up with the normal routine of puppy care and unschooling and family...::::: ::

So, no I am not unvaxed for solely the belief in "herd immunity." Not at all. However, the reasons here are different somewhat from the reasons to vax or not to vax in rural Africa, so I am trying to tease out the issues and rebuild my beliefs according to a rural African situation. It, to me, is not apples to apples, especially considering (as a PP said) medical care there... The fact that it sounds like I could be worse off going to a hospital than NOT going to a hospital. KWIM? So I am just trying to figure out a new system and the real risks versus the perceived risks... the risk of the vaccine versus the real risk of the diseases... the risk of care versus the risk of staying out of hospitals altogether.

I am totally not concerned with Tetanus. I may be about diptheria. I don't know anything about it there in Africa where I will be, nor do I know anything about its treatment in said place. I know what there is to know about Pertussis, and I again have to check the numbers in Rwanda and Kenya as I would not really want to give it to my baby.... who will be under the 6 months where I am concerned about it- but who knows maybe they vax for that anyway? I don't know, that is another piece to figure out while my head is spinning with so much other stuff.

Let's see. They are not advising HepB unless I decide to have sex with someone there unprotected which is pretty darn unlikely, he he. Hopefully I would get to decide. I guess it doesn't always happen that way, but I don't need to attract that experience to my existence...

HepA they are suggesting, and honestly I know NOTHING about it for some reason... my mind is a total BLANK. Gotta stay up tonight and read about it...

Polio- they want me to have the inactivated vax. Not a bad idea for a place with polio, but then I gotta weight the chance of contracting the disease with the risk of vaxing for it... and then also the risks after I contract the disease (if I did) and what that may mean to my family... Just thinking out loud here, let me know if I am completely wacko!

They recommend MMR... I went to a college of totally unvaxed kids, and we had two outbreaks, yes a lot of people died of measels. But blah... life is uncertain. People die and the others get stronger. Harsh, but true. I don't know how prevalent it is there and what my true risks of it are, and what treatment would be in the hospital there and if that treatment would be enough or if it would put me at risk for other dread things....

Meningitis- they only recommend this during the dry season which is not when I will be there and for prolonged exposure to the local populace, which I would suspect I will have since I will be in an orphanage for most of the time. Hmmm... again, gotta go research the disease.

They do say that just because a country requires a certain vaccination, it does not imply that there is not a great risk with other diseases as well. So I can't just say that yellow fever is a huge risk but not polio, for instance.

Sigh.

Now gotta go wash my clothes so I have something to wear for the homestudy today...

Oh, and I am not bringing dd now... too much on her wee system and I will not be comfortable bringing her without vaxes.

Still spinning:

[harmonymama]

Jaya,
I totally sympathize with how overwhelming it is preparing for a trip to Africa. Let me know if you need any help with finding other support there. Regarding, Hep A, it can make you very, very sick for a long-time, not fatally ill, but miserable. However I did not get vaxed and did not contract it in my nine months there. However, I never ate street food, restaurant food rarely, and we bleached all fresh fruits and veggies at home. I think a lot of these things also depend upon where and how you will be eating and drinking. If you will be eating many, most of your meals out with little control over how it is prepared, then I'd get Hep A if I were you, FWIW. Sanitation is the main variable in disease in Africa. Again, your biggest concern is going to be giardia, amoebas, worms, salmonella, things like that. It might help to take some natural remedies: herbs, acidophilus, vit. C, etc. with you. Also find a good clinic/lab to go to when you get ill, rather than a hospital. Try the Adventist Clinic in Kigali, that's where most expats go whenever they get ill. Its not too expensive either.

All the best,
Celeste

[kaylee18]

If you are planning to travel really soon, there may not be enough time for a vaccine to produce a response anyway. Multi-stage vaccines such as Tdap commonly take 5-6 months to produce a high antibody titer, and even single-injection vaccines such as MMR take 6 weeks to 3 months for the antibody response IIRC.

[ariahsmum]

Originally Posted by kaylee18

If you are planning to travel really soon, there may not be enough time for a vaccine to produce a response anyway. Multi-stage vaccines such as Tdap commonly take 5-6 months to produce a high antibody titer, and even single-injection vaccines such as MMR take 6 weeks to 3 months for the antibody response IIRC.

This totally makes sense and is what I thought originally, but then I wonder why all the clinics are telling me that I can just go 10 days in advance and immunity is straight away? Grr...See why I hate all this : !

Thanks so much Celeste, I will pm you for more health info sometime when I remember: I'm gonna go order a bunch of my favorite VitC right now.

[ariahsmum]

Okay, so I'm replying to myself (guess I like hearing myself talk) but...

FOR CRYING IN THE NIGHT!!!!! I talked with a "secretary" (as the doc referred to her) today who sounded fantastic and helpful. I thought I would go to that clinic just by virtue of her interaction with me...But then the doc called me back to answer some questions and drum roll please,:...

When I asked about the ingredients for yellow fever and polio, if they had mercury (cause I specifically wanted him to order in mercury free-vaxes for me) he interrupted me to tell me "I don't know and even if they *did* have thimerisol they are *completely safe*."

Blah blah blah.

Guess I won't be going there! At least if I am gonna vax selectively, I need to go to a place willing to work with me! Geesh.

I shouldn't be surprised.

Alright, I've heard myself talk enough. Off to clean. Ha!

[amnesiac]

FYI - neither one of those contains thimerosal.

[Deborah]

Originally Posted by amnesiac

FYI - neither one of those contains thimerosal.

So glad that you know more than the doctor who works in a clinic specializing in giving these injections!

My goodness:

[amnesiac]

Travel medicine has sort of become a specialty of mine lately!

[harmonymama]

By my recollection yellow fever and Dtap can and do contain thimerosol, at least Dtap for sure, but you may be looking at a different polio vax.

[wagamama]

I think the biggest factor here is - where will you be staying? In rural areas, or in the city? Will you be living in "huts" in villages, or staying in expat-style apartments?

My DH works in international aid. We lived in Nairobi from 2004-6, and now live in Nigeria. Before we left, I got all my vaxes because I was scared and didn't know any better. I also had a baby in Kenya, and he was fully vaxed up to a year (then I stopped).

Personally, I totally REGRET getting all those vaxes for myself and my son. We are living in apartments in big cities, we don't eat street food ... the risks of contracting a disease are fairly low. Yes, there are higher risks for things like menengitis and polio, but still, they are not so high.

Malaria is definitely our biggest concern, but we don't take any medication for it. Instead, we are very careful about not being outside at sunset, using window screens and mosquito nets, etc. However, if I was living in a rural area, I might take the medication.

Anyway, I wish I had known then what I know now. Please think carefully about this decision.

[amnesiac]

Yellow fever is a live virus vaccine so it cannot contain thimerosal.

[harmonymama]

Originally Posted by wagamama

I think the biggest factor here is - where will you be staying? In rural areas, or in the city? Will you be living in "huts" in villages, or staying in expat-style apartments?

My DH works in international aid. We lived in Nairobi from 2004-6, and now live in Nigeria. Before we left, I got all my vaxes because I was scared and didn't know any better. I also had a baby in Kenya, and he was fully vaxed up to a year (then I stopped).

Personally, I totally REGRET getting all those vaxes for myself and my son. We are living in apartments in big cities, we don't eat street food ... the risks of contracting a disease are fairly low. Yes, there are higher risks for things like menengitis and polio, but still, they are not so high.

Malaria is definitely our biggest concern, but we don't take any medication for it. Instead, we are very careful about not being outside at sunset, using window screens and mosquito nets, etc. However, if I was living in a rural area, I might take the medication.

Anyway, I wish I had known then what I know now. Please think carefully about this decision.

:
ariahsmum, I hope you listen closely to those of us who have lived in Africa. Everything depends on your sanitation, living arrangements, food you eat, etc. These things are so much more important than vaccines. After you have lived there you will see things differently. BTW, how long will you be there? I have seen time and again both in Africa and India among the expats we knew the ones who were the most fully vaccinated and took all the meds got sick more often and more seriously than those of us who were not FWIW. I think that while vaccines may protect against the disease they are designed for, they also compromise the immune system and make it less effective at fighting off all the everyday things.

[ariahsmum]

Getting closer

Thanks everyone for your opinions, knowledge and experiences... honestly, this is all happening so fast and you may wonder why on earth I am still here researching this... well I haven't even had time to look up any info as I have been only keeping one nostril above water getting everything gatherd for the homestudy, traveling to appointments, talking with the agency, talking with people in Rwanda, getting fundraisers going, looking into lactation etc all on top of everything else I normally do. I just haven't gotten to a comfortable spot knowledge-wise yet with these issues.

I am about to make an appointment tomorrow with the clinic so I gotta decide. So much to sort out- what is the real risk of contracting these diseases? Can I contract them anyway even with the vax? Even if I get the vax, will it have enough time to produce antibodies prior to travel (End of January)? Sigh. In my spare time I will do it.

Part of the problem is i don't really know what to expect in Rwanda. I will be in Kigali for the most part (that is where the orphanage is) and I have no idea what my arrangements will be. I assume that I will be staying at a place that is "nice" (altho no pricey hotel) maybe with a host family, maybe renting an apartment type of thing. I will be likely spending most of my time in the orphanage however unless they allow me to take the child home with me while we wait for the adoption to go thru. Length of stay could be 1-3 months. BTW, I don't even know what street food is, nor do I have a clue what expat means altho I get the context.

As it stands now, I also have to go back thru Nairobi in order to get the child's visa. I will not know anyone there and will be mostly at the US embassy so no bushwacking or huts there...

I know they "require" Yellow fever. So I guess I gotta get that. (no thimerosal in it BTW)

I know I will most likely take antimalarials.

They suggest two adult doses of MMR but I have had one dose when I was 19 and all other countries only recommend one dose... so right now I am planning to skip that one (any other ideas here).

The travel clinic is NOT recommending HepB. anyone have ideas on if that is correct or not? I am not planning any IV drug use or sexual activity, obviously I can't know if i will need a transfusion (BTDT)...

HepA is recommended for all travelers. No idea about this... haven't looked into it don't know even how it is spread (food and water). Looks like the vax contains formaldehyde and a bunch of "other ingredients".

Meningitis is recommended for this area ONLY IN THE DRY SEASON. I am not planning to be there during that time. (May thru OCtober I hear?) Does this seem right or true for those of you that have been there?

Polio they do recommend- it is inactivated one dose, no thimerosal but preserved in formaldehyde and contains phenoxyethanol (woo-hoo). I am leaning toward taking this... ideas?

Tetanus/Diptheria. Okay, I am totally confused on this. I am not worried about pertussis. But I have not had any vax in this series, so it is my understanding that I would need the whole series beginning with one does of DTaP and followed 4 weeks later with one DT and another DT 6 months after.
If this is true (is it?) then I donlt have time for it anyway, unless my body will start producing antiboties on the first DTaP and therefore offer me some protection. Another question- do I really need to worry about tetanus? I know there is good info from Aviva J rohm but I have not had a chance to read it. And I still have yet to learn about Diptheria, how it is spread (food and water?), how much is there and what treatment/prognosis is as well as how effective the vax is anyway. Help me here.

Ugh- where is AmyD when I need her? She would have all this all sorted out for me in about 2 hours max. Sigh, I miss her.

So to recap:

meningitis- no (not dry season)
HepB-no
MMR-no(had one adult does)
Polio-yes
yellow fever- yes (required)
HepA- yes (have no idea why though)
DT or DTaP- maybe?

Seriously, if anyone of you can takes each vax listed above and give me some idea of if I am on the right track, please let me know. Any conflicting or enlightening ideas welcome... it would be sooo helpful to not have to come home tonight and stumble around the internet forever searching for info...

A million thanks in advance,

[amnesiac]

Generally it is recommended that if you are going to get any vaccines you do so at least 2 weeks before you depart. No vaccine is ever 100% perfect so yes it's posibble to get sick even if you vaccinate. With regard to your list:

meningitis- no (not dry season)
HepB-no
MMR-no(had one adult does)
Polio-yes
yellow fever- yes (required)
HepA- yes (have no idea why though)
DT or DTaP- maybe?

I would add that the dry season is actually December-June. You can verify that & look at the map of the "meningitis belt" here. People who are most at risk of contracting that are those who have prolonged, close contact with someone infected. So I don't know how that fits in with your plans exactly.

I don't see typhoid on your list so I'm not sure if that's a yes or no for you but typoid & hep A are both foodborne, whereas hep B is bloodborne. That's why many travelers place hep B lower on their list of priorities when choosing which vaccines (if any) they want.

If you want to read what is in each of those vaccines, just click on the brand name in this chart.

[janellesmommy]

OT, but Ariahsmum, just wondering how BOTH you and your DH managed to go through childhood unvaccinated? And how does your mom feel about you putting vaccines in your body, LOL

[ariahsmum]

How did we *both* manage? All our parents are also unvaxed (with exception I believe of smallpox) ... essentially they don't believe in medicines... used religious exemptions to get us thru.

And get this, my brother was born when I was 12... at a time when everyone was circ'ed... but my parents said NO!

Aren't they so cool? And they weren't even hippies...

Oh, and amnesiac, thanks sooo much. The travel clinic isn't recommending typhoid. Hmmm.... I will check that out.

[crocus]

I am planning to travel to Rwanda for 3 weeks next summer so this thread is especially interesting for me. My DD (3.5 months) is currently unvaxed and I would love to keep it that way, but since my DH is originally from Rwanda, we would like her to meet her grandparents and extended family in Kigali. It is such a hard decision to make! What did you decide to do, ariahsmum?

n

[harmonymama]

ariahsmum-
sorry I didn't see your message sooner. Diptheria is a very serious, probably fatal disease, rare though possible to contract in Rwanda. I would not worry about Tetanus, can only be contracted through a puncture wound.

I personally would not worry about polio for myself especially not for a short-term stay. There has not been a case in Rwanda in many years. The only risk would be contraction through someone travelling into Rwanda from another country.

I'd also be interested in what you decided.

[ariahsmum]

OMG- I crack myself up!

Alright, I have to say that you would have totally loved being a fly on the wall at my appointment! I took an entire day off, brought dd to my mother's house, drove two hours to a huge international clinic and met with a doc for supposedly a 1/2 hour appointment (where they were willing to give me *all* the shots I "needed" that day.) Okay, I had done like hours and hours of research, and was still totally dragging my heels on what to do. I was previously resigned to yellow fever, but then the night before found a blurb about it being live virus and the consequent warnings with lactation. I want to nurse this baby!!!!

So, I was having second thoughts and thinking I could get a medical exception made. Ha!

So... doc was really great, some resident was sitting in with her, and I warned her about me. I just need to know everything, and i think I know everything . So, she sat with me for TWO hours. Yup, you read that right, TWO hours! Lemme just say that if anyone needs an int'l doc, this is the one! She was fantastic!

The run down according to her:

Since I am unvaxed, she does not think it worth it to try to catch me up with either Polio or DTaP. She crossed em off the list right quick. I love when decisions are made for me!

Yellow fever... definitely more complicated risk/bene analysis since the nursing thing.... I don't know. Yellow fever sounds downright fugly to get, major fatality rate with it... it is there I guess, so hmmm...

She originally said no to typhoid since it seems to only provide 70% immunity, but then she thinks that is a better than 0% immunity that I have unvaxed... hmmm.

HepA maybe.

HepB no

She actually recommended influenza, which I listened to rather than gasp and shudder in horror. Her reasoning seemed to make sense- that I would be flying with tons of exposure to lots of people, and that lying alone in a hotel room with flu in Rwanda leaves something to be desired... but she didn't talk about the fact that they don't even know if the strain of the vax will match the strain of flu so maybe ineffective form what I understand. I decided in the night (up at 3:30am going over and over this in my head, lol.) that I would get the famous lypo-spheric vita C and take tons and also snort eucalyptus oil on the plane every so often as it kills the germies in my nose... and then of course bring my oscillioisoiosksonmmumum... or whatever it is called.

So stuck still on yellow fever (she offered me an exemption) HepA and typhoid.

Guess I just need to go in healthy and wash hands and avoid scary food... no swimming in creepy crudy waters...

Oh, and stay away from baby spit. How do I do that?

Anyway, can you believe I left for the day, traveled two hours back home and didn't even return with one iota of vax in my system? people laugh at how much thought I put into this, but really...

I want to do what is right for me, and that includes whatever I am gonna feel good that I have protection from. I don't want to dig my heels in to no vax, then be terrified and stressed the whole time that I am gonna get some dred- plague disease.

Tell me you read this! I hate talking to myself!