Vaccinations

[LHT28]

21 hours 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.

The  big  question is  where are you going??

 

Have been to the Caribbean &  through the Panama  canal many times  & never required  shots

Basic shots  like Tetanus  should be up to date 

Check with your Doctor  & check the requirements  for  the Countries you will be visiting

besides  the CDC

check  https://www.iamat.org/country-health-advice

 

 

[new_cruiser]

2 hours ago, resjes said:

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.

 

The CDC provides advice for cholera prevention.

https://www.cdc.gov/cholera/preventionsteps.html

If you are traveling in an area where it is a concern, stick to bottled water/drinks and cooked food served hot and peel fruits. Water and food aboard your ship shouldn't be a concern as it is produced from sea water by the ship's plant.

 

I've not taken anti-malarial drugs on cruises. Malaria infection is from mosquito bites and those bites can carry other infections that don't have vaccines (e.g. zika and dengue fever). So unless spending a lot of time in a place where malaria risk is high, it's generally better to prevent bites using mosquito repellent (picardin or DEET). I prefer to use picardin because it is as effective as DEET, is non-greasy, has little smell and won't harm plastics. Sawyer is a brand available in the US that uses picardin. Anti-malaria drugs function by making your blood unfriendly (i.e. toxic) to the parasite, but your body may not react well to the drug either. I've taken anti-malaria drugs for land trips in areas where it is endemic, but not for cruises where the time exposure isn't that long.

 

CDC information on Malaria including the risk per country.

https://www.cdc.gov/malaria/travelers/index.html

[GeezerCouple]

I probably should have emphasized, when mentioning a friend/colleague who died from malaria, that he was NOT on a cruise.

He was not even on vacation.  He was in Africa, on a relatively short scientific project.  This was not near a coast, and not where cruise passengers are likely to go. 

(We'll never know why he got that sick, that fast.  As far as we all knew, he did not have a weakened immune system or anything unusual like that.)

 

However, my point was that IF one IS going to a place where there are concerns about "exotic diseases" (to those of us unaccustomed to some of these diseases), they can be very real, and they can even be deadly,... even with the very best medical care.

 

GC

[SRF]

On 3/5/2019 at 11:30 AM, resjes said:

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.

 

One thing to mention is when and what series Hep A you got.

 

The first Hep A vaccine was a single shot.  Seems it did not work too well.  They went to a two shots, 1 month apart, better.  And currently, it is combined with Hep B and is 3 shots, 1, then 1 month later another, then 6 months after the first one.

 

I prefer the oral thyphoid.  Since its path is intestinal, I figure innoculating the intestinal tract is better.  4 pills, every other day.  Pills MUST be keep cold at all times.

 

 

[SRF]

On 3/5/2019 at 11:39 AM, Hlitner said:

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).

 

1)  The people at the airport checking, do not care what country your passport if from.  If they want to see a YF vaccine, you better be able to show them one, or be delayed at best.

 

2)  In about 70% of the cases where they wanted to see it, they were happen to see the ICOV yellow booklet, they did not even look in it.

 

3)  When they actually look in the booklet, I am not sure they can read well enough to tell how long ago your vaccination was.

 

All that said, I still want to have it, to not have to sit in a 3rd world terminal, waiting for someone who actually might know what they are doing and capable of making a decision. 

[GeezerCouple]

11 minutes ago, SRF said:

 

One thing to mention is when and what series Hep A you got.

 

The first Hep A vaccine was a single shot.  Seems it did not work too well.  They went to a two shots, 1 month apart, better.  And currently, it is combined with Hep B and is 3 shots, 1, then 1 month later another, then 6 months after the first one.

 

I prefer the oral thyphoid.  Since its path is intestinal, I figure innoculating the intestinal tract is better.  4 pills, every other day.  Pills MUST be keep cold at all times.

 

 

 

We each got a single Hep A and Hep B shot a few years ago.

I recently asked that we get tested, and sure enough, NO immunity. 

 

So we are partway through the 2/3 series now.

But ours don't include any combined shot:  2 for A, 3 for B.

 

GC

[sanger727]

34 minutes ago, SRF said:

 

I prefer the oral thyphoid.  Since its path is intestinal, I figure innoculating the intestinal tract is better.  4 pills, every other day.  Pills MUST be keep cold at all times.

 

 

I did the oral one as well when I went to Africa but for a different reason. The oral vaccine is good for 5 years as opposed to 2 with the shot and it was cheaper.

 

if this is still reference the labadee stop, I’m confused about why this is recommended. You get typhoid from contaminated food and water. Isn’t labadee essentially a private area run by the cruise line? So all the food and drink will either come from the boat or in some way be shipped by the cruise line? 

[sanger727]

34 minutes ago, SRF said:

 

I prefer the oral thyphoid.  Since its path is intestinal, I figure innoculating the intestinal tract is better.  4 pills, every other day.  Pills MUST be keep cold at all times.

 

 

I did the oral one as well when I went to Africa but for a different reason. The oral vaccine is good for 5 years as opposed to 2 with the shot and it was cheaper.

 

if this is still reference the labadee stop, I’m confused about why this is recommended. You get typhoid from contaminated food and water. Isn’t labadee essentially a private area run by the cruise line? So all the food and drink will either come from the boat or in some way be shipped by the cruise line? 

[resjes]

1 hour ago, SRF said:

One thing to mention is when and what series Hep A you got.

 

The first Hep A vaccine was a single shot.  Seems it did not work too well.  They went to a two shots, 1 month apart, better.  And currently, it is combined with Hep B and is 3 shots, 1, then 1 month later another, then 6 months after the first one.

It says "unspecified formula" on mine, I guess my pediatrician didn't write it down on their chart. It has a HEP A shot in June 2006 and again June 2007. My HEP B was June 2000, August 2000 (I was most likely away and that is why it was 2 months apart), and May 2001.

 

Regarding the typhoid via oral route, does it interact with meds? I noticed a lot of "oral immunizations" are really just antibiotics. Which, I am highly allergic to many.

 

I'm hearing different things about Labadee. Some have said the food/water comes from cruise but others says that just because it is a port owned by RCI, doesn't mean the food can't be contaminated with cholera, etc.

[wheezedr]

Oral typhoid is a vaccine, not an antibiotic. It is significantly more effective than the injectable vaccine, with a longer effective  life.  It is also way over the top for most Caribbean cruisers.  In fact you are agonizing way to much about immunization for your Caribbean itinerary.  In 40 years of practice I cared for literally thousands of patients who traveled to every continent but one, Antarctica.  I spent lots of time reviewing patients records and CDC and others recommended vaccines, as well as lecturing to both medical students and house staff on the subject.  Most important, maintain your usual vaccinations, including seasonal ones like the Flu, WASH your hands, and be practical in what you eat and drink when in other parts of the world.  Try to use things that are bottled or canned and processed, bottled water, soft drinks, beer.  But remember, if your not sure, do not pour them over the local ice.  Kind of defeats the purpose.  You can always drink your beer warm and pretend you’re British.

[LHT28]

Just now, resjes said:

I'm hearing different things about Labadee. Some have said the food/water comes from cruise but others says that just because it is a port owned by RCI, doesn't mean the food can't be contaminated with cholera, etc.

Thousands of cruisers visit Labadee  each year

If Cholera was a problem there   you would hear  more about it

 

I think you are overthinking  this

JMO

[Go-Bucks!]

On 3/7/2019 at 1:55 PM, wheezedr said:

It is also way over the top for most Caribbean cruisers.  In fact you are agonizing way to much about immunization for your Caribbean itinerary.  

 

TOTALLY agree!  Millions of Americans visit Caribbean islands each year and don't get the vaccinations you are concerned about. 

 

I'm a nurse who's currently on a world cruise going to 36 countries on 5 continents...I consulted with a Nurse Practitioner and Pharmacist at CVS before leaving home to decide which vaccines I might need. Originally I called a Travel Clinic but they did not accept my health insurance, wanted $85 just to be seen and each vaccine cost between $100-400!!  My insurance covered everything at CVS 100%! 

 

Anyway, I was already up to date with influenza, Tdap, shingles and MMR. After studying the CDC guidelines, we decided to have me get the Twinrix (combined Hep A & Hep B) according to the accelerated schedule, the oral typhoid vaccine, and the Prevnar 13 (pneumonia). Cholera and a polio booster were discussed but they didn't recommend them.

 

I would suggest that you might not want to travel overseas at all if you are severely immunocompromised...but most people with good immunity do not need to be fearful of rare diseases in the Caribbean.  That said, using mosquito spray with DEET should help to reduce the chance of Zika, dengue, malaria or other mosquito borne diseases. 

[GeezerCouple]

2 hours ago, Go-Bucks! said:

 

TOTALLY agree!  Millions of Americans visit Caribbean islands each year and don't get the vaccinations you are concerned about. 

 

I'm a nurse who's currently on a world cruise going to 36 countries on 5 continents...I consulted with a Nurse Practitioner and Pharmacist at CVS before leaving home to decide which vaccines I might need. Originally I called a Travel Clinic but they did not accept my health insurance, wanted $85 just to be seen and each vaccine cost between $100-400!!  My insurance covered everything at CVS 100%! 

 

Anyway, I was already up to date with influenza, Tdap, shingles and MMR. After studying the CDC guidelines, we decided to have me get the Twinrix (combined Hep A & Hep B) according to the accelerated schedule, the oral typhoid vaccine, and the Prevnar 13 (pneumonia). Cholera and a polio booster were discussed but they didn't recommend them.

 

I would suggest that you might not want to travel overseas at all if you are severely immunocompromised...but most people with good immunity do not need to be fearful of rare diseases in the Caribbean.  That said, using mosquito spray with DEET should help to reduce the chance of Zika, dengue, malaria or other mosquito borne diseases. 

 

I'm curious about the combo Hep A & B vaccine,  How many shots are given?

We didn't know about that (not sure it matters, except inconvenience, which is minimal), and need 2 Hep A, but 3 Hep B.

 

Thanks.

 

GC

[Go-Bucks!]

1 hour ago, GeezerCouple said:

 

I'm curious about the combo Hep A & B vaccine,  How many shots are given?

We didn't know about that (not sure it matters, except inconvenience, which is minimal), and need 2 Hep A, but 3 Hep B.

 

Thanks.

 

GC

 

Here is the CDC guideline for the accelerated dosing schedule for Twinrix:

 

Notice to Readers: FDA Approval of an Alternate Dosing Schedule for a Combined Hepatitis A and B Vaccine (Twinrix^®)

 

In April 2007, GlaxoSmithKline Vaccine Division (GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania) received approval from the Food and Drug Administration (FDA) for an alternate schedule for Twinrix^®, a combined hepatitis A and hepatitis B vaccine. Twinrix was first licensed by FDA in 2001 on a 3-dose schedule (0, 1, and 6 months) for vaccination of persons aged >18 years (1). Using the newly licensed, alternate 4-dose schedule, Twinrix doses can be administered at 0, 7, and 21--30 days, followed by a dose at 12 months.

In immunogenicity studies among adults aged >18 years, the first 3 doses of the alternate schedule provided equivalent protection to the first 2 doses in the standard 3-dose Twinrix series (2). The first 3 doses of the alternate schedule also have proven effective in providing protection equivalent to a single dose of monovalent hepatitis A vaccine and to 2 doses of monovalent hepatitis B vaccine, administered using the licensed schedules for the monvalent vaccines (3). Thus, the alternate 4-dose schedule can be useful if vaccination with Twinrix has been initiated and travel or other potential exposure is anticipated before the second dose of Twinrix (or monovalent hepatitis B vaccine) is due, according to the standard 3-dose schedule (i.e., 1 month after the first dose). Additional information is available from the manufacturer's package insert (4) and GlaxoSmithKline Vaccines, telephone 800-366-8900.

[Go-Bucks!]

GeezerCouple:

 

The reason I chose this accelerated dosing was because I wanted the most protection as quickly as possible because I was leaving very shortly on this long cruise.

 

Next December I'll need to get the final dose of Twinrix, the Prevnar 23, the newest shingle vaccine and a polio booster.  That should do it until 2022 when I'll need another Tdap.  Well, yearly flu too.

Edited March 8, 2019 by Go-Bucks!

[resjes]

People - just to clarify. I made this topic so I could be informed about vaccines. Please keep your thoughts to yourself regarding if I should reconsider my trip because I sound too sick to you. Thanks.

 

I will go to the travel doctor (and pay the $95 out of pocket). I'd rather have vaccines done in a doctor's office and have the recordation. Hopefully, I won't need too many vaccines and the oral meds are covered by my insurance (oddly, the shot vaccines are not!).

 

Thanks to everyone who has given me valuable input on this topic.

[K32682]

On 3/5/2019 at 2:41 PM, new_cruiser said:

I've not taken anti-malarial drugs on cruises. Malaria infection is from mosquito bites and those bites can carry other infections that don't have vaccines (e.g. zika and dengue fever). So unless spending a lot of time in a place where malaria risk is high, it's generally better to prevent bites using mosquito repellent (picardin or DEET).

 

This is very good advice for malaria.  I've done four extended business trips in northern Namibia which is just inside the CDC's malarial zone.  My travel doc insisted on Malarone which I took on the first trip and suffered annoying but manageable side effects.

 

I stopped taking it after a conversation with South African-trained physician who ran a clinic in Namibia.  She told me that region is considered "low transmission,"  no one she knew took anti-malarials, that not all mosquitoes carried the parasite and her view was that reported cases were mostly from workers who came from the north, specifically Angola, where rates are higher. 

 

The guest house where we stayed was sprayed daily, I was scrupulous about using DEET repellent in the evenings and wore clothes treated with premethrin. As a result of my African experiences I would certainly never consider anti-malarial drugs on a cruise.   

Edited March 8, 2019 by K32682

[new_cruiser]

8 hours ago, Go-Bucks! said:

That said, using mosquito spray with DEET should help to reduce the chance of Zika, dengue, malaria or other mosquito borne diseases. 

Repellent with picardin is just as effective and it's more pleasant to use. It's non-greasy and has almost no smell (to humans) so they don't have to add strong fragrances to cover it up. 

 

I agree with most of your other points. I did get the polio booster in my 50s for a 3-week trip in China. Probably overkill, but it's a one time thing. 

 

I did oral typhoid before my Panama & Costa Rica cruise but that was more because of other trips I have coming up (land and cruise in Thailand & land in Costa Rica). My husband didn't get it since he was only going on the cruise.

[LHT28]

Just now, resjes said:

People - just to clarify. I made this topic so I could be informed about vaccines. Please keep your thoughts to yourself regarding if I should reconsider my trip because I sound too sick to you. Thanks.

 

Charming

[SRF]

On 3/7/2019 at 1:29 PM, GeezerCouple said:

 

We each got a single Hep A and Hep B shot a few years ago.

I recently asked that we get tested, and sure enough, NO immunity. 

 

So we are partway through the 2/3 series now.

But ours don't include any combined shot:  2 for A, 3 for B.

 

GC

 

When they first came out with the Hep A vaccine, it was supposed to be good for 2 years.  One major university offered it to all their teaching hospital staff and bio/biochem research lab people.  At 1 year, the tested for antibody, and there was NONE. 😄

 

Later testing discovered, it was good for about 6 months for immunity.

Edited March 8, 2019 by SRF

[GeezerCouple]

6 minutes ago, SRF said:

 

When they first came out with the Hep A vaccine, it was supposed to be good for 2 years.  One major university offered it to all their teaching hospital staff and bio/biochem research lab people.  At 1 year, the tested for antibody, and there was NONE. 😄

 

Later testing discovered, it was good for about 6 months for immunity.

 

Well!  I sure hope that the current vaccinations last longer!

If not, they *certainly* should be telling us at the time.
We were told we should have gotten more than one shot.  We still have zero recollection of being told that when we were given the shots... that we needed to come back (or go elsewhere) for followup shots.

 

Hmmm!

 

GC

[SRF]

Again, it depends one when you got the vaccination.

 

The situation I mentioned was mid to late 80s.

 

In the mid 90s, I got the Hep A vaccination, and it was one shot, wait 30 days before traveling.

 

In the late 90s, it went to 2 shots, 1 month apart.

 

In the 2000s, it went to typically being included with the Hep B, so 3 shots, one, then one month later another, and then 6 months after the first one, you get the last one.

 

And then some medical people wonder why I don't believe in "lifetime" vaccination. 😄

 

 

[pacruise804]

On 3/8/2019 at 9:22 AM, fyree39 said:

snip

 

P.S. First time cruisers are like first time parents.  After a few cruises, we stop worrying about a whole lot of things! 😜

 

Very true 😉