Tanzania/Kenya Vaccine recomendations

Hi,

yellow fever is a must as you will need the certificate when travelling between Kenya and Tanzania and also to enter Thailand having been in Kenya / Tanzania

Other than that none are a must, though It is recommended that you are up to date with the standard vaccinations / boosters recommended for an adult living in the west, Diptheria, Tetanus, and Polio. Also recommended are Hepatitis A and Typhoid. It is sensible to be up to date with all these for travelling anywhere, not just the tropics

I would add Hep B to the above list, as well as an effective anti-malarial treatment. Although prevention is often better than a cure. I am not sure of your home country but a visit to a major city hospital that has a tropical medicine clinic might be helpful. Sound like a really great trip. One thing that may not get raised is that the street dogs in Thailand carry a number nasty complaints so stay well away. Cheers.

You may wish to have a look at the Web site of the Public Health Agency of Canada, which has up-to-date fact sheets for every country. Note that they preface all their advisories with "talk to your own doctor" -- nothing really replaces a conversation directly between you and a travel medical professional, especially when it comes to choosing an antimalarial. You may find that the antimalarial (and anti-diarrhoeal) of choice is different for your Asian and African destinations.

[http://www.phac-aspc.gc.ca/tmp-pmv/countries-pays/index-eng.php]

Health Information for Travelers to Kenya. From the US CDC.

Recommendations are pretty much the same for Tanzania, and there are only a couple of other considerations for Southeast Asia.

Yellow fever is a must. Tanzania and Thailand both require it if you are arriving directly from an infected area. See map

Hepatitis A is always a good idea. It is spread by fecal contamination of food & drink. You have little control over who will be handling your food, drink or utensils and how meticulous thy are about handwashing. Heck, you can get it in a developed country--there is currently an outbreak in the US associated with frozen berries sold by a supermarket chain.

There is a combined Hep A/B vaccine. Hep B is spread by body fluids. Even if you have no plans to get, shall we say, very well acquainted with someone you meet on the road, it is possible to get Hep B from a shave or manicure, from a tattoo or piercing, or from needles or blood products used for medical treatment.

Typhoid can be hard to diagnose and there are antibiotic-ressitant strains out there.

If you have not been given a polio booster as an adult, this is a good idea.

Japanese encephalitis occurs in Southeast Asia, but not Africa. It is primarily a disease of pigs & some birds and is spread by mosquitoes that breed around rice fields & hang out in pig sties. Immunization is usually recommended only for people who will be spending a month or more in rural areas.

Ask your doctor if you will be going to a meningitis risk area in Africa.

You should always take precautions about mosquito bites. Besides malaria, yellow fever & JE, there is dengue, for which there is no immunization and which is a serious risk in some places.

As far as malaria medication:
i've been living in Kenya for 2 years as a peace corps volunteer from america and most of us are taking doxycycline. it's pretty mild, just a daily drug. others are taking mefloquine, which is weekly, but has a history of some strange side effects (such as bizarre, graphic dreams or paranoia). I think those side effects are primarily documented when usage is over an extended period of time. I highly recommend bringing insect repellent, regardless of your malaria prophylaxis, even though mosquitos aren't too bothersome in some areas. Have fun!

KA - I have used both doxcycline and mefloquine (Lariam) and now only use mefloquine as doxcy makes me (and many Anglo-Celtic people) very, very sun sensative (factor 30+ sun screens are no protection). A trial useage of mefloquine (half a tablet a couple of days apart) will provide a good indication of any side affects. But again its an issue to be discussed with your doctor.

Thanks so much for all the advice.

I think some booster vaccines maybe required then. Def Hep A also.

We are only spending 2 nights at a Luxuary Camp in the Mara and then 9 nights on a tour from Nairobi to Zanzibar. I expect our hosts for both will be very careful with food and water prep for tourists. Although it always pay's to be careful.

We will carry insect repellent and anticeptic hand gel at all times.

I don't think sunburn will be to much of an issue for us as we keep well covered and are exposed to the ozone in NZ & Auz so used to the strong rays and will take sunscreen with us.

May pay to try the anti maleria tablets a few weeks prior to departure to make sure no side effect occue do you suggest?

IF planning to stop controception while on our honeymoon I have read that anti Maleria tablets may cause side effects in conceiving. Is this true? Does any one know from experience?
I have a feeling that this may not be recommended.

Thanks Again - New Zealand

Contraception, if it's the Pill, often isn't effective while taking anti-malarials...

The problem is only with doxycycline and with some, not all, oral & patch contraceptives. HOwever, the UK Health Agency recently concluded that is not an issue.

Q. Are there any issues with taking doxycycline and hormonal contraception? (Updated December 2012)
A. Pregnancies have been reported following concomitant use of combined oral contraceptives and antibiotics, including tetracycline, a non-enzyme-inducing antibiotic. The hypothesis was that the contraception failed due to the antibiotic temporarily reducing colonic bacteria which in turn reduced the enterohepatic recycling of ethinylestradiol, the semi-synthetic oestrogen contained in all combined hormonal contraceptives.
Having reviewed the available evidence, the Faculty of Sexual and Reproductive Healthcare Clinical Excellence Unit revised its guidance in 2012. These guidelines state that additional contraceptive precautions are NOT required when using non- enzyme-inducing antibiotics, such as doxycycline, concomitantly with combined hormonal contraception.
Additional contraception is also not necessary for women using progesterone only contraception; progesterones do not undergo secondary re-absorption via the enterohepatic circulation.
Women using oral contraception should be advised that the efficacy of contraception can be reduced by episodes of diarrhoea or vomiting, in which case additional contraceptive precautions, such as condoms, should be used.

However, there is another issue. Woman planning to become pregnant may want to wait until all traces of antimalarials have left the system. Mefloquine [Lariam] is usually not permitted in the first trimester. Pregnant women should not take doxycycline, at all--it can harm the fetus. The UK health folks tool US CDC data and translated the information into times

Chemoprophylaxis prior to conception
If a female traveller is planning to conceive during a visit to a destination with a high risk of contracting chloroquine-resistant falciparum malaria, expert advice should be sought
Time to allow after finishing a course of an antimalarial before attempting to conceive:
• Mefloquine [Lariam]: 3 months.
• Doxycycline: 1 week.
• Atovaquone/proguanil [Malarone]: 2 weeks.
Women who have taken mefloquine inadvertently just prior to or during the first trimester should be advised that this does not constitute an indication to terminate the pregnancy.

One other thing. Malaria in a pregnant woman is a medical emergency. For assorted reasons, pregnancy makes you more susceptible to serious complications. These not only include death of the mother, but may include miscarriage.

You may want to seriously consider not trying to conceive until after the honeymoon.

If you will only be in a malaria area for 9 days, Malarone may work for you. Although it is much more expensive on a per pill basis, it is only taken for a week after leaving a malaria area (the other two require you to take them for a month after leaving) , so you take fewer ills overall. (And you can stop the contraception sooner.)

Malarone has few reported side effects.