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Any Medicos out there? Do I need 2 lots of Hepatitis A+B shots?

Any Medicos out there? Do I need 2 lots of Hepatitis A+B shots?

Old Sep 9, 2003, 7:34 am
  #1  
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Any Medicos out there? Do I need 2 lots of Hepatitis A+B shots?

A weird thread even for me, and I appreciate any advice offered is: "not to be relied on as being a consultation and other necessary disclaimers" etc, etc.

I travel a lot to some pretty off-beat and unusual places, where hygiene standards are not the same as most first world countries. And have done so for 30 years.

A couple of weeks ago I was staying at a tiny native village 10 kms up a deeply rutted mud track on the side of a mountain. The last 4km by foot in pitch darkness. In the Highlands of Papua New Guinea. Accessible by 4WD only. No power at all. No running water. No shower. No sanitation. No phones. No internet. No TV. No Flyertalk. No food or booze other than what you bought along. "Challenging" shall we say.

Those and other small places in Africa, Asia and South and Central America etc means you need to be right up with inoculations. Due to a change in doctor, I do not have records from years back, but I am quite certain I have had one or more courses of Hepatitis A+B jabs over the years, along with all the other stuff. Yellow Fever, typhoid, cholera, Malaria etc, etc.

Current doctor suggested I have another course "just to be sure". Had one shot a month back. Wants to give me another now, and another booster in a few months. First jab was something called "Twinrix" 1mm dose. Not sure if that brand is sold outside oz.

Firstly it is VERY expensive - here at least. Secondly my arm REALLY hurt after his jab!

My sister is a nursing sister and told me (afterwards!) I simply did not need the initial one, and certainly did not need the others as any initial courses would have protected me for life.

Is anyone here up to speed with this kind of info?

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Old Sep 9, 2003, 9:29 am
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I took Hepatitis A today and it cost me 400SEK
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Old Sep 9, 2003, 9:43 am
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Glen I suggest the following:

Try to get your records from your old doctor to see what he gave you.

Typhoid and Cholera are not routinely given in the US, so I don't know much about them. There is no immunization for malaria, only prophylaxis pills that you take once you get to your destination.

Visit the CDC website for more details on what vaccines are recommended for what locations: http://www.cdc.gov/travel/destinat.htm

Hepatitis A vaccine is given in two sessions, separated by at least 6 mos (1 month in the case of twinrix). Twinrix is a new combination Hep A and Hep B vaccine made by GSK: http://www.twinrix.com/

Hepatitis B vaccine is usually given as a series of 3 shots over a span of at least 6 mos.

If you are unsure what type of shots you have received in the past and if you don't want any new shots, ask your doctor to check your antibody titre.

Good luck (all usual disclaimers apply).
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Old Sep 9, 2003, 9:57 am
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Thanks for heads up sgopal2.

The Twinrix I got a month back was a combined jab of Hep A+B. A follow up now was supposed to occur and a booster in 3 or 6 months.

Other Doctor records I sadly can't access but he was always jabbing me with something. He was fanatical. I've been to the Amazon 3 or 4 times and this was a must as hygiene there is not great. And I know darn well there was a course of Hep A and B at some point. Grrr.

If I take nothing now is the first jab a month back of no lasting effect? My sister (who is not an MD but a operation ward recovery Sister all the same) says that they now feel Hep can be combated a lot more effectively with jabs than they used to think. As Kempis points out this stuff can cost a bomb, especially when combined in 1 shot. Can't put a price on health of course, but if I already had the shots it seems wasteful.

Yes the Malaria is always 'per vacation' - this one was 8 x Larium 250MG. Pre, during and post visit. I was in coastal New Guinea as well, in Madang and Port Moresby .. Goroka and Mount Hagen are too elevated for mozzies.
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Old Sep 9, 2003, 10:14 am
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If you find you do need a course of Hep B, you might check on the cost of getting them here or in Canada, since you come through this way frequently anyway. Since they became required for students in California the cost has come down considerably. Insurance covered ours, but there are frequently clinics set up for those who need them and don't have insurance.
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Old Sep 9, 2003, 12:31 pm
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I'm not a doctor, but everything I've read says that if you want to get the best and longest lasting protection, you need to do have at least two shots.

Unless the cost is really outrageous, I'd get the second round.

But, that's just me. I tend to think it's better to be on the safe side, as getting sick is never fun, especially while abroad.

d
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Old Sep 9, 2003, 12:43 pm
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Up here, the claim is that a 2nd Hep A booster 12 months after the 1st will give you 20 year immunity. Hep B is 3 over 6 months. Cost for the Hep A is CAD 65 for the 1st and CAd 45 for the 2nd. Hep B is CAD 35 each.
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Old Sep 9, 2003, 3:27 pm
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We had the A + B series and our MD told us w/ out the 2nd shot, the vaccine is not effective.


burkey once referred me to a site that has been very helpful about these and other issues

https://www.tripprep.com/scripts/main/default.asp

you have to register but it's free and has a lot more useful stuff than other sites of its type.
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Old Sep 10, 2003, 3:13 pm
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<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Originally posted by squeakr:
We had the A + B series and our MD told us w/ out the 2nd shot, the vaccine is not effective. </font>
The above is true ONLY IF you have never had a HepA or HepB vaccination before. If it is the first vaccination, then 1 shot of either (or the combination) will not afford any protection.

If you have been vaccinated previously, then 1 shot may be enough of a 'booster'. But the only way to know is to get a blood test to test your immunity for both A & B ('titres').

RE: Hep B -- if you responded to your first set of 3 shots, then you are likely protected for ~10 years. Initially, the thought was protection for life, but as time went on, a fair number of people lost their immunity, so a booster is recommended.

RE: Hep A -- the vaccine is too new too say much on long-term (&gt;10 years) immunity. If you were vaccinated more than 5 years ago, I would check the blood test first.

As an aside, I received 3, yes THREE, series of HepB shots (9 in total over the years -- ouch!) and I NEVER mounted a response by my blood test. Although I was working in high-risk areas, I stopped getting them.
(stick me once, shame on you; stick me 9 times, and I am bloody fool)



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Old Sep 10, 2003, 3:19 pm
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Regarding the other vaccinations --

Yellow Fever -- is good for 10 years, and most countries that require immunization records want to see that is was done in that time period.

Typhoid -- not sure how long it lasts, not too many years. There is an oral form (2 capsules) available.

Malaria -- as noted, it has to be taken for each trip. AND DON'T FORGET TO TAKE IT AFTER YOU LEAVE -- malaria can 'hide' in the body for months/years after you leave the area (the record I heard was a WW2 vet getting malaria in the 1980s)

**** As always, please confirm these suggestions with the authorities, as the recommendations change often. I would go to the CDC site.


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Old Sep 13, 2003, 1:05 am
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DaDOKin DC - excellent advice, thank you.

JUST what I wqs looking for. OK, seems like two more courses of jabs are on the schedule.

Better safe than sorry, and if I did have all 3 jabs it would have been some years back, and may not be much protection for me now.

We are heading to the Latin America rainforests soon so now or never I guess.
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Old Sep 13, 2003, 9:35 am
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Twinrix (or however spelled) is against A and B. You need two shots with a few weeks inbetween. After you had this you need to let your blood checked after I think 10 years. If you are often in high risk areas your doc can check your blood if you still have enough antibodies. I paid in May 35 Euros for this. The vaccine is here around 100 Euros per shot.
My mother also travels (well, not so of the beaten path) but a lot into rural areas around the world, and she goes to our local tropical institut, who offer for tourists checkups and are allowed to administer (and have them always available) all possible vaccines. They also do bloodchecks to see what antibodies you already have.
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Old Sep 13, 2003, 9:53 pm
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Thanks Daydream.

In Australia blood tests are totally free. We can do every day and be tested for anything we like. So I should get a test to see if I have antibodies to the hepatitus? If I do, there seems no need for more shots - is that the theory?
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Old Sep 14, 2003, 5:56 am
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Blood tests after Hep B are routine in the UK (although vaccinations for this are not routinely carried out - you have to ask specially for it here). Even after a course of vaccinations, you still may not have developed immunity (although A + B are given seperately here, so not sure how much this will apply). One of my colleagues cannot get Hep B to "stick", while another needed two more injections.

Hep A will provide 6 weeks of protection if the course is not completed. 10 years if course completed.
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Old Sep 14, 2003, 1:02 pm
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ozstamps:yes, in theory thats how it should work. If you get the blood test, you want to have them do a qualitative test which will tell you "how much" antibody is present (not just a positive or negative) and then check with the OZ equivalent of the Centers for Disease Control to see if they have established what antibody levels are considered "protective". Interestingly, our hospital requires all employees to get these shots, but never tests for anitbody response. Although some people develope an immunity by getting mild cases of hepatits (like a bad stomach flu - but they never become jaundice) its more common to get immunity to the common "childhood" diseases that way, at least in the States.


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