TOPIC: Travel & Vaccinations

There have been several posts recently about visiting Bangladesh in person. For anyone thinking of jumping on the next plane, it could be worth remembering that several countries recommend getting vaccinated for some or all of the following before visiting Bangladesh:

Hepatitis A and B, Typhoid, Dyptheria, Tetanus

In particular, I have heard that people with Hep-C can be particularly susceptible to Hep-A and Hep-B. Does anyone here have any experience / recommendations on this? Is it necessary to get vaccinated if staying only briefly in Dhaka?

Me, I think I had (vaccinations) for Dyptheria/Tetanus a long time ago, but never Hep A+B or typhoid...

I guess, the same question could equally arise re travel to India, ... or even Australia?

Thanks!

Sources:
www.mdtravelhealth.com/destinations/asia/bangladesh.html
travelhealthpro.org.uk/locations/bangladesh/
www.travelhealth.ie/countries/Bangladesh.php
www.pasteur-lille.fr/vaccinations-voyages.php?pays=Bangladesh

I know, not sure I want all those vaccines in my already stressed body Vororo.

Hepatitis A (viral) and Typhoid (Salmonella Typhi bacteria) are both faecal oral - clean water (bottled), no salad and chances of getting it are low. Faecal oral is the medically polite way of saying "eat shit and die". I bet you never knew where that phrase came from? This is where.

Hepatitis B is spread via bodily fluids exchange so safe sex and not sharing needles with IVDU minimise risk

ADT (Acellular Diphtheria and Tetanus) is a cheap and cheerful vaccination good to boost every 5-10 years regardless.

If you were planning a day trip chances are you don't need these. If you were staying longer not a bad option.

Did I mention the time I stayed in for a year in the Solomon Islands and decided I did not need malaria prophylaxis anymore? After I actually got malaria I realised I was wrong. If you're wondering it's like an "I wish I was dead" dose of flu. Actually it was more like "I wish I had continued to take my Doxy" dose of reality check.

So short stay with care, you should be ok to skip things. Long stay... get the lot.

I have been immunised twice for Hep B. Once before travelling to Asia about 10 years ago, and again by the Liver Clinic when my blood tests showed I had no resistance to Hep B. about 3-4 years ago.
My recent bloods showed that I don't have resistance to Hep B. again. At first the Registrar thought I might have developed an auto immune disease, further tests showed I haven't. The clinic did recommend that I get vaccinated again quickly. At this stage I'm waiting until I finish my 12 weeks of Sof/Dac. Yesterday I learnt I have no HCV detected. I'm not planning any trips to Asia in the near future. Am I making the right decision?
At this stage the clinic could not give me a reason why I don't have Hep b immunity.
Can you shed any light on this Dr. Freeman?

Hi Vicki

When I got my hepB vacc. the procedure was to do it once and then test right away to see if my immunity was good enough. It was not, so I got a 2nd dose then which boosted it to the correct level. I don't understand it but you have to keep at it with the boosters until you get to the right level. I assumed that once I got there I stayed there, but I've never been tested since so I don't actually know.

dt

Interesting and thanks Downtime. The registrar at the Liver Clinic said that you shouldn't need a booster once you have been vaccinated against Hep B. Maybe I misunderstood something?

What I meant to convey is that the hepB vaccination that I got (Engerix- does not always give good enough immunity if you only do it the one time. Maybe that is what happened to you. The only way to know is to test after it has been done and repeat the vacc until you do show immune. I documented all by HBV shots as follows:

2007 October 5th
HepB first shot

2007 November 2nd
HepB 2nd shot

2008 April 4th
HepB 3rd shot.

2008 June 3rd
Blood draw shows HBV booster required

2008 June 25th
HepB 4th (booster) shot at GP .

August 28th 2008, test shows HBV antibody levels are now OK.

ENGERIX-B was the vacc.
Somehow the editor put in a smiley face instead.

That makes sense. Thanks. I'll take this info back to the clinic on my next visit.

www.immunise.health.gov.au/internet/immu...handbook10-4-5#4-5-6

Booster doses

Booster doses of hepatitis B vaccine (after completion of a primary course by using recommended schedule) are not recommended for immunocompetent persons. This applies to children and adults, including healthcare workers and dentists. This is because there is good evidence that a completed primary course of hepatitis B vaccination provides long-lasting protection. Even though vaccine-induced antibody levels may decline with time and may become undetectable, immune memory persists and is thought to result in a protective immune response on re-exposure. However, booster doses are recommended for persons who are immunocompromised, in particular those with either HIV infection or renal failure. The time for boosting in such persons should be decided by regular monitoring of anti-HBs levels at 6- to 12-monthly intervals.

Very interesting doc.
My hbv vaccinations were directed by my hepc doc at a UK hospital infectious diseases / virology department. I am not immunocompromised. So there's a difference in policy between UK and AU, or at least there was circa 2007.
dt

My hospital routinely checked to see if I had resistance to HepB - I do but I was vaccinated years ago. I would say it's definitely worth checking to see if you are immune before having more?

Hi LG,

This is interesting because you are in the UK also. If your hospital was routinely checking it implies that they were prepared to give you another vaccination if they found you had no resistance to Hepb. Otherwise why check? Are you immunocompromised?

The guidelines posted by the doc say not to worry about it. Get the primary course and you are good to go. No need to check.

So I don't know, but good luck with this Vicki. If you learn any more at your next clinic visit I'd be interested to hear about it.
dt

Hi DT - My first hospital didn't check for resistance, they just told me I must have Hep A and B vaccinations. ASAP. Luckily I don't just do As I'm told even though they told my GP to ensure I did this.

I changed hospital and new hospital did a routine check for all Hepatitis - Which was nice as I as going to check for immunity privately, so then it came back I was immune, as I suspected as I lived abroad for a while. So no need to have the vaccine. Hospital never discussed, so I don't know if they would offer it, rather they'd tell you to go to your GP and get it. I believe you can get them free if your hospital recommends you need them to your GP.

Think I will save the HepA vaccination until my liver is feeling a bit better.