Risk of Hepatitis?

November 11, 2008 8:18 AM

Wife and I are heading to Egypt in less than a month and have read Hepatitis A & B vaccinations are recommended. As insurance doesn't cover this, it's a whopping $500 for both of us to get jabbed. How risky is it to not get this vaccination for African travel?

I seem to recall that this used to be a fairly standard inoculation given to kids, but for whatever reason, we both never had it done. Wiki says it's transmittable through contaminated food and water, which I imagine in Egypt is slightly more likely to occur, but usually contracted by kids.

While I don't want to play fast and loose with our health, is this one of those immediate expenses that can be up there with trip insurance and extended warranties?

posted by remlapm to health & fitness (21 comments total)

Have you stopped by the local public health clinic? I think at mine the shots are $40 piece (3 shots, but you get A&B together).

Also, I'm not sure how much protection you'll have in just a month's time. You get one shot, wait 3 months for another, and then 6 for the last.
posted by sbutler at 8:34 AM on November 11, 2008

I would recommend getting both, but you have no time to get the Hep B shot. It is a series of three shots, with the second a month after the first and the third six months after that. The Hep A vaccine is two shots, with the second at least six months after the first. You could start the process now, but I don't know the efficacy of only having the first part of the sequence.

As for whether you should get them or not, I would recommend at least Hep A if you are going to be doing a good deal of traveling. It was recommended even for countries like Greece. As for Hep B, even in the US they take it pretty seriously. I am a graduate student in the US (US citizen, too), and they required me to prove all my immunities through either immunization records or blood tests. When my Hep B test came up negative, I had to get all the shots again. It can wear off, apparently.

The cheapest way to get the shots would most likely be through your county health office. It tends to be cheaper and they do many of the travel vaccinations.
posted by Gneisskate at 8:37 AM on November 11, 2008 [1 favorite has favorites]

Does your insurance not cover the vaccination specifically because you have requested it for travel, or just in general. Depending on your plan, you might be able to request a GP to simply administer the vaccination without mentioning that it is part of a travel consultation. If your visa doesn't require it, then you don't need to have a Yellow Card (and the corresponding travel consultation from a physician).
posted by Burhanistan at 8:38 AM on November 11, 2008

1) Unlike most "extended warranties", getting vaccinated is definitely something that's worth the money, particularly for travel in the developing world. Depending on where you go, the incidence rate can be close to 100%. Public hygiene is often downright disastrous, and you can contract fairly unpleasant diseases even if you aren't doing anything irresponsible. Contaminated drinking water is a prime cause of Hep-A infections, but even eating food which has been prepared with contaminated water and then inadequately cooked can infect you. Hep-B is slightly harder to come by, as it generally involves some exchange of bodily fluid, but seriously, don't mess around. There are vaccines, they work, and there's no good reason not to take them.

2) Especially not the cost. sbutler is right: There's no way this should cost $500. Someone is giving you the runaround. Look for other options.
posted by valkyryn at 8:45 AM on November 11, 2008

$500? I had mine done for some Africa travel at a travel clinic and it didn't cost even half of this. Less than a month is too late to be fully protected - they are a couple of injections with time elapsed in between. (Three, I think, if you go for the Twinrix.) I had this issue too, but the first shot apparently had me up to 85% protected.

I'd really recommend it. I was viciously ill with food poisoning - twice - while in Egypt. And I was exceptionally careful about what I ate.
posted by meerkatty at 8:54 AM on November 11, 2008

(D'oh. I just realized that $500 was for both of you. I paid about $200 for mine. Still - recommended. It's your health - and it's for life!)
posted by meerkatty at 8:56 AM on November 11, 2008

you do NOT want to be hospitalized in Egypt. Even if your travel insurance covers airlifts and Israel is just a short ride away, you do NOT want that to be your option.

There are things that you skimp on when you travel. vaccinations is not one of them.

are you sure your insurance won't cover it? also, you don't need to go to the special travel medicine wing of whatever big hospital to get it done. that is probably why it's $500. just guessing.
posted by micawber at 9:26 AM on November 11, 2008

I'm facing the same thing -- going to Egypt next month. I called the hospital "travel clinic," which was ridiculously expensive. My first hint should have been that it was for "executives," and charged extra for several vaccinations same-day. I then called my primary care doc, who charged for the vaccinations only and it was more reasonable, but not much less than the $500 for both of you. I think that's just what it costs. My fancy health insurance plan does not cover it, regardless of the reason, so you may be stuck. (hee). The travel clinic recommended getting not only Hep A and Hep B, but also tetanus, polio, and a flu shot. IANAD, but my dad and travel buddy is, and his firm advice was not to fuck around with this. Not the same as travel insurance or extended warranties, which I generally think are overkill.
posted by *s at 9:39 AM on November 11, 2008

Yeah, as someone who ate food from the street all year in Egypt, I can tell you that I am deeply thankful that I had those shots. Go to your public health office to get the shots.

Since you're not going to be completely innoculated though, be careful when eating food in Egypt because I suppose that's where there's the most danger of getting sick. I would avoid salads at all costs and eat only peelable fruits raw. Since you're going to be there in December or so it is orange season and I am insanely jealous of you. Eat tons and tons of the oranges there, they are really fantastic.

The water in Cairo and Alexandria is fine and should not make you sick. Avoid water in the south of Egypt and do not drink the water in Sharm el Sheikh or Sinai at all, not even for brushing your teeth. Despite the fact that most hotels in Sharm have a very western appearance, the water there is completely undrinkable and will get you sick (most of my friends got sick there; I have a strong stomach I guess...this, after a month of drinking Alexandria tap water). Really, though, bottled water is cheap and readily available and Cairo water tastes terrible so drinking bottled water is a better idea anyway.

If you are going to be there for longer than a week, do eat pickles, which are regularly served with fuul and available nearly everywhere. These pickles (assuming they are not made badly, and most are fine) will have friendly local bacteria that will help with digestion. Similarly get your hands on some yoghurt which should also help to acclimatize your stomach.

Street food is really fantastic but far too risky if you are not innoculated. Avoid all stands without running water. The most important variable, though, is throughput: does this shop get a lot of customers? If so, their food will be made more freshly and will have less time to sit and go bad.

Meat is nearly always very well cooked in Egypt (almost impossible to get something cooked rare) so this is less of a concern. Fish will similarly be well-cooked although try to go for saltwater fish (from the Mediterranean) rather than freshwater fish (from the icky Nile). The fish I saw in Egypt was generally very fresh and looked at least as good or better than the fish that you get at the average supermarket in the States (i.e. it is definitely fresher than what you'd see in an Acme, Giant, Kroger, etc. and at least as fresh as what you'd see in a Whole Foods which generally has fresher fish). Delicious and worth eating at an establishment that appears clean.

If you are a foodie or would like food recommendations feel free to contact me via MeMail.
posted by Deathalicious at 10:37 AM on November 11, 2008 [1 favorite has favorites]

I can attest that Deathalicious is a fantastic Egypt food guide! :)
posted by k8t at 11:25 AM on November 11, 2008

A woman I work with just went through this. Children are regularly vaccinated for Hep B. In California - you get your first dose before you leave the hospital after being born but in what seems to be a cost control measure - adults are not routinely given hep B vaccines anymore. Insurance would cover it if you were a meth addled sex worker as Hep B is fluid born (think same transmission as HIV). Hep A is oral/fecal (food worker has Hep A - doesn't wash hands - you get Hep A) and if you only get one - get that one.
I know nothing of the Egyptian health care system - but I'm guessing they don't have the same rigorous testing of their blood supply like we do. If you needed a transfusion while you were there - you could potentially be exposed to Hep B. So... don't get an accident, don't have crazy unprotected sex with someone not your spouse and don't share needles and you should be ok without Hep B vaccination. It's that first one you have to worry about...
posted by Wolfie at 11:29 AM on November 11, 2008

OK, Hep A is foodborne so it would definitely make sense to me. I know around these parts every restaurant worker needs the Hep A vaccine, so I'd imagine that drives the price down, but I'm not sure if that's US-wide.

The part I'm wondering about is Hep B which the CDC describes as transmissible from "Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn." (Not saying it's a bad idea, just that I wouldn't be as worried about it.)
posted by Kid Charlemagne at 11:35 AM on November 11, 2008

Three hours of comments and nobody mentions the Hep B thing. Don't preview, and then someone does before I hit . Sigh.
posted by Kid Charlemagne at 11:37 AM on November 11, 2008

The NHS's patient leaflets are always useful in cases like these, though of course their information about licensing and so on will not always be applicable to the US.

Hep B vaccination leaflet - note in particular that an accelerated course, which takes only 3 weeks, is available in the UK at least, which probably means it will be in the US as well (it's much more frequent that things not available over here will be over there than vice versa). This was partly what led me to these leaflets, because I was sure I remembered having the short course 5 years ago.
Hep A vaccination leaflet - less detailed, in large part because it's more straightforward; you should just get it.
posted by Acheman at 12:38 PM on November 11, 2008

I had this convo with my PCP about 20 years ago, and back then they didn't worry so much about Hep A, so this is very old data. I asked him if I needed Hep B, and he asked if I could be exposed to it.
"I share a washroom with 500 people at the office."
"Bend over."

Point being, you really need it in this country and I wouldn't want to be out of the country without it. Think about it; do you want to bet that everyone in Egypt is going to wash their hands when they see you coming? (Blood, semen, other body fluids. For the phrase "other body fluids", trying substituting in your head, "fecal borne disease". Suddenly it sounds like a lot less attractive risk to be taking, doesn't it?)

You also do need tetanus (and should always keep it up to date anyway), flu, & polio. If you are old enough, maybe pneumonia too. If your immunization history is deficient in any way, catch it up. Outside this country, people still have mumps, measles, chicken pox, that kind of measles you can have more than once (whatever it's called) and nobody else in your environment there is likely to be immunized. You do not want any of these as an adult. Mumps, for example, on an adult, can "drop on you" as the oldtimers called it and can kill one or both testicles. I don't know about smallpox but you should ask. It's easy to overlook the kid stuff, but ask for your history, in case something got missed back then.

Basically, ask your PCP, and read the State Dept recommendations. Anything they recommend, I wouldn't leave home without it. I would guess even the the first Hep B shot would convey some protection, and don't forget to finish the series when you get home; it's still a great idea to be fully protected.

IANAD, and it's a little late to start now, so this is not advice, it's just questions you should ask your doctor.

There must be a cheaper way to get this if you look around. The expensive Hep B shots might be available at the the County Health Service. Many/most counties have an STD clinic, and since it can be sexually transmitted, it's possible they offer the shots for that a lot cheaper. (I knew someone within the last 5 years in our county who just wandered in, with a request for routine testing, and he got the shots there for incredibly cheap or free. If they don't look receptive to a request for routine testing, the kind you'd ask for if you were starting a new relationship, you could always develop some mysterious rash that comes and goes, and look vague about the details, but most of them don't ask questions. Too many people these days starting new relationships who ask for it.)
posted by unrepentanthippie at 12:40 PM on November 11, 2008

Confession: I did not look up the "fecal borne" part, but the doctor was pretty emphatic about it at the time. Your doctor's opinion may vary, and that's why I suggest you ask them.
posted by unrepentanthippie at 12:51 PM on November 11, 2008

Just to check back in, I found someone here (NYC) that is willing to load me up with basically anything we want (HepA/B, Typhoid, Flu, Tetanus) but it will cost us about $80 a pop. NYC public health wasn't too accommodating, so we need to go to a private office.

Though, you have all scared me senseless and now I don't want to leave my hotel, so we are getting it done.
posted by remlapm at 12:58 PM on November 11, 2008

You'll be fine. I found Egypt to be relatively clean. Get the shots, shop around (I suggest calling at least 3-5 places). I find that hospital "travel clinics" are the most expensive. Some lucky folks find cheap local government health offices but you might need to go to a private "travel clinic." When you ask the price also ask if there are any additional costs like consultation, injection fee etc. Even though I know exactly what I need when I go in they always charge me a $30 consultation fee and $5 per injection extra. Make sure that's $80 per shot, so you know you'll need more shots for Hep B so it's $80 x 3 ultimately.

Insurance will often pay for this sort of thing if you get it from your primary doctor. A lot of primary doctors don't cover travel vaccinations but Hep might be possible. Is your tetnus up to date? You need a booster every 10 years.
posted by Bunglegirl at 1:13 PM on November 11, 2008

read the State Dept recommendations. Anything they recommend, I wouldn't leave home without it.

It's up to everyone to decide what's needed but if I read the State Department/CDC warnings or followed all of their advice I'd never leave my house, let alone the U.S. My non-medical opinion is that the OP will be good with Hep A&B and Tetnus. People that travel a lot should probably get their Polio and Meningitis shots updated too.

When I get sick it's usually from eating in nice restaurants. I like to see them making the food in front of me, that the only way to know it hasn't been sitting around.
posted by Bunglegirl at 1:25 PM on November 11, 2008

Bunglebirl -- "relatively clean"?!? Wow, where else have you traveled? :)
posted by Deathalicious at 8:42 PM on November 11, 2008

Deathalicious, I was going to say "really clean and Western" but thought you guys would think I was crazy. I've been to around 50 countries, a lot of them more "scary," obscure, remote and/or dirty than Egypt... India, Ethiopia, Congo, Madagascar, Tajikistan... any country with free wi-fi in McDonalds (like Egypt) is pretty developed to me.

The only problem I had in Egypt was constant (and I mean literally every few minutes) solicitations for sex from old men. I've been to a lot more supposedly conservative Muslim countries and Egypt is the only one where I wish I had covered my hair, the only part of my body not covered in loose clothing. It's worth the hassle, though and I think the OP shouldn't let the warnings in this thread about disease and food frighten him too much. The longer you have to travel the more adventurous you can be with food because your stomach will build up tolerance to the local bacteria.
posted by Bunglegirl at 9:21 AM on November 12, 2008