How dangerous is traveling to Africa without shots?
June 27, 2016 8:05 PM   Subscribe

I'm going to be traveling to Tanzania next month, a family trip. I'm trying to decide whether to get Hepatitis A and B shots before I go.

I'll be traveling to Tanzania for (roughly) a week's stay while a couple of family members go mountain climbing - I and the rest of the vertigo-afflicted will be hanging out below, possibly going on safari. We'll be taking malaria pills and I'm taking an oral vaccine for typhoid, but I'm hesitating over whether Hepatitis A and B are worth the added cost (I'm having to pay out of pocket since my insurance won't cover it).

Doing research online, neither A nor B seems to be terrifying - you're most likely to get them if you're doing risky stuff/eating really sketchy food, neither seem massively communicable (they don't seem to be airborne?) or mortal if you catch them, both are treatable. Yet pretty much every site I visit says MAKE SURE YOU ARE VACCINATED BEFORE YOU GO in big blazing fiery letters. From past experiences I know I'm not a person with good instincts in terms of medical risk (this is exacerbated by a severe distaste for needles). So I wanted to see if anyone in the community here has input on just how stupid this idea is, and what I seem to be missing in terms of just how scary these diseases are.
posted by AdamCSnider to Health & Fitness (41 answers total)
Dude, get the vaccines.

Chronic Hep B can lead to liver scarring and liver cancer, not to mention minor inconveniences like severe abdominal pain and yellow fucking eyeballs. Kids are routinely vaccinated for Hep B now, because it sucks.

Hep A is less "serious" but also highly contagious. It could be more serious for an immune-compromised person.

You know you're being ridiculous. This is a travel cost. However, talk to your doctor about whether there's an anxiolytic they can give you to help you not freak out from needles. Ultimately neither the panic reaction nor the needles can kill you, but cirrhosis really is a bitch.
posted by chesty_a_arthur at 8:12 PM on June 27, 2016 [41 favorites]

Should have added: that trip sounds amazing, and I hope you enjoy every second of it.
posted by chesty_a_arthur at 8:14 PM on June 27, 2016 [4 favorites]

Get the shots. Hepatitis is both fairly common and really really really not a smart idea to contract, if you can help it.

If the expense is bothering you, imagine you're buying a product called Not Having To Worry About Getting Fucking Hepatitis.
posted by theodolite at 8:15 PM on June 27, 2016 [61 favorites]

If it's the money, imagine how expensive living with hepatitis might be. Go get your shots. Amortize the cost in your head across the decade or two or however long it is until you need a booster shot (if ever) and travel a lot more until then to get your money's worth out of your shots.
posted by slateyness at 8:18 PM on June 27, 2016 [7 favorites]

I'm not understanding what the downside to the vaccination is. Get the vaccines. Get them even if you're not traveling.

Btw, doesn't "they're both treatable" involve dialysis and/or transplants? Those are hardly simple treatments with no risk of side effects or complications.
posted by If only I had a penguin... at 8:31 PM on June 27, 2016 [8 favorites]

I recently had the Hep A and B vaccines, and if I remember correctly, one of them is a course of 2 shots given six months apart, and the other is a course of three shots given at zero months, one month, and then six months (better check on that though!). In other words, a single dose isn't the full vaccine. I would imagine that a single dose is better than nothing (possibly lots better), but I'd look into the immunity conferred by a single dose of each over the timeframe you have (I think immunity may take a few weeks to build up?).
posted by ClaireBear at 8:33 PM on June 27, 2016 [4 favorites]

Another thing is (and this is NOT MEDICAL ADVICE): from my own online research on the subject previously, it sounded like Hep A is easier to contract (from sketchy hand-washing and then contaminated food, etc.), whereas Hep B sounded to me like it needed more intimate contact. Depending on your anticipated travel activities and their level of contact/risk, if you can only afford one vaccine Hep A would probably be the one to get (but check with your doctor!). As someone who has had five doses of these two vaccines in the past year (and who also has a dislike of getting shots!), I can confirm that they aren't bad (not as bad as TDaP), your arm aches a bit for only a couple of days, and if it makes you feel better you can think of all the shots you're not getting from having to get hepatitis treatment afterwards.

A few questions. (1) I'm surprised that your insurance doesn't cover it. When I asked my first insurance, they told me that if I simply wanted to get it, it was covered, but if it was for a purpose (e.g. work), it wasn't covered. I switched insurance before my final doses and the same applied there too. I thought most insurance schemes in the US were encouraged/required to cover key vaccines. You might want to call and confirm that it's not covered, and make clear that you want it for personal reasons. If you're outside the US, YMMV obviously. (2) Do you have your pediatric records? Many people in the US had the complete Hep B vaccine course already, and other Western countries also commonly give one or the other (I think England, for instance, vaccinates regularly for Hep A?). You might want to double-check that you haven't had one or both if you're not sure.
posted by ClaireBear at 8:43 PM on June 27, 2016 [1 favorite]

Can you even get a visa without the shots?

No shots would be penny wise & dollar foolish --- or an ounce of prevention is worth a pound of cure, if you prefer that one. And would your health insurance pay for avoidable medical problems?!? I.e., if you choose not to get the shots and end up needing dialysis or other hospitalization because of either version of the Hep, might they consider that something you get to pay for 100% because you could have easily avoided needing it?
posted by easily confused at 8:48 PM on June 27, 2016 [5 favorites]

According to the WHO, Hep. A sounds quite serious if you contract it:

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality... The hepatitis A virus is one of the most frequent causes of foodborne infection. ... Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens. The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life.

You can look at the WHO page for Hep B yourself, but note that:

Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia, where between 5–10% of the adult population is chronically infected...

See also the map on this page, all of Africa appears to be in the "high risk" category (as opposed to Western Europe, Canada, and the US, which are "low risk"). Also on that page:

- Approximately 30-50% of travelers will experience some physical problem while traveling to Asia, Africa, or Latin America. ESPECIALLY if they did not immunize.
- Hepatitis A is the most frequently occurring vaccine-preventable infection in travelers today.

- Most people believe that they are not at risk if they limit their trips to large cities, fine hotels and restaurants, and visit only popular tourist sites. "First Class" ensures only comfort, it does not ensure protection against illness, in fact according to the World Health Organization, most cases of hepatitis A occur in travelers who stay at "middle and upper level" accommodations. You must remember that first class in Calcutta or Nairobi is not the same as first class in New York City or Las Vegas.

posted by ClaireBear at 8:55 PM on June 27, 2016 [1 favorite]

You should really talk to a travel doctor. IAA epidemiologist, IANY epidemiologist, I am outside my specialty, this is not epidemiologic advice and you should really talk to a travel doctor. Here is the CDC page about travelling to Tanzania.

Hepatitis A virus is transmitted by the fecal-oral route, and can survive on hands for several hours. It's endemic in Tanzania. The incubation period is 15-50 days, so it has the potential to really ruin your vacation. There's a two-dose vaccine (0 and 6-12 months) for longer-term protection but a single dose gives almost complete protection at 4 weeks, so it's still feasible if you act quickly. Hepatitis A causes an acute hepatitis, and rarely, fulminant hepatitis (acute liver failure).

Hepatitis B virus is a bloodborne pathogen, so it's not easily acquired (sexual contact, health care exposures involving blood or needles, tattoos). Hep B can cause an acute hepatitis, but in the majority adults it is asymptomatic. Sometimes the acute phase ramps up into fulminant hepatitis. In about a third to half of adults, Hep B causes chronic hepatitis, which can result in cirrhosis or liver cancer. Its incubation period is 45-180 days. You've missed the boat for full coverage - it's a three-dose vaccine usually given at 0, 1 and 6 months, and even the compressed schedule of 0, 1, and 3 months, which doesn't provide great coverage, isn't possible given your timeframe. That said, if you might need medical or dental care in Tanzania, you should start the series.

Btw, doesn't "they're both treatable" involve dialysis and/or transplants?

Not commonly - fulminant hepatitis is a rare complication with either Hep A or B, and transplantation is only necessary where the liver doesn't recover (and is also sometimes necessary with HBV cirrhosis). Most people with acute hepatitis are treated with supportive care (nausea and pain control, fluids.) Chronic hepatitis requires medication to eliminate the causative virus, and where necessary, to address liver failure. Hemodialysis is not a major feature of treatment for viral hepatides.
posted by gingerest at 8:56 PM on June 27, 2016 [13 favorites]

You can get hepatitis by drinking tapwater. Or ice cubes. Good idea to get the shots.
posted by My Dad at 9:02 PM on June 27, 2016 [1 favorite]

Most insurance doesn't cover travel related vaccinations, but Hepatitis A and B are now standard immunizations for children and frequently required for college students. If you're over the age of 30 or so, you might have missed out on getting them as a child but they're still recommended for adults in some cases.

tldr; Ask for the vaccine because of lifestyle risk factors and your insurance will probably cover it. If they don't, you probably can get a discount for paying cash and not billing through insurance.
posted by asphericalcow at 9:02 PM on June 27, 2016 [3 favorites]

The only required vaccination for Tanzania is for yellow fever, and that's only if you've recently been in a country in the yellow fever zone.

Both Hep A and Hep B are worth getting. (Chances are lower, but without the vaccination you could catch hepatitis in the United States without even leaving home.) Hep A is more important than Hep B, but both are important, I'd hate to prioritize one over the other.

It looks like Walgreens, CVS, Minute Clinic and such places often have both Hep A and Hep B vaccinations available, if you need to price shop.

On preview, gingerest just beat me in linking to the CDC page. Note that typhoid is also a recommended vaccination. You might be offered a choice between injection or oral typhoid vaccine. I've done the oral typhoid vaccine....for me, it was miserable. I'll probably need another one in a few years, I intend to get an injection instead next time.
posted by gimonca at 9:04 PM on June 27, 2016

Kids get the shots now. You're tough enough. ;)
I had a friend who got Hep A. She was sick for a year. It wasn't dangerous, but-- she was sick for a year. It was like a year-long mono.

I have to have injections fairly frequently, and it never gets easy. I find it best to look away. And I tell them, "Surprise me." I don't want to have to anticipate while they count.
posted by my-sharona at 9:04 PM on June 27, 2016 [1 favorite]

I didn't get either vaccine when I went in 2003. I actually didn't get ANY shots then or any other time I've visited southern Africa.

But I only drank bottled water, carried my own hand sanitiser, ate very little meat, and wasn't in super rural areas for long.

Given the situation you described, I'd do at least Hep A.

Have fun! Southern Africa is my favourite place to visit in the world.
posted by guster4lovers at 9:16 PM on June 27, 2016

FYI: If your insurance does not cover it, check with your county Health Department - many of them offer certain adult vaccinations, often including the Hep A & B series, at a very low cost.
posted by adrienneleigh at 9:34 PM on June 27, 2016


Why? Ask me about the time I ended up in a hospital for a few nights coming back from Nigeria, having gone without any vaccinations (I did have hepatitis A & B, but none of the fancier ones)

OR ask me about the time we almost died in Zanzibar (off the cost of Tanzania)...not related to not getting vaccinations, but still.

AND when in Dar es Salaam, I did get a really bad stomach infection, and needed to take antibiotics. It was miserable.

Please take care of your health, ESPECIALLY in many parts of Africa. Otherwise, if you F up, call me once hopefully you're safe and well, and we'll laugh about the trauma together. But please, don't let it get to that point.
posted by cacao at 10:47 PM on June 27, 2016 [2 favorites]

Dude, just get the shots. FFS, you live in a first-world country, avail yourself of the advantages.

You will hate yourself for the rest of your life if you catch either of these virulent and horrible and preventable diseases.
posted by ananci at 11:31 PM on June 27, 2016 [6 favorites]

Nthing get the shots.

And as for needles... I used to be so afraid of shots/blood draws but it turns out needles really aren't so bad. It's mind over matter. When you go, wear comfortable clothing. Look away when they're preparing and administering the shot. Television is wonderfully distracting if there's one in the room -- but if you want, you can watch something on your phone or tablet to distract you, or just sing a little song to yourself. Easy peasy.
posted by mochapickle at 11:32 PM on June 27, 2016

My husband had a case of a Hep A that pretty much put him flat in his back for 2 weeks. I caught a case if it at an organic farm in spite of scrupulous hand washing.

Get the shots.
posted by SLC Mom at 12:08 AM on June 28, 2016

I'm African. I live in Africa. My vaccines are up to date. Don't be cheap. It could cost you.
posted by Kwadeng at 12:28 AM on June 28, 2016 [7 favorites]

The thing with Hep A is that you can control everything you do - you can drink only bottled water, you can look carefully at the places you choose to eat, you can "boil it, peel it, cook it or forget it" all you like, but you can't control the people who touch your food. You can't tell whether your very well-trained, smart, clean cook or waiter washed their hands well enough after going to the bathroom, or whether they got slightly lazy and allowed a spray of tap water to contaminate your food. You can't control whether you accidentally get shower water in your mouth, or whether the lip of a soda can is contaminated. Yes, these things sound unlikely, but it's not as simple as avoiding places that look super sketchy.

With Hep B, you are unlikely to be exposed. You don't sound high risk, and actually you could avoid this. However, if you plan to travel more in the future, it's a good one to have. The worry is emergencies - if you are in a bus that crashes and you are contaminated with someone else's blood, or you need emergency medical care in a hospital where they don't observe what we consider proper sterile procedures. You can't control this.

I totally get the needle thing, but your brain is lying to you here and it's not being rational.
posted by kadia_a at 12:35 AM on June 28, 2016 [4 favorites]

I imagine if you get Hep A or B, needles will be involved in the treatment. A needle in time saves nine, and all that.
posted by EndsOfInvention at 3:20 AM on June 28, 2016 [2 favorites]

I also wonder if your travel insurance will cover you* for an illness that you could have been vaccinated against.

(*hospital treatment, repatriation, changed flights and accommodation for any family or friends who stay with you, etc)
posted by EndsOfInvention at 3:22 AM on June 28, 2016

My dad contracted Hep A here stateside when I was in college. He was and is an extremely healthy, athletic guy and it knocked him sideways for months--close to a year. And he didn't experience any complications (which are common), he just was miserable and in pain and jaundiced for nearly a year. It's no joke, it's not the flu, it can permanently damage your liver and keep you down (i.e. not working) for months. Get the vaccine.
posted by soren_lorensen at 4:35 AM on June 28, 2016 [5 favorites]

And as a side note, we suspect he contracted it at a restaurant that we both ate at, but I'd just returned from China and had had the vaccines already, so I was protected.
posted by soren_lorensen at 4:36 AM on June 28, 2016 [2 favorites]

Think about feeling terrible, not being able to do things, for a long time. Think about the days taken from your life. I think you're underestimating the potential risks.
posted by amtho at 4:48 AM on June 28, 2016 [1 favorite]

6 years ago, before going to Guatemala, I got a Hep A vaccine at the local county health clinic for $20. It's a super common vaccine - check to see if any low-cost clinics are offering anything similar.
posted by chainsofreedom at 5:16 AM on June 28, 2016

get the vaccines. you want to remember your awesome trip not an illness with potentially lifelong effects. Your trip sounds really great! Enjoy.
posted by RichardHenryYarbo at 7:05 AM on June 28, 2016

Doing research online, neither A nor B seems to be terrifying

I'm an epidemiologist and this line made me want to faint dramatically in your direction. You almost certainly are aware that the course of infection for most people of any illness is not equivalent to the worst possible course, the most serious course, the most long-lasting sequelae, the most pernicious autoimmune impacts, the gravest impact on quality of life, and on and on and on. If you need to be reminded of these things, perhaps search online for clinical case studies of people who had less than ideal experiences that began with hepatitis A or B.

Get the vaccines.
posted by late afternoon dreaming hotel at 7:27 AM on June 28, 2016 [8 favorites]

Thanks everyone! I had a long talk with the staff of my local County Health Department. I've scheduled my shots. I'll be picking up a prescription for oral typhoid as well, and I'm looking around for malaria pills, as they appear not to have them locally. I appreciate the feedback and encouragement.
posted by AdamCSnider at 7:37 AM on June 28, 2016 [10 favorites]

Glad you're getting the vaccine! Just as an added data point, the American CDC also recommends Hepatitis A&B vaccines for men who have sex with men.
posted by Nelson at 7:40 AM on June 28, 2016 [2 favorites]

Congrats on making this choice! We are all very relieved for you!
posted by cadge at 7:50 AM on June 28, 2016 [1 favorite]

In case future travelers have a similar question, specifically about the cost component - when I was planning travel to Africa and had health insurance that wouldn't cover these immunizations, I got Hep A & B vaccines for free via an STD clinic.
posted by Signed Sealed Delivered at 9:40 AM on June 28, 2016 [1 favorite]

Your insurance may or may not cover the vaccines. A lot of travel clinics won't take insurance, but you may be able to get reimbursed. Check with your plan if the county health department isn't going to be cheap. Unlike typhoid and yellow fever, Hep A and Hep B are vaccines most primary care doctors keep around.

If you have a while till you leave, your regular pharmacy can probably order your malaria prophylaxis. A lot of places don't keep it in stock since it can be expensive and low-demand, and they don't want to get stuck with expired medication. If they know someone has a particular prescription to fill they can often get it in a few days to a week.
posted by The Elusive Architeuthis at 9:59 AM on June 28, 2016

(this is exacerbated by a severe distaste for needles)

I know this sounds a bit obvious, but just look away or close your eyes while they do each shot. The pain is just a little pinch and you don't have to even see the needle if you don't want to, and you tell them that.
posted by w0mbat at 10:43 AM on June 28, 2016

Yes, you made absolutely the right decision on the shots! You can ask for a prescription for antimalarials when at the health department and your normal pharmacy can order them for you. Were you able to make the appointment specifically for travel medicine? There's a nearby county with travel medicine appointments once a week and I'm sure somewhere near you has them as well. I live in a small town and I was pleasantly surprised that my neighborhood pharmacy actually had them in stock; the health department can likely head you in the right direction.

I'd also consider getting that yellow fever shot just to be extra careful since there are concerns about a new epidemic. Sure, you won't be in Angola or Congo and it's not a requirement but it can't hurt, especially if you plan to do more world traveling in the future.

I recently traveled to Côte d'Ivoire for a week, which is also Africa albeit in a very different region than Tanzania (as we all know!) In any case, I had a wonderful time and came back without any major health issues. (FWIW, occasional diarrhea and vomiting are par for the course.) I went with a slew of medicines "just in case." I didn't use any of them other than the antimalarials (Proguanil, I believe) but I was glad to be prepared. I'm sure that having the various vaccinations beforehand helped me stay healthy. I'm so glad that I won't need to get any more for awhile, regardless of where I travel. I only had to the pay for the oral typhoid out-of-pocket and the health department may be able to help you with the medical billing. Do bring your shot record with you while traveling just in case. While we're at it, I'd also recommend bringing little packs of tissues and hand sanitizer for when you're out and about. I used mine all the time!

I wish you a wonderful trip! Please tell us how it goes!
posted by smorgasbord at 11:14 AM on June 28, 2016

Glad you're getting the shots, and definitely get antimalarials. They don't need to be fancy; Doxycline is relatively cheap. Malaria is the worst.
posted by ChuraChura at 1:20 PM on June 28, 2016 [1 favorite]


It is done.

I'm picking up the oral typhoid and some malaria pills later this week. Apparently yellow fever is not a concern at present, according to the travel doctor I saw and the Tanzanian embassy, but I'll keep my eyes on the news and maybe go for that as well if the situation changes.

Thanks again all.
posted by AdamCSnider at 7:04 PM on June 28, 2016 [9 favorites]

You don't have enough time for one (6 month period of 3 shots unless things have changed) but I think starting the rounds offers some protection. But: customs may not let you in without evidence of completion. Do check before you fly.
posted by semaphore at 7:57 PM on June 29, 2016

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