Vaccines

[guru]

So I went to Sukhumvit Hospital next to BTS Ekkamai to get the flu vaccine. To save coming back I asked if there were any boosters I could get whilst I was there. She recommended Tetanus, diphtheria and whopping cough as a combo. I said I had a 2015 tetanus shot in that very hospital. She said computer records there only go back to 2017 so couldn’t check on her computer but said the only tetanus vaccine they stock is the three combo one so it definitely would have been that combo.

 

She asked me what other vaccines I’ve had so I told her I had three shots of rabies pre exposure 21 years ago so she said I need a booster for that. Only 1 shot so I went ahead.

If I get potentially exposed would I need the full four (or five?) post exposure vaccines or just two? Trying to google and it says if received modern vaccine then only two but I don’t know if 21 year old initial vaccine is modern or not?

 

Back to tetanus/diphtheria/whooping cough, when I got home and found the vaccine card from 2015 it mentions that I received three doses of tetanus toxoid 0.5 ml over 7 months and nothing about diphtheria or whooping cough which I thought it would have if it was the combo that the doctor claimed it would definitely have been? There’s a load of Thai printed script on the back of the card but the only bit readable to me is Clostridium tetani which must be referring to tetanus. I can only guess it was just a tetanus shot?

 

[Pilotman]

bit naive to ask a Thai hospital if you need additional vaccinations.  They will almost always invent some, even if you don't need them. They are medical based, profit generating businesses, not really facilities for curing aliments and preventing others.  Actually, they can be, provided they can charge you over the odds to do it. 

Edited July 29, 2019 by Pilotman

[marcusarelus]

1 minute ago, Pilotman said:

bit naive to ask a Thai hospital if you need additional vaccinations.  They will almost always invent some, even if you don't need them. They are medical based, profit generating businesses, not really facilities for curing aliments and preventing others.  Actually, they can be, provided they can charge you over the odds to do it. 

Thai hospitals never invent vaccinations.  Thai hospitals exist to cure and prevent illness.  Tell us what turned you against Thailand? 

[CGW]

11 minutes ago, marcusarelus said:

Thai hospitals exist to cure and prevent illness.

Please inform them of this, they consider themselves business people who make money from sickness, as do all those in the medical industry 

The fallacy of the "exist to cure and prevent illness" died out long ago, thought everyone was wise to this given the obscene profits made by the pharmaceutical industry!

Edited July 29, 2019 by CGW

[Pilotman]

14 minutes ago, marcusarelus said:

Thai hospitals never invent vaccinations.  Thai hospitals exist to cure and prevent illness.  Tell us what turned you against Thailand? 

Ha, good one.  I'm not against Thailand, I live here quite happily,  it's the overall appalling health care provision, especially for its citizens.  Vaccinations of anti bionics to young children who have a cold, unnecessary procedures like MRIs and CT scans, that are clearly not needed but foisted on unaware people.  The widespread giving of pain killers and anti bionics without thought or reason, such as for clearly virus based problems. The acceptance of a Temporary Provisional Licence to practice medicine for 'doctors' who have failed their final exams.  My wife went for a test procedure in one hospital a while back and was asked by the doctor what medication she wanted to be prescribed !  When we queried that remark, we were told, 'well I will give you want you want'.  Need I say more?    

Edited July 29, 2019 by Pilotman

[Canuckabroad]

For rabies, my doctor told me if I went a year without a booster then I should get the entire 3 shot schedule all over again.  You are still recommended to get GRIP and booster shot treatment after a potential exposure.  Lab workers and bat handlers who are routinely exposed to rabies have their serotonin levels checked annually, and sometimes they need more than the usual 3 shots for full immunity.

 

What the rabies vaccination provides you is a level of backup and safety.  It gives you time to delay getting postexposure shots (so you don't ruin your vacation) and a line of defense if you don't treat a rabies contact (like if the animal looks domesticated or if a child doesn't report a bite).  Rabies is the most lethal virus known to man, it's 100% fatal once symptoms start to appear.  And the shots are dirt cheap in SEA so you should get the full course.

[CGW]

19 minutes ago, Canuckabroad said:

And the shots are dirt cheap in SEA so you should get the full course.

How about just managing the situation and don't get bitten? worked for me for the past 64 years, without filling my body with crap vaccines.

[LosLobo]

4 hours ago, Canuckabroad said:

For rabies, my doctor told me if I went a year without a booster then I should get the entire 3 shot schedule all over again.  You are still recommended to get GRIP and booster shot treatment after a potential exposure.  Lab workers and bat handlers who are routinely exposed to rabies have their serotonin levels checked annually, and sometimes they need more than the usual 3 shots for full immunity.

 

What the rabies vaccination provides you is a level of backup and safety.  It gives you time to delay getting postexposure shots (so you don't ruin your vacation) and a line of defense if you don't treat a rabies contact (like if the animal looks domesticated or if a child doesn't report a bite).  Rabies is the most lethal virus known to man, it's 100% fatal once symptoms start to appear.  And the shots are dirt cheap in SEA so you should get the full course.

Rabies pre-exposure prophylaxis (3 shots) has been proven to produce an effective antibody response in humans even after 14 years.

 

Booster doses are not recommended for travellers.

 

After a potential exposure HRIG (GRIP) is not required.

 

Two booster doses are required on day 0 and day 3.

 

Lab workers and bat handlers who are routinely exposed to rabies have their titer levels of rabies virus neutralizing antibody (RVNA) (serotonin) tested.

 

All rabies contacts should be evaluated/treated.

 

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html

Edited July 29, 2019 by LosLobo

[guru]

Rabies pre-exposure prophylaxis (3 shots) has been proven to produce an effective antibody response in humans even after 14 years.

 

Booster doses are not recommended for travellers.

 

After a potential exposure HRIG (GRIP) is not required.

 

Two booster doses are required on day 0 and day 3.

 

Lab workers and bat handlers who are routinely exposed to rabies have their titer levels of rabies virus neutralizing antibody (RVNA) (serotonin) tested.

 

All rabies contacts should be evaluated/treated.

 

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html

Thanks for this. Very useful.

 

There does seem to be some conflicting advice depending on the source.

 

CDC link above: “Booster doses are not recommended for travellers.”

 

NHS link below: “For travellers, 1 booster dose may be considered if you were vaccinated more than a year ago and you're travelling to a high-risk area again.”

 

https://www.nhs.uk/conditions/rabies/vaccination/

 

[Canuckabroad]

1 hour ago, LosLobo said:

Rabies pre-exposure prophylaxis (3 shots) has been proven to produce an effective antibody response in humans even after 14 years.

 

Booster doses are not recommended for travellers.

 

After a potential exposure HRIG (GRIP) is not required.

 

Two booster doses are required on day 0 and day 3.

 

Lab workers and bat handlers who are routinely exposed to rabies have their titer levels of rabies virus neutralizing antibody (RVNA) (serotonin) tested.

 

All rabies contacts should be evaluated/treated.

 

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html

Thanks for the corrections, I wrote my reply at the gym and going by memory.

 

I remember reading that many people who survived contact with rabies years after their vaccinations were still left with neurological damage.

 

CDC doesn't recommend boosters for travelers because they are expected to be returning to first-world healthcare infrastructures.  Their vaccinations are meant to provide safeguards that delay the onset of symptoms until they receive further medical care, unlike researchers and animal workers who might encounter it with more frequency.  Long-term residents in countries where rabies is widespread are in a higher risk group than travelers.

[Sheryl]

1. It sounds like what you received was tetanus booster though TD (tetanus and diptheria) is also commonly given.  DPT is not given to adults and I cannot believe the hospital does nto stock plain TT or TD. Among other things, TT (tetanus toxoid) booster alone is routinely given to pregnant women. The doctor you saw, if that was whom you quote, seems poorly informed to say the least.

 

2. There is a limited information on the best schedule for rabies boosters.

 

  CDC  guidelines in place are for developed countries where risk is small and for travellers. People at very high risk, for example veterinarians, are recommended to get periodic blood tests to measure antibody titers and usually get boosters every 6 -24 months but that would be serious overkill for someone living in Thailand but not routinely handling animals other than vaccinated pets. For travellers to areas where rabies is endemic (Thailand qualifies as such) the CDC recommendation is to have the primary vaccine series and no booster.  There is no CDC recommendation for people at continuous low grade risk which is how I would characterize people living in Thailand. 

 

People who have had the pre-exposure vaccine require only 2 doses of vaccine post-exposure if they are boitten and do nto need the immune globulin. However that presupposes that they had adequate antibody titers prior to being bitten.

 

WHO studies and recommendations are more relevant as these have included countries where rabies is endemic and vaccinations for the general public.  These suggest boosters at 10 year intervals and that is supported by several studies of antibody titers in people over time. However there is no recommendation as to what to do if more than 10years have passed, as in your case (and mine).

 

https://www.sciencedirect.com/science/article/pii/S0264410X08005379?via%3Dihub

 

The safest thing to do for someone who has had more than 10 years elapse since vaccination would be to either (1) repeat the series and then get 10 yearly boosters thereafter or (2) get your antibody titer measured first and based on that either get a booster or repeat the series, but that test is expensive.

 

The most practical thing to do is probably just to assume your titer is low but not nil, and get a single booster now and repeat at 10 year intervals.

 

" .... individuals at continued risk of exposure to rabies virus should be evaluated on a case-by-case basis for scheduling of antibody titre monitoring, if available, or a routine booster. Routine booster vaccination is recommended if the antibody titre is < 0.5 IU/ml.
A routine pre-exposure booster vaccination, if indicated, consists of:
1-site ID (intradermal) or 1-site IM (intramuscular) vaccine administration "

https://www.who.int/rabies/Rabies_Clinicians_FAQs_21Sep2018.pdf

 

Aside from rabies, if you ever travel to the countryside you should be immunized for Japanese B encephalitis. And if you have not already had it, Hep A and B vaccine is recommended (Hep A is part of routine vaccination schedules in developed countries nowadays but that started only in I think the late 1980's so older people may not have had it).

 

And if you are over 65, should get the penumoccocal vaccines (2 types given a year apart) and annual influenza shots (can get if younger too but especially important for older people). Shingles vaccine is well worth getting after age 50-55 though the new, better vaccine is not yet available in Thailand.