Are Hep. A, Typhoid Fever Vaccinations Neccessary?

[catbrigab]

After reading the CDC website and learning about which vaccinations to get before visiting Thailand, I am very curious to know how prevelant the diseases Hepatitis A and Typhoid Fever really are in the Chiang Mai area only. In order for me and my twin 9-year-old daughters to be vaccinated, it is going to cost me between $400-$500US!!! Naturally, I do not want to play around with my childrens' health, but can anyone direct me to some public health statistics that show the prevelance of Hepatitis A and Typhoid Fever in the Chiang Mai area? Because we will be staying in Chiang Mai for one month, this issue could be a more important one. I need facts, not just ideas, or opinions. Thanks much.

Edited September 9, 2005 by catbrigab

[Davey]

After reading the CDC website and learning about which vaccinations to get before visiting Thailand, I am very curious to know how prevelant the diseases Hepatitis A and Typhoid Fever really are in the Chiang Mai area only.  In order for me and my twin 9-year-old daughters to be vaccinated, it is going to cost me between $400-$500US!!!  Naturally, I do not want to play around with my childrens' health, but can anyone direct me to some public health statistics that show the prevelance of Hepatitis A and Typhoid Fever in the Chiang Mai area?  Because we will be staying in Chiang Mai for one month, this issue could be a more important one.  I need facts, not just ideas, or opinions.  Thanks much.

<{POST_SNAPBACK}>

Typhoid Fever: The incidence of typhoid (enteric) fever is slowly decreasing. Typhoid is reported countrywide, with the highest incidence in the northern and the southern regions, and the incidence greater in the summer and during the rainy seasons (between March and October). Typhoid vaccine is recommended for extended travel outside of tourist areas. The typhoid vacccines are 60% to 70% effective. Food and drink precautions should continue to be observed.

Hepatitis: Hepatitis A vaccine is recommended for all nonimmune travelers. Hepatitis E is endemic, with seroposivity rates of 22% in adults. There is no vaccine for hepatitis E. The hepatitis B carrier rate in the adult general population is about 9%. The usual traveler without lifestyle problems is at virtually no risk of acquiring hepatitis B virus (HBV), but vaccination is recommended for sexual tourists, long-term visitors, and anybody wanting increased protection. Hepatitis C is endemic and is largely transmitted by blood products and body fluids. Like HBV, hepatitis C carries no increased risk for travelers who have a normal lifestyle.

Extracts from this website

I know you may be reluctant to pay $400-$500, but I think it is a small price to pay to ensure your childrens safety.

You may also find this website useful

[Khun Larry]

Hep A 1200 baht BKK Red Cross.

Avaxim Vaccine from Aventis Pasteur, France. Dee maak

[catbrigab]

Thanks Davey. The first website was particularly enlightening! I once was a fearless world traveler. Now that I have kids and want to show them the world, suddenly the world is a very scary place with too many risks! I hate to say this, but the more I read about all the potential diseases in Thailand...I am not so sure I want to risk going there with my kids!! This summer I took them for a month to Belize, to a small island which was not nearly as "scary" (disease ridden) as Thailand is sounding. I was in Thailand BC (before children) and loved it. I have spent the last couple months since our return from Belize debating on which countries are best and cheapest to bring them next summer. I thought Chiang Mai would provide us all with enough interesting things to do while still keeping expenses low. But with the cost of flights and now the vaccinations, and the health risks....and god knows what else I'm missing....I may have to rethink this, AGAIN. Sorry if I am rambling about nothing pertinent for this forum. I really am sorry but.....I AM JUST SOOOOOO FRUSTRATED!

Once again, I do appreciate your info., and it is good to have every single fact.

[zxray]

Hep A 1200 baht BKK Red Cross.

Avaxim Vaccine from Aventis Pasteur, France. Dee maak

<{POST_SNAPBACK}>

Larry, is this a one shot innoculation?

When I was innoculated for hep in the states, I had to return after one month for a second injection. cost 200 USD. Because of the obvious savings I would be interested in being innoculated in LOS next time, if it is a one shot vaccine.

Typhoid was 60 USD at the county health dept.

Thanks Ray

[Khun Larry]

Hep A 1200 baht BKK Red Cross.

Avaxim Vaccine from Aventis Pasteur, France. Dee maak

<{POST_SNAPBACK}>

Larry, is this a one shot innoculation?

When I was innoculated for hep in the states, I had to return after one month for a second injection. cost 200 USD. Because of the obvious savings I would be interested in being innoculated in LOS next time, if it is a one shot vaccine.

Typhoid was 60 USD at the county health dept.

Thanks Ray

<{POST_SNAPBACK}>

First shot good for 1 year

Return in 6 months for booster then you are good for 10 years. 1200 baht each, same same.

I was surprised to learn these are not lifetime vaccinations. If you havent been vaccinated in 10 years then it is time.

[zxray]

Hep A 1200 baht BKK Red Cross.

Avaxim Vaccine from Aventis Pasteur, France. Dee maak

<{POST_SNAPBACK}>

Larry, is this a one shot innoculation?

When I was innoculated for hep in the states, I had to return after one month for a second injection. cost 200 USD. Because of the obvious savings I would be interested in being innoculated in LOS next time, if it is a one shot vaccine.

Typhoid was 60 USD at the county health dept.

Thanks Ray

<{POST_SNAPBACK}>

Good Info. Thanks Larry. I will look into it again when I need next vacination.

Ray

[Sheryl]

After reading the CDC website and learning about which vaccinations to get before visiting Thailand, I am very curious to know how prevelant the diseases Hepatitis A and Typhoid Fever really are in the Chiang Mai area only.  In order for me and my twin 9-year-old daughters to be vaccinated, it is going to cost me between $400-$500US!!!  Naturally, I do not want to play around with my childrens' health, but can anyone direct me to some public health statistics that show the prevelance of Hepatitis A and Typhoid Fever in the Chiang Mai area?  Because we will be staying in Chiang Mai for one month, this issue could be a more important one.  I need facts, not just ideas, or opinions.  Thanks much.

Hepatitis A vaccine absolutely essential no matter where you are going...in fact, one can get Hep A in N America, Europe, Australia etc quite easily from un or undercooked seafood. It is food and water borne. The vaccine is highly effective. I had Hepatitis A back in 1980 before the vaccine came out and believe me, you don't want it.

The thyphoid risk is lower especially if you are acreful of what you eat and drink, and the vaccine is less effective (again, bitter experience talking -- I got both the vaccine and the disease, in my case contacted in Phnom Penh which is more or less the typhoid capital of the world.) It is also food and water borne but there are people who are chronic carriers and if a chronic carrier happens to be the person who prepared your food, you can get it no matter how clean the restaurant was. Although due to both lower incidence and less benefit from the vaccine I would rate the typhoid vaccine lower in improtance than the Hep A, it's still better to get it than not. It's a miserable illness and think how you'll feel if your children get it and you didn't have them vaccinated.

Another vaccine you didn't mention but should get is for Japanense B encephalitis. Risk is small but consequences are devastating - death or brain damage. Vaccine is highly effective. It is spread by mosquitoes and its resevoir is the pig, so anyplace with pigs and mosquitoes is a risk. Obviously the countryside is higher risk than the city but there are people raising pigs not too far outside Chiang Mai and there have been epidemics in northern Thailand.

As with all the vaccines mentioned, available in Thailand at lower cost than at home. But don't delay -- make it your first activity on arrival.

Whatever you decide, if you or your kids get ill within 6 months of returning home be sure your doc knows where you were. Aside from the innate misery of these illnesses, there's an added problem of having them after you're back home because the docs are very unfamiliar esp with typhoid. Even if they know to suspect it, they are likely to prescribe the wrong drugs because the strains over here are resistant to the drugs usually given in the west. Incubation period for Hep A is up to 6 months and for typhoid, 2-3 weeks.

(Don't mean to sound discouraging -- have a great vacation! But do get all relevant vaccines and seek appropriate care if you get ill afterwards).

[Crushdepth]

Two people in my office have had hep A (out of 15 people). I really think you'd have to be out of your mind not to get vaccinated.

[ding]

immune globulin (IG) is good for 3 - 5 months and is effective immediately. It's the one to take if you don't have weeks before you travel to allow Hep A Vaccine to become effective.

IG is also good if you think you have already been exposed to Hep A, as a treatment. Don't wait around thinking about it if so!

IG is also going to protect you from a lot of things aside from Hep A & B.

Hep A Vaccine is much longer lasting, however.

[Old Man River]

Last year my daughter got Typhoid. She was born in Bangkok and we assumed that the normal innoculations given kids included Typhoid. We were wrong. She was in the hospital for days and was miserable. While Typhoid is now not normally fatal due to antibiotics I really think you shouldn't knowingly take this risk.

[Ijustwannateach]

A friend of mine was told before he came here (from the U.K.) that whether or not he got the typhoid vaccine he would probably have contact immunity (from low levels present in the water, etc.) within a year or so.

It's probably more of a serious issue for children, however, especially if they haven't received any immunities from breastfeeding from a typhoid-immune mother.

"Steven"

[Sheryl]

A friend of mine was told before he came here (from the U.K.) that whether or not he got the typhoid vaccine he would probably have contact immunity (from low levels present in the water, etc.) within a year or so.

It's probably more of a serious issue for children, however, especially if they haven't received any immunities from breastfeeding from a typhoid-immune mother.

"Steven"

Don't know who told him that but it's way off base. One of the most troublesome aspects of typhoid is that there is no lasting immunity -- even after getting it, you can get it again (I mean a whole new infection,; you can also have recurrences from the original illness for up to about a year). Studies have shown that acquired immunity levels go back to near nil in about 12 months. And in Cambodia, where I work, the locals all get it -- hard to find anyone who hasn't -- and they get it repeatedly. (Ditto the farang who live there). Same thing reported from India where typhois is also endemic.

Apparently the person in the UK was assuming a steady very low level of nonstop exposure, but that's a pretty tenuous assumption.

It's true that the vaccine is not very effective, but it's better than nothing. That and being careful what you eat/drink, especially if you travel to Phnom Penh.

[lingling]

Last year my daughter got Typhoid. She was born in Bangkok and we assumed that the normal innoculations given kids included Typhoid. We were wrong. She was in the hospital for days and was miserable.  While Typhoid is now not normally fatal due to antibiotics I really think you shouldn't knowingly take this risk.

<{POST_SNAPBACK}>

It is, but not until they are 5-6 years old. (at least at the major international hospitals). Maybe because it is a live vaccine...

[lingling]

After reading the CDC website and learning about which vaccinations to get before visiting Thailand, I am very curious to know how prevelant the diseases Hepatitis A and Typhoid Fever really are in the Chiang Mai area only.  In order for me and my twin 9-year-old daughters to be vaccinated, it is going to cost me between $400-$500US!!!  Naturally, I do not want to play around with my childrens' health, but can anyone direct me to some public health statistics that show the prevelance of Hepatitis A and Typhoid Fever in the Chiang Mai area?  Because we will be staying in Chiang Mai for one month, this issue could be a more important one.  I need facts, not just ideas, or opinions.  Thanks much.

<{POST_SNAPBACK}>

That's US healthcare for you. Get quotes from a couple of different clinics before you fork out $$$. Shouldn't be anywhere near that expensive...

[Habs]

After reading the CDC website and learning about which vaccinations to get before visiting Thailand, I am very curious to know how prevelant the diseases Hepatitis A and Typhoid Fever really are in the Chiang Mai area only.  In order for me and my twin 9-year-old daughters to be vaccinated, it is going to cost me between $400-$500US!!!  Naturally, I do not want to play around with my childrens' health, but can anyone direct me to some public health statistics that show the prevelance of Hepatitis A and Typhoid Fever in the Chiang Mai area?  Because we will be staying in Chiang Mai for one month, this issue could be a more important one.  I need facts, not just ideas, or opinions.  Thanks much.

<{POST_SNAPBACK}>

That's US healthcare for you. Get quotes from a couple of different clinics before you fork out $$$. Shouldn't be anywhere near that expensive...

<{POST_SNAPBACK}>

[bina]

interesting:

hep A ... in israel, anyone in the army has probably had it... all kids from the past 10 years are vaccinated at birth and thru out the childhood years, aslso hepB... all teenagers were vaccinated last year, and then all young adults.... us old fogies 40+ were considered lifestyle not at risk types... i started all mine twice and each time didnt do the last shot its 1 mo, 3 mos and 6 mo's.... for the hep b

i thought the encephalitis thing wasnt very effective (or just for a particulr type ?)...

polio also should be checked (americans are too sterile these days) since it is in and around the water in middle east thailand etc... and there ahs been talk of revacinnating (mothers with young babies are automatically exposed when changing nappies of vaccinated babies)...

my vaccinated daughter was recently hospitalized for 'WHOOPING COUGH'.!!! seems israel, america etc it is reoccurring in the 12 year old+ age groups (the vaccine seems to wear off)...

so really, u arent safer here there or any where, just take basic precautions drink bottled water, bring your own meds, wash hands frequently, use mosqiuto repellants and trust that most kids, being naturally dirtier than us due to play time/eating habits, dont seem to get sick as much (not so with under three age group)... and do bring thermometer etc ,.... strange fevers etc should be checked out even if normally u would wait a few days before going to the doc's...

my sister came to israel to visit, from the states, looking like english colonist moving to africa with all her meds and antibiotics etc... its not like we dont have hospitals, same for thailand, u arent going jungle bushwacking are u??? relax and enjoy...

[Sheryl]

interesting:

hep A ... in israel, anyone in the army has probably had it... all kids from the past 10 years are vaccinated at birth and thru out the childhood years, aslso hepB... all teenagers were vaccinated last year, and then all young adults.... us old fogies 40+ were  considered lifestyle not at risk types... i started all mine twice and each time didnt do the last shot its 1 mo, 3 mos and 6 mo's.... for the hep b

i thought the encephalitis thing wasnt very effective (or just for a particulr type ?)...

polio also should be checked (americans are too sterile these days) since it is in and around the water in middle  east thailand etc... and there ahs been talk of revacinnating (mothers with young babies are automatically exposed when changing nappies of vaccinated babies)...

my vaccinated daughter was recently hospitalized for 'WHOOPING COUGH'.!!! seems israel, america etc it is reoccurring in the 12 year old+ age groups (the vaccine seems to wear off)...

so really, u arent safer here there or any where, just take basic precautions drink bottled water, bring your own meds, wash hands frequently, use mosqiuto repellants and trust that most kids, being naturally dirtier than us due to play time/eating habits, dont seem to get sick as much (not so with under three age group)... and do bring thermometer etc ,.... strange fevers etc should be checked out even if normally u would wait a few days before going to the doc's...

my sister came to israel to visit, from the states,  looking like english colonist moving to africa with all her meds and antibiotics etc... its not like we dont have hospitals, same for thailand, u arent going jungle bushwacking are u??? relax and enjoy...

You should however at a minimum get the Hep A vaccine which in fact is desirable wheverever you go -- it can be gotten even in the US, especially from shellfish. Also it's quite effective. The Jap Encephalitis B vaccine is also effective.It is the typhoid vaccine which is only 50% effective.

The reason for the pertussis (whooping cough) outbreaks in developed countries is that it is the pertussis component of DPT vaccine (diptheria, pertussis, tetanus -- the one given to infants during their first year of life) that causes many children to have fevers after immunization. This in turn leads parents to complain and many pedicatricians started giving onlt DT vaccine to avoid it, feekling that the risk of pertussis was low. Enough docs have done this that there are now enough non-immunized people around for small outbreaks to occur. (I investigated one while working forthe State Health Dept in Hawaii).

[Old Man River]

A friend of mine was told before he came here (from the U.K.) that whether or not he got the typhoid vaccine he would probably have contact immunity (from low levels present in the water, etc.) within a year or so.

It's probably more of a serious issue for children, however, especially if they haven't received any immunities from breastfeeding from a typhoid-immune mother.

"Steven"

<{POST_SNAPBACK}>

Don't know who told him that but it's way off base. One of the most troublesome aspects of typhoid is that there is no lasting immunity -- even after getting it, you can get it again (I mean a whole new infection,; you can also have recurrences from the original illness for up to about a year). Studies have shown that acquired immunity levels go back to near nil in about 12 months. And in Cambodia, where I work, the locals all get it -- hard to find anyone who hasn't -- and they get it repeatedly. (Ditto the farang who live there). Same thing reported from India where typhois is also endemic.

Apparently the person in the UK was assuming a steady very low level of nonstop exposure, but that's a pretty tenuous assumption.

It's true that the vaccine is not very effective, but it's better than nothing. That and being careful what you eat/drink, especially if you travel to Phnom Penh.

<{POST_SNAPBACK}>

Thanks for this info. Our doctor at Bamrungrad Hospital in Bangkok told us that once having Thyphoid Fever, our daughter couldn't get it again. From what you say, this isn't the case. While one always monitors their children for illinesses etc., I will pay particularly closer attention if she has a reoccurrence of the red blotches on her face that accompanies Thyphoid.

I can't begin to explain how awful it was to drive our little one with a high fever through Bangkok peak traffic to get to Bamrungrad's emergancy room.

[thejaundicedeye]

fyi:

get the twinx here in bkk - hep/a-b

dont bother w/ typhoid here in thailand

[jumpybongo]

just contaced the travel clinic in uk who recommend the following

hep A

hep B

hep C

anti malarials

rabies shots at 1 7 14 and 28 days

typhoid

japanese encyphillitus

all have to be paid for as not available on nhs

any good advice please?

[PMNL]

Get Hep A and Typhoid from UK.

For JE, Hep.B,Rabies you can get them here in Thailand with reasonable cost ( All about 6000-7000 Baht full course).

There is no need for anti-malarial unless you go to the bush near Thailands boder ( North, Isan,South).

Hep C is your choice , it is only blood and sexual trasmission though.

Friends from UK were given JE for 180 quids/person, you can get 1500 baht/person here in thailand with the very same vaccine.

[PMNL]

Another one that you should get booster is Tetanus, if last one was done more than 10 years.

Good Luck

[Sheryl]

Hep A and rabies, absolutely

Hep B and C: if any likelihood you will have sex with locals while here. (In other words, most likely, yes

Typhoid vaccine not very effective and risk pretty low, very low if you are reasonably careful about what you eat

Japanese B encephalitis: yes if you will be out in rural areas. It is mosquito-borne and resevoir is the pig so common in areas where pigs are raised. Foreigners living here have contacted it, it is often fatal and when not fatal can cause permanent brain damage . On the oher hand if your planned itinierary is all in cities, risk extremely low.

Ignore what theytell you re malaria. One, you wil not be at risk unless you spend the night in remote jungle areas. two, they will recommend drugs that don't work here (they always do, because the drug ensitivities here are unique to here). And three, these drugs have some nasty side effects.

Juidicious use of mosquito repellent a good idea tho..not so much to avoid malaria as to avoid dengue and chikungya, which unlike malaria are very easily gotten here, even in the cities.