Ouch!!!

One of the less fun aspects of travelling to East Africa is the need for multiple immunizations. We knew we needed to get them, but were not sure of what we should get or when. We looked at different sources (NIH, CDC, Tanzanian Embassy, etc.) and got different answers, so we made an appointment at the travel medicine clinic at Virginia Mason to get some advice.

The doctor we saw at Virginia Mason was very knowledgeable and helpful. We needed to get a number of vaccinations, including:

Yellow Fever (required to enter Tanzania)
Typhoid (this would be a live oral vaccine, pills taken over 4 days)
Measles, Mumps, and Rubella booster (MMR),
Diptheria, Tetanus, Pertussus booster (DPT),
Flu,
Polio booster (there was a recent outbreak in neighboring Uganda), and
Hepatitis A and B

As it turned out, we were just in time. Our trip was about 6 months and 3 days off, and the Hepatitis A/B vaccine was a series of 3 shots of a combined vaccine called Twinrix given immediately, after one month, and after 6 months. We would just be able to complete the series before we left. Notice that the MMR, DPT and Polio are "boosters". This isn't really true - these were new courses of vaccination. Vaccines do wear off with time, and since most vaccinations are given in childhood it makes sense to get revaccinated as an adult. This isn't a big issue for most people in the US because of good sanitation and low incidence of disease, but if you are travelling to a third world country revaccination is a really good idea.

In addition to the vaccines, we were prescribed a few doses of Cipro to carry as a cure for, ahem, traveler's malaise, and Malarone as malarial prophylaxis. Malarone is expensive and doesn't guarantee you won't get malaria, but it helps, and malaria is endemic to the region we would be visiting. We had to take it on a strict schedule, starting a couple of days before we entered the malarial area and ending a few days after we left. Since we were spending so much time on the road and crossing so many time zones, just trying to figure out when to take the pills each day was an exercise in head scratching.

The shots were uncomfortable, and some of them stung like crazy, but the oral Typhoid vaccine was probably the worst. It needed to be refrigerated and taken first thing on waking (on an empty stomach, and we couldn't eat for a couple of hours after) with at least 16 ounces of cold water. The water left us feeling a little nauseous, and then as the day wore on the effects of the vaccine left us feeling completely exhausted. This would be gone by the next morning, but of course then it was time for the next dose. We could have gotten a shot for Typhoid instead, but this would have only lasted for three years while the oral vaccine lasts five years. An unpleasant dilemma.