Vaccination for Africa!

In just a few days, I’m departing on an adventure, heading to Africa!   I’m headed specifically to Nairobi, Kenya for a day followed by two weeks in Arusha, Tanzania ending with a Safari!!!!  Thanks to my coworker pal Kristen who writes this blog (even more specifically, has several posts from her previous trips to Africa, here)... and we’re joining one of her PT School professors and 7 students from Stony Brook University to do some physical therapy-related work. I don’t have the details of what we’ll be doing yet- so stay tuned for the post-Africa blog posts for that... but the preparations for the trip have been very interesting and I thought I’d write about the medical preparations for the journey - along with some thoughts on vaccination.

From: http://pcwww.liv.ac.uk/epidemics/MAL_geography.htm

Let's talk about medications.  Thanks to Virginia Mason’s Infectious Disease Department- not only was I able to receive the shots and prescriptions I needed, but they also explained many of the possible risks and made recommendations for me. They collected my dates and destinations of travel in advance, prepared a stack of pamphlets for me, and had the shots and prescriptions I needed ready to go.  I now have a whole pharmacy packed based on things that my body might encounter that it doesn't generally experience at home. Specifically- Tanzania is in the malaria belt and Kenya has an escalated risk for contracting yellow fever. And so- I have malaria medications and I had a yellow fever vaccine this week. The provider who organized all my medical care for these travels, Lisa Roberts PA-C was very thorough and presented the options for all the medications - such as discussing my choices for malaria medicines because some of them can be hallucinogenic.

Some interesting facts about these diseases:
Malaria:
1) Link: There are five types of malaria parasites called plasmodium.  One type, Plasmodium Falciparum, can be life threatening and induce liver failure, kidney failure, and coma.  This is generally the type that you take preventive mediation for when traveling.
2) Link: Malaria is transmitted by mosquitos, so using bug repellent containing DEET, long sleeves and pants, and taking preventive medications are all useful preparations. The particular type of mosquito, the Anopheles Mosquito, cannot survive in climates cooler than 68*F, so since central Africa is so warm, this is a common region for the disease.  As global warming continues, the malaria belt is expanding.  Even though the United States has successfully managed to reduce malaria cases, we do house these mosquitos, so there is always the risk that malaria can become a bigger problem here at home.
3) Link: There is a malaria vaccine, but it has a low efficacy and requires four injections... so I'm not immunized, I'm taking preventive medications. The reason for this is that the DNA of that plasmodium reproduces so fast, it can build resistance - just like we've seen with antibiotics resulting in things like methicillin resistant staphylococcus aureus (MRSA - the SuperBug) which, by means of evolution do not respond to the usual medications.  I'm so glad I read "The Origin of Species" by Charles Darwin, and wrote about it here.

Yellow Fever:
1) Link: Yellow Fever is also transmitted by mosquitos.  About 15% of those who are infected will have severe symptoms including shock, organ failure, and possible death.
2) Link:  The vaccine against yellow fever is considered to be life-long protection and 99% effective.  and is a live vaccine, which means that scientists took the actual disease, weakened it, and then it gets injected into you to build up immunity to it. There is also a shortage of the vaccine with limited number of places where you can go to get one - so if you're looking to travel, plan ahead!  You need a specific yellow card marked with your immunization in some cases - for example if you spend time in Kenya before going to Tanzania, like we are, you need the shot.

In addition to malaria and yellow fever, we also discussed risks for hepatitis, rabies, measles, mumps, rubella, influenza, and diphtheria, along with multiple symptoms that could require treatment, particularly related to gastro-intestinal distress which I won't go into detail about but which also included some shots and medicines.

What is a vaccine, anyways?  A vaccine is a medicine used to prepare your immune system to fight a disease in case it ever comes into contact with it.  Our body fights off disease by using a system that requires exposure to something to build up a defense system.  The vaccine is the first exposure to a disease, usually a weakened or dead version of it, so the body can recognize invaders and be prepared to fight.  There is considerable controversy around the country with some parents believing that vaccines are dangerous - or they don't believe in inoculation for a variety of reasons.

While I've been going through these preparations and getting additional immunizations beyond the ones I've had for public schooling, college, graduate school, working on an ambulance and now working in a hospital-based system, Seattle Children's and many other places around the country, have been facing increased episodes of cases of measles. Seattle Children's publicized exposures there here and this article describes the over 1,000 cases identified in the US this year, a considerable increase since measles was considered to be eradicated in 2000.  Measles is a highly contagious disease spread through coughing or sneezing or bodily fluids of infected people and does not have a cure.  A contagious person will likely infect 90% of the non-immunized people they come into contact with.  There is a high risk of fatality from measles because of the complications of the condition - immune compromise and opportunistic infections like pneumonia.  The vaccine is only 97% effective, so even those who are immunized aren't perfectly protected, but because of the high risk, it's essential that people vaccinate their children.  I urge everyone to read about the signs and symptoms of measles, particularly if you are in an area where there has been a spike in cases as it looks like there is a current epidemic occurring or if you are a healthcare provider.

Volunteering Emergency Response in Israel in 2006

Several cases of measles in Washington have been linked back to being at Seattle-Tacoma International Airport, where I'll be headed to depart for Africa in just a few days.  Interestingly, I also found this article looking at the measles epidemic occurring on the east coast, reporting cases in New York in Orthodox Jews who do not inoculate their children and who had recently traveled from Israel (which has been having an outbreak as well).  This article also discusses the Orthodox Jews having this increase in cases.  Having been to Israel several times and lived there as a volunteer EMT in 2006, knowing that they're so advanced in their medical and technological developments, this shocked me!  Over 500 of the cases in the US are in NY in this population, and Washington is 2nd on the list.  As a Jew myself, I can't understand why the Orthodox aren't taking care of this.  It seems that some believe vaccination is against Jewish law, which is of course an interpretation of something, though I'm not sure what, because vaccines obviously did not exist at the time Jewish law was written. What is for certain part of Jewish law is to do anything that may save a life, and since vaccination can save lives, it seems to me that more Jews would support vaccination.

Even the APTA has a position on this.  Physical therapists are in a prime position to encourage families to get their immunizations as part of their regular health care.  The risks of not doing so many times could include fatality - to your own family member or to someone else.  The benefits far outweigh the risks.