Immunizations for India

Electron micrograph of red blood cells infected with Plasmodium falciparum, the parasite that causes malaria in humans. During its development, the parasite forms protrusions called 'knobs' on the surface of its host red blood cell which enable it to avoid destruction and cause inflammation. Using scanning electron microscopy, this image shows a knob-rich infected blood cell surrounded by knobless uninfected blood cells. Rick Fairhurst and Jordan Zuspann, National Institute of Allergy and Infectious Diseases, National Institutes of Health. @2006.
Electron micrograph of red blood cells infected with Plasmodium falciparum, the parasite that causes malaria in humans. During its development, the parasite forms protrusions called ‘knobs’ on the surface of its host red blood cell which enable it to avoid destruction and cause inflammation. Using scanning electron microscopy, this image shows a knob-rich infected blood cell surrounded by knobless uninfected blood cells. Photo creidt: Rick Fairhurst and Jordan Zuspann, National Institute of Allergy and Infectious Diseases, National Institutes of Health, @2006.

(Before you read any further, please note that if you are traveling to a foreign country, you should consult a medical professional on what immunizations are advised because the risks are always changing. I am noting the particular immunizations I am taking for my upcoming trip to India so that I have easy access to what I’ve gotten—just in case. Also, the vaccines were a little more complicated than I expected them to be, with scheduling concerns and time needed pre-trip for dosing.)

I have heard about the risks posed by immunizations, and while I think immunizations for children are important, I suspect that we Americans might be overdoing it. Maybe we get too much, too soon?

Also, actions speak louder than words. When it came to my own body, I didn’t hesitate about getting immunizations. For me, weighing all the potential risks, it was a no-brainer.

My general practitioner said he couldn’t give me the immunizations and advised me to consult a “travel clinic.” So on January 23, 2017, I visited the travel clinic in my area, and since these immunizations are not covered by insurance, I paid $442 for two shots and a prescription for two sets of pills. I walked out with a travel card, which in medical lingo indicated the vaccinations I had just received. Thankfully, this was also written out for me (in layman’s terms) in my departing paperwork.

The vaccines I got are listed below: (A shot in each shoulder. As of Feb 5, my shoulders still ache slightly; 24 hours after the shots, I experienced extreme drowsiness and fatigue to the point where I questioned if it was safe for me to drive; this subsided after a day.)

  • Diptheria/Tetanus/Pertussis (Tdap)—(Offers long-term protection)
  • Hepatitis A and B—(need to return prior to the trip for a booster; afterward offers lifetime protection)

Pills:

  • Vivotif for Typhoid—(pills contain weakened live bacteria) Yum. A booster is needed every 5 years for those to remain at risk. (Protection up to 5 years.) A neat feature for this medication is that you can text TRAVEL to the manufacturer, and they will send you reminders so you’ll take your pills on time.
  • Atovaquone-proguanil (aka Malarone) for Malaria—(real-time protection; not long lasting)

Vivotif. The pills are a little tricky, especially if you have many distractions in your life. The Vivotif offers, but does not guarantee, up to 5 years of protection from Typhoid Fever. You have four pills to take, which must be taken a day apart. You need to finish the entire round of medication at least one week prior to departing. Pills must be taken on an empty stomach (two hours after a meal or one hour before a meal).  Vivotif must be kept refrigerated. I figured, why wait to the last minute, so I’m beginning my course of Vivotif today.

Malarone.  I have to take these pills with me to India. I have to start taking the pills 2 days before I depart and continue taking them for 7 days after I return.

*******

So now, what am I hopefully protected against? My departing paperwork says the following:

Clostridium tetani
Clostridium tetani

TETANUS (Lockjaw). Rare in the United States today. Causes painful muscle tightening and stiffness, usually all over the body. Can lead to tightening of the muscles in the head and neck so that you can’t open your mouth, swallow, or sometimes even breathe. Tetanus kills about 10% of those infected, even after they receive the best medical care. Enters the body through cuts, scratches, or wounds.

Corynebacterium diphtheriae
Corynebacterium diphtheriae

DIPTHERIA. Rare in the United States today. Can cause a thick coating in the back of the throat; Can lead to breathing problems, heart failure, paralysis, and death. Caused by bacteria. Spread from person to person through secretions from coughing and sneezing.

Bordetella pertussis
Bordetella pertussis

PERTUSSIS (Whooping Cough). A baterial disease that causes severe coughing spells, which result in difficulty breathing. Marked by vomiting and disturbed sleep. Can cause weight loss, incontinence, and rib fractures. Up to 5% of adults who contract pertussis are hospitalized or have complications that include pneumonia or death. Spread from person to person through secretions from coughing and sneezing.

Hepatitus A virus
Hepatitus A virus

HEPATITIS A. A viral disease that affects the liver.  Caused by ingestion of contaminated food or water or via contact with an infected person. Most people recover from infection. Associated with lack of safe water and poor sanitation and hygiene. Can cause acute liver failure, which is often fatal. Does not cause chronic liver disease. Most people recover.

hepatitus-b-virus
Hepatitus B virus

HEPATITIS B. Hepatitis B is a serious infection that affects the liver. It is caused by the hepatitis B virus. Can cause cirrhosis of the liver or liver cancer. Can cause loss of appetite; fatigue, pain in muscles, joints, and stomach; diarrhea; vomiting; and jaundice. People who are chronically infected can spread the disease even though they don’t look sick. Virus is easily spread through contact with blood or other bodily fluids of an infected person. People can also be infected from contact with a contaminated object, where the virus can live for up to 7 days. Can be infected by breaks in skill (bites, cuts, sores), contact with objects (toothbrushes, razors, unsanitized medical devices), sex, sharing needles, being stuck by a used needle.

salmonella-enterica-serovar-typhimurium
Salmonella enterica serovar typhimurium

TYPHOID FEVER. Can be caught from eating or drinking contaminated food or water. It is caused by a bacterium, S Typhi. Causes a high fever, fatigue, weakness, stomach pains, headache, loss of appetite, and sometimes a rash. If untreated, kills up to 30% of those infected. Some infected people become carriers and spread the disease to others.

a sporozoite of Plasmodium bergei migrating through the cytoplasm of midgut epithelia of an Anopheles stephensi mosquito
A sporozoite of Plasmodium bergei migrating through the cytoplasm of midgut epithelia of an Anopheles stephensi mosquito

MALARIA. A serious, sometimes fatal disease caused by a parasite. There are four kinds of malaria that can affect humans. You get Malaria from the bite of a malaria-infected mosquito. Once a person is bitten, malaria parasites enter the bloodstream and travel to the person’s liver where they grow and multiply. The parasites leave the liver any time from 8 days to several months, and enter the person’s red blood cells, where they release toxins, which make the person feel sick. Symptoms include flu-like illness, shaking chills, headache, muscle aches, and fatigue. Nausea, vomiting and diarrhea may also occur. Malaria can cause anemia and jaundice due to the loss of red blood cells. P. falciparum type of malaria can cause kidney failure, seizures, confusion, coma, and death. Some malaria parasites can rest in the liver for up to 4 years! Prevention: Take the antimalarial drug exactly on schedule without missing doses. Prevent mosquito and other insect bites. Use DEET repellent on exposed skin and wear long pants and long-sleeved shirts, especially from dusk to dawn when mosquitoes tend to bite.

Other diseases which could be of concern in India, but for which I have not received vaccinations include:

  • Cholera(risk exists throughout the country; not sure why I didn’t get this one); potentially fatal bacterial disease of the small intestine; severe vomiting and diarrhea; can kill within hours if not treated; spread through contaminated food or water from infected human feces
  • Japanese encephalitis—(Risk exists, but I’m not traveling to a high-risk area; insect precautions recommended)
  • Rabies—(a very expensive vaccine at over $400; but risks are significant from dogs, bats, monkeys; scratches should be taken seriously)
  • Brucellosis—(Risk exists throughout India; travellers advised not to consume unpasteurized dairy products.)
  • Chikungunya—(Peak transmission from June through October; risk exists throughout year, especially in Southern India; daytime insect precautions are recommended.)
  • Dengue—(Significant risk exists in urban and rural areas; transmission occurs throughout the year especially during rainy season; daytime insect precautions are recommended.)
  • Leishmaniasis—(not prevalent in Maharashtra state; insect precautions recommended)
  • Leptospirosis—(risks to those in Maharashtra with fresh water exposure)
  • Melioidosis—(risk exists throughout the country, especially in Maharashtra and other states; highest transmission activity is June through September; avoid contact with potentially contaminated soil or water)
  • Traveler’s diarrhea—(High risk throughout the country, including deluxe accommodations; My doc recommended that I take Immodium and Peptobismol with me; still need to purchase those.)
  • Tuberculosis—(India is in highest risk category for TB; IGRA should be taken by those planning to spend more than 3 months; “travelers should avoid public transportation and crowded public places whenever possible”); stay away from people with persistent cough.

Misc. Risks: Air pollution, terrorist, train accidents.

Other precautions: hand washing; avoid street vendors, buffets without food covers, shellfish, raw or undercooked foods, unpasteurized dairy products, mayo, unpeeled fruits, and salads, tap water, and ice. Use sealed water bottles for brushing teeth.

My doctor began our vaccination discussion by saying that the majority of the world’s drug-resistant diseases originate in India.

Shopping List: Immodium, DEET (30-35%) or Picaridin (greater than 20%), Peptomismol tablets

Predeparture:  pack eyeglasses, sunglasses, hand sanitizer, lip balm, medical insurance

Medical Care in Mumbai:

  • Private ambulance in Mumbai—Breach Candy Hospital — +91.22.2366.7997
  • P. D. Hindjua National Hospital and Medical Research Center— +91.22.2445.2575 or 1298

 

 

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