Medical

Vaccinations & Travel advice

At the Municipal Public Health Department we made an appointment for obtaining the necessary vaccinations. Do this at least 7 months in advance so that you will have enough time to get the 2nd and the 3rd dose needed for some diseases. Take into account that it will cost you a lot of money; all in all the vaccinations cost us about 800 euros and another 300 euros for the Malaria prophylaxis. In 2014 we choose not to have us vaccinated. Some vaccinations were still valid and for the remaining we will go without because we are convinced, that not all vaccinations are necessary and that vaccinations are not always beneficiary to your health. 

Please note: this is our personal opinion and not a travel advice. 

The vaccinations we obtained 2006 - 2007 are:

If you do not have ORS...

ORS kan easily be made by yourself using salt and sugar. Mix 1 liter (mineral or boiled) water with 40 grams of sugar (8 tea spoons or lumps) and 3,5 grs of salt (1 tea spoon). Make sure the drink does not taste saltier than tears.  

Also a coke (Coca Cola) can be an alternative for ORS.

Our meaning after the trip: With our health we had no issues. We have hardly been sick and therefore did not use any medicine from our own “pharmacy” . The only medicine we did use we had to buy. If we would go on a new trip we would not bring so much again. The medicine we would bring are: Paracetamol and another good but stronger pain killer. We also would bring biltricide (for Bilharzia), a creme for mould infections, creme for the treatment of burns (which is the most common injuries amongst travellers) and something for allergic reactions. Mosquito spray is something we would buy locally as those sprays are cheaper and better. We also would nog bring any vitamins. Even in the middle of nowhere where there are no large supermarkets you can always get fresh fruits and vegetables. Our ear thermometer on the other hand is something we did use quite often and instead of a broad spectrum antibiotic we would bring Metrodinazole and Cyproflaxin. If you want t bring antibiotics thise two are a much better choice. The are given in case of colon infections. Also bring something for dry lips and feet. Due to drought and high temperatures you easily get cracks in your lips and heels.

Instructions is case of emergency ...

Handy instructions: Where there is no doctor

Download free pdf version here

Hepatitis A

Disease: Liver infection caused by bad hygiene.

Vaccination: 2 vaccinations (Havrix)

Protection: 25 years (after 2 vaccinations)

Hepatitis B

Disease: Liver infection caused by a virus. Contamination through blood or other body fluids. Can be transmitted through sex or blood transfusion, but also through non-sterile actions at the dentist or through a contaminated shaving blade at the hairdresser.

Vaccination: 3 injections (The first one at day 1, the second 1 month later and the third between 6 and 12 months after the first.

Protection: for life

DTP

Disease: Diphtheria, Tetany, Polio

Vaccination: 1 refresher vaccination

Protection: 10 years

Yellow Fever

Disease: Infectious disease caused by a virus. It is spread by mosquitoes. This is the only vaccination that is obliged in some countries.

Vaccination: 1 injection

Protection: 10 years

* Rabiës: Even after vaccination you still have to go to a hospital as soon as possible when you have been bitten or licked by a contaminated mammal.  Still we choose to obtain this pretty expensive vaccination because of two very important advantages. First, if you are vaccinated you have more time to get to a hospital after contact with a contaminated mammal (without vaccination you have to get to a hospital within 24 hours, with vaccination you have about a week to get to a hospital). The other big advantage is the treatment. If you are vaccinated, you only have to obtain two injections with the rabies vaccine after contamination (one on day 0 and one on day 3; consulates and embassies should know where the vaccine can be obtained). If you are not vaccinated, you have to obtain 6 injections with the rabies vaccine and within 24 hours after contamination you also have to get a MARIG (immunoglobulin) vaccination. A substance that in hard to obtain is many of the African and Asian countries. If you have been vaccinated you do not need an injection with this immunoglobulin anymore.

Our meaning after the trip: Maybe because we have not been sick, but if we ever go again we will not take all these vaccinations again. Through extensive travelling it is our experiences that as a tourist it is not likely to get in contact with diseases like meningitis and rabies. For our trip in 2014-2015 we did not get any vaccinations anymore. It is our opinion that being wise and careful is a good way of protecting yourself without getting all those (not always harmless) vaccinations.  

Cholera

Acute infection disease caused by bacteria that multiply inside your bowels. It is transmitted in situations with bad hygiene. For tourists the risk of getting this is very low. In the Netherlands vaccinations for this disease are not given. However in your medical passport you can get a stamp saying "Cholera not indicated". This stamp is for free and valid for half a year. If you intend to travel longer you can aks for several stamps and fill in the dates later.

TBC

Tuberculosis is a very contagious disease that still frequently occurs. In order to protect yourself against TB you can get a BCG vaccination, which is valid for two years. The vaccination however does not give full protection and also has a big disadvantage. After you once had the vaccination you can never ever have a Mantoux test to test for TB anymore. The Mantoux test will then always give a positive result so in order to check on TB you will always have to make lung photo's. the vaccination also leave a big scar. Keeping in mind these disadvantages and the knowledge that is doet not give full protection we decided not the get the vaccination. The Municipal Public Health Department also advices to have a Mantoux test shortly before you leave as well as when you return.  The test prior to a journey has no influence on the treatment of chances of recovery. This test is mainly used to make sure that you were not infected when you left and in case of TB this is beneficiary to an investigation. Because, as TB is very contagious, in case of infection all persons who have been in contact with the patient must be tested. We choose not to test ourselves prior to our journey.

Malaria profylaxe

How do we protect ourselves against malaris? We have given this matter due consideration. Preferably we would not take any prophylaxis at all as it is really bad stuff. However, after consulation with someone who is not only a doctor, but has lived in Africa for serveral years himself, we decided to use prophylaxis. As Malerone is not prescribed for any use longer than 3 months we will need Lariam. As Lariam is one of the strongest Malaria prophylaxes you only need one pill per week. Lariam can cause severe side effects so prior to our journey we tested it in order to see how our bodies react to the medicine. We had no problems. As a alternative for Lariam you can also use a combination of Paludrine (1x per day) and Chloroquine (1x per week).

Our meaning after the trip: Lariam is a very bad medicine, that to our opinion is prescripted too easy. We were given the advice to start taking anti-malaria drugs in the south of Egypt. Looking back this was not needed. Until Nairobi we hardly saw any mosquito. In Sudan it was too hot and too dry and in Ethiopia we were at higher altitudes most of the time. Of course this depends on the period of the year. However if there is one place where we had the most mosquitos, it was around Lake Victoria, and in Malawi, Zambia and Mozambique. The last three countries we visited without taking prophylaxe. Somewhere halfway Tanzania we stopped using Lariam. To protect ourselves we wore more clothes (trousers, long sleeves and socks) from an hour before dark until sunrise and use a good repellent. For us this was sufficient as we both did not get sick. If we ever go to Africa again we would try to avoid using profylaxe as much as possible and if we do need to take something (in 2014 we used profylaxe in Mozambique as it was the end of rainy season there) we would get it from a local doctor as locally better and cheaper alternatives are available. A good mosquito spray is Peaceful Sleep or Tabard; it works better than Deet. However if you might get sick and you are worried just go to a local clinic and do a test. They are cheap and easily done. We did it several times and it was done very hygenic with sterile materials. When you do not use prophylaxe do not take any risk. As soon as you feel different (headache, burning eyes, diarrea, no hungry) do a test. Note that at the start of a Malaria infection you have no fever. And as with most infections the sooner you are diagnosed the less sick you get.  During our 2014-2015 trip we did not use any profylaxe in Asia. Only in Mozambique for a short period of 6 weeks. We got the drugs locally.

Dentist and family doctor

Of course we informed our dentist and family doctor about our plans. Especially for the dentist this is important; because when you have not consulted him for a while you can get problems with your health insurance, at least that is the situation in the Netherlands. Prior to departure the dentist gave our teeth a thorough examination and did some extra maintenance like removing tartar and replacing old fillings. As we are both pretty healthy our family doctor did not had much to do. Still visiting him was worthwhile. With our family doctor we discussed specifics we have to keep in mind whilst traveling. He also advised us what medicine we have to take with us. He also had to arrange a large part of these medicines as they can only be obtained on prescription. Finally Belinda had her blood tested in order to know her blood group. Markus already knew this from the time he served in the army. 

Medicine and other supplies  

Typhoid

Disease: Infection caused by the salmonella bacterium. Transmitted in situations with bad hygiene.

Vaccination: 1 injection

Protection: 3 years

Meningitis

Disease: Spread by small drops of moisture that come out when coughing, sneezing etc. The risk of contamination is higher in more dense populated areas.

Vaccination: 1 injection

Protection: 3 years

Rabiës

Disease: Caused by licking and biting of contaminated mammals.

Vaccination: 3 vaccinations (the first on day 1, the second on day 8 and the thrid on day 28)

Protection: 2 years. After a repeat on approx. day 295, protection period can be extended to 5 years.

Please note: during the 5 week vaccination period it is better not to use any malaria prophylaxis

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