8071126351_4dd221677aA teaching program in Tanzania.

Dear Dr. Pat:

My husband and I are retired teachers. In August we plan to go to Tanzania to train teachers at a school for orphaned children that our church supports. We don’t have access to a doctor who is a travel-medicine specialist, so we have to depend on our local GP. However, he has so little time to take care of the community that I worry that he may not be up on the latest recommendations for vaccinations and other precautions we should take to avoid illness.

We are both 67 and are reasonably healthy. My husband has glaucoma that is well controlled with eye drops. We both wear glasses and take a medication for mild high blood pressure, and we are quite fit. We ride our bicycles about 20 miles a week and go to a gym every day. We look forward to cycling while we are in Tanzania as well.  What should we do to stay as healthy as possible, since we will be in this remote area for three months?   

Marilyn

 

Dear Marilyn:

First of all, your husband and you are doing wonderful work by sharing your talents in order to train the teachers at the school your church supports. You set an example for all of us. Many of us in our second half of life are giving back to the community in meaningful ways, often traveling to parts of the world where infections transmitted by insects, food, and water are very common. Some of these infections can be prevented by vaccinations that are current for the area where you are traveling, and avoiding other infections requires constant mindfulness and vigilance.

Many of my patients are traveling to exotic places this year, so I have spent lots of time helping them prepare for a safe trip. It is ideal for travelers to visit a travel medicine clinic or doctor before embarking on a trip where there are many infectious diseases endemic to the area. I encourage you to do this, but in this week’s article I will discuss vaccines that are recommended by the Centers for Disease Control and Prevention (CDC) for Tanzania. Next week’s Medical Monday article will cover the other important behaviors that travelers must adopt in order to avoid illnesses and accidents.

The Routine Vaccinations

Vaccinations are divided into “routine” vaccines and vaccines specific for the country to which you’ll be traveling. The routine vaccines that are recommended include

• measles-mumps-rubella (MMR) vaccine

• diphtheria-pertussis-tetanus vaccine

• varicella (chickenpox) vaccine

• and your yearly flu shot

You’ll need these shots unless you can document that you are already immune to these infectious diseases or have a contraindication to their use.

Vaccinations for Travel to Tanzania

The CDC’s current recommendations for vaccinations include

Hepatitis A, which can be transmitted through contaminated food or water in Tanzania, regardless of where you are eating or staying.

 • Polio vaccine may be necessary before your trip to Tanzania. According to the CDC, “If you were vaccinated against polio as a child but have never had an additional dose as an adult, you should get an additional dose. Adults need only one additional dose in their lives. If you were not vaccinated as a child, talk to your doctor about getting vaccinated.”

Typhoid, which can be transmitted from contaminated food or water. This vaccination is recommended.

 • Hepatitis B vaccination is a good idea. This virus is transmitted through exposure to blood or other bodily fluids and could be transmitted if you have medical treatment unexpectedly (for an accident requiring surgical treatment, for example).

Malaria, which is transmitted from the bite of an infected female mosquito. There are several drug regimens for the prevention of malaria. The CDC-recommended drugs for Tanzania are atovaquone-proguanil, doxycycline, or mefloquine. Malaria in this area has become resistant to treatment with other drugs.  It is so important that the you be compulsive about taking the malaria prevention regimen you choose with your doctor. If you develop a reaction to the medication, discuss what drug you must take in its place with your doctor before leaving for your trip.

Yellow Fever, which is transmitted from the bite of infected mosquitoes. It is generally not recommended for travelers to Tanzania, but if you plan to travel to a neighboring area where Yellow Fever is present, you must have a certificate of vaccination in order to return to Tanzania.

Rabies vaccination is a three-part series given over the course of three weeks. Only your doctor can recommend what is right for you. Rabies is a deadly disease caused by a virus that is spread in the saliva of infected animals.  According to the CDC, people usually get rabies from licks, bites, or scratches from infected dogs and other animals such as bats, foxes, raccoons, and mongooses. Rabies affects the central nervous system, ultimately causing brain disease and death. Once symptoms of rabies appear, the disease is nearly always fatal, so prevention is especially important.

Rabies infections in humans in Tanzania is thought to be a real public health issue, because dogs and cats, the primary source of the infection, are not vaccinated.  In an important paper, P.G. Coleman, et al, discussed the mortality and morbidity of rabies transmission to humans in Tanzania, noting, “Rabies exerts a considerable public health impact, exceeding other prominent diseases that currently achieve a higher priority for disease control.”  You can find this article on the CDC’s website.

To keep from getting rabies, the CDC recommends that you:

  1.  Avoid animal bites by not touching any animals, including wild animals and pets.
  2.  Supervise children closely, especially around dogs, cats, and wildlife.
  3.  Act quickly if an animal bites or scratches you.  Wash the wound well with soap and water. See a health care provider right away, even if you don’t feel sick or your wound does not look serious.
  4.  The CDC emphasizes, “To prevent rabies, you may need to start a series of vaccinations immediately.” Adequate vaccination for exposure to rabies is not available in all parts of the world.  You may have to be transferred to the nearest destination where complete care can be obtained.
  5. Adequate vaccination for exposure to rabies is not available in all parts of the world, so consider buying supplemental health insurance. Medical-evacuation insurance may cover the cost to transfer you to the nearest destination where complete care can be obtained. Some policies may cover your eventual return to your home country.

There are many other guidelines that you must follow if you don’t want to become ill. In next week’s post I’ll review some of these so that you can discuss them with your physician.

Dr. Pat