Going on Safari is unlike any other vacation you will ever plan. Apart from the clothing recommendations and luggage restrictions, which we will most definitely cover in upcoming posts, there are the medical requirements. Because no matter where you go in Africa, you will be going to a developing nation. Even South Africa and Botswana in the South, which are prosperous nations and where we will be spending most of our time, are subject to diseases that do not widely exist or have been mostly eradicated in the populous Western nations.
Which called for my first ever visit to the travel medicine clinic at my local hospital.Your primary care physician will not have the necessary information to help you or access to all the vaccinations you might need. She will however be able to give you a referral to a travel medicine clinic. Tip: DO NOT forget to get the official referral if your health plan requires it. Some or all of your costs may be covered, but they will not be if you don’t get the referral in advance. You can also find travel medicine clinics online, but I was quite happy with the clinic my doctor referred.
Tip: Make sure you have your shot record and your itinerary with you when you go the the clinic. I remembered to ask my doctor about my last tetanus shot, saving me one pin prick, but couldn’t remember whether I’d had the measles as a child. So I had to call my mom from the doctor’s office.
Consensus was that I had indeed had the measles, and my bouts with chicken pox (legendary) and mumps were well remembered.
At the clinic, the doctor or nurse practitioner will review your itinerary against the Center for Disease Control recommendations for US citizens, and advise you given your age, susceptibility and general health. NOTHING is required by the US, although some vaccinations may be required by the country you are visiting. Most things are strongly recommended and a few, like rabies, are optional. I decided to do the optional rabies vaccination because we live in a fairly rural area and I have the dogs. In some cases, the order in which you are visiting countries will be relevant, which is why the clinic needs the day by day itinerary, not just the list of countries you plan to visit.
This is serious shit, people.
Tip: You may need multiple visits to the clinic. Make your first appointment six weeks to a month before your trip.
On my first visit last week, I got three shots — hepatitis A/B, meningitis and a polio booster. I was also prescribed an oral vaccine for typhoid (more about that in a minute) and had to make a series of appointments for the rabies vaccine (3 appointments exactly seven days apart) and a second hepatitis shot. I also got a prescription for malaria medicine to be taken before, during and after the trip and a precautionary antibiotic in case of diarrhea that doesn’t respond to OTC medicine like Imodium.
A word about the typhoid vaccine. There are two options, a shot or an oral live vaccine called Vivotif. I opted for the oral med, as it had a longer duration, lasting for about 5 years. This proved to be a mixed blessing. There are four pills, to be taken in the morning every other day at least a week before departure. THE PILLS MUST BE REFRIGERATED. So far so good. Except our fridge died, unbeknownst to us, and the pills were at about 60 degrees Fahrenheit for 24 hours.
Were the pills still good? I had taken the first one Thursday morning before we realized that the fridge had been on the fritz, possibly for a day or two. Why did it take so long to realize that the fridge was fraked? The freezer was fine and the fridge light still worked. The butter in the door was soft but we initially attributed that to folks not shutting the door firmly.
If you are doing the math, that meant I had 48 hours to figure out whether the pills were still active or even safe to take if inactive. There was no information in the product insert that answered this specific question.
Just in case they were still good, we stored them in our travel fridge and I called the travel clinic Thursday afternoon. Closed. Left a message. Didn’t get a call back on Friday morning. Called again after we got back from the vet. They told me that the call had been referred to the nurses’ line, and I should hear sometime that day.
I did. Shortly before 5pm, and the nurse did not know the answer. She suggested I contact the manufacturer directly. By the time I tracked down the number on the Internet — it was NOT printed on the insert — it was after 5pm and their offices were, you guessed it, closed. I sent an email just in case someone checked it one last time before the weekend, but no such luck.
By this time, I knew I was SOL for getting a definitive answer before Monday, and had to make a decision about taking the pill on Saturday. The nurse had been a little leery about taking it, in case I had to retake the whole dose again. Would that be too much medicine, active or not, in my body? Would there be any harmful effects if the vaccine had gone bad? Too many unanswered questions, so I decided to stop the sequence and start over.
Naturally of course, I got a reply to my email first thing Monday morning:
Vivotif can be left out of the refrigerator for up to 24 hours as long as it out of direct sunlight and under 80 degrees.
In other words, my pills were still good, but it didn’t matter because they were useless to me. I replied, very nicely, to the gentleman at the company that it would have been nice if this information were in the insert or at least on the website, as I now would have to start over with a new package anyway. I was irritated but not over the top angry because our fridge is under extended warranty, which pays up to $250 for spoiled food. We didn’t have much food, so I figured the cost of the replacement medicine would be covered.
Turns out the drug manufacturer has a free replacement program — I’m guessing this is not the first time something like this has happened. So all’s well that ends well. When I go get my first rabies vaccination next week, I’ll pick up the replacement Vivotif and start again. I’ve got time before I leave on September 11th.
Moral of this story? Don’t wait until the last minute to make your appointment at the travel clinic. You need time to get the necessary shots and handle any mishaps like mine with the Vivotif.
Oh, and I hope the manufacturer Crucell Berna reads this post and puts that additional information about Vivotif storage on the website or the insert. Sure, people will now be able to find it here, but I am not a doctor and don’t play one on the Internet. It’s much much better for the information to come directly from the company.
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Added 11 August
Some additional precautions:
- Drink only bottled, boiled or treated water.
- Brush teeth with mouthwash or bottled water. Rinse toothbrush with same.
- Use Purell or other antibacterial handwash. Carry a small bottle with you.
- Use insect repellent with DEET. Apply sunscreen first, wait 20 minutes, then apply insect repellent.