michele_d

Hi Everyone,
We are headed to China the first week of December. We will be visiting Beijing, Shanghai and the Yangtze river between Yichang and Chongqing. I have some questions about what vaccines are recommended.

I got on the CDC site and it looks like we will need Hep A because of food and water issues, and also the Malaria prophylaxis. Okay, so it appears the Hep B is recommended if we share needles! or get a tattoo!, both of which we have no plan to do. Also, Typhoid is recommended if we visit small villages, which I am sure we will do from the cruise ship on the river. So, do you think that one is necessary also?

My doctor has deferred to the CDC and the CDC has said I have to determine myself if I need these two vaccines, they will not recommend either way, so here I am at Fodors, where I know somebody has had experience with this.

As a last resort we will get all four but I would really like some feedback on this if anyone can help me. Thanks in advance.
Michele

Kathie

You've had some medical advice and your doctor has deferred to the cdc who defers to your decision-making.

Here is my take on it (and what I would do in your position):

Hep A - it's wise to have this even if you are staying at home. Hep A is a disese of sanitation, and you have no control who is handling your food. Indeed, there are periodic outbreaks of Hep A even in Western Europe and North America.

Hep B is more your call. The other reason to get Hep B is if you needed medical treament in China, you would be protected from Hep B from unsterile needles.

Typhoid is another disease of sanitation. If you do not eat anything off the ship, you are probably at lower risk, but not at no risk. If you travel to tropical climates or plan to do so in the next few years, the typhoid vaccine is a good investment.

Malaria - there is no vaccine for malaria, but you can take anti-malarials to prevent malaria. I'm not sure excatly where you are going that is considered malarial risk. The cdc website has pretty good info on where is/is not malarial risk, but you might also look at the NHS fit for travel website as it has the best malarial risk maps. When I have a moment, I'll find teh link and post it here for you.

Marija

We were told that none of the areas you are visiting is malarial. You probably won't be eating in the small villages where the boat stops. All meals are onboard. I think the typhoid pills confer longer protection than the vaccine.

Kathie

Here is the malarial risk map:
http://www.fitfortravel.scot.nhs.uk/...laria-map.aspx

Since I don't know all of where you are going, I'm not sure if you'll be visiting malarial risk areas, though the places you mention are low/no risk.

Marija is correct that the typhoid shot confers 2 years of protection, the oral vaccine 4-5 years. While the typhoid vaccine is only about 85% effective, since there is antibiotic-resistant typhoid in the area of the world, IMO, the vaccine is worthwhile.

You didn't mention it, but I'm assuming you are up to date on routine vaccines, i.e, diptheria/tetanus, measles/mumps/rubella.

michele_d

Kathie and Marija,
Thank you both so much for your input.

This is what the CDC website says about Malaria, "Some major river cruises may go through malaria endemic areas in Anhui and Hubei provinces". We will be in the Hubei provence and I am a mosquito magnet, so since the cruise ends in Chongqing, which is just on the border of where malaria is high risk I probably will get that vaccine. Just in case those little buggers can't read a map.

I hadn't thought about Hep B risk from unclean medical tools. I had to go to an emergency dental hospital in Rome and was surprised even at the conditions there, nothing like I am used to at my own dentist, so I'll probably opt for that too.

I read that they can combine the Hep A and B into one vaccine, we'll probably have to go on the "fast track" vaccine route for that series since you need three shots over six months and we are leaving in 5 months.

We do plan to travel to the rain forest in the next few years so it sounds like the typhoid vaccine is a good idea. Sounds like to oral vaccine is definitely the way to go for that one. Thanks for the tip.

So many vaccines...but I guess it is a small price to pay to ensure our health.

Thank you again. I knew I could count on the Fodorites to help.
Michele

Kathie

Just one note, Michele, there is no vaccine for malaria. You'll need an anti-malarial medication. Since your exposure time will be short, you'll likely want Malarone, as you start taking it one day before entering the risk area and continue it for one week after leaving the area. The other antimalarials require you to continue them for one month after leaving the risk area. Malarone should be taken at approximately the same time each day (such as at breakfast) and should be taken at a time when you are eating something that has some fat, such as full-fat milk or yogurt, etc, as one of the components is fat-soluble. But do discuss this with your doctor. Perhaps there is a reason one of the other anti-malarials would be better for you.

michele_d

Kathie,
This sounds like the malaria prophylactic my doc told my husband about. (She wouldn't recommend anything else though!) It is also the one, Atovaquone/proguanil (Malarone), that is recommended on the CDC site.

At least I have some guidance now and I can go to my doc and tell her what I want.

Thanks again.

qwovadis

Mdtravelhealth.com China best web info onvthis for me.

hope this helps...

Hep A food water precautions the only absolutes for me

typhoid only partially effective wise if eating a lot of street food

Hep b only if pllanning to share body fluids with strangers tatoos etc

Malaria unless in high risk rural areas for long periods of time

Just use cutteradvanced.com and insect precautions in all areas

Except for deep south persoanally.

Happy Travels idaa.org for Travel MDs of quality if needed

amyb

michele, I just went to a Travel Health Clinic for my trip to China this September. My doctor referred me to the Travel Clinic because they would have better experience and also have all the vaccinations in stock. I told them the exact cities/towns I'd be in and they gave me the shots I need. I got my second Hep A (first one was before Russia last fall, I was due for the second booster), first Hep B in case I end up in a hospital over there and exposed to it. For Hep B, you need two before you go: first two a month apart and then a booster 6 months later in order to be covered for life. I also took the Typhoid oral pill, every other day for a week, which is good for 5 years (the shot is only for 2 years). Based on my locations in China, they did not recommend malaria medication, but did recommend very strong insect repellent. I also got a Tetanus/Diptheria/Pertussis booster. And, given the recent measles outbreaks here in Boston, they recommend people of a certain age to get a MMR booster.

Call your health insurance company first. The face value of all this was over $600 but I just had to pay my co-pay of $25.

The other thing the clinician gave me was a prescription for Cipro, for any intestinal distress that does not respond to Immodium.

HappyTrvlr

Amyb...I just picked up the typhoid pills. Did you have a reaction to them?my doctor said some people have problems taking them.

Kathie

Happy, I've taken the typhoid pills several times and never had more than a slightly upset stomach. People are actually more likely to have a reaction to teh shots - very sore arm, feeling under the weather for a few days.

amyb

I had no problem with the pills. I just got up an hour earlier and took them before breakfast like they said to. The only reaction I had was a really sore arm from the MMR.

HappyTrvlr

Last time I had th typhoidr shot but my MD recommended the pills as the protection lasts longer. Glad they aren't a problem. Thanks.

michele_d

Thanks guys for all the feedback. It gives me a much clearer picture of what to address with my doctor. I will call my insurance so I know if any of it will be covered.

Our trip will be the first week of December and it will be cold so maybe I will be so covered up that the mosquitoes won't be able to find anywhere to land.

JPDeM

Beijing and Shanghai are big modern cities and you need nothing special there.
As far as the cruise is concerned, I would just not go. A big time waster.