Hepatitis A in India, Hep A Immune Globulin shots...

Wazen

Well everyone I have quite a situation...

I recently got my first Hep A shot, its the first of a two shot series. I cant get the second shot until I come back from Inida. So I was hoping on the IG shot, which is a quick prevention shot that covers you for just 2 months. But I am going to be in India for 3 months or longer!

If worst comes to worst, does anyone know the availability of the Hep A Immune Globulin shot in India? Anyone got it in India before, or have information about it?

Aloha

narsimha

Wazen,

You are still far better off with the Hep A vaccine. It is a great vaccine and far more desirable than getting gamma globulin (injected human serum protein- yuck!). One shot of hep A vax will still give you something like 90-95% protection. You still need to get the second shot to make sure it lasts, but it is not the end of the world.

I tried to pull the CDC web site for the actual citation, but it is really slow right now. It has great travel medicine advice:

www.cdc.gov then click on Travelers' Health

...and please I know many IM'ers say it is OK, but avoid salads and unpeeled veggies and fruits. You don't need to be paranoid, but no sense in asking for trouble.

Narsimha

Wazen

Aloha Narsimha

Is there anything wrong with the IG shot, besides the fact that it sounds gross?

As it pertians to the *regular* Hep A vaccination, I read that the first of the two shot series works great to produce antibodies.. but the antibodies are only detectable for the first 30 days! So theoretically you only have sufficient protection for only 30 days after teh first shot....but for some reason, they make you wait 6 months between the shots!

Thats why I am considering the IG right before my departure on Jan 13.., and would probably need to get it during my third month in India, somtime in march...

edwardseco

If you go IG be sure to have someone who knows how it inject it! If done while it is still cold its like a jell and requires a horse doctor syringe in the behind. Shouted the clinic walls down because of that fool nurse..

Wazen

Hi edward,
did you get the shot in India?

narsimha

1. Nothing "wrong" with the gamma globulin, it just is not effective as the Hep A vaccine, only lasts a limited time, and can be painful.

2. I could not find detailed studies of the longevity of single dose of Hep A vaccine, but your 30 day figure is suspiciously short. Serum IgG (antibodies) have a half-life of about 30 days, so the worst case scenario is that post-vaccination antibody levels would last at a minimum of several months.

I have pasted the abstract from a recent paper in the American Journal of Medicine entitled "Hepatitis A vaccine in the last-minute traveler"
by Bradley A. Connor, MD, which basically says you should be OK as is:

Current recommendations state that travelers should receive hepatitis A vaccine 2 to 4 weeks before departure. Such recommendations, however, may dissuade last-minute travelers from receiving the vaccine. A preponderance of evidence exists to support hepatitis A vaccination of the imminent departure traveler and therefore suggests that these guidelines merit reconsideration. In examining this issue, one of the most important elements to determine is the amount of time required for seroconversion
following vaccination. Clinical trials of hepatitis A vaccines measured antibody response at 2 and 4 weeks after vaccination. However, studies investigating early seroconversion found that the vast majority of vaccinees develop antibodies within 2 weeks of vaccination, some as early as 12 days after vaccination. This is relevant information, given that the hepatitis A virus has an average incubation period of 28 days. Seroconversion is predicated on achieving a “protective” antibody level. However, levels of antibody considered protective remain debatable. Evidence suggests that clinical disease does not occur at antibody levels lower than those currently accepted as protective. Furthermore, hepatitis A vaccine has been proved effective in controlling outbreaks worldwide. Research data show that a single dose of vaccine can halt outbreaks if an adequate number of susceptible individuals are vaccinated. Information from rapid-outbreak control studies and those assessing postexposure administration of hepatitis A vaccine suggest that late vaccination provides a significant degree of protection. For these reasons, hepatitis A vaccine may be administered at any time before departure because it will still provide travelers with protection.

Am J Med. 2005 Oct;118 Suppl 10A:58S-62S.

Sama

I got my first hep A shot in July, went to India in September for a month. my doctor told me that I don't need the booster (the second shot) until at least 6 months after the first shot

__________________
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BE THE REVOLUTION

Wazen

I went to the travel clinic yesterday, and the Doc said I "Should" be covered for my 3 month visit to India, but will need the second shot to make it official.

Also, when I showed up in person yesterday, they said they no longer give the IG shot! Many other clinics I called didnt seem to carry it aswell...

Thanks for the information everyone.
It really makes me feel a little better and safer about this trip..
Narsimha, Thank you for posting all of that! I appreciate the help guys

So in the end I think I will hold off on the IG shot. Now to decide wether to get the Jap E shot or save my $400!

narsimha

Wazen,

I just got my 2nd Japanese Encephalitis vaccine yesterday, but only because I will be on a 2 week bike ride in the south, and even then I was on the fence in terms of risk and benefit. Unless you are going to be outdoors extensively in rural areas, CDC does not recommend JE vaccine. You will probably get much more benefit from using DEET regularly. JE vaccine is not a modern vaccine like, say hepatitis A or B vaccine, that is given to millions and is very pure. JE vaccine is not given to many westerners and is essentially an "orphan" product. Supposedly there are clincal trials being performed to develop a more modern version. Also, you shoudl know the current JE vaccine is made from JE infected mouse brains. I kid you not!

You can read more about JE in the JE virus section of CDC's the Health Information for International Travel at:
http://www2.ncid.cdc.gov/travel/yb/u...=jenc eph.htm

One of the best articles I found was Shlim DR, Solomon T. Japanese encephalitis vaccine for travelers: exploring the limits of risk in Clinical Infectious Diseases, 2002 Jul 15;183-8. One of the paragraphs reads:

The CDC concluded that the overall risk of JE for travelers
to areas where JE is endemic was < 1 case per 1,000,000 travelers.
However, they noted that “short-term travelers to developed
and urban areas” may have accounted for most of the denominator.
When they tried to estimate the risk of JE for travelers
actually spending time in rural destinations during the season
of risk, they came up with a very rough range of 1 case per
5000 to 1 case per 20,000 travelers per week [1].

The best type of DEET is the microencapsulated formulation of about 30-35% that is "timed release" and works for 8 hours. One of the available brands is Ultrathon, you can buy it on the web. The 100% DEET doesn't work as long and seems to be absorbed more. I used Ultrathon in Bali a few years back and it was great.

Check out the CDC's Protection against Mosquitoes and Other Arthropods section of the Health Information for International Travel

http://www2.ncid.cdc.gov/travel/yb/u...sNav=browseoyb

Surfs up, gotta' go,

Have a great trip!

edwardseco

Wazen, 'fraid not..

Steve

I wouldn´t worry to much about Hep A, but Hep B is quite dangerous because often it becomes chronic and the viruses will slowly destroy your liver.
Same with Hep C, but no vaccination available yet.
Nowadays Hep B vaccination is given to children in Germany, but I don´t know when they actually started it.
So many of the "mid-aged" of us don´t have any protection.

__________________
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I hate crime and I hate criminals (Masti)

Wazen

Wow thanks for all the good advice!

It is a tough call.. I made my apointment for the Jap E shot in the end...

Since im going for 3 months, without any real plans yet, im wasting the $400 for peace of mind...

... and im already regreting it!

narsimha

Steve, you are right that Hep A is generally milder and does not have the capacity to become chronic, whereas B does. However, you are wrong to say that Hep A is not something to worry about. Hep A IS more likely to make travelers ill than Hep B. People can get severely ill (and rarely die) with Hep A.

Most importantly, western travelers are far more likely to get Hep A, than Hep B. Hep A is fecal-orally transmitted (food, water, etc.), so that everyone is at risk. The major route of transmission of Hep B is sexual and blood borne (needles, tattoos, blood). If you avoid those risk factors your chance of avoiding Hep B is pretty good. You can decrease Hep A risk by the usual dietary avoidance, but nothing (other than a vaccine) will protect you from clean food that was then handled by someone who is shedding the virus.

BOTTOM LINE: Get the Hep A vaccine, the risk/benefit ratio is something on the order of seat belts or not injecting drugs. Pretty much black & white.

There are lots of travel vaccines whose value to the average tourist is debatable (rabies, JEV, meningococcal) but Hepatitis A in South Asia is not one of those. It is a no brainer.

Surfs up, gotta' go

edwardseco

Hep A took my brother in law out for a month. He didn't recover his hearty athletic health for a year. JE is very uncommon and I believe the season is over until Spring. My sister in law has seen some cases in Hyd-Secunderabad over the years. Some parts of UP on the the Nepal border are ugly in season..

Wanderer22

Wazen, You are very wise to be concerned about Hepatitus A. It's a nasty disease that may have far reaching effects. I got my present immunity the hard way by catching it in India during the 70's. There were no vaccines for Hep back then.
It's known that certain viruses can trigger auto-immune problems that may not surface for many years. Have always wondered if Hep A had anything to do with intestinal and liver problems I've experienced in later life.

Found this site recently. Good information on how to stay healthy.
Hep A gets spread the same way as Diarrhea, so the same precautions should help prevent exposure.
http://ciwec-clinic.com/diar/index.html

W22