Q:With interest I read the What Doctors Don't Tell You about hepatitis B (Vol 3 No 4.). However what to do if one goes to a foreign country? In December of this year, I will visit Nepal and will have to have a number of vaccinations. I wonder if you would be so kind as to give me any suggestions as to whether these vaccinations are so dangerous. J. V. H., Chichester.
A:Most travellers heading anywhere but Europe or North America resemble human pin cushions by the time their GP has given all their jabs. For Nepal, the vaccines usually recommended (but not mandated) are: cholera, typhoid and polio. It's also recommended that you take anti malarial pills. The only requirement you may have is to produce a certificate proving you've had a yellow fever vaccine if you intend to enter an area infected with the disease.With travel vaccines doctors usually don't admit that 1) they have no idea what you ought to have in various countries and 2) the medical literature shows that many of these jabs are rubbish ie, won't afford you the protection you need. Currently, for travel to most parts of Africa, the Middle East, Asia and South and Central America, MIMS, the British doctor's drugs bible, recommends that travellers get typhoid, cholera, polio, tetanus, hepatitis A and B, yellow fever and malaria pills. There are also vaccines for rabies and Japanese B encephalitis travellers.
We put your questions to our panel member and resident vaccination expert J. Anthony Morris, formerly of the American Food and Drug Administration and National Institutes of Health. His quotes appear in Roman type under the headings about the various vaccines:
"It is generally recognized that there is no satisfactory cholera vaccine. The product available up to the present has been largely a public relations gambit. So distrusted is the current vaccine that the medical authorities didn't bother to rush the drug to Peru during the outbreak there last year." As MIMS Magazine noted (15 May 1991): "Cholera vaccine is of low efficacy and Iitsuse is declining. A single dose satisfied certification requirements." In other words, even though doctors know it doesn't work, you are required to have it whenever you cross infected areas at certain times of the year.
Last year (5 July) a copy of GP, the newspaper sent to all general practitioners, confirmed this view: "Certain vaccines such as that given for cholera are known to be of no value, and the emphasis in general practice should really shift more towards proper advice, which can often be more time consuming than injections."
The British Medical Journal (17 February 1990) also acknowledged that cholera vaccine was overprescribed by GPs. Nevertheless, it was the view of correspondent P. G. Baddeley, a GP in Gloucestershire, that although the Department of Health booklet "Before You Go" is "overgenerous" in its recommendations for cholera vaccinees:
"It has never been the contractual responsibility of British general practitioners to advise patients who are about to travel abroad on health requirements." Furthermore, he says, "It could create confusion and worry if the general practitioner or the practice nurse did not take time to explain adequately why they were apparently ignoring official DoH advice. Unlike the author, we concluded that it might be simpler and even cheaper to stick to the DoH recommendations."
Finally, he said that the onus should be on the traveller to get information on vaccinations from embassies or consulates of the country about to be visited.