Aagh so confused about vaccinations for Malaysia!

[TravellingWilberry]

Going to peninsular Malaysia (not East) for 3 weeks and struggling to work out what vaccinations we might need (adults and pre-teen kids). Planning on visiting KL, Tioman island, langkawi, Penang and maybe the Taman Negara.

Have had consultation with Boots who said that we need MMR (already had) plus tetanus booster for me- fine.

Also said we need Rabies vaccinations because we might go for a walk in the rainforest and there may be stray dogs but on researching, rabies only seems to be an issue in East Malaysia and we would avoid going near animals/ strays anyway?

The pharmacist also said we should consider cholera, Hep A, Hep B, Japanese encephalitis, TB and Typhoid but was unwilling to say whether we actually should have them or not.
If I paid for all those I would not be able to afford my holiday and I'm reluctant to put the kids through vaccinations they don't really need.

Anyone in Malaysia or been to Malaysia recently who can advise?!

Go to a proper travel clinic and have a consultation. We found it really helpful when my DD2 was going travelling round South East Asia and helped her make an informed decision.

I think in the end she had all those bar Japanese encephalitis.

The consultation I had was at a proper travel clinic- a Boots one!

I was particularly pleased that she had the rabies course. There were 2 options for that.
Tbh I wouldn’t travel anywhere that jabs are recommended without having them.
If you can’t afford the cost of them, choose somewhere else.

Don't think you need rabies

I would get TB
Hep A & B possibly but risk of you catching it is low

Worst case is vaccinations are much cheaper in Malaysia so get them when you are there?

I have family in Malaysia and visit regularly and only did TB and Hep B

Hepatitis transmission is similar to HIV, via blood or sex so would guess your risk is low

Hospitals in Malaysia are good, especially private hospitals

There's a small risk of catching dengue but there's no vaccinations for that anyway. Bring lots of mozzie spray

Again for malaria but that's more likely if you go into Borneo in the jungle. Very low risk of malaria in peninsula so I wouldn't bother taking anti-malarial medicine

This is NHS advice (Scotland):

www.fitfortravel.nhs.uk/destinations/asia-east/malaysia

Yes I was told at the consultation that malaria tablets not required, just cover up and use DEET spray, mosquito net etc.

Tbh I wouldn’t travel anywhere that jabs are recommended without having them.

Me neither, happy to have the ones she said I needed it's the 'consider these' ones I'm struggling with as she could not/ would not say whether I needed them or not, just that I should 'consider ' having them and it's 'up to me' - I was hoping for specific medical advice from her!

Have booked in with another travel clinic tomorrow, hopefully will be more useful.

Does your NHS medical clinic not provide travel advice and injections? I usually make an appointment with the nurse and let the them know in advance where we’re going. Injections have always been free (bar rabies which DH needed last year).

No our NHS surgery said they will not give out any travel advice or give any vaccinations.

All they could do was print out a list of the vaccinations we had already had.

Ah ok! I guess we’re lucky then.

Our practice nurse runs a travel clinic. Shame yours doesn't

Hep A is transmitted through infected water and food, it can cause serious liver damage.
Hep B is blood/bodily fluids.

travelhealthpro.org.uk/country/137/malaysia#Vaccine_recommendations

A lot of them depend on where you are going to be travelling. Not all may be required so you weigh up the risks and make your own choices as to which to get

When are you travelling, OP?

I struggled with this when DS went treking in Borneo several years ago- and I had done a travel medicine diploma a couple of years previously and was working with people travelling in the region for work. ( I am now retired so not fully up to speed)

All his routine vacwere up to date, and he had Hep A&B combined which at the time was free on the NHS. (Not sure it still is) .He has his vaccine record now but I think he had typhoid but I didn't consider cholera. If I remember correctly, it isn't a particularly effective vaccine anyway. He had anti-malarials but not convinced it was essential.
Didn't have Jap E because at the time it was not licensed for teenagers. The NHS advice is:
Japanese encephalitis vaccination
The vaccine gives protection for more than 9 out of every 10 people who have it.
You should get vaccinated if you're:
planning a long stay in a high-risk country (usually at least a month)
visiting a high-risk area during the rainy season or where there's a year-round risk because there's a tropical climate
visiting rural areas in a high-risk country, such as rice fields, marshlands or somewhere close to pig farms
taking part in activities while in a high-risk country that may increase your risk of becoming infected, such as cycling or camping
working in a laboratory with potential exposure to the virus

I think I understand why the pharmacist said "consider" because in some cases it depends on what you are doing while you are in Malaysia and where you are going there. The other thing is check carefully what is available on the NHS- some travel clinics will charge for giving things things you can get free from the GP surgery.

We haven’t had free jabs for holidays for years from the GP travel clinic. It’s been expensive for 4 of us over the years. Some GP services are better than others. Malaria tabs have been very expensive.

I’d have the free ones - hep a, typhoid, etc

Hep b worth it especially for kids as life long.

And rabies I’d do it. For the simple example of a case recently in the uk and they couldn’t get the plasma.

Have a look too at Nathnac and Fitfortravel websites.
As a practice nurse our surgery stopped doing travel for all vaccines but those free on the NHS, dtp, typhoid and hep a. We simply don't have the time. Hep A probably worth getting, two doses gives 25 year protection, advisable for loads of countries.

I just had Hep A when I went.

Regards rabies, if you are bitten while on holiday you will be vaccinated there and then, even if you have been previously vaccinated. Co-pays are usually cheaper than vaccines, mine is cheaper than the rabies course so I don’t bother vaccinating for it.

Drfox is very cheap for anti-malarials compared to boots etc, when I go away I buy the number I need to take before I go away and then I buy the rest in country.

Our nhs surgery will not give any travel vaccinations, they say they have 'opted out' of this service.

After a helpful consultation with a c experienced nurse at the travel clinic and based on what we plan to do and where we plan to go she recommended

Polio/ diphtheria / tetanus booster for me
Hep A
Typhoid
DEET, covering up and mosquito avoidance (low risk for malaria)
Good hygiene practices

So feeling a lot better about things now- just need to wait and see what the coronavirus situation is nearer travel time

If you've already had a course of rabies vaccine before travel and bitten or scratched, you will need a further two doses of vaccine.
If you've had nothing, it is a medical emergency and you will need to find somewhere that has the immunoglobulin (global shortage) and then further vaccines on top. I've known people who've had to be airlifted to other countries in search of the immunoglobulin.
It's always an individual risk assessment which you have to make. You provide patients with the facts and they make the decisions.