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Injections for Kenya?



 
 
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  #21  
Old December 2nd, 2004, 07:04 PM
claudel
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In article ,
Marc Lurie wrote:
Hans-Georg,

That's an intersting angle to look at the situation, and I can
certainly see where you are comming from.

Because I work in those areas, and the chances of being bitten by a
dog, rat, mongoose, bat etc. are pretty high, I have made sure that I
was vaccinated against rabies because I know that rabies is incurable
once the symptoms present, and I also know that I won't trust my life
to a potentially dodgy east African doctor with potentially dodgy
generic Indiam medicines.


Even in "civilized" areas the treatment for rabies after exposure
in no fun. A friend of mine and her children had to undergo it
after their dog got into a disagreement with a rabid raccoon.
The low competence of the local health authorities didn't help.

1st bureaucrat: It's dead? Put it in a plastic bag and freeze it.

2nd bureaucrat: You touched it? You weren't supposed to do that.

At least the current series of shots is fewer than it used to be
and no one got sick.

My doc recommended that I skip the rabies vaccination because
of the low possibility of contact since I don't work with animals.


The shots were (are) expensive, but I weighed it up and figured they
were well worth it.


I'd do/pay just about anything to avoid post-exposure rabies
treatment.


You're quite right about a good insect repellant - worth much more
than all the tablets.


Yep. Relatively inexpensive as well.


Claude

snip
  #22  
Old December 6th, 2004, 03:18 PM
riverman
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"Hans-Georg Michna" wrote in message
...

Claude,

if only it were that simple. The problem is that the injection
has its own side effects. A few people die from inoculations.
Taking a few extra shots doesn't necessarily put you on the safe
side. Also, they cost money that you could spend on other things
that increase your likely lifespan.

Another problem is a mathematical one. It is always difficult to
treat very small risks properly, and people tend to be unable to
deal with them (so they play the lottery, for example).

To give an example, you pay money for a shot that decreases your
one-in-a-billion chance to die from yellow fever during your
two-week vacation. Then you cross the street in Nairobi and
incur a one-in-a-million (a thousand times higher) risk to get
run over by a car (particularly because the cars come from the
wrong side, but that's another matter). If you spent that same
money on a local guide, it might be vastly more effective in
decreasing your total small risk of premature death.

Even spending the same amount of money on reducing the residual
malaria risk further may be more efficient, for example by
selecting and buying the most efficient insect repellant (which
would reduce your yellow fever risk at the same time, by the
way).

In short, the yellow fever shot may not be the most
cost-efficient way to prolong your life.

I will only mention on the side that you could probably save the
live of a sick African child by spending that same money on him,
rather than on yourself.

Hans-Georg



Hans-Georg:

What an idiotic and academically wasteful argument. Your point is only
well-taken if you have a very finite amount of money and need to make a
single choice and use risk-based decision making about where to spend your
money: either on a yellow-fever shot, malaria meds, mosquito net, tour guide
or bug dope. If that's the situation in someone's life, they might be even
better off not spending money on the plane ticket to get to Kenya, or better
yet, they should skip a meal (0% chance of death by doing that) to buy a
long sleeve shirt (measurable chance of avoiding a mosquito bite) instead.
Life is full of choices, and its impossible to limit each single choice to a
cost-efficient analysis....especially when the costs are so trivial compared
to the cost of the actualized risk, no matter how slim it is.

Risk-analyses are based on multiplying the chances of incurring an illness
times the seriousness of that illness. A microscopic chance of getting
Bubonic Plague doesn't necessitate getting vaccinated. A huge chance of
stubbing your toe doesn't neccessitate getting steel-toed boots. But a
small, but measurable, chance of getting Yellow Fever does imply the
importance of getting vaccinated.

Furthermore, a cost-based risk analysis means to divide that assumed risk by
the cost, for a 'unit cost of assumed risk' factor. If the risk of side
effects are small enough, and the cost is low enough, it makes statistical
sense to take the medication based on that, alone. It costs $20 to take the
meds, and there is amost a zero percent chance of serious side effect, and
the illness is VERY serious, then its a no-brainer.

The reality is that we all take multiple precautions in life, some with
predicatable and measurable effects, others with unpredictable effects. But
the cumulative effect is what matters: get a Yellow Fever shot, your HepA
and HepB shots, your tetanus shot, your MMR and typhus shots, and then you
have a cumulative protection that is measurable, at relatively low cost, and
with minimal chance for deleterious side effects.

--riverman


  #23  
Old December 7th, 2004, 08:20 PM
Hans-Georg Michna
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On Mon, 6 Dec 2004 15:18:16 +0100, "riverman"
wrote:

What an idiotic and academically wasteful argument.


Riverman (and Claude),

do your sums. Estimate the likelihood of side effects. Compare
it of the likelihood of contracting yellow fever. Both can kill.

Without the numbers your statement has no meaning. The argument
that it can't hurt to get the shots is simply not true.

Hans-Georg

--
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  #24  
Old December 7th, 2004, 08:39 PM
claudel
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In article ,
Hans-Georg Michna wrote:
On Mon, 6 Dec 2004 15:18:16 +0100, "riverman"
wrote:

What an idiotic and academically wasteful argument.


Riverman (and Claude),

do your sums. Estimate the likelihood of side effects. Compare
it of the likelihood of contracting yellow fever. Both can kill.


Speaking for myself, I did.

I balanced the cost of the vaccination, which in my case was zero
as it was covered by insurance, and the possibility of adverse side
effects from the vaccination against both the likelihood of contracting
yellow fever and the possibility of encountering some sort of bureaucratic
snarl at an inconvienient moment due to the lack of the vaccination doco
and decided to have it. I _did_ discuss the possibilities of adverse
reactions to the various vaccines with my physician before I had any
shots.

If I had it to do over again I would not have had the first Hepatitis A&B,
Diptheria/Tetanus, Typhoid, first Japanese Encephalitis, and YF shots all
at the same time. :^). There was a time factor involved, though.

It took me a couple of days for my immune system to recover and I was pretty
much wiped out. Better than _really_ getting sick, though, I suppose.


Claude


  #25  
Old December 8th, 2004, 04:23 PM
riverman
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"Hans-Georg Michna" wrote in message
...
On Mon, 6 Dec 2004 15:18:16 +0100, "riverman"
wrote:

What an idiotic and academically wasteful argument.


riverman (and Claude),

do your sums. Estimate the likelihood of side effects. Compare
it of the likelihood of contracting yellow fever. Both can kill.

Without the numbers your statement has no meaning. The argument
that it can't hurt to get the shots is simply not true.


First of all, I'm not saying 'it cant hurt to get the shots' any more than
you are saying 'it cant hurt to skip them'. The shots can kill, the disease
can kill. We are talking about probable outcomes and acceptable risks.

Additionally, I'm saying that choosing to spend $5 on bug dope instead of
a vaccine is a false economy, and that WAS the academically wasteful point
of your post. My suggestion: get both, and get a mosquito net too.

But OK, I'll do the sums, and provide my sources.

The CDC and WHO have documented exactly 7 patients worldwide who developed
severe side effects from the YF vaccine between 1996 and 2001*. This is out
of 30 million who have had the vaccine, so that makes the odds of getting
really sick, sometime in a 5-year period, about .000023%. (I am disregarding
the less than 5% chance of getting headaches, muscle aches or a temporary
rash as a 'serious illness' on par with getting Yellow Fever.)

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.

This outbreak was attributed to the poor vaccination program
in-country...you speak of the altruism of helping a native Kenyan with your
money...I'd offer that participating in the vaccination program to eliminate
any chance of helping start another epidemic is much more altruistic.

These stats are for Yellow Fever only. Do the sums for all the other
diseases of that region, then add them up. Or just take your chances...the
traveller just might be sitting next to someone coming from Nigeria (20,000
cases between 1982 and 1996).

--riverman

* http://www.cdc.gov/ncidod/dvbid/yell...cine/index.htm
** http://www.who.int/vaccines-surveill...s/htmls/YF.htm
http://www.who.int/vaccines/globalsu...cidenceyel.htm,
page 48.
*** http://www.who.int/vaccines-document...DF/www9842.pdf
**** http://www.travmed.com/maps/country.epl?c=Kenya


  #26  
Old December 9th, 2004, 09:05 PM
Hans-Georg Michna
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On Wed, 8 Dec 2004 16:23:21 +0100, "riverman"
wrote:

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.


Riverman,

so how many tourists died from yellow fever then?

Probably none, and we still have no reasonable statistics at
all. It's all wild guesswork, except for the doctors and the
pharma industry. For them it works out well. (:-)

Hans-Georg

--
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  #27  
Old December 9th, 2004, 09:05 PM
Hans-Georg Michna
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On Wed, 8 Dec 2004 16:23:21 +0100, "riverman"
wrote:

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.


Riverman,

so how many tourists died from yellow fever then?

Probably none, and we still have no reasonable statistics at
all. It's all wild guesswork, except for the doctors and the
pharma industry. For them it works out well. (:-)

Hans-Georg

--
No mail, please.
  #28  
Old December 10th, 2004, 10:37 AM
riverman
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"Hans-Georg Michna" wrote in message
...
On Wed, 8 Dec 2004 16:23:21 +0100, "riverman"
wrote:

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters
Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.


Riverman,

so how many tourists died from yellow fever then?

Probably none, and we still have no reasonable statistics at
all. It's all wild guesswork, except for the doctors and the
pharma industry. For them it works out well. (:-)

Hans-Georg



So thats your point? That the recommendation to have yellow fever
vaccinations, and the defination of 'at risk zones' is merely a conspiracy
by doctors and the pharma industry to pad their pockets, while in real life
the vaccine poses a measurable and inherent threat to the patients?

Then why would the WHO and CDC, who have no allegiences to pharma industries
(and in fact battle them constantly for affordable medications for AIDS,
etc), be taking their preventative stance about YF? Why would they risk
their entire organization by supporting saomething with no basis, that could
so completely discredit them?

Look at how many people have died from Yellow Fever before vaccinations were
made available, as opposed to how many people have died from the vaccine. If
your implications are correct, you're pretty much sitting on a time bomb,
with your fortune to be made. Not to mention the lawsuits for wrongful
death, personal injury, etc.

I'm waiting to see any evidence for your claims, as that would be
fascinating.

--riverman


  #29  
Old December 10th, 2004, 10:37 AM
riverman
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"Hans-Georg Michna" wrote in message
...
On Wed, 8 Dec 2004 16:23:21 +0100, "riverman"
wrote:

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters
Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.


Riverman,

so how many tourists died from yellow fever then?

Probably none, and we still have no reasonable statistics at
all. It's all wild guesswork, except for the doctors and the
pharma industry. For them it works out well. (:-)

Hans-Georg



So thats your point? That the recommendation to have yellow fever
vaccinations, and the defination of 'at risk zones' is merely a conspiracy
by doctors and the pharma industry to pad their pockets, while in real life
the vaccine poses a measurable and inherent threat to the patients?

Then why would the WHO and CDC, who have no allegiences to pharma industries
(and in fact battle them constantly for affordable medications for AIDS,
etc), be taking their preventative stance about YF? Why would they risk
their entire organization by supporting saomething with no basis, that could
so completely discredit them?

Look at how many people have died from Yellow Fever before vaccinations were
made available, as opposed to how many people have died from the vaccine. If
your implications are correct, you're pretty much sitting on a time bomb,
with your fortune to be made. Not to mention the lawsuits for wrongful
death, personal injury, etc.

I'm waiting to see any evidence for your claims, as that would be
fascinating.

--riverman


  #30  
Old December 10th, 2004, 11:46 AM
riverman
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"Hans-Georg Michna" wrote in message
...
On Wed, 8 Dec 2004 16:23:21 +0100, "riverman"
wrote:

Although the vaccine is not required, the WHO considers Kenya one of their
'at risk' countries**, and recommends a vaccine for anyone who enters
Kenya
and goes outside the urban area****, considering that there was a serious,
and unexpected, outbreak as recently as Sept 92-March 93***.


Riverman,

so how many tourists died from yellow fever then?

Probably none, and we still have no reasonable statistics at
all. It's all wild guesswork, except for the doctors and the
pharma industry. For them it works out well. (:-)


From
http://patients.uptodate.com/topic.a...=Travel+Advice
Yellow fever in expatriates and travelers to Africa and South America has
been rare since the introduction of routine vaccination after World War II.
Since that time, eleven recorded cases have been published, including two
fatal cases in 1996 in unvaccinated American and Swiss tourists who acquired
the infection in Brazil and died after returning home. An additional fatal
case was reported in an unvaccinated Californian who had traveled in the
rainforests of Venezuela with six others; five of these six companions had
been vaccinated against yellow fever. A tenth (fatal) case occurred in a
German tourist in 1999. An eleventh fatal case occurred in November 2001 in
an unvaccinated Begian tourist exposed to yellow fever in the Gambia. A
previously healthy Texan who traveled with a group to fish on the Rio Negro
in rural Brazil was also reported to have died with yellow fever on March
14, 2002; the patient had not been vaccinated against yellow fever. These
events emphasize the risk of exposure in the endemic zone, whe

a.. The virus may circulate silently between nonhuman primates and
mosquitoes
b.. Surveillance for human disease is minimal
c.. The indigenous population may be protected by vaccination.
--riverman
Google under "yellow fever tourist deaths"


 




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