and then Good News!!

PeakFreaks has received permission from the Nepalese government to let the trekkers spend the night at base camp (BC) for this year only!! We're in under the wire. So exciting!!

Now lets hope we are able to make it to BC without altitude sickness (or other ailments).

Half Price Rabies Shots...

Do I have your attention now? That's right half price!

When we first considered rabies vaccinations back in 2010, the cost per shot was $60 Canadian. We both needed 3 shots each for a total of $360. Because this was all out of pocket expenses (and we had other vaccinations to pay for) we decided against it.  On this trip there is more of a need for rabies prevention—we will be visiting monkey temples and Kathmandu has a high instance of rabies—so we wanted more info about risks.

The shocker was the cost...$220 per shot, 3 shots per person for a total of  $1320 (plus taxes)

After some discussions with the travel nurse we had a better understanding of what our options were. A few important considerations were:

• Rabies is always fatal in humans if not treated
• Signs of infection in humans only appears once its too late to treat
• Pre-exposure rabies vaccination will give you rabies antibodies (pretty much) for life
• When it comes to rabies vaccinations, there are two type of vaccine:
• rabies vaccine (expensive but fairly easy to acquire)
• rabies immune globulin (very, very expensive and difficult to acquire)

1. If you get bit or scratched by a rabid animal and you have no rabies antibodies, you need 1 shot of  rabies immune globulin AND then a series of four shots of  rabies vaccine. If you happen to be in an area where immune globulin is not available you're in trouble!
2. If you have rabies antibodies and then get bit, you would only need 3 rabies vaccine shots. No need for the expensive, hard to find globulin.

Armed with this knowledge we decided to take the plunge. As almost an afterthought, our travel nurse made a suggestion that we might want to consider a vaccination method that is not widely used in Canada but is globally accepted as safe and effective.

Instead of injecting one full vial of vaccine intramuscularly  (IM) we could share a vial and each have half injected intradermally (ID). This would reduce our entire cost by half. The caveat...there is a 5% chance that we won't develop enough antibobies and we may need a single, full dose if the 3 half doses didn't take. We decided to take a week to research and discuss.

The rabies vaccine we were going to be using was RabAvert. From the RabAvert drug insert::

RabAvert MUST NOT BE USED SUBCUTANEOUSLY OR INTRADERMALLY.
RabAvert must be injected intramuscularly. For adults, the deltoid area is the preferred site of immunization; for small children and infants, administration into the anterolateral zone of the thigh is preferred. The use of the gluteal region should be avoided, since administration in this area may result in lower neutralizing antibody titers (1).

From the Public Health Agency of Canada web site:

While intramuscular (IM) administration of rabies vaccine is the gold standard, the World Health Organization (WHO) considers the intradermal (ID) regimen an acceptable alternative as it uses less vaccine to produce a comparable degree of protection against rabies.In a number of countries throughout the world, ID administration has become standard practice. Although not recommended by the manufacturer in Canada, ID vaccination with rabies cell culture vaccines is an economical and widely accepted alternative to IM vaccination and uses one-tenth of the IM dose.


We decided to go ahead with ID method—95% success rate sounds good to us. Even if we both failed, we would still save money. The only caveat would be if we don't get our blood test results back before we left. We were taking a chance that we may not be fully protected on the trip.

This will be the first time that this Primacy travel clinic has administered rabies vaccine using the ID method, so special permission was needed by the clinic doctor. We're officially guinea pigs!

Bad News...

Today, a brief email to Becky at PeakFreaks brought discouraging news.
Apparently the Nepalese government has set in place a new rule that trekkers can no longer spend the night at Everest Base Camp. Only climbers (and I'm assuming support staff) can camp overnight. Becky only found out about this yesterday and I guess now is dealing with trying to get overnight accommodations for the entire trekking team that is arriving ahead of us.

This is a bit upsetting because the main reason why we chose PeakFreaks is because they are the only trekking company that offered this experience. Since they actually have climbers attempting to summit Everest, all the necessary permits/licenses are purchased—the trekkers are covered under that permit.

Visit to the Travel Doc

Our travel doc told us that Nepal is referred to (in her circles) as the "diarrhea capital of the world"! Crap!!! Guess we can expect a prescription for Cipro.

All our shots are up to date as per our last trip: http://kilemabound.blogspot.com/2010/08/vaccinations-you-knew-there-would-be.html   The only considerations for this trip will be:


Maleria:
 The trek to base camp will be at elevations that are too high for mosquitoes but since we will be spending about 6 days in and around the Chitwan jungle region, a prescription for Malrone is in order. We start the drug one day prior to entering the maleria zone and continue it until 7 days after we leave it.

Rabies:
We will be visiting a couple of temples where monkeys run freely and the dogs around Kathmandu are known to carry rabies. We will need to make a decision about whether or not to get vaccinated.

High Altitude Sickness
HAS is a real possibility and hard to predict. We are being prescribed Diamox to use as either a preventive or in the event that we start noticing symptoms. One of the main side effects of the drug is drowsiness so I don't think we will be taking these as a preventative measure. Since the drugs main effect on the body is to force CO2 out through urine, the pills act as a diuretic. A more interesting side effect of this is that any carbonated drinks will taste flat to the person taking the drug.

Japanese Encephalitis
This was  briefly passed over as not being needed.


Anti-parasitic Medication
This was something that we didn't have for our trip to Africa, however the CACHA pharmacist sent everyone home with one Mebendazade (de-worming) tablet to take as a precaution. Since this was still large in our minds we made a request for single tablet each, but were told that this really wasn't necessary for this trip.

Anti-diarreah/ Anti-nausea
We have prescriptions for both Cipro and Zithromax to be used as needed. Apparently Cipro doesn't always work on the types of bacteria found in Nepal so we are instructed to try the Cipro first, then after a day or two, if its not working, we need to switch to Zithromax. Hopefully we don't need either!!