Mefloquine Monday’s and Vaxxed to the Max

So what vaccines did we get for Burundi?

Yellow Fever

For starters we can’t even get a visa without the yellow fever vaccine- so that was an absolute must! Yellow fever is a mosquito born illness that is endemic in sub-Saharan Africa and parts of South America. Travelers going to west Africa are at the highest risk and it is estimated nearly 90% of yellow fever cases are reported from this region.. We are headed to east central Africa but the risk is still high. The good news is that the yellow fever vaccine works extremely well! Studies have shown that greater than 92% of vaccine recipients had detectable antibodies after 10 or more years. For this reason most people are one and done with the yellow fever vaccine. You can of course still consider a booster on a case by case basis, for example: if it has been over 10 years and someone is going to a highly endemic area in peak season (think West Africa in the rainy season).

The vaccine is recommended for everyone 9 months and older.

Rabies

The rabies virus comes from an infected animal bite and infects your central nervous system. Rabid dogs are common in Burundi and there is not ready access to treatment in most parts of the country so the vaccine is SUPER important, especially for our kiddo who at almost three is very curious and the one most likely to be petting stray animals. The vaccine is a 3 dose series with the second dose 7 days after the first and the third dose 21-28 days following the second dose. Prevention is key because once symptoms begin, Rabies is nearly 100% fatal!

You may need another booster in 3 years or you can check for titers and re-asses.

Typhoid

Typhoid comes from eating contaminated food or water. Symptoms include fatigue, fever and GI symptoms. This is a bacterial infection and can be treated with antibiotics. Vaccine options are interesting because typhoid actually has an oral option! The oral capsule is a total of 4 capsules- one taken every other day- and completed over one week. This will cover you for 5 years but the caveat is it’s only for those ages 6 and above. The injectable vaccine is one dose and only last’s for 2 years.

Random typhoid tangent: Have you heard of typhoid Mary? She was a carrier of typhoid: meaning she shed active virus but had no symptoms. Unfortunately, she was also a cook and this lead to several typhoid outbreaks in the early 1900’s in NYC. Her misfortune also lied in the fact that her signature dish was peach ice cream, which does not bode well for typhoid because the bacteria survives in cold but is killed by cooking food in high temperatures. They could not get her to stop working (that must have been some delicious peach ice cream) and she spent nearly 23 years in forced confinement until she passed in 1938.

Polio

Most of us received this as a child but a one time Polio booster (for adults previously fully vaccinated) is being recommended if you travel to certain parts of the world and there has been an increase in cases recently. Prior to the vaccine, Polio caused nearly 15,000 cases of paralysis a year (YAY for science!!).

But wait, what about Malaria?!!

There are several medication options for Malaria prevention. The most common one’s are: Malarone (pill taken daily), Mefloquine (pill taken once a week, thus the adage: Mefloquine Monday’s) and doxycycline (pill taken once a day). These all have different side effect profiles that I won’t get into, but we decided to go with mefloquine because the once a week dosing was appealing. Now this medication is not for everyone and it can sometimes cause pretty vivid dreams- which is not a horrible side effect in my opinion UNLESS we are talking night terrors- then I may need to re-evaluate…. Stay tuned and I will report back on the dreams.

We will of course continue with mosquito nets and DEET because malaria is no joke, and the primary malaria species in Burundi is P. Falciparum which is the deadliest form.

I feel like I need to send a shout out to the med unit at main state. They were absolutely amazing in explaining all of this to us and they were really great with vaccinating my kiddo. Bonus: we received all these vaccinations and medications FREE of charge from the health clinic at DOS. A few of my MED classmates have families out of state that didn’t come with them to DC for orientation, and they were quoted an insane price tag of $5,000 for these travel vaccinations! The health clinic is absolutely the way to go if you can.

Disclaimer: This is meant as an overview and not meant to be taken as medical advice.

Our diplo passports are in! Next up is our Visa to Burundi.

We are entering into our second week of MED training, with only one more week to go.

We are learning mostly the administrative side of our job. So for example: Charting (brace yourself it’s paper charting-GASP), how to medevac and order medications and vaccines - to name a few admin duties. While not the most exciting topics, they are all things that are very relevant to our day to day job and imperative to know. We will get a few infectious disease lectures but that is about the extent of our clinical training. It seems as if most of the learning takes place on the job, because each location is unique and may do things a bit differently. Due to this autonomy, I can totally see why they require at least 5 years of clinical experience before you are able to apply.

I thought I would include a few tips for anyone that may be in the process or about to go through the process…

So to recap: Six weeks of general orientation, immediately followed by 5 days of FACT training (in Southern Virginia- you will stay in a hotel during this time), followed by a week of online modules and then 3 weeks of MED training.

I thought things would be chill after FACT, as we had that one week of online modules, but it was anything but! This has definitely been one of the more stressful parts of orientation. FACT was 8am-5p with a one hour commute each way (the actual facility is in a pretty remote area) so they were LONG and very active day’s and essentially nothing got done that week. A few takeaways:

• You will likely get your TMONE (official assignment document) during FACT training. Keep an eye out for it and once you receive it email SIA to make an appointment to drop off passport application paperwork ASAP. Go to SIA over-prepared with paperwork, bring copies and if you have children they need to be present (unless your family is out of town then it is completely different and in that case feel free to send me a message for more insight).

• Email the medical clinic copies of everyone’s vaccine record then call them and make an appointment. You may need multiple vaccines over a period of time, so start early (although remember you can most likely finish vaccine series at post, we will need to do this for our third rabies).

• You will need your diplomatic passport before you can get your Visa so it’s imperative you start early on this. I was able to get in to SIA and drop everything off the Wednesday after we came back from FACT and I received my diplomatic passport about 5 working days later.

• If your family is not with you at orientation, consider flying them out the week after FACT training to do vaccines and passport stuff in DC. It seems easier to do, than attempting at a local passport facility in other parts of the country (although not impossible, several classmates definitely did this) and it is certainly cheaper in regards to vaccines.

The exact schedule may change for other classes, but I thought it would be helpful to see a roadmap of our orientation and how things unfolded because it sometimes feels like you are driving blind in this process!

I’m really looking forward to the rest of MED training and of course spending time with the entire MED crew as we have become fast BFFs.

In other news, someone is obsessed with taco trucks. Can you blame him?