Vaccines while on Remicade

[Tesscorm]

Stephen's going to Dominican Republic in July. Asked GI his thoughts and he said he was okay with Dominican BUT to ask at a travel medical centre and get back to him with any recommendations (before giving Stephen anything).

GI is now away for a few days but I'm curious if anyone's ever had any of these vaccines while on remicade

DucOral - travel doc says this is what he would normally recommend to all travellers, however, had a bit of concern as it may cause diarrhea and may trigger a flare!!! Said he doesn't believe there is any conflict with remicade and if Stephen is in remission through remicade then the DucOral shouldn't trigger a flare.

Twinrix (hepatitis) - S had these vaccinations in 2006 (I think it's a series of 3 vaccines) but doctor said that the protection of either A or B (forget which) wears out sooner so it would be a good idea to get revaccinated.

Anyone have any experience with this??

 

[Lisa]

Tess - is he going somewhere that cholera is a concern? That is what the DucOral is for...

Description
Dukoral® is a drinkable vaccine with a documented protective effect against diarrhea caused by cholera, as well as traveler’s diarrhea in Canada. The vaccine stimulates a protective immune response in the gut and has a demonstrated protective efficacy against cholera of approximately 84-86%.

Dukoral® was first licensed in 1991 and is now licensed in 65 countries. It is presently the only internationally licensed oral cholera vaccine. To date, over 15 million doses of Dukoral® have been supplied with very few adverse events reported.

Dukoral® consists of the following two main vaccine components:

Heat- and formalin-killed whole-cell V. cholerae O1 Classical and El Tor vibrios. These induce mucosal IgA antibacterial immunity, which interferes with colonization and adherence of cholera vibrios to the intestinal epithelium.
The non-toxic B subunit-binding portion of the cholera toxin (cholera B subunit), which is known to induce protective antitoxic IgA immunity

Regarding the Twinrix -

If you have decreased immune function from other medications (see also Drug Interactions) or other illness (such as HIV, leukemia, lymphoma, other cancer), your body may not make enough antibodies to protect you from hepatitis A or hepatitis B infection. Antibody levels may be checked after the vaccine series.

Some of the products that may interact with this drug include: chemotherapy, corticosteroids (such as prednisone, dexamethasone), drugs that weaken the immune system (such as cyclosporine, efalizumab, tacrolimus, mycophenolate).

 

[Tesscorm]

Thank you so much for that info! I should have looked up the interactions myself! :facepalm:

Dr. said there had been 'some' cholera in the past (but not a major outbreak - have paperwork at home) but, as long as S stays in the resort, eats only cooked foods, bottled water, etc. he should be fine, even without the vaccine. But, if he could have the vaccine, it would provide added protection.

This doctor was absolutely HORRIBLE!!! I have NEVER met anyone like him! In Ontario, our healthcare doesn't cover 'travel medical' advice, so I had to pay for the consult and, maybe the doctor also gets a vaccine 'commission'??? While we were there, he'd asked to review Stephens vaccine record... when I questioned something he said, he answered 'you're not listening are you?' Then said S needed these two vaccines plus tetanus. I said I would review all with his GI and would get back to him. He said I was too superstitious and that I didn't need to check with GI! Told him I wasn't being superstitious (wtf?) and that I was going to follow the GI's instructions. Said neither tetanus nor twinrix had any effect on remicade so we would just go ahead with tetanus. I said no again! He said I was being over the top and ridiculous! That S's GI was a gastro specialist and that HE was an infectious diseases specialist so HE knew what he was talking about! When I said that was fine but I was still going to wait, he's shaking his head, half laughing and saying I just don't trust him! WTF!!!!

So we left... went to write up my email to the GI and, when looking at Stephen's vaccine record, saw that he had, in fact, had his tetanus vaccine and was up to date!!!

Sorry but what an absolute a---sss!!!!

Now I'm afraid to send S to him for any vaccines! He may even give him the wrong med!! (But, he's a one minute walk and S's doctor is an hour's drive! :ymad

 

[crohnsinct]

What other drugs could interact with Dukoral?There may be an interaction between cholera and travellers' diarrhea vaccine and any of the following:

encapsulated oral typhoid vaccine (do not take within 8 hours of each other)
immunosuppressants (e.g., azathioprine, cyclosporine, prednisone, dexamethasone, etanercept, infliximab, tacrolimus, sirolimus)
other vaccines and medications taken by mouth (do not take other medications 1 hour before and 1 hour after this vaccine)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,
change one of the medications to another,
change how you are taking one or both of the medications, or
leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

 

[crohnsinct]

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

abdominal pain
diarrhea
nausea
vomiting
Stop taking the medication and seek immediate medical attention if any of the following occur:

signs of a severe allergic reaction (difficulty breathing, hives, swelling of the mouth or throat)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.


Immunocompromised people: This vaccine may not be as effective for people with a compromised immune system (e.g., people with AIDS, people taking anti-rejection medications after an organ transplant, people receiving chemotherapy, people taking any medication that suppresses the immune system). People who have reduced immune function should discuss with their doctor how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Protection against cholera and travellers' diarrhea caused by ETEC: Not all people who take the vaccine will be fully protected against cholera and travellers' diarrhea caused by ETEC. This vaccine will not protect against diarrhea caused by other organisms. Travellers should take all necessary precautions to avoid contact with, or ingestion of, potentially contaminated sources of food or water (e.g., drink bottled or boiled water, wash hands before eating and after using toilet facilities).

 

[xmdmom]

These pages might be helpful
http://wwwnc.cdc.gov/travel/notices/watch/cholera-dominican-republic.htm
http://wwwnc.cdc.gov/travel/destinations/dominican-republic.htm

 

[Tesscorm]

I'm really thinking I should report this guy! I can't believe he was soooo insistent on giving Stephen the vaccines right away! I don't get it, unless as I said above, he gets some sort of commission from the vaccines?!?! But I can't believe any doctor, rude or not, would do that!!!

Now... unless these interactions are very minor??? Perhaps it's again a case of very, very little risk, etc., etc., etc. Really curious what GI will say...

 

[crohnsinct]

Did you ask him about the rate of TB in DR? That was a huge sticking fact for our travel doc with Remicade. Remicade patients should never travel anywhere with a high rate of TB.

 

[Tesscorm]

Thanks xmdmom.

Those links reminded me of something else... travel dr said he was going to give S a prescription for antibiotics (he was supposed to write name on paper but didnt...) that he would take for three days if he got sick while he was away. But, when I read the paperwork, it said quinolone antibiotics, one of which is Cipro which Stephen is allergic to - so not sure if that means he'd be more likely to be allergic to another quinolone antibiotic??? Sent this question to GI as well... and whether he should take probiotics with him to take concurrently just in case... :yfaint:

Hate that so much goes into a trip that everyone else takes for granted! :ymad:

Crohnsinct - no I didn't think to ask! I should've saved myself the consulting fee and just asked here and gone back to the GI with THESE recommendations! :lol: Will check on the links xmdmom sent...

 

[Lisa]

This might put you at ease a little....

I have traveled to Finland multiple times without any adverse effects - and without taking any additional meds...

I was in the Bahamas for a week in February...did NOT need to take any special precautions..and YES - we did go off the resort and ate 'local'.....

I have also been to Jamacia without any additional vaccinations or ill effects (except maybe a little too much alcohol! lol)

I think if S is careful with what he eats, drinks bottled water (should anyway when traveling!), and maintains sanitary behaviors, he should be fine as he is. Pack extra alcohol wipes/gel for him to use.....and remind him to wash hands often.

 

[Tesscorm]

Thanks Pasobuff... I think it is easy to get carried away with the risks and worries! Once that ball gets rolling..... utahere:

In this one instance, luckily, Stephen is a picky eater! :lol: He pretty much dissects each forkful before putting it in his mouth :ywow: and doesn't like fruits or veggies (unless pushed to eat)! So, I'm pretty sure he'll be living off pizza, chicken nuggets, fries and beer! :lol: And, for this one particular week, may be the safest diet for him!

 

[upsetmom]

Tess i'm glad you didn't give in to this DR....we've been told by our GI that my daughters not to have any vaccine till they ring them up first and tell them what sort of a vaccine it is.

 

[Johnnysmom]

Dominican republic makes me a little nervous. Johnny became symptomatic a few months after we went. I am not sure if it was his "trigger" into starting this disease or not. My husbands whole family lives there and I can only tell you that I would never ever go to a hospital there. If for some reason something happens and he needs care, have a back up plan to get him out of there. My mother-in-law lives there now and grew up there and we literally have dozens of relatives.

I always brush my teeth with bottled water. And the mojito's made half our family sick last time because of the leaves in them. If anything is rinsed in the water it will make you sick. We stayed away from any fresh fruit/salads etc.

If he is careful I think he should be fine. We weren't aware of Johnny's disease last time we went and I wasn't quite the paranoid germaphobe I am now. My mother-in-law wants my son to spend two months there when he turns 15 to learn the language. I am trying to work up to that!

We were fine in the Bahamas too and in Puerto Rico. Our GI did recommend that Johnny do probiotics when we went to the Bahamas.

 

[crohnsinct]

No mojitos?! What's the point in going then?!

 

[Tesscorm]

My mother-in-law lives there now and grew up there and we literally have dozens of relatives.

Johnnysmom - will your family take me in for a week? I'll be the back-up plan because, you know, NOTHING else will ease my worry while he's away? :lol:

Too bad about the mohitos...