As this will be the first time we are visiting Sub-Saharan Africa, I did some extensive research and reading up on the type of vaccines we should administer and what to look out for to ensure we remain healthy throughout the journey. 

Disclaimer: I am sharing these information based on personal experience and the information here may not be extensive. They can give you some ideas of what to look out for. 

To start of, there is a vaccination requirement difference between entering Tanzania directly from your home country and entering Tanzania from Kenya.

Let me first share why we decided to enter Tanzania by Kenya. 

Our plane will land in Kenya (Jomo Kenyatta Airport) where we will stay a night in Nairobi before taking a free 6-hour shutter bus to Moshi, Tanzania. (included in our trekking package). We decided on this instead of flying directly to Kilimanjaro as it is much cheaper to reach Kilimanjaro this way. If you book about 5 months ahead of time, the price of flight from Singapore to Kenya cost about S$1320.00 on Ethiopian airline as compared to flying directly to Kilimanjaro which cost about S$2200.00. There are also much cheaper options from other airlnes like Air India and Air Indigo which offer flight from Singapore to Kenya at a price as low as S$600.00 if you book 10 - 12 months in advance. Sadly, by the time I booked my flight right after Lunar New Year in Feburary (4 months earlier), the price of flight from the Ethiopian airline has already risen to S$1592.00. So I suggest that you book your flight early. 

Anyway, as Kenya is a Yellow Fever Endemic country, Tanzania requires all tourists entering from Kenya to possess the Yellow Fever Vaccination Certification. It cost about S$220.00 to get a Yellow Vaccination in Singapore  As such, please factor in this cost when deciding whether to fly direct to Kilimanjaro or to land in Kenya.

Here are some useful details (in point form) I found out and my evaluation on each of the vaccines. (These are information as of Feb 2024)

Vaccination Requirements 

1) Yellow Fever Certificate is compulsory when travelling from Kenya to Tanzania. After taking the Vaccine, need to wait 10 days before the cert is valid. And Singaporeans also need to have this certificate to return back to Singapore from Kenya. If not, we will need to be quarantined for 6 days. So do get Yellow Fever Certificate if you are travelling to and from any Yellow Fever Endemic Countries in Africa.

2) Other vaccines that are recommended for trip to Kenya and Tanzania:
* TdaP (Tetanus etc)
* COVID-19
* Influenzas
* MMR (Mumps, Measles, Rubella)
* Polio
* Hep A (2 shots)
* Hep B (3 shots)
* Tyhoid
* Rabies (can spread by animal bits and even scratch)
* Cholera

We might already have some of the above so need to check medical record to see if our earlier vaccination is still valid. Certain vaccines needs a few weeks to take effect and certain vaccines can't be taken together so do start getting yourself vaccinated early and consult the doctor or nurse for more details.

3) There is no vaccine for Malaria so will need to buy medicine for it. In Singapore, we are prescribed by the doctor with Doxycycline for this purpose which we needed to take daily before, during and after the trip. 

4) Diamox (or Acetazolamide) is a kind of pill which helps reduce chance of altitude sickness. It has to be taken daily before and during the climb. I suggest we take it. I did not take it when I went to Everest Base Camp in 2019 and started having mild attitude sickness at the 4800m mark despite having acclimatised for 2 days which caused sleeping difficulty for 2 night. (Please read my blog on my EBC trip for details) So this trip, I will be taking it to increase my chance of success. Side effect if it is constant peeing during the hike. This pill needs to be prescribed by doctors and they will ask you for your climbing dates to give you the exact number of pills you need.

I recommend reading www.travelbughealth.com for more vaccine related details for travel to Kenya and Tanzania

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While considering which vaccine to take and which to pass, I read further into each of them and did my own price-risk analysis. Here are some of my thoughts which must not be taken as an expert advice. Please weight your own price-risk as well.

Info about Rabies and Rabies Vaccine

While reading whether it is worth to take the Rabies Vaccine, I considered the following:

It cost SGD$320 per dose. And need 3 doses (over 1 month). So total cost is close to S$1000!

Source:
https://clarihealth.com/sg/

Rabies is mainly transmitted by Saliva of infected Animal bites (Mainly dogs). Once infected, the virus will slowly affect the brain. it takes about 2-10 days for 1st symptom to appear (fever, malaise, fatigue, anorexia, cough, sore throat, abdominal pain, nausea, vomiting or diarrhea.) and once the virus starts affecting the brain (neuro-stage), death can happen between 2-7 days.

However, it has an incubation period up to many years. So after being bitten by an infected dog and shows no symptoms, we cannot assume that we did not get rabies. See a doctor to test if our blood contains the virus.

Rabies is deadly (not suddenly) but very treatable.

So it is advisable to minimise contact with dogs when we are in Africa. And if we get bitten, once return back to our Country, to seek medical examination immediately to test if we have the virus.

As we are only in Africa for 2 weeks and mostly away from civilization, I personally will not be taking the Rabies vaccine after understanding the risk and the cost involve.

I will just get medical treatment back in Singapore when the need arise.

Source:
https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Rabies.aspx#:~:text=Post%2DExposure%20Treatment,-The%20most%20effective&text=Post%2Dexposure%20vaccination%20consists%20of,vaccine%20and%20human%20rabies%20immunoglobulin.

Info about Cholera and its vaccine

- Kenya and Tansania have known Cholera cases.

- Infected by drinking unclean water and food prepared by unclean water.

- Once infected, the person can have severe diarrhea up to 5 days.

- Kidney failure happens when left untreated (less than 10% chance).

- Death happens due to dehydration due to vomiting and diarrhea.

- Can be treated by keep drinking water (+ electrolyte) and let the virus comes out within 5 days naturally (if antibiotics are not available)

- Can be prevented by

1. Make sure all water we drink are boiled.
2. Make sure all water we drink have chlorine pills (Aqua pills) added - provided by our provider
3. Drink only from mineral water bottle and not from the tap
4. Do not eat food (and vege) that is raw and uncooked
5. Do not eat ice cream and cold water containing ice cube (Drink only refrigerated cold can drink)

- Most cases reported are people who have stayed in Africa for more than 1 month or doing disaster relief work and exposed to unclean water

- Vaccine is not by needle, but by drinking 2 doses of liquid.

- Protection is only for 6 months after vaccination

- Cost of each dose is S$121.00 (Thus $242.00 in total)

After learning all these, considering the fact that it can be cured naturally and during the climb, we will be drinking chlorine treated water and our water will be boiled by the provider and that steps can be taken to prevent this from happening, I will skip Cholera Vaccine but I will exercise with care and follow the prevention advice listed above. I will also have access to clean water during my stay in Africa for rehydration purpose. Death cases happen because victim has no access to clean water upon getting the virus and dies of dehydration.

Sources:
Price guide of all vaccines in a private clinic in Singapore:
https://minmed.sg/travel-vaccination/

More about Cholera:
https://clarihealth.com/sg/vaccinations/cholera/

https://www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Cholera.aspx

Info about Polio and its vaccine

Cost of vaccine is 3x $101 = $303 and can protect up to 18 years.

However, Kenya and Tanzania have no case of Polio since 2016. 

Polio is only a major concern to those who wants to travel to Afghanistan and Pakistan and slight concern for those going UAE, Nigeria, Sudan, Chad, Cameroon, Angola and Congo.

Congo is just beside Tanzania.

Polio virus resides in the intestine and throat of infected person thus it is mainly spread by poop and cough and sneeze. As long as I practice hygiene like washing hands and eat food from clean sources, I believe I will be fine.

As such, I won't be taking the Polio Vaccine.

Here is a link to see where Polio is still reported today.
https://worldpopulationreview.com/country-rankings/countries-with-polio

Info about Yellow Fever Certification

I gave a call to Tan Tock Seng Hospital to enquire about the cost. The person on the phone said that it cost S$260 per dose (before GST) and must call in to make appointment first.

The certification last forever so only need to take once in a life time.

Other cheaper options are (as published on their website)

S$210 before GST (located at Tanjong Pagar or orchard)
https://atamed.sg/yellow-fever-vaccine-in-singapore

S$212 before GST (located at Jewel Changi)
https://minmed.sg/travel-vaccination/

After vaccinated, need to wait 10 days before the Certidicate is valid.

As this is mandatory since we are travelling between Kenya and Tanzania, I will be taking it.

Other Vaccine related info good to read

I have earlier documented the vaccines I took in 2019 before my Everest Base Camp trip in 2019 which is still relevant to this trip to Mount Kilimanjaro.
Here is the link to read:
https://linuslin.sg/everest-adventure/what-are-my-biological-defences-in-nepal-and-india/

There is also a chart you can read which shows what kind of vaccine is needed for which country.

I did not take Hep B vaccine back then in 2019 after knowing it spread by sexual intercourse with the local or infected needle or blood related procedure. As these are unlikely events that will happen in this trip, I will be skipping Hep B vaccine as well.

Both Hep A and Hep B can cause liver damage and failure. Both have no cure but most infected people will be able to recover on their own.

My Grand Vaccination Summery for your reference
I went to polyclinic today (14 Feb 2024) and gotten some vaccinatons. Here are details you might be keen:

PS: I found my old Blue Health Booklet which shows I had taken Polio vaccine and MMR in my childhood. So I guess all Singaporeans should already have MMR unless we missed the vaccination dates in Primary School.

Price mentioned are quoted by Bukit Panjang Polyclinic (Singapore) thus they are subsidised. Also we do not need to pay 9% GST in polyclinic.

* Yellow Fever ($210 - $260) - Not taken yet (lifetime)
* TdaP ($50) - Taken (Valid 10 years)
* COVID-19 - Taken 4 shots before
* Infuenza ($32) - Taken (Valid 1 year)
* MMR (Mumps, Measles, Rebella) ($20x2) - Taken before in 1992 (lifetime)
* Polio - Taken in 1992, ignore
* Hep A (2 shots) ($85x2) - Taken before in 2019 (last 15 years)
* Hep B (3 shots) ($20x3)- Ignore
* Tyhoid ($31) - Taken (Valid 3 years)
* Rabies (can spread by animal bits and even scratch) - Ignore
* Cholera - Ignore
* Anti-Malaria Pill, Doxycycline ($4.79 for 56 pills) - Doctor Prescribed. Will be taking
* Altitude Sickness Pill, (Diamox, Acetazolamide) ($5.60 for 10 pills) - Doctor Prescribed then bring prescription to Unity Pharmacy to buy OTC.

Side notes:
- MMR and Hep B can be claimed by Medisave (only applicable in Singapore).
- MMR and Chicken Pox Vaccine cannot be taken together as they are Live Vaccine.
- COVID-19 vaccine cannot be taken within 2 weeks before or after any other vaccine
- Deoxycline pillls has to be taken 1 day before trip, during trip and 1 month after trip
- Diamox, Acetazolamide (optional) has to be taken 1 day before ascend and during ascend. Can stop after reaching back below 2700m.

Polyclinic Price vs Private Clinic Price: (before GST)
MMR: $20 per dose (Medisave) vs $51 per dose
Typhoid: $31 per dose vs $41 per dose
Hep A: $85 per dose vs $81 per dose
Hep B: $20 per dose (Medisave) vs $55 per dose
Flu: $32 per dose vs $40 per dose
TDAP: $50 per dose vs $60 per dose

So all in all, only Hep A is possible to get slightly cheaper in private clinic. All others are substantially cheaper in Polyclinic. However Polyclinic absorbs all 9% GST. So this makes Hep A cheaper in Polyclinic too!

All these are what I have learnt today.

Hope it is helpful!

And if you are reading up till this point, I guess you must be really serious about attempting Mount Kilimanjaro soon! Have a great time planning for your adventure! 

Safety First Always!