Travel Health: Immunizations, Diarrhea & Malaria

If you’re a relatively healthy person, being prepared to travel – health-wise – is not a hard thing, but it still requires a bit of thought and prior preparation. In this post, we’ll talk about three very important travel health topics: travel immunizations, travelers diarrhea, and malaria prevention.

One to two months prior to traveling, I review the currency and completeness of my travel immunizations, I make sure I am ready to deal with travelers diarrhea on the road (as this may require prescriptions), and I talk to my doctor/travel clinic about how to prevent malaria while I’m traveling (as appropriate by country).

TRAVEL HEALTH – START WITH TRAVEL IMMUNIZATIONS

Before you get any new immunizations, check any available health records to see what immunizations you already have received. These may be on file with your doctor – call and see if they can help you with any information. This may save you time and money later if you can avoid needlessly receiving additional doses of vaccines.

WHERE CAN YOU GET TRAVEL IMMUNIZATIONS?

Some physicians offer travel vaccinations themselves, others will relate you to a travel medicine clinic like Passport Health or the VNA (Visiting Nurse Association). The CDC also offers links to various travel clinics throughout the states. Your county or city health department may also be able to direct you on this as well.

Most travel medicine clinics also offer health consultations directly related to the countries you plan to visit – they’ll talk you through everything you need to know, and suggest appropriate vaccines and medication. This is incredibly helpful if you’re unfamiliar with the travel immunization process, and what immunizations might be available or recommended.

WHAT IMMUNIZATIONS DO YOU NEED?

The immunizations you will need depends entirely on the countries you plan to visit, and can be discussed in a consultation with your doctor or travel clinic. Note that some immunizations require multiple doses and will take weeks or months to complete all doses needed for full effectiveness of a given vaccine – so the best thing to do is to plan a visit (and/or consultation) with a travel clinic as soon as you know your destination and rough travel dates.

Routine, oft-recommended immunizations for any traveler (or non-traveler for that matter) include the following:

The following immunizations are often recommended for tropical countries or developing countries as well:

Typhoid – available in pill form (5 years of efficacy) or injection (2 years)
Polio booster – just because Polio has been eradicated in the US doesn’t mean it’s so in the developing world! Even as an adult, it may be a good idea to re-up your level of immunization.
Yellow Fever – required for entry into some countries – make sure you don’t skip this if you need it! The CDC has a run down of current immigration requirements by country here. You’ll also need to carry your yellow fever immunization card when you go – don’t forget!

Some doctors and nurses will recommend the below vaccinations as well – but said vaccinations can be prohibitively expensive for independent travelers:

Note: If you’re a US citizen, you’ve likely already been immunized for measles, mumps and rubella – but ask your doctor anyhow.

DO TRAVEL IMMUNIZATIONS HAVE NASTY SIDE EFFECTS?

Travel vaccines should not have serious side effects for most people. Additionally, most travel vaccines do not conflict with one another and and can be administered simultaneously in one travel clinic office visit.

I have gotten as many as five booster shots in one office visit with nothing more than a sore arm afterwards – but if you have a severe reaction after receiving travel vaccinations, call your doctor and visit the emergency room.

HOW MUCH DO TRAVEL IMMUNIZATIONS COST?

Most travel vaccinations will run $50-100 per dose. Rabies and Japanese Encephalitis cost markedly more than this. Some vaccinations require multiple doses for full effectiveness (Hep A, Hep B, Rabies, Japanese Encephalitis, etc), which increases costs.

Note: my self-paid insurance did not cover ANY of my travel immunization costs, so I have at this point skipped the Rabies and Japanese Encephalitis immunizations. I might go ahead with them if an employer was footing the bill, or my insurance decided to cover me more effectively.

DEALING WITH TRAVELERS DIARRHEA

Travelers diarrhea is a near fact of life for anyone on the road. It’s no fun, but it doesn’t have to be the end of your trip either.

To prevent travelers diarrhea, maintain the following habits as best you can:

Don’t drink tap water, and make sure ice cubes in any drink are from a bottled or purified source
Wash your hands frequently, especially after using the bathroom and prior to eating
Eat only food that is fully cooked
Eat only fruit and vegetables you can peel (if that fruit/veg is uncooked)
Avoid eating shellfish
Avoid eating street vendor food (I find this one difficult)

When that doesn’t work, I come prepared with the following to ameliorate the suffering of travelers diarrhea:

Imodium, or a similar over the counter anti-diarrheal for cases in which I want to “stop up” a bit and reduce the frequency and watery-ness of bowel movements (note that this will NOT cure bacterial/viral infections – only symptoms of travelers diarrhea)
Azithromycin and/or Ciprofloxacin for combatting diarrhea caused by bacterial infections (prescription required – make sure to fill it before you leave your home country)
Oral Rehydration Salts for counteracting diarrhea-related dehydration (these are available over the counter)

Travelers diarrhea and related dehydration can be serious/dangerous, so make sure your travel buddy, tour guide, concierge etc knows if you get seriously dehydrated when diarrheal, or if other complications have arisen in previous bouts with diarrhea. You may need more serious medical attention than your personal medical kit can offer.

DO YOU NEED MALARIA PREVENTION MEDICATION?

This depends entirely on what country, and what region(s) of what country you’ll be visiting. Discuss your itinerary with a travel health clinic accordingly.

Another relevant question – what KIND of malaria meds do you need? There are four regularly available antimalarial drugs (pill form, no booster shots of any kind available at the time of writing) available in the US (prescription required for any/all):

Atovaquone/proguanil (brand name “Malarone”)
Doxycycline (various brand names, generics)
Mefloquine (brand name “Lariam” or generic)
Chloroquine (brand name “Aralen” or generics)

Making things even more complicated: some strains of malaria have developed resistance to malaria prophylaxis methods, namely Chloroquine and Mefloquine. Again, make sure you discuss specific destinations with your health provider.

Are there negative side effects?

In short, YES. Side effects are why a lot of travelers skip out on getting and/or taking their malaria pills.

A couple of examples (in short): Doxycycline can have unfortunate side effects like increased photosensitivity, and nausea. Mefloquine can cause nausea or even bouts of psychosis, and can’t be prescribed to those with clinical depression or suicidal episodes. Atovaquone has fewer side effects than the above, but costs more than either. One medication might be better for you than another based on this, because if you HATE taking your pills and they make you ill, you stand a pretty good chance of STOPPING taking them.

A consideration of costs:

Some of these pills are noticeably more expensive than others. An example: Atovaquone (Malarone) is often known as the method with the lowest incidence of side effects – but it’s also far more expensive than a cheaper options like Doxycycline. The cost of the more expensive pills can add up for namely those that are taking multi-month trips in malarial zones, and/or those that don’t carry health insurance that’ll cover these drugs (I pretty much pay for my malaria prophylaxis pills out of pocket every time).

In other words, there’s a lot to think about when choosing a malaria prevention pill that’s right for you.

My personal experiences with each type of pill, just for fun (your mileage may vary):

I took Doxycycline in Southeast Asia. I found it rather annoying to have to take a pill two times a day, and found that the pills agitated my stomach a bit as well, but not as badly as Mefloquine. Photosensitivity wasn’t a huge issue for me. All and all, not a terrible experience, but there was nothing fun about it either.
I took Atovaquone during six weeks in the Peruvian Amazon. Side effects were almost nonexistent. Someone else was paying for the pills, so I didn’t have to worry about the cost.
I took Mefloquine in Kenya. Every time I took the pill (one pill weekly), I got a sour, aching feeling in my stomach, but most of the time that feeling went away. One time it didn’t, and I became as dizzy as I’ve ever been in my entire life, started sweating profusely, and projectile vomited three times against the exterior wall of a pit toilet. This somewhat traumatic experience made it difficult to return to taking the pills regularly.
I’ve not yet taken Cholorquine because it hasn’t been recommended for effective malaria prevention anywhere I’ve visited.

DO I REALLY HAVE TO TAKE MALARIA PREVENTION MEDS?

This is one of the most hotly debated topics in the traveling world.

Some travelers dose up with great regularity. Others don’t bother, or quit taking their meds mid-trip. Some claim that they’ll take their meds if they show signs of malaria (chills, sweating, fever, vomiting, headache, diarrhea).

What should you do? The responsible thing to do is to take your malaria meds if you’re in a known malarial zone. Malaria can KILL you, or on a lesser scale, ruin your trip due to illness. You don’t want malaria.

Also of importance: most antimalarials require you to start and finish taking the pills some weeks before and after travel. Make sure to read the labels and to order enough pills to cover you before, during and after your trip.

Other practices you can engage in to keep the mosquitos at bay and thus lessen your exposure to malaria:

Wear high DEET-content insect repellant (this is often not available in the countries you visit – buy plenty at home)
Sleep under a mosquito net
Wear loose fitting clothing with long sleeves / legs

Here’s a great post about malaria and the myths that surround it from friend and travel writer Emily at AlongDustyRoads. If you won’t listen to me, listen to her – she’s a doctor!

WHAT ELSE SHOULD I DO IN REGARDS TO MY HEALTH AS IT RELATES TO TRAVEL?

Do you have food allergies? There might be shellfish (etc) lurking in the street food you’re scarfing. Talk to your doctor before you leave about risks and fixes.
If you regularly take prescription drugs, bring more than enough to get you through your trip, in the original bottle.
If you wear contacts, bring extras. If you wear glasses, consider bringing a backup pair.
Bring birth control and condoms from home. Just because a country is industrialized doesn’t mean their birth control methods (or access methods) are modernized.

Thanks for reading!