One of my friends went to Africa. He came back with amazing photos, stories, and souvenirs. He also came back with malaria. He was very sick.
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As with any international trip, some preparation, along with your excitement, can go a long way to a wonderful experience.
It is important to consider is getting any needed vaccines or prophylactics prior to your travel.
Note: This post is in no way meant to give medical or pharmaceutical advice, only my own personal knowledge and experiences. Also this post is centric to those who live in the United States.
Doing Your Homework
Step 1 is to do some homework and see what you most likely need. Two sites I start with are:
Put in your destination country and see what you need. For example, I put in France, and it says I need nothing special for a trip there – no surprise.
However, if I put in Vanuatu, they recommend: Malaria pills, Typhoid Vaccine, Tetanus, and Hepatitis A vaccine.
Step 2 is to pull your vaccination records to see what vaccines you have gotten and when.
Step 3 is to find a travel pharmacy or travel clinic to get what you need.
Let’s take a look at some common immunizations you may need for international travel.
Typhoid fever comes from salmonella typhi bacteria. Salmonella typhi is spread through food or water and person to person (usually through fecal-oral route by someone who did not wash their hands well enough).
Typhoid will give you a dangerously high fever and make you very sick quickly. It may cause hemorrhaging with bowel perforation and may lead to sepsis. If that is not enough to make you get the vaccine, then consider that typhoid is extremely painful.
The vaccine needs to be administered a minimum of 1 week before travel. Your shoulder will be sore for a day, but that is certainly preferred over severe, bloody diarrhea. The vaccine is not 100% effective, but hedge your bets and get it, and also wash your hands frequently, don’t drink untreated water, avoid raw fruits and vegetables that you can’t peel, and ensure food is cooked until very hot.
Typhoid vaccine is good for only two years.
Note that salmonella typhi is different than the bacteria which we often associate with salmonellosis food poisoning.
Hepatitis is an inflammation of the liver caused by a virus. Our livers do a lot of things, including breaking down fat to make energy, cleaning our blood, making the proteins that let our blood clot when necessary, and so much more. So keeping the liver healthy is pretty important.
Hepatitis A is transmitted when a “person ingests food or water that is contaminated with the feces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation and poor personal hygiene.” Recovery from Hep A is slow.
Hepatitis A is found in many places around the world, including areas of the United States where it is currently epidemic.
The Hepatitis A vaccine should be given at least two weeks before travel, and you need a booster shot 6 months after the first shot. This is a large-volume vaccine, so yes your arm will hurt. When I got both my original shot and my booster, I felt blah for a couple days which is pretty normal, but far better than getting hepatitis.
Based on how common hep A is in the United States, those living in the US may consider this vaccine even if you are not traveling.
Malaria is a blood-born parasite that is transmitted by a mosquito. The parasites mature in your liver then go to the blood stream where they infect red-blood cells causing them to burst. This leads to all sorts of serious problems with the functions of your body. Take malaria seriously because it is serious.
There is no vaccine for malaria. Instead it is treated with the same medicines as if you had malaria, preventing the parasite from surviving in your body.
Anti-malaria pills are taken either weekly or daily, and you will need one that does not already have a resistance in the area you are travelling. Malarone is the newest anti-malarial, and others that may be recommended include chloroquine, mefloquine/lariam (which may give you some wild, colorful dreams), and doxycycline.
When I was in Africa, I read a study about how the safari visitors who most often got malaria where those on the very high end trips. The study showed these extremely affluent people did not think of things like malaria, and their safari organizers were more likely to bring up Krug champagne than malaria.
The Yellow Fever virus is transmitted by, yes you guessed it, mosquitoes. Yellow fever may have symptoms similar to the flu, but in some subset of the people that get it, they may advance to become much sicker, including jaundice (hence the name) leading to a toxic phase and death if it is untreated.
Yellow fever is primarily found in central Africa and parts of South America.
Important: Some countries require proof of yellow fever vaccine (yellow fever vaccination certificate ) for select travelers, so know this ahead of time or you won’t get into the country.
It is believed that the yellow fever vaccine is good for a lifetime.
Tetanus is a bacterial infection that enters the body through breaks in the skin. The bacteria creates a toxin that interferes with the nerves that control muscles (like your jaw muscle hence it is often called lock-jaw).
This is another vaccine that everyone in the United States should get even if not travelling, and a booster every 10 years is recommended. Yes this shot hurts, yes you will probably get “dead arm” for a day, along with a low-grade fever, but that is a heck of a lot better than not being able to breath because your chest muscles have locked up.
Cholera is caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It is common in undeveloped countries and may give you extremely severe violent diarrhea. Those that will need this vaccine are usually people going to undeveloped areas with a history of cholera to do community/humanitarian work or visit family.
This vaccine is taken orally.
Japanese Encephalitis is a virus transmitted by mosquitoes. It is most commonly found in select rural parts of Asia so many travelers will not need the vaccine.
Encephalitis is an inflammation of the brain – never a good thing to have happen. So if you are going to a risk area, this is a vaccine you want to seriously consider. The vaccine is a two shot series, that takes at least two weeks to start to work.
Two best practices to consider:
- Get a tropical strength, deet-based bug repellent cream if you are going to a mosquito danger zone. Spread it over all exposed skin. Many diseases are transmitted by mosquitoes and some have no vaccine, like dengue fever, west Nile virus, or zika.
- Consider bringing Ciprofloxacin with you. Cipro is a powerful antibiotic used for gastrointestinal bacteria-based “issues”. Depending on your health history, you may take it if needed (but at least you have it) or you may take it as a preventative. As with any antibiotics, once you start taking it, finish the whole dose so you do not build up a resistance where it won’t work in the future.
Travel Clinics and Travel Pharmacies
If you live in the United States I recommend you look for a travel pharmacy before a travel clinic. What is the difference?
Travel Clinic – a clinic that specializes in determining what you need for international travel and providing the prescriptions and shots. Usually their own doctors write the scripts and they are more expensive than a travel pharmacy.
Travel Pharmacy – a regular pharmacy that also offers international travel services. Usually much less expensive than a travel clinic, however they contact your regular doctor to write the scripts.
A third option is Public Health Clinics, however, they generally only provide vaccines (for discounted prices) and you must determine by yourself what you need.
This post should not scare anyone from travelling. Instead it should be used to help have the safest and healthiest travel possible.
I traveled to Honduras for business last month. Your advice is straight on. An ounce of prevention. I went to my local public health department in NC. In addition to the shots for Hep A and Typhoid, the nurse provided a detailed orientation session on health risks and other travel concerns. I got an anti malaria prescription at a local pharmacy for only $5 on my plan. The shots were a lot more expensive, but essential. Fortunately for me, my work covered it. And you can get a nice travel sized container of Repel at a sporting goods store like Academy.
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I heard that many people don’t take malaria pills as they say it makes you sick to begin with. Did you experience any sickness from malaria pills?
No, I didn’t.
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I didn’t feel any sickness either, but to be clear the newest malaria drug Malarone is far less likely to make people feel nausea and lethargy than some of the older pills. Key point is to NOT take it on an empty stomach – take it with food. Milk or ice cream is recommended to coat the stomach.
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As if I needed any more reason to eat ice-cream. That’s good to know anyway. I’ve been looking into a trip to South Africa perhaps.