Your Travel Medicine Questions Answered!

Getting sick abroad is not fun. Getting REALLY sick while traveling is the absolute worst (trust me, I’ve been there).

Because I prefer to spend my time on the beach, not in the ER, I went in for a travel medicine consultation a couple weeks ago. I visited that Capitol Travel Medicine clinic in Arlington (which I absolutely recommend if you are in the DC area). The nurse practitioner, Tanya Hardwell, was extremely helpful as she went over my itinerary and suggested the appropriate precautions I could take to reduce my risk of, you know, dying of some horrible exotic disease.

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Creative Commons License photo credit: NathanF

The travel clinic gathers information on all the countries on your route, determine the most dangerous (health-wise) and advise you based on the guidelines there. In my case the most dangerous country was Cambodia. I ended up getting a tetanus booster, a meningitis booster, the Hepatitis A vaccine and a Typhoid vaccine (which luckily for my poor arm came in pill form). The Japanese Encephalitis vaccine was also recommended, but due to the diseases rarity and the vaccinations high cost I decided to take my chances.

Tanya also prescribed me 6 months worth of malaria pills for my SE Asian adventures and gave me some great general information on staying healthy on the road.

Because I’m such an insatiable blogger, she also happily agreed to answer some of my most pressing questions for you guys:

Why is it important to get the proper shots before you travel?

The health risks in other parts of the world, particularly developing areas, can vary greatly compared to the United States and there are a lot of diseases our immune systems just aren’t prepared to handle.

What is the benefit of visiting a travel clinic versus your regular doctor?

Travel clinics specifically cater to overseas travel so they are the most current and informed regarding recommendations and requirements. They get daily updates on outbreaks around the world.

Remember that travel clinicians aren’t there to sell vaccinations to you; they are there primarily to give advice. What you choose to do is totally your own decision.

Are there places where shots are “mandatory” or are they usually just recommended?

The only vaccine that is ever mandatory is the one for Yellow Fever, which is required in certain parts of Africa and South America. All of the other vaccinations are merely advised.

Are travel shots ever covered by insurance?

It really depends on your policy- some people with higher-level PPO plans or federal insurance plans might find themselves covered. It’s probably better to assume not though.

What if you don’t have enough time to get all the necessary shots before you leave?

Come in anyways. The antibodies in most vaccinations begin working within the first week and some protection is always better than nothing.

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Creative Commons License photo credit: christopher.vanbelle

There are fours drugs licensed for use in the US:

– Chloroquine Phosphate (Aralen)

– Mefloquine (Lariam)

– Malarone

– Doxycycline

Each has their pros and cons. There are possible side effects and cost considerations.  A travel clinician can talk you through your options and help you decide which is best for you.

Of course there are so many strains of Malaria that none of these medications are 100% effective. It’s always important to take precautions and use bug spray when in infected areas.

Incidentally, the cheapest place to get your malaria prescription filled appears to be Costco.

I’ve heard you can get some medications (like malaria pills) cheaper in Asia, what are your thoughts on that?

This can be very tempting because of the cost but there are a lot of quality control issues and there is a risk of counterfeit medications. If you do buy medication abroad you want to take care to make sure they are coming from a reputable source.

What diseases are travelers at risk for that cannot be vaccinated against?

Dengue fever is probably the biggest one. Rates are rising rapidly- even in places like Texas and LA! Developing a vaccine for Dengue is very difficult because vaccines work by giving you small doses of a disease, but Dengue is much more dangerous the second time it infects you.

The NIH is working on a malaria vaccine but that could take many years to come to fruition.

What advice would you give a twenty-something going abroad?

Don’t be intimidated by the risks. Knowledge is important of course but the best thing you can do is get out there and see the world.

18 thoughts on “Your Travel Medicine Questions Answered!”

  1. Great post. I also highly recommend you go to a travel clinic or a doctor who specializes in travel medicine. We happened to have one in our clinic at home, and he does a lot of exotic traveling himself which I found reassuring.

    Regular doctors tend to over prescribe because they really don’t know the facts and want to error on the side of caution and also protect their own butts. I know so many people who have been prescribed unnecessary malaria pills for places as talked about like SE Asia when they were not needed.

    The consultation cost $50 but it was well worth it, he gave us so much valuable information, such as exactly what tests to ask for if we felt we had malaria. By the way I have no idea what it means but we were told to make sure we both a “thick” and “thin” smear test done.

    He also gave us his personal email to contact him with questions at anytime, that was worth it’s weight in gold!

    And a shout out to the other Audrey I see posted above. I don’t meet many others:)

  2. Condoms when traveling are always a good idea, even for for women.

    Also, Malaria medications don’t actually prevent you from becoming infected, they just make an infection less deadly and reduce the side effects. It’s best to use prevention more than anything else – Bug repellents with DEET are always a must. 3M Ultrathon has been rated as the best stuff out there for tropical countries – it has 34.34% DEET and is applied as a waterproof cream. The other option is to get something with close to 100% DEET, but just know that it should only be used when traveling deep in the jungle where Malaria is definitely present. That being said, DEET also can have nasty side effects and it melts most plastics in a matter of hours (including ziplock bags). A newer insect repellent that contains picaridine is becoming more popular because it doesn’t have the nasty side effects that come with DEET, but it’s only really useful in areas outside the tropics, and hasn’t shown to significantly reduce the chances of becoming infected with malaria or dengue fever. Of course, a bed net with insecticide is a must.

  3. Most travel clinics charge for a consultation (which is then cancelled if you do actually get a jab from them) so i doubt you could do an over the phone consultation. Basically they would need to know what countries you are going to and at what time of the year, also how long you’ll be in those countries – but the good news is that they all use the same website that ‘regular people’ have access to to look up the vaccinations needed – this is http://www.travax.nhs.uk. You can check on any particular outbreaks on http://www.fco.gov.uk.

  4. Do you think they’d do a consultation over the phone for someone overseas?
    It’d be great to get a consultation in English…

  5. Check with your regular GP first as many of them (depending on size and location) do have a ‘travel clinic’ within them. I got almost all of my vaccinations and anti-malarials from my regular doctor and only had to go to an independent travel clinic for Jap B and Rabies (and this was only because there is a shortage of these at the moment and only the travel clinic has regular orders of them.

    It’s great to sit and have a chat with the nurses in the travel clinic however, as many of them have actually been travelling themselves and give you all sorts of ‘hands-on’ tips and tricks! Be wary though – they will never TELL you that you have to have this and that – they will only recommended but the risk is up to you, and recommendations really do vary depending on exactly what towns and villages you will be near when you’re abroad.

    We opted out of a couple (like the tick-born encephalitus and cholera) but then decided to go for the expensive Jap B vaccination – as we couldn’t be certain that we wouldn’t be squatting with a load of pigs!

    1. Yeah, I found the specific knowledge of the nurse at the travel clinic to be really valuable. Since they see so many travelers they also had a really good grip on what has worked for other people (particularly helpful with malaria information).

  6. And if I may take the risk of being inapporpriate or TMI…

    The one medication I truly, wholeheartedly recommend to take care of before you leave is contraception. You never know when romance is going to strike, and condoms are only 75% effective! Plus sizing is different in different countries, with higher risks of slipping, ripping ect (oh Japanese condoms, I do not miss thee).

    For long term travellers I really recommend getting the semi-permanent contraceptive method of your choice, such as an implant or an IUD. It can be difficult to get BC pills refills in places, to calculate when to take it while jumping time zones, to have to prove you are allowed to carry it through customs and risk having it confiscated… None of that with a semi permanent BC and this way, no worries for 2 to 10 years!
    And I really encourage everyone (male or female for that matter) to carry a morning after pill around, just in case. It’s not legally available everywhere and you don’t want to have to figure it out under an emergency situation.

    Fertile sperms are a lot more widespread than malaria infected mosquitoes. Just sayin’.

    1. Thanks for bringing this up Aelle, it is something all travelers in our age group really need to think about. Travelers at the very least need to bring some condoms along to protect against pregnancy and STDs.

  7. I second Ayngelina’s comment about being able to pick up some vaccinations on the road. We weren’t able to get Japanese Encephalitis vaccinations in Prague before we left because the vaccine wasn’t available in the country. So, we went to a Canadian-run clinic in Saigon and a Korean clinic in Hanoi (it was a 2-shot series) and had excellent care and the vaccines cost $10/person. More recently, we got booster shots in Buenos Aires. Not quite as cheap as SE Asia, but much less than in the United States.

    Regarding taking malaria medicine in SE Asia, I’d advise asking around at a local clinic or asking expats living in those areas whether you need to really take them. For us, we spent most of our time in SE Asia in the winter/dry season when Malaria really isn’t a problem in most of the well-traveled and mountain areas. We also picked up malaria medications in Vietnam/Malaysia/India for a fraction of the cost and from reputable distributors.

    Another thing to keep in mind is that most countries in SE Asia don’t require prescriptions for medications, so pick up your cipro (or other stomach antibiotics) and other preventive medicines on the ground. It’s easier, cheaper and the locals will tell you what works best for the bacteria in that area.

    Just a couple more months until the great adventure begins!

    1. Thanks for all that great information Audrey! I hadn’t realized that you don’t need a prescription for cipro in SE Asia so that’s really good to know.

    2. Re: Malaria: +1. When it comes to malaria meds, definitely ask around and take them only if strictly necessary. Most (if not all) cities in SE Asia are treated year round, and dry seasons are safe/safer all over.

      Taking 6 months straight of malaria meds is a terrible idea. They have really nasty side effects, not the least of which are depression, uncontrollable anger (troops stationned in SE Asia with mandatory malaria treatment end up with significantly increased rates of suicide and homicide) and loss of vision (my roommates in Kuala Lumpur used to live in the indonesian jungle and had stopped taking their meds when they started going blind, around the 5th month of treatment, and their vision never fully came back).

      Of course if you’re going to be trekking in the jungle of Borneo the risk/benefit balance is very different than if you’re chilling in Koh Samui or visiting Jakarta. Keep yourself well informed through local sources and judge wisely which is the lesser evil.

  8. Great post! Didn’t think about the benefits of going to a travel clinic versus a regular doctor before. Good for you for getting on top of this! I know someone who got dengue fever in Thailand a few months ago and it was terribly scary–he was in a lot of pain and they weren’t sure if he would recover. Thank goodness he’s fine! It’s definitely wise to familiarize yourself with those types of things before you go so you know what to do. I think it’s also wise for folks to carefully read their medical insurance policy (if they have one) before they go, as the rules about what happens when you get sick abroad can be a bit tricky.

  9. Another quick tip is that a lot of vaccines and medication are available on the road, particularly when you are going to an area where it is needed.

    Ten years ago I went to the Philippines and was not able to get all of my Twinrix shots before I left, I simply called the Canadian consulate and they recommended a doctor for me. The shots were much cheaper than in Canada.

    Also Malaria medication is widely available and at a fraction of the cost. It´s the same medication, you can ask for it by name.

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