Photo credit – Norm and Debra
This is a guest post by Phil from Phil in the blank.
Travelers, from their own experiences and the second hand tales of others, share opinions on everything from the best place to stay to the hard-to-find restaurant that has $2 plates of delicious food.
They also share their opinions on a range of travel health issues.
Sometimes these opinions are well-informed. Other times, they are incomplete or worse, just plain wrong. Three of the most controversial travel health issues are malaria prophylactics, the rabies vaccine and traveler’s diarrhea.
In this post, I will address the differing opinions on these topics and provide a recommendation for each one.
Before I get started, let me first say that I am not a doctor. The following recommendations are based on a collection of current research from a variety of sources.
That said, you should arrange for a travel health consultation if you plan on traveling to a tropical or developing world area. A doctor at a travel health clinic can provide reliable advice that is tailored to your destination.
While there is not yet a malaria vaccine available, there are several medications that can be taken as a prophylactic. Almost every traveler I meet has an opinion on which one to take or whether to take them at all.
At least one of the prophylactics – mefloquine, also known as Lariam – is notorious for its possible side effects.
Another is an antibiotic – doxycycline – with its own set of possible side effects.
A third, Malarone, has fewer possible side effects, but it’s a daily tablet and it’s the most expensive of the three.
The prophylactic decision is further complicated by the fact that there are different strains of malaria. It is foolish to think of malaria as one disease that is the same throughout the world.
You might not have taken a prophylactic during your trip to Asia. Perhaps malaria was endemic at your destination but not widespread and the strain present was the milder plasmodium vivax or plasmodium ovale. You made it through your trip malaria-free.
Now you are planning a trip to West Africa and you’re thinking malaria is no big deal.
Except malaria is more widespread in West Africa and the dominant strain is plasmodium falciparum, the most virulent strain and the one responsible for most cases of severe and cerebral malaria, which can kill you.
Photo credit – wild_turkey5300
All of this is to say that malaria prevention – and treatment – depends on your specific destination. There is no one-size-fits-all strategy. Instead, take the following course of action:
- Use this table from the CDC to see what strain (if any) of malaria is present and what prophylactic is recommended.
- Have a consultation at a travel health clinic and talk about the different options with a doctor several weeks before your trip.
- If you are taking a prophylactic, test it out before hand and make sure you don’t have significant side effects. Keep in mind that if you are taking mefloquine, it needs to be taken several weeks before your trip anyways for it to be effective.
- Carry a backup treatment option. While it is unlikely, you can get malaria even if you are taking a prophylactic.
I came down with malaria while taking mefloquine in northern Benin. If it wasn’t for a round of coartem (a good emergency standby treatment for plasmodium falciparum), I might have been in big trouble – early treatment is critical and in this case, the nearest clinic was almost a day away.
Few travelers get the rabies vaccine. It is a costly series of injections and even with the vaccine, you still need to get additional injections if you are bitten or scratched by an animal.
Photo credit – Wordyeti
Most travelers reason that rabies is rare and you still need post-exposure treatment regardless of whether you have the vaccine, so why go through the trouble?
While it’s true that the vaccine does not confer immunity, it buys you time in the event that you are bitten or scratched by an animal. Timely treatment is critical in rabies cases and it certainly doesn’t hurt to extend the grace period.
Perhaps more importantly, the vaccine removes the most difficult step of post-exposure treatment: the administration of rabies immune globulin (RIG). RIG is expensive and it’s not well-stocked by every clinic.
If you’ve been vaccinated, you won’t need the RIG booster as part of your treatment.
Personally, I have never elected to have the rabies vaccine. But I’m rarely around animals and I spend most of my time in cities.
While most travelers you meet may say, “skip it,” you should review your itinerary and talk to a doctor at a travel health clinic before making a decision on whether or not to get the rabies vaccine.
Traveler’s diarrhea and its various incarnations (“Delhi belly,” “Montezuma’s revenge,” etc.) afflict almost every traveler at one point or another.
Whether it’s from undercooked food or unfiltered water, you may find yourself making some unwanted trips to the bathroom if you’re traveling in the developing world.
Most cases of traveler’s diarrhea last a couple of days before going away on their own. During this time, many people will pop a few doses of Imodium, considering it a form of treatment.
Photo credit – meddygarnet
Imodium slows down your gut, meaning less trips to the bathroom and presumably, greater comfort, but it doesn’t treat traveler’s diarrhea – it merely helps you manage the symptoms.
Furthermore, there is some evidence that suggests Imodium may prolong the illness. By slowing down your gut, it’s possible that the offending bacteria stays in your GI tract longer.
If you are battling traveler’s diarrhea and you need to board a bus for a long voyage, by all means, take some Imodium, but don’t expect it to cure the illness.
If possible, reschedule your bus trip, go to the bathroom as often as needed, rest as much as possible, and rehydrate with water and oral rehydration salts (you can buy these at any pharmacy for less than $1).
If you have persistent or severe diarrhea, you may need to take an antibiotic like ciprofloxacin (talk to a doctor at a travel health clinic about self-administering this medication if you have not done so before).
If you are having other symptoms besides diarrhea, or you are seeing blood or mucous in your stool (gross, I know), you should go to a clinic – there is a chance you have something beyond a simple bacterial infection.
Hopefully, this post has provided some insight into some of the more controversial travel health issues. It does not intend to say that you shouldn’t seek advice from other travelers or that anecdotal evidence from the tales of others is worthless.
What it does intend to say is that if you are traveling to a tropical or developing world area for the first time, you should have a conversation with a doctor who specializes in travel health.
If you are prepared, most travel health issues will never come up, and if they do, you’ll know how to deal with them.
Bio: Phil Paoletta is currently traveling through West Africa teaching people how to draw camels. You can keep up with his wanderings at his blog Phil in the Blank. He also blogs about travel health at Sick on the Road and travel safety at My Travel Safety.