Inoculations
From Macska Travel Co.
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[edit] A Warning About Health-Insurance Providers
It is well worth your time to investigate (using the resources provided here) what antimalarials you will need. Kat's HMO (Kaiser Permanente) prescribed her lariam (mefloquine), even though she specifically told them that we would be traveling in areas with mefloquine-resistant malaria. In other words, you must unfortunately take care to be better informed than your health insurance provider, and when you are, you may find that they don't cover the drug you actually need. For example, as of May 2008, neither Kaiser Permanente, nor Blue Cross / Blue Shield, nor United Health / Student Resources will cover the cost of malarone (the antimalarial we actually need.) Another win for free-market capitalism! In case you are wondering, malarone runs about $50 per week per person. It's not cheap, but it beats getting sick with malaria.
Update 2009: We went ahead and got malarone through United Health / Student Resources just by going to Matt's student health clinic. Somehow or another, they didn't ask, we didn't tell, and it was covered, even though they explicitly said that it would not be.
[edit] Routine Vaccinations
- MMR
- DTP/DT
- Varicella
Unless you've already had Chickenpox, in which case, you don't need this.
- Influenza
At first, I wasn't worried about this one. However, the CDC recommends the seasonal flu vaccine if you are traveling to areas with H5N1 avian flu, so this is a positive for us.
- Pneumococcal
This is only indicated for those with serious chronic conditions, e.g., liver disease, which we thankfully don't suffer from.
- Hep A/B
As far as we are concerned, Hep A is indicated if we are traveling to places with high levels of endemic Hep A. Hep B is indicated for us if we may be exposed to it during the course of medical treatment. Pretty much all of the places we are going to recommend the Hep B vaccine, and to be honest, it seems like cheap insurance should something go wrong.
- Meningococcal
If you've ever lived in the dorms, you've probably had to get this.
- Zoster (only recommended for > 60 years old)
[edit] Vaccine Descriptions
- Polio - Recommended for adult travelers who have received a primary series with either inactivated poliovirus vaccine (IPV) or oral polio vaccine (OPV). They should receive another dose of IPV before departure. (It's worth noting that Matt had the OPV last administered... when he was 2. :-)
- Rabies - Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, hiking, or work.
- Typhoid - Recommended for all unvaccinated people traveling to or working in Eastern Europe and Northern Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.
- Antimalarial Drugs - There are different kinds of antimalarial drugs, but the important bit seems to be to avoid mefloquine (trade name "lariam"), as there are large areas in Thailand, Vietnam and Cambodia that are mefloquine resistant. The best drug out of the bunch seems to be the combination of atovaquone/proguanil (trade name "malarone"), because doxycycline can cause greater sun sensitivity. Note that aside from another antimalarial primaquine (which is rarely administered because of potential side-effects), these two drugs appear to be our only real choice.
We need to purchase our antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
[edit] CDC Recommendations for Vaccination by Country and Area
Here I've only listed the recommended vaccinations over and above the routine vaccinations. It's a little bit shocking how much of the world still requires a polio vaccination -- this is a disease that should've been wiped out by now! We've had a vaccine for it since the 50's!
[edit] Eastern Europe
Typhoid, Rabies, Polio.
[edit] Jordan
Typhoid, Rabies, Polio.
[edit] Thailand
Typhoid, Rabies, Polio. Japanese Encephalitis if we travel to rural farming areas. Malaria risk on the eastern and western borders.
Although there is no vaccine for it, Dengue fever is a concern.
[edit] Cambodia
Typhoid, Rabies, Polio. Japanese Encephalitis if we travel to rural farming areas. Malaria risk throughout the country, including risk in the temple complex at Angkor Wat. No risk in Phnom Penh and around Lake Tonle Sap.
Dengue fever is a concern.
[edit] Vietnam
Typhoid, Rabies, Polio. Japanese Encephalitis if we travel to rural farming areas. For malaria, you will need to take one of the following antimalarial drugs: only atovaquone/proguanil or doxycycline in the southern part of the country in the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dac Lac, Gia Lai, and Kon Tum. All other areas: atovaquone/proguanil, doxycycline or mefloquine (primaquine in special circumstances and only after G6PD testing).
Dengue fever is a concern.
[edit] Japan
Japanese Encephalitis if we go to rural areas (unlikely.) Otherwise, nothing out of the ordinary, 'cause that's how Japan rolls.
