Another holiday season is rapidly approaching, and most of you made flight and hotel reservations months ago — but have you spent equal efforts preparing for good health on your hard earned holiday? Each holiday season I see a massive rush of patients in my hospital just a few days before their vacations, looking for travel medicines and advice. Very often, those medicines are sold out, or they’ve run out of time for vaccinations. That’s why it’s crucial to plan early. You still have time now, so follow my tips below and you should be fine.
First, you need to know the health risks of the places you are visiting. You may think you need nothing, but what if your 5-star beach resort is in a high risk malaria zone? This is why the first step is to always check a travel website to see what you need. My favorite is from the US CDC and State Department, at www.cdc.gov/travel, but the UK also has a useful site at www.gov.uk/foreign-travel-advice. Both have fully detailed and updated summaries of every country’s health status, listing potential threats and outbreaks. Perhaps you need a Hepatitis A vaccine, or a polio booster, or malaria prevention pills — these websites will give you the answers. Bookmark these websites, and read before you go visit your doctor! This will save a lot of time for both you and the doctor.
Many people will be visiting tropical jungles and beach resorts, so let’s discuss the main problems there: diseases from mosquitoes and stomach infections. Mosquitoes are a major hassle in most of these countries, and they can infect you not just with deadly malaria parasites but a host of other bugs causing dengue fever, typhoid fever, japanese encephalitis — and many others. Your number one treatment is prevention! That means using really good anti-mosquito spray, which usually contains Picaridin or the chemical DEET. DEET is much more widely available, and you should use one with at least 20% DEET. Please don’t scrimp on wimpy mosquito repellants, especially for your children. This includes China’s very popular green bottles full of eucalyptus oil or citronella — they only work for a couple hours and barely work. Even babies and children should use DEET, as it is officially rated safe by pediatric groups for any child over 2 months of age (read here for more safety information).
Malaria is such a serious threat worldwide that many travelers should be taking preventive medicines during their entire trip. Here in China we usually prescribe doxycycline, which you have to take every day — and continue to take for 28 days after your trip. Malaria is a tricky parasite and can stay dormant inside your blood cells for months, so it’s important to finish all of the medicines!
Vaccines are also important for many countries, especially hepatitis A and B, japanese encephalitis, rabies and any needed boosters. Many of these vaccines need to be given at least a few weeks in advance in order to get the multiple shots needed, and you also need that time for the protective antibodies to develop.
The number one cause of a ruined vacation that I see is being stuck on a toilet for days with diarrhea. Everyone should prepare a small medicine bag stocked with the most useful pills, especially for these very common stomach infections. My favorite OTC medicine for this is loperamide (immodium), which is very effective to slow down most people’s watery (non-bloody) diarrhea. It doesn’t cure the infection but it does cut down the frequency of bathroom visits, which can be wonderful if you are on a long plane or bus ride. A couple of healthier OTC medicines can help you recover more quickly, including the charcoal powder Smecta as well as probiotic pills (capsule forms of the good bacteria in yogurt). Both are also available for infants and toddlers.
In southern Asia, many bouts of diarrhea are caused by bacterial infections, so you should seriously consider carrying along some antibiotics as well. For example, many travel doctors now prescribe azithromycin with instructions on how to use as soon as diarrhea symptoms start. You would need a doctor’s visit to get these antibiotics; many local pharmacies will sell these to you but this isn’t legal — and their instructions often are incorrect. Their choice of antibiotics may be dangerous for children — or useless against the infection. Your local pharmacist is not a medical doctor!
Summer is just starting, and many of us are planning for long vacations. I often hear sad stories from patients who had their vacations ruined from diarrhea or other illnesses, so I think it’s important for travellers to bring along a do-it-yourself travel first aid kit. Every kit should have the basics, most of which are over the counter (OTC), although a couple are prescription-only. Here’s my choice:
1. Diarrhea medicines. I think the number one cause of a ruined vacation is being stuck on a toilet for days with diarrhea. My favorite OTC medicine for this is loperamide (immodium), which is generally effective after age 2 to slow down most people’s watery (non-bloody) diarrhea. It doesn’t cure the infection but it does cut down the frequency of bathroom visits, which can be a godsend if you are on a long plane or bus ride. Also, a couple other healthy OTC medicines can help you recover more quickly, including the charcoal powder Smecta as well as probiotic pills such as Medilac. Both are also available for infants and toddlers.
In southern Asia, many bouts of diarrhea are caused by bacterial infections, so you should seriously consider carrying along some antibiotics as well. For example, many travel doctors now prescribe azithromycin with instructions on how to use as soon as diarrhea symptoms start. You would need a doctor’s visit to get antibiotics; oftentimes a local pharmacy will sell these to you but this isn’t legal and their instructions often are incorrect, or their choice may be dangerous for children.
2. Pain and fever medicines. It’s very common to get a headache or pain during vacations, whether from a sunburn, altitude sickness or any myriad reason. To help with this, you should bring along some child and adult versions of pain medicines, as you never know what your local pharmacy will have. Tylenol (paracetamol) and Motrin (ibuprofen) are the two most common OTC medicines, and both are very safe at the proper dose. I prefer ibuprofen due to its anti-inflammatory properties, although it can cause more stomach problems. Most children’s syrups come in sizes under 100 ml and thus are good for carry-on luggage.
3. Your DIY first aid kit should also include: small bottles of alcohol hand sanitizer; bandaids; an antibiotic ointment; chewable antacid pills to cure heartburn; anti-itch cream such as hydrocortisone; and good anti-mosquito spray — DEET 10-30% and picaridin 5-10% are by far the most effective and are considered safe for children over 2 months of age by the American Academy of Pediatrics.
4. Prescription medicines. If you take daily medicines for chronic diseases, don’t forget to bring enough to cover your trip — and maybe a bit more in case an elephant tramples on them. Also, keep a detailed list of your medicines somewhere safe, in case you lose your luggage and need all new medicines.
Don’t forget that you may need special vaccines or other prescription medicines, depending on where you travel. Many southeast Asian countries have malaria, so you may need to take prescription anti-malaria pills as prevention during and after your trip. If you go to Tibet you may want to bring medicine to prevent altitude sickness, a common illness which has ruined many people’s long-planned vacations. In all these cases, you need to plan at least one month in advance as you may need to receive a series of vaccines (such as rabies or japanese encephalitis), or your local clinic may need a few weeks to reorder malaria medicines, which frequently run out just before national holidays.
No matter where you travel, I always recommend that you first check out the U.S. CDC’s travel website, at http://www.cdc.gov/travel. They provide detailed information for every country regarding which vaccines you need as well as other health and security concerns.
We are in the middle of the summer travel season, and many expats are travelling to southern and tropical countries near China. Many of those areas have mosquitoes that can transmit malaria, a nasty parasite that can make people very sick. Malaria still kills about 1 million people a year worldwide — 85% of whom are children under 5. Taking certain medicines as prevention can dramatically reduce your risks of getting this very common tropical disease. The big problem is resistance to medicines, which varies by country — which is why travelers need to check out the CDC travel website, read their FAQ on their travelling country and find out which medicines (and vaccines) they need. You can also take a quick look at the malaria map below for Asia, which is updated at another CDC malaria website:
Which Medicine To Take?
Each malaria medicine has its pros and cons, especially with side effects and cost. There’s a recent literature review by the Cochrane Collaboration, the leading group on evidence-based reviews, which showed that some medicines, especially mefloquine, may not be as safe as others. Here’s their nice summary:
…Atovaquone-proguanil and doxycycline are the best tolerated regimens. Mefloquine has more adverse effects than other drugs, and these adverse effects are sometimes serious. However mefloquine may still be an appropriate choice for those travellers who have taken it previously, without any adverse events. Other factors should be considered by prescribers, in addition to tolerability: cost, ease of administration, possible drug-drug interactions, travel itinerary, and the additional protection that may be afforded by doxycycline against other infections, besides malaria.
My favorite malaria prevention medicine for patients is doxycycline, and I’m glad this latest review reinforces its safety profile over the others. It also is usually cheaper — although it must be taken daily, and for 28 days after return from vacation.
Don’t Forget To Do Some Research First
As I’ve mentioned before, travelers should first check a travel website like the US CDC Travel page, and read their country’s description for the latest recommendations on vaccines, medicines, disease outbreaks and security issues. It can provide you a lot of peace of mind.
- Don’t forget your mosquito spray! This is crucial, especially for children. Mosquitos spread a lot more diseases than just malaria.
- Do your research at least a month earlier, as you may need special vaccines such as japanese encephalitis, rabies, or yellow fever
- Don’t forget your travel kit, which should have medicines for diarrhea, fevers, allergies, skin rashes, etc…
It’s the height of summer and everyone is in the middle of their traveling. I get many visits from patients asking about travel issues like, “do I need malaria pills for ___ place?” or “which vaccines do I need for ___?” Well, here’s a little secret that may save you some time: before you see the doctor, first go to the CDC Travel website and read their updated page on the country you plan to visit. This website, by the US Center for Disease Control, is the same website the doctors use, to see which vaccines are needed, as well as malaria and other issues. It also gives important information on any crucial outbreaks.
It’s a fantastic website, completely free and updated constantly. It’s a must-use, every time you travel.
By the way, try to research your travel country at least one month before visiting, to give you enough time for vaccines. Many vaccines such as japanese encephalitis are a 3 shot series that take at least 21 days.