mollybee

Even though they are not required, would it be a good idea to take a tetanus shot and a hepatis B shot before going to Mala Mala and three camps in Botswana?

Also, is malerone still the preferred anti-malarial pill?

Kavey

Mollybee
Unless we have any practicising doctors here I'd ensure you get advice from a travel clinic doctor rather than us travellers.
The recommended anti-malarials do have a tendency to change according to most recent reports on the immunity of the various malarial strains to the various prophylactics and what was recommended to one of us for a trip 3 months ago may already be out of date for a trip tomorrow.
Our doctor receives a monthly update poster with all the innoculations and anti-malarials for each region/ country.
See if yours has one too.

sandi

Inoculations and/or malaria meds should be discussed with your physician or a tropical diseases specialist. However, you can check the www.cdc.gov/travel site for information regarding travel to southern African countries - SA and Botswana in your case. With this information you will be able to ask questions specific to your travel.

Generally, it's a good idea to be current with a Tetanus inoculation regardless whether one is traveling to Africa or elsewhere (it's good for 10-years). As to Hep-B, which is a protection against blood borne diseases (dirty needles, working with hospital patients), it's often recommended to those who will be spending in excess of 3-months at a destination - those working for the Peace Corp, NGOs, etc. It's the Hep-A normally recommended against food borne infection; this too can serve one well in their home country (also good for 10-years). Though there is presently a combination Hep-A/B available.

Again, it's your own physician who knows your medical history who should recommend what you require for travel. As well as, the appropriate medication for malaria. Be aware that most insurance companies do not cover these expenses, so be prepared to hear some pretty high prices.

Recently there was a thread that reminded people to consider the public health center, where prices are usually less costly then direct from their physician or a travel medicine clinic.

Favor

Be careful if you visit a travel clinic. They may try and sell you on everything from soup to nuts (e.g. rabies, menigitis, yellow fever, etc.) officially required or no.

Also, be aware that different insurance companies formularies or 'allowed prescriptions' may or may not include the latest thinking on malaria meds/preventatives. As sandi said, be prepared for high prices on meds purchased outside your insurance coverage.

Our insurance company was indeed willing to cover Malarone - the catch was we had to already have malaria to get the prescription.

tashak

On the other hand, don't assume that your insurance doesn not cover malarone. My travel clinic really tried to push lariam...I resisted because it caused insomnia and nightmares on a previous trip. Turns out my insurance DID cover the malarone after all.

Although we are not doctors, I do suggest doing your own research before you go to the travel clinic. Some practitioners don't keep up on the latest news, and some have their own favorite drug companies or drug rep, and may not give you unbiassed advice. If you go armed with info from legit sources (CDC, etc.) you'll be in a better position to help the doctor take care of you. (I asked a public health contact about this, and they said that malarone is what the CDC folks prefer when they go on trips to malarial regions...

morrika

Besides Larium & Malarone, there's also doxycycline which is also an anti-biotic. In my case, it was substantially less expensive than Malarone but you have to take it longer when back from your trip.

If you go to a Travel Dr/Clinic, compare any vaccination prices w/your public health dept. The TripRix vaccine (combo Hep A/B) was being offered by my Public Health Dept for $20 per does (need 3 over 6 mos.). However, the Travel Clinic was offering it $140 per dose - yes that's right!

Anyhow, most likely, your regular doctor probably would only have Tetanus on hand, so if you want/need other vaccines, you'd have to see a travel specialist or go to public health dept. Also, I don't think the public health dept can write presciptions, but my regular offered to do that for me.

tashak

A warning about doxyclyline-- it does not have the same level of effectiveness as larium or malarone. In the US it is recommended only for people who for health reasona cannot take the other two...(In the I doubt most doctors will prescribe it unless that is the case). I know someone who got malaria on a trip to Mala Mala this year (and that was the only place he was outside Joburg) and he swore he took doxyclycline religiously. So must exercise caution (and use all other recommended precautions-- I'm not sure he used repellent for example).

sandi

Reminder - whether a traveler takes Lariam, Malarone or doxycycline to ward off malaria, these are not inoculations. Only an inoculation would protect you from the disease. Sadly, there is no inoculation despite years of effort in this area. So in addition to the meds, one has to use repellent w/Deet on exposed skin during mossie biting time - dusk to dawn. In addition, use mosquito netting where provided, or coils, and spray your rooms/tents.

Despite all precautions, there are cases of people who come down with malaria - though an episode under such circumstance is supposed to be less toxic, then if not taking meds. Lets hope for an inoculation against this disease to save the millions (mostly children) who die yearly from malaria worldwide.

ArthurSA

Even "legit" sources such as CDC can be suspect. I find it amusing at best that South Africa and some other Southern African countries are lumped together with a directive not to drink the tap (faucet) water only bottled, not put ice cubes in drinks, etc.! Together with (as far as I can remember, I haven't re-checked) all sorts of shots that should be taken. And then that info is also picked up and repeated by other overseas-based sites.

That doesn't make their malaria info suspect, but it does give cause to wonder.

sandi

ArthurSA - You are absolutely correct when it comes to South Africa. Unless one is going into malaria prevelent areas, there is no need to be overly inoculated or be popping pills. And the tap water and ice cubes are just fine down your way.

However, for travel in general, people should be current as regards their individual health. Amazingly, most adults don't visit a physician unless something is wrong and more often then not they just ignore any aches or pains. I would bet that the last time most adults had an inoculation was probably in infancy. It's not until someone decides on a socalled "exotic" locale for their holiday - Africa, South East Asia, India (you've got the idea) - do they hear/learn anything about health precautions. Yet, these same individuals are unaware of the fact that it's just as important to protect themselves from what can bite them on their butts in their home countries - for which being current with Tetanus and Hep-A, at minimum, should be considered.

I believe, whether it is the CDC or any other governments' health agencies, they have to provide the information, then it's up to the individual in consultation with their own physician to make the appropriate decisions, case-by-case. No one can make anyone take pills or be inoculated - but I can assure them they they certainly can drink the water in South Africa.