itsv

Okay, its me again, the mother with the 13 yr. old son going to China in 5 days as a student ambassador in people to people. As probablly expected a rash of emails between parents regarding vaccinations (specifically malaria and thyphoid) has sent the group in a panic. So I figured I'd turn to all of you again (I have appreciated your help so much) and ask all of you for your experience.

Here are the facts: Son is going to beijing, xian, shanghai and hongkong, will be gone for 18 days. will travel on plane, train and bus. CDC says you do not need malaria or tyhpoid if going to cities and tourist areas in China. Took CDC printout on China to son's dr. and after review Dr. says son does not need malaria or tyhpoid. Plus she did not want to give it to a kid on his own since side effects could be bad. instead gave son bug spray and lotion with deet and told to wear it everyday. Son got tetanus, hep a and mennegits.

One parent in the group went to a travel clinic who said her son should get$300 worth of shots including malaria and tyhpoid. Sent email to whole group and as can imagine panic has resulted. Clinic said they could do a group vaccination session (Makes me suspect clinic since with 40 kids it would be a big money maker for clinic.) Everyone's dr. is saying someting different.

What have you done for your trips in China? Just had three neighbors comeback from same places had no shots and did not get sick.

Any thoughts etc, appreciated,
itsv

quimbymoy

hi,
in preparation for my trip in september, the travel clinic i went to suggested a hep a shot, something you can get from unsanitary food. so that's all i got. they didn't think i needed typhoid for those areas. i think your son is fine. don't panic!

Patty

Travel clinics will sometimes try to oversell vaccinations which may be unnecessary for your particular situation. In this case, I think your suspicions might be correct.

I personally haven't gotten any shots in preparation for any of my trips to China.

Kathie

The best source for info on travel medicine is www.cdc.gov/travel It looks like you did your homework! Most general practitioners have no experience with travel medicine, which is why people get so much divergent advice. I believe your doc did a good job with your son from all the info you've given us.

Reasonable people can disagree about the typhoid shot issue for China. It is spread by contaminated food and water, but it is most prevalent in tropical areas, which is not where your son will be.

As you saw from the cdc website, only limited ares of China are malarial risk. It sounds like he will not be in those areas. He should still use mosquito repellant, as dengue exists in China. It would be hard to justify giving anti-malarials to people for this itinerary.

BigJim

Unfortunately, I don't think you'll EVER get the "right" answer to this. As you can see just from the other posts, people have done different things. One of the many inconsistent things about international travel. We just got back from Beijing, Xian, Shanghai, Guilin, and HK. I was told by my doctor that I needed Hep B (or was it A?) and Tetnus. My wife's doctor gave her both Hep A and B as well as Tetnus.

So your guess is as good as mine!! I wish you luck!!

Marija

When will we get a travel report BigJim? Please!

itsv

Thanks everyone for your help. I had a definite feeling the anti-malarial was an oversell based on where they are going. Yes, my son's doctor did recommend bug spray/lotion with DEET and that is what he will use. I know some people can have bad side effects from the malaria drugs (hallucinations, abdonminal pains, headaches etc.) and would not want my 13yr. dealing with that sort of thing. His doctor agreed and did her homework.

thanks for helping get rid of the panic feelings. For those with trips coming up, Good luck and have a great time,
itsv

jimdrew

It's been a few months since I've checked the CDC website, but I thought I remember Shanghai and Hong Kong being Marlaria zones from July - whenever. All I know is that I have a bottle of Doxycycline (malaria prevention) for my upcoming trip to Shanghai, Hangzhou, Suzhou, and Nanjing. I'm in northern China (Hebei Pr) and wearing "Deep woods OFF" just doesn't cut it with the mosquitoes sometimes.

Hep A is definitely necessary. I think if there is one you need to get, it's that.

I think going to a "travel doctor" or specialist in travel medicine is a good idea. I had such a hard time convincing my girlfriend that she needed Hep A before her 3 week visit because her doctor said it wasn't necessary. So ridiculous. Finding someone that deals with those questions everyday and gives you information directly from the CDC will ease your worries.

rkkwan

A "travel doctor" makes his money by selling vaccines. Remember that...

rkkwan

Direct from the CDC:

"The risk of malaria in Hong Kong S.A.R. is so limited that taking an antimalarial drug is not recommended."

I grew up in Hong Kong and visit frequently. Can't remember hearing once anybody get malaria in the territory.

---

BTW, one can read an article a thousand ways. The way I read the CDC's East Asia recommendation, basically the only vaccine that recommend generally is Heptatitis A. Typhoid and malaria is not needed in the "developed" large cities your son is going.

Kathie

rkwwan, I must disagree with out about travel doctors. While there are definitely for-profit travel clinics that may push more than is necessary, a good travel medicine specialist can help you sort out what is the best combination of immunizations, medications and preventaive measures for you to take depending on your individual health history, where you are going and what you'll be doing. I always recommend to peple that they check for a travel meicine clinic at the nearest medical school both because you are more likely to get real expertise and you are less likely to have someone pushing unnecessary measures. I'm always amazed at how many people never think to consier travel immunizations or refer to them as "too expensive."

You are, of course, quite correct about Hong Kong having minimal risk of malaria.

By the way, I feel compelled to add for the benefit of itsv and others who are not familiar with anti-malarials... There are a number of antimalarials on the market. Each has a different side efect profile, and some are no longer affective in certain areas of the world. One anti-malarial, larium (mefloquine) has the potential to cause very serious side effects including hallucinations, severe depression, paranoia, etc., but less than 5% of people have those effects. Unfortunately, beacuse of horror stories about larium, many peple have come to believe that all antimalarials are dangerous or have severe side effects. Some of the anti-malarials have few side efects like malarone and doxycycline. Remember that if you are traveling in a maalrial risk area, the risks of malaria far out weigh the risks of an anti-malarial.

itsv

Thanks everyone for your help. The Dad who started the chain of panicky emails keeps on telling me, " the fact is that the U.S. government (the CDC) is advising that malaria is a problem in Shanghai." I do not see that warning anyplace on the CDC website. I only read that malaria is a problem in the rural areas of the Shanghai province. Am I missing something on the CDC website or am I reading the thing wrong.? Our kids are going to the City of Shanghai.

I agree that travel specialist can be helpful. Indeed, this travel clinic's own website says no need for malaria or typhoid for the cities.http://www.mdtravelhealth.com/destin...sia/china.html. However I think the travel clinic the other kid's Dad visited is a little suspect because they were quick to say they could vaccinate the whole group of 40 kids at $300-400 per kid.

I am giong with no malaria shot. Our dr. gave him tetanus, the new mennigetis shot for teenagers and DEET spray. He already had hepatitis because in San diego drs. here are concerned about water and being so close to Mexico.

Thanks for all the great help, Itsv.

rkkwan

Kathie - I only wrote one sentence about "travel doctors". I did not say they're not knowledgable or helpful; or they are unethical or anything.

You cannot disagree with me that they make their living selling vaccines. Just like surgeons make their money cutting people open, or architects make their money designing buildings, or engineers make their money building stuff.

Jed

rkkwan - It is true that surgeons make most of their money by cutting people open, and travel doctors make some money by 'selling vaccines' (although most is made by giving advice).

But for a doctor to recommend unnecessary treatment ('selling vaccines') for the sake of money is unethical, and that is what you are suggesting.

I'm not saying that some doctors don't overttreat, but I believe that the majority of doctors do what is in the best interest of their patient, and not for money. If you don't trust your doctor, you have the wrong doctor.

itsv - When we went to China, we relied on the CDC advice.

rkkwan

Hm... How can a simple sentence in my first post imply I'm calling these doctors unethical?

As many of the posts in this thread has shown, it's a matter of opinion and judgment here, no about absolute right or wrong.

Please don't put words in my mouth that I did not say.

It's totally okay for a florist to try to sell you the biggest bouquet or a cruise specialist trying to sell you the best stateroom on a ship. It's definitely totally okay for a "travel doctor" to recommend the safest way to travel and get you all the vaccines and treatment.

Kathie

itsv, I read the cdc website the same way you do. By the way, there is no shot for malaria.

rkkwan, I'm sorry if I was too hard on you. I read your sentence in the same way as Jed did. The ethical standards for doctors (and all health care providers) is a bit different than for florists. To say that something is "needed" when it is not, is a clear ethical breach for a doctor. It is certainly true that reasonable and ethical doctors can disagree on some recommendations. But there are are places where the standards of care are very clear.

rkkwan

Well, since you guys get me started, I'd say more about this now...

Here's why a "travel doctor" will tend to be over-cautious, and recommend vaccines that the CDC or your family may not say you need.

Let's use the OP as an example. Their itinerary consists entirely of modern, developed cities, and let's assume they're staying at foreign-owned 4* and 5* hotels, all meals well prepared. A fodorite (rkkwan) says that the CDC don't recommend Typhoid vaccination for this trip.

But what if 13-yr old Johnny likes to swim, and decides he should get a dip in the Huangpo River while in Shanghai. And while he's a good swimmer, a boat created some wake and he swallowed two mouth-fulls of water and get Typhoid?

Now, itsv and Johnny can't really sue rkkwan for something rkkwan says on a public discussion board. But if they'd gone to a "travel doctor" and the doc says, "nah, no one gets Typhoid in Shanghai", well he can get sued. Even if it's frivilous and get tossed out, he still lose out with large attorney fees and time to defend himself.

Now, Johnny's pediatrician is different. He's treated him since he's a baby, and know the family well. The chances of the OP and Johnny suing him for suggesting "no Typhoid" is much smaller, and he can be more objective in his recommendations.

These are the issues involved. Not just the money the "travel doctor" charges you for the vaccine, but also his money - and time, and reputation and license.

[I keep saying money because that seems to be the word that upsets some people. Hey, I work with doctors, my sister's a doctor. They do have to think about their wallet!]

Sargent

When I was younger I actually went with People to People to China, and I did not need shots then. I have also never needed any shots or other vaccinations for China the several times I have been back since. Don't worry.

Kathie

rkkwan, my experience is clearly different from yours. I've heard of family docs prescribing anti-malarials for Chaing Mai (clearly not needed), recommending Jap E Enc for anyone traveling to Asia (only recommended for stays in rural areas of more than a month) or prescribing chlorquinine for travelers to SE Asia (where the malaria has long shown resistance) and not thinking of issues like typhoid. Indeed, I've seen more over-prescribing from non-specialists who are overly cautious because they are practicing outside their area of expertise. A good travel medicine doc will ask questions about not just where a person will be going, but what they will be doing. All the travel med clinics in the US use the cdc database to inform their decisions.

A family physician will be just as legally liable as a travel doc for malpractice. However, no physician in their right mind would say to someone that they won't or cannot get a particular illness. They will talk about risk and risk factors.

The issue here really isn't one of the travel medicine specialist vs. the general practitioner, the issue is about providing good, competent care and advice about travel issues.

You and I have different points of view about whether to consult a travel medicine specialist or one's own family physician about immunizations and such, but we appear to agree on the wisdom of consulting a professional about immunizations prior to travel. It's the people who post messages to the effect that "I didn't get any shots and I didn't ge sick so you don't need any shots either" that really drive me crazy.

rkkwan

Kathie - That's fair enough. I can totally respect what you said in your last post. I think the OP probably has enough information - and points of view - to make a wise decision now!