my travel clinic appointment
 

I just returned from an appointment with a physician at my university's travel clinic. I thought other travelers may find this informative...

We are going to Tokyo, Hong Kong, Siem Reap and Bangkok.

She suggested:

Hepatitis A Vaccine (first dose today)
Oral Typhoid Vaccine (Vivotef; four-dose prescription)
Malarone (start 2 days before entering Siem Reap, continue while there and for 7 days after departing Siem Reap)
Azithromycin (if needed for traveler's diarrhea: 1000 mg)

imodium as needed
no preventive use of pepto bismol (I asked)
sunscreen applied before DEET
insect repellent with DEET (ultrathon cream) on exposed skin
insecticide with permethrin for clothing
animal avoidance due to endemic rabies

Thanks for the information. We just returned from a trip to Bali and I wish we had been able to go to a travel clinic because our doctors just made their best guess at the CDC recommendations. By your account, they did very well. We did find Pepto Bismol handy on several occassions, however. Have fun.

PB only masks move severe problems....good for a quick fix but nothing more...imo

T&L---looks like a plan....that is the kind of suggestions we always get, plus hep B

sorry and polio vac and tetnus

I should have mentioned that we both have Hep B, tetanus, polio, and all other typical vaccines up to date...

pmccallum-- did you try looking for a travel clinic run by your county? My parents saw travel nurses in their county in Florida. Maybe try that next time.

Tim and Liz, it sounds like you had a good appt. with the Travel med clinic.

pmccallum, All travel clinics in the US use the cdc website info (along with regular email updates) to make recommendations. Everything Tim and Liz were recommended is on the cdc website (although the antibiotic to take along is at the prescriber's discretion).

Wishing you a great trip. And of course a report later. ((*))

Thanks, Jed. We do not leave until March but will definitely write a report. We are also starting a travel blog but have not decided yet how "public" it will be.
Do you have any upcoming trips planned?

Ask your doctor about Japanese encephalitis virus (JEV) for some places in Asia.

In Thailand they have a very good pharmacy system. You can get many things right over the counter without prescription pretty, cheap with government price controls! Doxycycline is sometimes used for malaria too! Some sunlight sensitivity but it is real cheap in Thailand through their pharmacies (3 baht to 8 baht per 100 mg cap.) Check with your doctor.

Malerone may be harder to get overseas and like you mentioned, you have to start it a few days before you leave home. Check on some of the after effects.


Have a good trip.

T&L, hope you didn't pay for this advise. Just standard run of the mill precautions.
Very basic general travel advise.

No physician required for this info!!

Have a nice trip.

Yes, I know, advice!!!

Leigh, but they did need a physician to prescribe the vaccines and the antibiotics and the malarone.

Sir, JE vaccine is recommended only for those whose travels take them to rural farming areas for 6 weeks or more. Also, malarone is not available in Thailand. Indeed, the only place it is available in SE Asia is in Singapore. It is available only by prescription in SIngapore and the price is bascially the same as in the US and Western Europe. Malarone is started one or two days before entering the malarial risk area. It is the anti-malarial with the fewest side effects.

Kathie-Did you take Malarone when visiting Siem Reap?
Last time I was there (2002) we took Doxy. While there, we met a doctor who was with Doctors without Borders. She told me there were very few cases (if any) of Malaria in Siem Reap. Others (locals) told us the same.
I know the CDC still recommends anti-malarials, but I wonder if this is a case of them being over cautious. It would be interesting to see if there were any up to date statistics on numbers of Malaria cases originating in Siem Reap.
I would prefer not to take anything for this trip, but will still investigate Malarone.

Kristina, I did take malarone in Siem Reap. The WHO numbers indicate that it is a risk area.

Locals often tell people that there is no malaria in an area. Some of that has to do with the partial immunity that locals develop from being repeatedly exposed to malaria. You and I don't have that immunity.

If you opt not to take anti-malarials, do take all the appropriate precautions - repellant, long pants and long sleeves especially in the evening. Make sure your room is as mosquito - free as possible (be careful to close the door, make sure screens are intact if you open windows, you might want to burn a mosquito coil while you are away at dinner if there are mosquitos in your room, etc) The type of mosquito that carries malarial is most active from dusk to dawn. I don't remember being bitten while we were at the temples (even at dawn and at dusk), but we got eaten alive by mosquitos while eating outdoors at La Noria - despite deet, premethin spray on our clothes and a mosquito coil burning beneath our table!

I find malarone very easy to take. I've not had any side effects. And since you only have to take it for a week after leaving the malarial risk area, it's not the bother that doxy is. My medical insurance covers it with just a $30 copay.

Oh, and I posted elsewhere that it is important to take malarone with food or milk that includes some fat, as one of the active ingredients is fat-soluble. Someone on another travel board recommended taking along fish oil capsules and taking the malarone with that to ensure optimal absorption. I just make sure I'm taking it with a meal.

SirHalberd-
My MD did discuss JA with me, and that, along with Dengue Fever, is the reason that she suggested the DEET and permethrin. She said the vaccine is not necessary for someone with as short of a visit as mine.

Leigh-
Actually I did not pay for this advice, since I have free visits at my university's health clinic. However, I personally *would* pay for the advice of a travel or tropical medicine professional.

I am perfectly capable of checking the CDC website, as is Tim, who is a pharmacist, but I personally would rather visit a specialist than read a website or visit a general practitioner who has read the same website I can access.

Discussing the pros and cons of anti-malarials, preventive use of pepto bismol, rehydration methods if needed, ways to access medical care in Cambodia if we are bitten by a dog or have other injuries/ unexpected happenings... for me, proper counseling is one of the benefits of visiting a trained MD.

T&L, I absolutely agree. I always advocate that people read the cdc website ahead of time so you can intelligently discuss the issues with the doctor. There are always individual differences to be taken into account.

Kathie, that is good advice. From my last response it appears like I do not visit the CDC website, which is not true. I am in graduate school for something CDC-related... The CDC website is a very good resource, one that I actively recommend!

I just personally believe that someone who has access to a travel MD should visit one over a general practitioner when getting prescriptions for anti-malarials and such (other than perhaps a higher co-pay).

Fodors needs an edit function.

My last statement in the above post should read:
I just personally believe that someone who has access to a travel MD should visit one over a general practitioner when getting prescriptions for anti-malarials and such. The only reason I can imagine not doing so is a higher or an additional co-pay.

T&L, I was agreeing with you. From your posts, I was assuming you had looked at the cdc site and were well prepared for your visit.