Are any of these unnecessary?
Hi ewaiea,
Depends on how conservative one wishes to be. Kind of like insurance -- how much or little one feels comfortable with and the level of risk they are willing to assume is an individual decision.
The best advice is to get recommendations from an expert in travel medicine. This can be arranged through the International Society of Travel Medicine (ISTM) website (
ISTM - Home Page). Enter the Global Travel Clinic Locator at the upper left hand side of the page and locate one near you. Also you can check the International Association for Medical Assistance to Travellers (IAMAT)(
IAMAT Travel Health and Doctor Directory - Doctors/Clinics Worldwide) website.
Malaria, tetanus and hep A & B can be very nasty diseases, and yellow fever can lay you quite low for a period.
One should keep their tetanus vaccination up to date regardless of travel, so that surely is recommend. If one travels to locations where contracting hep A & B is a reasonable possibility, and in many less developed foreign venues it is, it is prudent to be vaccinated against these. Yellow fever seems less of a worry unless there is an outbreak in the area being visited.
As for MMR, again regardless of travel, adults 18 years or older who were born after 1956 should receive MMR if they are uncertain of their immunization status or if they have only had one MMR prior to school entry. Those born during or prior to 1956 generally are presumed to be immune and many within that age group will have had these diseases during childhood.
Malaria risk would appear relatively low (but not non-existent) given the itinerary described. If you're concerned about contracting the disease, you might find the following updated and edited version of my "Ask RSD" article on the topic in
Rodale's Scuba Diving to be informative:
"First order of business in preventing malaria (and dengue fever, yellow fever, etc.) is to avoid getting bitten by an infected mosquito.
"The danger and bother of insects can be substantially reduced by these precautions:
(1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful (
Search Results) As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products
permethrin pest control insect bed at permethrin-repellent.com)
(2) Try to stay indoors at dawn and dusk when many flying insects are most active (although the mosquito that transmits dengue is most active during the daytime), and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows;
(3) Wear insect repellent. The best protection against these and other insects arguably is full strength DEET. Some divers like things such as Avon's Skin-So-Soft and Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for long-lasting effectiveness.
Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon 34.34% (
Amazon.com: Ultrathon 34.34% DEET Sponge Applicator Lotion: Home & Garden) appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems and worse. Be aware that DEET can dissolve synthetics like plastics, rayon and nylon, so it's best to wear natural fibers and keep it off of your gear.
Relatively recently, picaridin-based repellants have been found to be quite effective and much less irritating to the skin and malodorous than DEET. The line of Cutter's Advanced products is an example (
United Industries - Cutter Insect Repellent - Cutter Bug Repellent - Mosquito Repellent).
However, based on the published scientific research some of these products contain questionably small amounts of picaridin, e.g., Cutter Advanced Picaridin Repel at 7%, Cutter Advanced Wipes at 5.75%. It is therefore recommended that a product like Cutter Advanced Aerosol with 15% picaridin be used. Some repellants available in foreign venues contain even higher concentrations of the chemical.
(4) Avoid scented toiletries and perfumes.
As regards chemoprophylaxis for malaria, Malarone (atovaquone/proguanil)(
Malarone Information from Drugs.com) is likely the best choice if your travel clinic recommends it.
Be aware that Lariam (mefloquine), an effective and often prescribed antimalarial, can pose problems, especially for the diver. The following updated article from my "Ask RSD" article on the topic in
Rodale's Scuba Diving may prove informative:
"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness.
The US package insert directs that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS.
Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.
Of most concern to the diver are the positions of some medical professionals that the drug simply should not be taken for malaria prophylaxis by those who are actively diving. These sources include Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.
The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction.
The FDA has come out with the following warning regarding mefloquine:
WHO Pharmaceuticals Newsletter 2003, No. 04: SAFETY OF MEDICINES: MEFLOQUINE - Patient guide warns of psychiatric adverse events
and
The following is very thorough--The Journal of the American Medical Association (Vol. 297 No. 20, May 23/30, 2007) (
JAMA -- This Week in JAMA, May 23/30, 2007, 297 (20): 2167) scroll down to the section on Lariam)."
Helpful?
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
