Roatan and immunizations

[salth2owannabe]

Here are two sites that are pretty informative:
Reported Malaria Cases - GlobalHealthFacts.org
MD Travel Health - Honduras - vaccinations, malaria, safety, and other medical advice
You'll find Honduras #62 on the malaria list for reported cases. Since much of Honduras' elevation precludes malaria concerns that leaves the costal areas seeing the bulk of the cases.
I was reading a Blog from a volunteer health worker on Roatan and she was saying that she was a little surprised that there were not more cases she said that many of the cases she did see went unreported.

 

[Canyondreamer]

Me and my dive body family (5) are leaving for a week of diving in Roatan Oct. 6, 2012. I am a physician (not ID) and try to do due diligence to protect me and my family against the various ailments and diseases able to be prophylaxed for prior to leaving for potentially risky areas of the globe. When reseacrhing the pros and cons of taking Malaria prophylaxis when going to Roatan, it quickly became clear, that the opinions and what people do is evenly divided between those taking malaria prophylaxis and those not taking prophylaxis, with this being pretty unchanged over the past decade. Firstly, there is no question that Malaria is a reality in Hondurus (and other countries South of the US border) including the Honduran Bay Islands (Roatan). The risk of severe side effects from the drugs effective in preventing malaria also are well documented. The risk (and cost) of the malaria prophylaxis vs the risk of aquiring malaria while in Roatan must be pretty even for that dispute and discussion to be unchanged and unresolved for more than 10 years - so in essence you could conclude: pick your poison.

Me and my family after much research and much discussion, decided NOT to take prophylaxis based on:

1) Searching through all available search engines - I have not been able to find any recent (within the last 10 years) definite report of any diver who did not take malaria prophylaxis when going to Roatan and who developed malaria after diving in Roatan

3) The people in my local dive shop who go to Roatan all the time, have never takken prophylaxis - and so far so good (and their rationale is not to risk side effects that interfere with their ability to dive with no recent documented cases of divers getting Malaria). (and asking people from the US who live on the island and who do not take prophylaxis - same thing)

3) In 2010, 1,688 diagnoses of Malaria was made in the US (10% or 169 cases were lifethreatening) amongst the tens-of-thousands of Americans (if not more) who traveled to Malaria endemic areas for various length of times for various reasons (CDC: Malaria Surveillance — United States, 2010). Of the tens-of-thousands of cruise passengers to endemic areas (and thousands of passengers stopping over in Roatan) in addition to the thousand of divers who do not take prophylaxis when going to Roatan, (most of the CDC reorted cases who must have been somewhere else than in Roatan), and the thousands (if not more) who go to Roatan without prophylaxis - the risk of acquiring malaria when going to Roatan just by definition must be low!.

Thus, taking all this into consideration - we have decided NOT to take malaria prophylaxis - and instead use comon sense and lots of mosquito repellant.

In case that doesn't work, and one or more of us develop malaria - I promise that I for sure will post it here (as I see it, if so, that would be the first of any diver here who would have developed it after diving in Roatan!!)

 

[large_diver]

It is indeed a low probability....but each person has to weigh the pros and cons for themselves.

During my first trip there this past March, I did hear a story from one of the CCV staff about a relatively recent case, although I think the person involved was a resident, not a guest.

My daughter and I have now taken Malarone on 2 trips (Tanzania and Roatan).....we both seemed to tolerate it well. We will definitely be taking it again when we go back to Roatan next March.

 

[DivinRich]

I work at a travel clinic and this has been a pretty good thread.

Couple of comments -

Hep A and Hep B are now given to children, the vaccines weren't available until 1982 for Hep B and 1995 for Hep A, therefore many adults never received them as children. If you travel or are in other risk groups we recommend getting them. Hep B is a series of 3 shots, Hep A is 2. Once you complete the series you are good for at least 25 years. Achievements in Public Health: Hepatitis B Vaccination --- United States, 1982--2002

Typhoid - Two forms, a shot and the pills. The shot is only good for 2 years and the pills good for 5. Many people report problems with taking the pills, but almost every person we've talked to after the fact didn't follow the instructions. Empty stomach (2 hours), FULL GLASS of Water at least one. Some data indicates the pills (vivotif) provides better protection.

Tetanus, currently recommended every 10 years, some recommend 5 years for travelling. Also should receive another booster when cut bad enough to get infected. Whooping cough is resurging and the Pertussis (whooping cough) vaccine is mixed in with the tetanus and is called TDaP. It is recommended that every adult gets a TDaP, children are immunized with a slightly different compound.

Side Effects of Anti-Malarials
[SIZE=-1]Like all medicines, anti-malarials can sometimes cause side-effects:[/SIZE]

Proguanil (Paludrine) can cause nausea and simple mouth ulcers. A component added to Malarone, not given alone in the US, not sure about other countries.

Chloroquine (Nivaquine or Avloclor) can cause nausea, temporary blurred vision and rashes. Many parts of the world chloroquine is not effective anymore (based upon the strain of malaria in the area), fortunately the majority of central America is not resitant to chloroquine, yet. Weekly pill. This is the one I take when travelling CA.

Mefloquine Patients with a history of psychiatric disturbances (including depression) should not take mefloquine as it may precipitate these conditions. It is now advised that mefloquine be started two and a half weeks before travel. Mefloquine is known for the "personality" side effects and my clinic doesn't recommend.

Doxycycline does carry some risk of photosensitisation i.e. can make you prone to sunburn. Cheapest option, need to take daily and also for a full month after trip.

Malarone is a relatively new treatment and is virtually free of side effects. It is licensed for use in stays of up to 28 days but there is now experience of it being taken safely for up to three months. - About $8-$10 a pill, taken 2 days before trip, daily during trip, and 4 days after, preferred but expensive.

No other tablets are required with mefloquine or doxycycline or Malarone

Different geographical locations require different types of medications based on the strains of the disease, I can't remember what Roatan falls under but a quick internet search will tell you.

I thought the last time I bought them, they were around $200 per person????

For Malarone, that sounds about right.​

Comments in bold and color.

Disclaimer, you should seek qualified medical care and get recommendations based upon your specific circumstances, travel plans, health history, etc. This material is in no way to be considered a consultation, instead just some random comments.

CDC page for Honduras. Health Information for Travelers to Honduras - Travelers' Health - CDC

 

[Canyondreamer]

FWIW - Fourth day on Roatan - haven't seen a mosquito nor been bitten - everybody healthy - but use all recommended precautions

Diving with 'Subway Scuba' on the North shore - absolutely impressed with their adherence to strict safety - more so than even in the US, I.e. this is the first time any dive shop insists we check our nitrox tanks and document both on a list and on the tank our findings (otherwise we have to ask - and sometimes they have to wipe the dust off the analyzer!!). Also adheres to a strict '3 dives per day and no more' policy - DM also insisted on checking basic skills on first dive no matter what card we flashed - sat well with me. Now off for wreck and open cave diving
Great crew! - but I digress - I could write a trip report in another thread if not done up the wazoo from here by others.

(sat by the lead tech running the decompression center in Roatan on the way here - some stories he could tell on the 3 hour long flight!)

 

[Divermikey]

Just my two cents, went to Roatan last June took Malarone with no side effects. I am going back on Dec 1 with a bottle of Malarone (reluctantly,dont like taking pills) but following my doctors' advice. Dont know if they work but, I feel safer. Small price to pay($10) for a great vacation.

 

[chillyinCanada]

Those of you that have had your TwinRix and/or Hep A & B shots separately, should consider getting checked on your Hep B immunization. Friends of mine that have had the shots, for some reason ended up getting tested for their immunity and found that their Hep B hadn't taken. I found that rather hard to believe, but nonetheless had my doc test me. Guess what? Had to have another Hep B shot.

 

[Glenn01]

Taking all these meds is a personal decision. If you decide to do the meds, I highly recommend, based on personal experience, trying the malaria medication before you travel. In preparation for a trip to Malasyian Borneo (diving at Sipidan, Sibouan, Montabouan, climbing Mount Kinabalu), I picked up malaria meds at my travel doctor. He advised trying them before travelling - I had not taken these before. I never got around to it.. big mistake. After taking the first pills, I awoke the following morning with a fever and headache. Never the less, we climbed Mount Kinabalu. Don't think I ever felt that bad or sweat that much. We stayed in huts near the summit - I was awake all night in, what was later described as, rigors. Uncontrollable shaking - hot and cold. Wow. Needless to say, I didn't finish the meds. Nor did we see a single mosquito in Borneo! I was a little shaky on the climb down but felt better after getting lots of fluids in me. Aside from that little adventure - it was the best trip ever!

 

[JonAten]

Canyondreamer, Any advice on what repellant you used to prevent mosquitos.

 

[diversteve]

View attachment 178839

DEET insect repellent spray for long lasting outdoor protection | OFF!® Insect Repellents - worked pretty well for me.

In addition to the mosquitoes there's sand flies on the beaches. Sometimes around the docks/boats also. I think they're more common than mosquitoes - swarms of them at dusk. I was on Malarone the whole time also.