Destination TBD

| Pills and Shots|

Vaccinations can be expensive, but they're worth it, if only for peace of mind. Visit a travel specialist who can provide you with accurate information for the areas you plan to travel.

Instead of visiting a doctor's office, I went to the city's health department and got my injections and prescriptions from a special travel clinic. Since my health insurance company didn't cover any costs related to travel, it was cheaper to go through the city clinic than a private doctor. I cancelled my policy with my insurance company before leaving so I didn't have to pay my monthly premiums while on the road and relied on my traveler's health insurance for medical expenses, though I never needed to use it.

The nurse at the clinic talked me into the expensive rabies vaccination and I'm glad I got it: I was bitten by a dog in Thailand. Once bitten, you must still receive 2 additional shots, spaced 1 week apart. If I hadn't had the original vaccination, I would have had to receive 5 shots spaced 1 month apart. This could be a major issue while traveling in remote areas, where the vaccination is hard to find, or if traveling on a schedule when an expired visa can pose problems.

For this trip, including India, China, mainland SE Asia, and Indonesia, I got the following vaccinations:

Vaccination            #/Shots        Schedule                  Fee Per Shot

Hepatitis A               2                  6-12 mos apart      $45.00
Hepatitis B               2                  6-12 mos apart      $40.00
Jap Encephalitis    2 or 3           0, 7, 30 days          $110.00
Polio Booster          1                                                    $40.00
Rabies                     3                  0, 7, 21 days           $165.00
Typhoid                   (oral)                                             $65.00
Tetanus                   1                                                    $25.00

I was also prescribed the following to take in a travel medical kit:
• Cipro (antibiotic)
• Doxycyclene (anti malaria pills)
• Influent (for women: yeast infection treatment)
• A 1-year supply of birth control pills

Save money by purchasing prescription drugs overseas. In Bangkok, Doxycyclene costs a mere 5 Baht per pill (a 1 month supply is less than $4.00). A pack of birth control pills is 60 Baht (about $1.50).

If your doctor prescribes Lariam, be aware that this anti malaria pill is known to cause psychotic side effects. For women: the birth control pill is compromised while on antibiotics and anti malaria pills, take condoms.

Over-the-counter meds & supplies in my travel kit:
• Neosporin
• Aspirin
• Tums
• Cold & Flu Medicine
• Fizzy Vitamin C tablets
• Band Aids
• Digital Thermometer
• Antibacterial lotion & wipes

Iillnesses that can be contracted while traveling include:

Hepatitis A
Hepatitis A is a serious liver disease caused by the HAV virus, found in the stool of people with Hepatitis A. It's usually spread through close personal contact and sometimes by eating food or drinking water containing HAV. It causes flu-like symptoms, jaundice, and severe stomach pain and diarrhea. People with Hep A often require hospitalization and sometimes die from the disease.

Hepatitis B
The Hepatitis B virus, HBV, can cause short-term illness that leads to loss of appetite, fatigue, pain in muscles and joints, diarrhea, vomiting, and jaundice. Long-term illnesses as a result from HBV include liver damage, liver cancer, and death. Hepatitis B is spread through contact with the blood and body fluids of an infected person. It is spread by having unprotected sex with an infected person, sharing needles or being stuck with an infected needle, and during birth when the virus passes from an infected mother to her baby.

Japanese Encephalitis
Japanese Encephalitis is a viral disease spread by mosquitoes from infected animals to humans. In its early stages, the disease appears to be a flu-like illness with headache, fever, gastrointestinal symptoms, confusion, and other behavior disturbances. If the illness progresses to inflammation of the brain, up to 30% of cases end in death and half end in permanent disability. There is no cure for the disease once it sets in.

Rabies is a serious disease caused by a virus (you remember Cujo, right?). Mainly a disease of animals, it can be spread to humans through a bite. Rabies can cause pain, fatigue, headaches, fever, and irritability followed by seizures, hallucinations, and paralysis. Rabies is often fatal.

Typhoid Fever is a life-threatening illness caused by Salmonella Typhi. This bacterium lives only in humans, and is carried in the bloodstream and intestinal tract of infected people. Typhoid Fever is spread through food and drink that have been handled by an infected individual and through sewage-contaminated water used for washing hands or food. Symptoms include a high fever, weakness, stomach pains, headache, loss of appetite, and at times, flat, rose-colored spots on the skin.

Malaria is a serious, sometimes fatal disease caused by a parasite that's transmitted by a mosquito bite. People with Malaria get very sick with high fevers, shaking chills, and flu-like illness. The disease can be treated, but stays with the infected person for life. Anti-Malaria pills can be taken as a preventative measure, but do not provide 100% protection. In addition to the medication, wearing protective clothing and using DEET is recommended.

Dengue Fever
Dengue Fever is a viral infection that's spread to humans by the bite of female Aedes Mosquitoes. After the infecting bite, symptoms develop within 3 - 14 days and include a sudden high fever, headache, weakness, and intense muscle, joint, and low back pain... hence the nickname, "break bone fever". Severe forms of the disease, Dengue hemorrhagic fever and Dengue shock syndrome, may occur in people who have previously been infected with one strain of Dengue virus and are later infected with a different strain. DHF and DSS begin like classic Dengue, but progress to abdominal pain and vomiting. The most severe cases can lead to bleeding at sites of minimal trauma (like hemophilia), circulatory failure, shock, and death. There is no vaccine against Dengue, so preventative measures such as clothing and insect repellant are important.

Altitude Sickness
Altitude Sickness is caused by lower levels of oxygen at high elevations that the body is not accustomed to. The simplest way to avoid or reduce the risk of Altitude Sickness is to ascend slowly, give your body time to acclimatize. Symptoms of acute mountain sickness (AMS) include headache, insomnia, irritability, dizziness, muscle aches, fatigue, loss of appetite, nausea or vomiting, swelling of the face, hands, or feet. If ignored, AMS can turn into High Altitude Cerebral Edema (HACE) with the addition of changes in consciousness and/or loss of coordination, hallucinations, and confusion. The third type of altitude sickness, High Altitude Pulmonary Edema (HAPE) is a buildup of fluid in the lungs that can occur along with HACE or as a separate illness. Both HACE and HAPE are considered medical emergencies.

© 2006, Cheryn Flanagan