Prepare for you best health

Visit your travel medical specialist

This visit should be made as early in the preparation process as possible. Some vaccination courses require a period of 8 weeks to be considered effective, and some medications need to be started well before departure. Visit the travel health clinic near you - a travel clinic will be on top of the latest international health news whereas general practitioners may not be. A listing of clinics world wide can be found at www.istm.org. A listing of clinics in Canada can be found at either of the following web sites: the Canadian Society for International Health - www.csih.org, or Health Canada - http://www.travelhealth.gc.ca (scroll down to the link Information for Travellers, then follow the Travel Clinics link). When choosing a clinic, you may want to consider looking at their consultation fees and vaccination costs to find the best deal. Some clinics charge reduced individual consultation fees if your share your appointment with any travel mates who are travelling to the same destination as you. Show up for your consultation prepared for your first jabs, and have with you your vaccination history, information on your current health status and medications, and the best idea you have of your itinerary.

Vaccinations are protective measures for your health. Whether you choose to have some or all available, or none at all, is up to you. However, all travellers should make sure their routine immunizations are complete and up-to-date as the risks for contracting the associated infections increases greatly in developing countries. In Canada, these vaccinations are covered by provincial health plans.

Routine vaccinations include:

• Tetanus-Diphtheria - Routine:
  • Nature:
    Tetanus: rare but severe bacterial infection, can lead to muscle contractions, breathing problems and death. Diphtheria: disease of the respiratory passages, can lead to heart disease.
  • Transmission:
    Tetanus: Contaminated soil via (minor) cuts, wounds, burns. Diphtheria: Person-to-person (coughing and sneezing), possibly in unpasteurized milk.
  • Geography:
    World wide, more prevalent in developing countries.
  • Vaccinations:
    Initiated with childhood series, adult single injection booster every ten years, less if travelling or if you have a contaminated wound.
  • Vaccination Side Effects:
    Local pain, swelling, mild fever.
• Poliomyelitis - Routine:
  • Nature:
    Can lead to paralysis.
  • Transmission:
    Contaminated food and water.
  • Geography:
    World wide pockets of outbreak, widespread in developing countries except South America.
  • Vaccinations:
    Initiated with childhood series, single booster as adult if travelling, if no childhood vaccinations take 2 vaccination doses 4 weeks apart.
  • Vaccination Side Effects:
    Local pain, swelling.
• Measles, Mumps and Rubella - Routine:
  • Nature:
    Measles: fever and rash, can lead to pneumonia, neurological problems. Mumps: fever with swelling in mouth, throat. Rubella: high risk to unborn child.
  • Transmission:
    Person-to-person (coughing and sneezing).
  • Geography:
    World wide, more prevalent in developing countries.
  • Vaccinations:
    One time series, usually given in childhood.
  • Vaccination Side Effects:
    Minimal local reaction, low grade fever, atypical measles rash 7-10 days after shot.

Other vaccinations should be considered on an individual basis. Your decision will be based on what part of the world you are visiting, national immigration laws, the local season in which you are visiting, whether you will be travelling in remote areas or not, how long you will be travelling for, who and what you might come in contact with and your current health status. Also remember that inoculations don't offer 100% protection for everyone, you must take many other health precautions while travelling too. See Health for more information. These vaccinations are not covered by government sponsored health plans and may or may not be covered by independent benefit and insurance plans. The Tuberculosis test is an exception to this and is covered by government health plans in Canada.

Vaccinations to consider include:

• Yellow Fever - May Be Required:
  • Nature:
    Viral infection, mild to severe.
  • Transmission:
    Mosquitoes.
  • Geography:
    Tropical Africa and South America.
  • Vaccinations:
    Required by some countries if itinerary includes travel to or transit through infected countries, WHO accredited clinic must issue certificate, vaccination and certificate valid for 10 years after 10 days of single injection inoculation.
  • Vaccination Side Effects:
    None.
• Meningococcal Meningitis - May Be Required:
  • Nature:
    Bacterial infection of brain and spinal cord, can occur very quickly.
  • Transmission:
    Person-to-person (coughing, sneezing) .
  • Geography:
    Can occur world wide, prevalent in Central Africa, Middle East, India, Mongolia.
  • Vaccinations:
    Required for travellers to Mecca, Saudi Arabia going for annual Hajj, Single injection, repeat every 3 to 5 years while at risk.
  • Vaccination Side Effects:
    Local reaction, headache, low grade fever.
• Hepatitis A - Recommended:
  • Nature:
    Disease of the liver, can last a month with fever, abdominal pain, nausea, fatigue, jaundice.
  • Transmission:
    Person-to-person (coughing and sneezing) or contaminated water.
  • Geography:
    Areas of poor sanitation, rural and urban; developing countries and Eastern and Southern Europe.
  • Vaccinations:
    Series of 2 injections (HAVRIX, VAQTA) spaced 6 to 12 months apart, provides protection for life. Can be administered with Hepatitis B vaccination in one shot (TWINRIX) with different protocol (same as Hepatitis B, below, with single booster injection at 12 months). If there is no time for the full vaccination series the traveller can consider ISG, or Gamma Globulin, which contains antibodies but is not truly a vaccination. This injection needs to be repeated every 3 to 6 months to remain effective.
  • Vaccination Side Effects:
    Hepatitis A only: minimal local reaction; combined with Hepatitis B: minimal local reaction, mild fever, headache.
• Hepatitis B - Recommended:
  • Nature:
    Virus affecting the liver, can lead to cancer.
  • Transmission:
    Bodily fluids.
  • Geography:
    World wide; more prevalent in Africa, Asia, Middle East, Pacific Islands, Amazon Basin and Caribbean.
  • Vaccinations:
    Series of 3 injections (ENGERIX B, RECOMBIVAX B) spaced 1, then 6 months apart, provides protection for life. Can be administered with Hepatitis B vaccination in one shot as per above protocol with single booster injection at 12 months. Recommended particularly for those travelling to developing countries who a) are children, b) plan to remain 6 or more months, c) plan to work in health care, or d) might have sexual partners while there.
  • Vaccination Side Effects:
    Minimal local reaction, mild fever, headache.
• Typhoid Fever - Recommended:
  • Nature:
    Life-threatening disease with increasing fever and multiple signs and symptoms.
  • Transmission:
    Person-to-person (coughing, sneezing) or contaminated water.
  • Geography:
    Areas with poor sanitation and poor water supply, especially rural; Africa, South and Southeast Asia, Middle East, Caribbean, Mexico, Central and South America.
  • Vaccinations:
    Liquid oral vaccination series (3 doses on alternate days) providing 4 to 7 years of protection, or more expensive single injection (Typhim Vi) providing 3 years of protection.
  • Vaccination Side Effects:
    Oral: cramps, diarrhoea; Injection: local pain, swelling, mild fever.
• Tuberculosis (TB) - Recommended:
  • Nature:
    Infection of the lungs and possibly other organs.
  • Transmission:
    Person-to-person (through air, i.e. speech), possibly in unpasteurized milk.
  • Geography:
    World wide, more prevalent in developing countries, hot climates especially.
  • Vaccinations:
    The Tuberculosis skin test is not actually a vaccination, but can protect you nonetheless. By injecting a substance into the skin and assessing the local reaction, the test can show whether or not you have been exposed to TB or not. The advantage in knowing this is that the effectiveness of certain drugs differs depending on how long you have had the disease. By knowing that you test negative before travelling, then show signs of TB after travelling and then test positive, doctors will have a better idea of how long you have carried the disease and how to treat it.
  • Test Side Effects:
    Local reaction.
• Rabies - Optional:
  • Nature:
    Rare brain infection, fatal if not treated.
  • Transmission:
    Bite, scratch or even lick from an infected animal.
  • Geography:
    Can occur world wide, high risk in North-western South America, Mexico, India and parts of Southeast Asia.
  • Vaccinations:
    Can be prevented through immediate post-exposure series of 5 injections spaced 3, then 4 then 7 then 14 days apart, with a dose of human rabies immune globulin. Can also be prevented with pre-exposure series of 3 injections spaced 1, then 2 weeks apart, and a less intense post-exposure series of 2 injections spaced 3 days apart, without human rabies immune globulin. Pre-exposure series is recommended for veterinarians, agricultural workers, hikers and anyone who is far away from help or may be somewhere where the post-exposure series and human rabies immune globulin is not readily available. Advantage of taking pre-exposure series is that post-exposure series is not quite so time critical, and rabies immune globulin is not always available in developing countries. Pre-vaccination series is effective for two years at which time antibodies should be checked.
  • Vaccination Side Effects:
    Minimal local reactions.
• Japanese Encephalitis B - Optional:
  • Nature:
    Viral infection of the brain, can lead to confusion and death.
  • Transmission:
    Mosquitoes.
  • Geography:
    Especially rural areas, South, East and Southeast Asia.
  • Vaccinations:
    Series of 3 injections spaced at least 1 week apart each, provides protection for 2 years; recommended for travellers planning to spend 3 or more weeks in a rural area.
  • Vaccination Side Effects:
    Local pain, one in 500 have allergic reaction (hives).
• Influenza - Optional:
  • Nature:
    The flu! Diffused muscle ache, headache, fatigue, cough.
  • Transmission:
    Seasonal, person-to-person (coughing, sneezing, contact), virus survives on clothing and hard surfaces for up to 2 days.
  • Geography:
    World wide.
  • Vaccinations:
    Single injection seasonally; recommended whether travelling or not for everyone at risk for exposure, those over age 65 or with chronic medical conditions (heart, kidney, lung, asthma, cancer, diabetes, anaemia).
  • Vaccination Side Effects:
    Minimal local reaction, mild flu-like illness.
• Pneumococcal Pneumonia - Optional:
  • Nature:
    Bacterial infection, can lead to 'blood poisoning'.
  • Transmission:
    Person-to-person (coughing and sneezing).
  • Geography:
    World wide.
  • Vaccinations:
    Single injection seasonally; recommended whether travelling or not for people over age 65, with sickle cell anaemia, without a spleen, with diabetes or with chronic lung, kidney or liver disease, not routinely given.
  • Vaccination Side Effects:
    Minimal local reaction.
• Cholera - Not Recommended:
  • Nature:
    Severe diarrhoea leading to rapid dehydration, death, can occur very quickly.
  • Transmission:
    Contaminated food and water.
  • Geography:
    Asia, Middle East, Africa, South America, Central America, parts of Europe and Mexico.
  • Vaccinations:
    Fairly ineffective (reduces symptoms), lasts only a short time duration, not generally recommended for travellers; 1 oral dose or 2 injections at least 1 week apart, effective for 6 months.
  • Vaccination Side Effects:
    Mild cramps and diarrhoea.

Vaccinations not only make you feel like a pin cushion, but can be costly. Check to see if they might be covered by any insurance plan you are eligible for. Ask your doctor about the possibility of sharing vials of vaccinations with other patients - if an entire vial containing several doses is opened just for you, you will have to pay the full cost, but if you have the shot on the same day as another patient, the cost of the vial may be shared. Finally, invest the few dollars it costs to get a personalized immunization booklet and any proof of vaccination or exclusion certificates you might need.

The second half of the puzzle is the medications you need to take with you.

First, ask about the risk of malaria in your destination and what anti-malarial medication you might need. Spread by infected mosquitoes, malaria is a parasitic disease that can be cured if diagnosed and treated without delay. It begins with signs and symptoms similar to that of the flu - fever, chills, head and body aches and pains, and can progress rapidly to seizures, coma, breathing and kidney problems and death. Those suspecting a case of malaria should seek medical consultation immediately and within 48 hours. The disease can be diagnosed by a simple blood test. It can take as little as 1 week to manifest itself, or as long as a year, which means that travellers should take seriously the signs and symptoms of malaria even after they return home.

More importantly, travellers should take the necessary precautions to protect themselves from malaria. First, be prepared to protect yourself against exposure to mosquitoes with repellent and proper clothing and mosquito netting (See Gear Shop: What to Take). Second, consider anti-malarial medications depending on what region of what country you are visiting, whether you will be in rural or urban areas, the altitude of the area and in what season you are visiting. Speak with your travel medical specialist to determine which anti-malarial drugs are effective in the areas you plan to travel. There are a few drugs to choose from but the areas in the world in which they are effective are always changing - strains of malaria in parts of the world evolve to be resistant to certain drugs. Anti-malarial drugs are actually suppressants of the disease's symptoms and do not kill the malaria parasite until its multiplication phase. Therefore taking an anti-malarial drug is not 100% effective and doesn't exempt you from other precautions against mosquitoes.

Although there are other drugs that can be used in combinations in special cases (such as contraindications), the three most common anti-malarial drugs include:

• Chloroquine:
  • Drug:
    ARALEN, AVLOCLOR, RESOCHIN: chloroquine diphosphate; or NIVAQUINE: chloroquine sulphate; or PLAQUENIL: hydroxychloroquine.
  • Geography:
    Appropriate for Egypt, Middle East, Mexico, Central America, Northern China - consult your travel doctor for the most up-to-date information.
  • Course:
    500 mg once weekly beginning 2 weeks before entering endemic area and ending 4 weeks after leaving.
  • Drug Side Effects:
    Bitter taste, stomach upset, nausea, vomiting, diarrhoea, itching skin, blurred vision, headache, insomnia; occasionally depression, hair loss, eye changes, skin eruptions; rarely hearing loss, psychosis, hair, nail and mucous membrane colour changes.
  • Precautions:
    Take after meal to avoid stomach upset.
• Mefloquine:
  • Drug:
    LARIAM, ELOQUINE: mefloquine hydrochloride.
  • Geography:
    Appropriate for Northern South America, Eastern Caribbean, Africa minus Egypt, South Asia and Southeast Asia minus Burma (Myanmar), Cambodia and Northern Thailand - consult your travel doctor for the most up-to-date information.
  • Course:
    250 mg once weekly beginning 2 weeks before entering endemic area and ending 4 weeks after leaving.
  • Drug Side Effects:
    Usually well tolerated, mild effects include nausea, vomiting, diarrhoea, headache, dizziness, insomnia; occasionally skin rash, hair loss, depression, nightmares; rarely seizures, psychosis.
  • Precautions:
    Take in the morning to minimize effects on sleep.
• Doxycycline:
  • Drug:
    VIBRAMYCIN, APO DOXYCYCLINE: doxycycline is an antibiotic in the tetracycline group.
  • Geography:
    Burma (Myanmar), Cambodia and Northern Thailand - consult your travel doctor for the most up-to-date information.
  • Course:
    100 mg daily beginning on first day in endemic area and ending 4 weeks after leaving.
  • Drug Side Effects:
    Skin photosensitivity (sunburn risk), nausea, vomiting, cramps, yeast and bacterial infections; in long term use, colitis and severe diarrhoea; occasionally allergic reactions.
  • Precautions:
    Protect against sunburn, may alter effectiveness of oral contraceptives, do not take with milk products.

In choosing the right drug for your travels, be sure to discuss contraindications with your travel medical specialist. If you plan to be in remote areas far from help for long periods of time, or are taking chloroquine in an area where there is the possibility of chloroquine-resistant malaria, discuss with your doctor the possibility of carrying with you a prescription for malaria self-treatment. Malaria self-treatment is a one-time triple dose of sulfadoxine(500mg)-pyrimethamine(25mg) (FANSIDAR), or a 3 day course of Atovquone (ATQ)/Proguanil (MALARONE). For more on what you need to know about malaria while on the road, see Health.

There are a couple of other medications to consider in putting together your own personal pharmacy that require a prescription from your doctor. If you will be travelling to altitude (over 3000 metres or 10 000 feet) at any time in your travels, discuss acute mountain sickness (AMS, also known as altitude sickness) with your doctor. Consider filling a prescription for acetazolamide (DIAMOX), a drug that allows the body to better deal with the lower levels of oxygen in the air we breathe at altitude, rather than simply masking the signs and symptoms of AMS. This fact makes the drug a viable one, but consider its side effects and contraindications. If you are going to altitude, educate yourself on AMS. They say that altitude kills, but really what kills is not respecting altitude and being aware of the seriousness of AMS. For more on altitude and AMS, see Health.

Another prescription medication to carry with you while travelling is an antibiotic treatment course for severe dysentery (severe 'traveller's diarrhoea') due to bacterial infection. The commonly prescribed Ciprofloxacin (500 mg tablet taken twice daily for three days) or Norfloxacin (400 mg tablet taken twice daily for three days) and often brings welcome relief after the first dose. Traveller's to more remote areas away from medical help may also want to consider carrying antibiotic courses (Azithromycin or Cephalexin) for other ailments such as ear, sinus or urinary tract infections, bronchitis, pneumonia and skin abscesses. Discuss these treatments and their indications with your doctor.

Finally, make sure that prescriptions you need for any other regular medications you take are adequate to cover you for the time you will be gone for. For an idea of what non-prescription medications you might want to carry with you, talk to your doctor and see Gear Shop: What to Take.

Buy medical insurance

Don't think about leaving home without making the valuable investment in medical insurance coverage. Any government coverage you already have will not be adequate. Buying medical insurance is relatively inexpensive, especially compared to its potential benefits. Having medical insurance can save you from shelling out hundreds of thousands of dollars in case of unexpected illness, accidents minor and major, and death. In the United States, a single day in the emergency room can cost upwards of $10,000! And remember, it is not only your pocketbook you are protecting, but that of your family and friends back home who will feel obligated, morally or otherwise, to cover your costs should something go wrong. Money aside, medical insurance can also save your life. Some facilities will only assist you if you have proof of insurance, and your insurer may be able to arrange evacuation or relocation to adequate medical facilities in the case of a medical emergency. Your insurer can also provide invaluable advice in case of problems, medical or otherwise.

Check to see if you might already be covered through your employers benefits plan (if you are taking a vacation or leave of absence from work), credit cards, memberships, etc. If you are, get the details on the nature, extent and any time restrictions on the coverage. You may have to supplement the insurance you already have with another plan.

Check out various types of insurance plans. Some cover you for some or all of pre-trip cancellation, trip interruption, medical expenses, personal accident benefits and baggage and personal effects. Amounts of coverage vary among different plans and so do the circumstances under which you can file claims. Shop around for medical insurance plans that fit your requirements in terms of your budget and what activities you plan to participate in - there are many options. Check out the plans offered by major banking institutions and independent insurers (like Bon Voyage, Voyageur or Belair Direct). Your travel agent should be able to recommend one. Budget minded agents can usually recommend budget minded plans. Medical insurance, however, is something you may not want to skimp on.

Read the fine print. Find out what is covered - helicopter evacuations, relocation transportation with nurse, hospitalization, prescription medications, a 24 hour toll-free medical assistance, etc. Find out if there are any activities that are not eligible for coverage, like scuba diving, rock climbing, etc. Find out if there are conditions on who is eligible for coverage and if there are time limits on the length of coverage. Find out the technical details of when your coverage begins and ends and what conditions surround the possibility of extending your coverage. Backpackers without concrete plans are the ones who may decide to extend vacations; extending your insurance coverage while away can be complicated, circumstantial or impossible. In order to ensure the plan you choose meets your needs, you may have to contact the insurer directly or have your agent do so for you. Before you leave, find out how to file claims while away and when back home, what official documentation you will need to obtain and submit and if there are time limits on doing so.

Final details...

Also before departure, pay a visit to your dentist, and let them know how long you will be away for. You want to reduce the risk of encountering dental problems while away as treatment may be expensive, risky or difficult to find. A toothache while travelling can be a pain in the mouth and a pain in the butt

Visit your vision care specialist and update your eyeglass or contact lens prescription. Take a copy of the prescription with you, as well as a spare pair of lenses, in case something should happen.

If you have a medical condition, make sure you have a Medic-Alert tag.

Finally, obtain a list of English speaking or recommended doctors in your destination country. Your best bet is to become a member of IAMAT, the International Association for Medical Assistance to Travellers. Annual membership is free; a donation is requested and I recommend it to perpetuate the organization. Membership provides you with a hard copy and a web-accessible up-to-date directory of world-wide health risks as well as qualified, English speaking doctors throughout the world who are associates who have agreed to a set payment structure for IAMAT members. Members receive medical assistance when away, and can be assured that member physicians provide competent care in continuously inspected clinics world wide. Check out www.iamat.org, or contact the membership office near you: Guelph, Canada; Toronto, Canada; Lewiston, New York, U.S.A.; Geneva, Switzerland and Christchurch, New Zealand.

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