Medical Recommendations for Southeast Asia
Hepatitis A: Definitely recommended. In the past folks got gamma-globulin which protected from Hep A as well as some extra immunity to other things but it is nearly impossible to get these days due to manufacturing problems so Hep A vaccine is the way to go. Lifetime duration?
Hepatitis B: If you plan on sharing needles or bodily fluids with someone youre unsure of, you should have this. Of course its a series of 3 over six months so if you havent done this already, use clean needles and learn to love latex. Anyone else going to get a tatoo this time? Lifetime duration?
Japanese Encephalitis: Generally recommended but the risk is low. More risk near rice fields apparently. I have yet to see any of these near Buda. There was an epidemic of encephalitis in Malaysia but this turned out to be Nipah virus, not JE virus. There is no vaccine for Nipah. I myself have not invested in JE virus immunization.
Rabies: Recommended for "spelunkers." I did this one when I realized that I wanted to keep doing long cave trips to exotic parts of the world and that my bat exposure was actually high. Unfortunately, then I went to China where there were no longer any bats because of gross deforestation. Still the higher risk is from dogs, etc. There has been rabies reported in Kalimantan, just south of where we will be...Series of three over one month, expensive. Probably could be skipped, just dont pet any strays. We did have a case of rabies in my hospital a few years ago. There was no history of bites but he had been licked by a strange dog when visiting India a few weeks/months beforehand. He died. Variable duration. Needs periodic boosting if antibody levels low.
Typhoid: Recommended. A series of 4 pills over seven days (no needles ;-) Dont take at the same time as you are taking Lariam (mefloquin) or any other antibiotic as you might kill off the attenuated virus and get no effect. Five years duration. those who got this just before the 1995 trip are on the edge of its efficacy.
Tetanus: Recommended for everyone, everywhere, every ten years.
Measles, mumps, rubella: did your parents take care of this? Anyone born before 1956 may not have had this as part of routine immunization. You might want to look into it. the current recommendation is to have a booster. This has been only for the last few years, so unless you recently enrolled in high school or college and had to show proof of immunization, you might have missed the second shot. Lifetime after the second one? Measles is now almost unheard of in the USA but then...
Malaria: There is malaria risk where we are going. Not the highest, but not non-existant either. The malaria there is resistant to chloroquin thus the recommendation for mefloquin (Lariam). The problem, as many have alluded to, is that Lariam has side effects. It can make one dizzy and off balance. This may be a hassle cruising in the jungle but can be frankly dangerous when caving. Anyone with epilepsy or neuro-psychiatric or certain cardiac problems may see these problems worsen. The dosage is 250 mg once per week, starting one week before leaving then continuing 4 weeks after returning.
One option is to take doxycycline once per day. This may have the added benefit of protecting against leptospirosis. The study that looked at "Lepto" had soldiers taking 200mg once per week and it was quite effective. Of course one could always take one pill a day for six days, then two pills a day on the seventh. The down side of doxy is that it makes you more susceptble to sunburn (so just stay underground all day?) and can make women more susceptible to vaginal yeast infections. I will have medication in camp for yeast for anyone who needs it. You need to take it two days before leaving then 4 weeks after you get back.
Personally, I have taken Lariam before and find the side effects minor and temporary. I will take Lariam once a week and doxy 200mg at the same time once a week. If it works out well I try to take them before rest days so that any clumsiness that Im not noticing will occur when Im sitting back with a beer in the river.
For those who have been on Lariam before and found the side effects significant, I would recommend doxy. If you have not tried it before you can at least have an idea of the side effects before you go since you need to start one week before arrival. If you feel fine, continue Lariam. If you get dizzy or have nightmares, then forget about it and take doxy. If you cannot tolerate Lariam, and are allergic to doxy, an option is "presumptive treatment." If effect, you wait to get fevers then take a different set of drugs to treat Malaria, just in case it is. I dont recommend this. In any case, protect yourself from mosquitos by using DEET or the repellant of your choice and keep em away at night with mosquito netting.
Read more at: http://www.cdc.gov/ncidod/dpd/malaria/seasia.htm
Dental: Go see your dentist now. Make sure you dont have any hidden cavities waiting to open up when you bite onto one of the ubiquitous bones in the canned chicken. If you have a problem in camp all I can do is look in your mouth and say "Gee, that looks like it hurts, you should go see your dentist."
Other medicines: Take what you know youll need. They may be available over there for cheaper but you dont know about the quality.
Everyone should have something for travellers diarrhea. Non-prescription stuff like imodium or pepto-bismol is good but even better when taken with an antibiotic like Cipro or Bactrim. The Cipro is also excellent for skin infections and urinary tract infections. Our water supply is rain water off the tarp covering the longhous. If effect this is "distilled" and should be safe, but you dont know how many flies from the latrine have been on the roof either. Few people had problems with diarrhea last time but most used filters, iodine, or chlorine to supplement the "distillation" process.
Bring along your pain reliever of choice. I will have some things available but probably cant supply the whole trip (this applies to Cipro and doxy, etc too). I cant tell you how many people had scrapes and tears from caving and walking in the jungle. Bring along some antibiotic cream and guaze bandages with tape. I ran out of the stuff that I brought last time.
I will have components of bee sting kits available, but if you know you are allergic, be sure to have your own kit with you. We had no problems in 1997 but the "other" expedition in 1996 did report a lot of bee stings. It may be a seasonal problem. I can write prescriptions for people living in California. Let me know if you need any for the above drugs.
See you all in Sarawak,
Roger Mortimer, MD
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Page last updated 1/22/00