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innoculations for Central/South America extended cruise
Planning to sail San Diego - El Salvador, stay 6 months to a year then Ecuador, stay a year and explore S. America. What shots are recommended prior to departure?
As all immunizations have risk, Id suggest consulting with a functioning expert.
Best is to consult with a practicing physician who has up-to-date experience with 'tropical' medicine, etc. as needed for the 'third world'. Then, that physician will tailor your immunizations to that specific area/country.
Even CDC recommendations (Yellow Book) can be 2 years out of date due the cyclical nature of such tropical diseases, etc.
For immunizations, definitely:
- Yellow fever
- Hepatitis A
- If you are planning local sexual adventures, then definitely Hepatitis B
Typhoid is worthwhile and, personally, I would (and have) taken it multiple times over the years (good for only 2 years)
If you're going to be on land for extended periods with no reasonable medical care locally, consider rabies pre-exposure. I've personally been attacked by dog packs in Kenya (rural) & Thailand (urban). On both occasions, I avoided bites, but it was a near thing.
Hep A (2 doses) & Hep B (3 doses) require multiple doses to be effective, so you need to start well in advance. There is a combination Hep A/Hep B vaccine (3 doses) that could be used and would save shots (but not the time required) if you wanted both.
In answer:
- tetanus: This is not specifically a travel vaccine--everyone should be up to date on it anyway. As a general rule, good until 10 years since last dose. If you are 8 to 9 years out, and will be travelling for an extended period, it's prudent to get this updated
- yellow fever is this the same as malaria?: Completely different diseases, that have only the common feature of being mosquito transmitted. There is no approved available for vaccine for malaria, although it is a current area of substantial research
- Deneg fever (?) spelling?: Dengue--There is no approved available for vaccine for dengue, although it is a current area of substantial research. If a safe and effective vaccine gets released it will be very worthwhile--but that's irrelevant given your time frame
- Is there a Zika vaccine yet?: No, but unless your bride plans to get pregnant, this is a low risk disease (low risk in the sense of having a severe disease result from infection--disease in pregnancy is VERY different--catastrophic for the unborn baby)
- Cholera? No effective vaccine, but relatively low risk issue
- Is there a Zika vaccine yet?: No, but unless your bride plans to get pregnant, this is a low risk disease (low risk in the sense of having a severe disease result from infection--disease in pregnancy is VERY different--catastrophic for the unborn baby)
I think it's too early to say that it's low risk. There is not a confirmed high risk yet, but this non-MD engineer wonders whether the nature of its activity on the brain could someday be shown to pose higher risk for alzheimers or other adult/geriatric brain ailments. (Warning: This is wild, unfounded speculation on my part.) The risk to newborns was easy to pinpoint because it becomes obvious in 9 months or less after exposure. Long term effects take long term observation.
Fortunately, the mosquitoes that carry Zika are so small that they can't fly effectively in the wind, so the risks while at sea are low. And they're mainly active in the morning, so nighttime at anchor should be OK even if there's no wind.
We're heading to Grenada in March, so I'm beginning to check this stuff out.
I think it's too early to say that it's low risk... the nature of its activity on the brain could someday be shown to pose higher risk for Alzheimers or other adult/geriatric brain ailments
It's certainly true that "absence of evidence is not evidence of absence". It's also true that, in adults, one of the complications of Zika infection is paralysis (Guillain-Barre syndrome), although rarely--probably in 1/10,000 to 1/100,000 infections--suggesting a propensity for neurological injury. And further it's true that the virus seems to stick around longer in at least some infected individuals than most other viruses. So I don't think your speculation is baseless. Nonetheless, it remains speculation, and we do know that over 80% of Zika infections cause no symptoms, and the large majority of the rest cause only transient mild illness in otherwise healthy adults.
Diseases like hepatitis A, or B, or typhoid, or malaria, or even dengue are quite a bit more dangerous, and immediately so, These are the considerations that led me to refer to Zika as "low risk" for non-pregnant healthy adults.
Interesting, I played with this and used the BVI as an example. They suggest Hep A and Typhoid, since each can be transmitted via contaminated food. I doubt I have either, unless they were routine years ago, and never considered travel inoculations for the BVI in the past. Probably won't this time either, but I'll think about it.
I think I can avoid getting a tattoo or caving, so Hep B and Rabies shouldn't be necessary.
This page can sometimes fall out of date, or as others have joked cover things you're not likely to need.
Most cities have hospitals or doctors who specialize in travel related illness or diseases from the area where you're traveling.
I Googled "San Diego tropical disease" and came up with a physicians group at UC San Diego (https://health.ucsd.edu/specialties/Pages/id.aspx). Their services include "Travel medicine, pre-trip inoculations, advice & prescriptions".
Doctors tend to be practical and can give you advice on what you really need; but I always start with the CDC site so I'm informed walking in.
You'll want to schedule your visit a couple of weeks before you leave in case they need to order a vaccine, and some vaccines can leave you feeling off for a few days afterward.
Being seriously ill in a third world hospital is no joke; I've been there. A little pre-trip preventive medicine is just being prepared.
Something else to look into is Travelers Insurance.
We ran into some folks at the Annapolis Boat show who travel to the Caribbean every winter and get health insurance through DAN (Diver's Alert Network). They said DAN now sells to boaters as well as diver's and had a good experience with them with an illness in the Bahamas.
I don't have personal experience here, but it's worth checking out. Other folks on SailNet may have direct experience with them.
Good timing. I just booked a Cruise and Learn in Grenada for March, and I have a couple weeks to get preferred rates on travel insurance. So far I've looked at AIG Travel Guard, Geico, and Allianz (through AAA). I plan to also check Travelex. I'll add DAN to the list.
"- Is there a Zika vaccine yet?: No, but unless your bride plans to get pregnant, this is a low risk disease "
As Takefive said, this is NOT a low-risk disease. It is currently an UNKNOWN RISK disease. Consider that thirty years ago, we all "knew" that once you had chickenpox, it was over and done with. Surprise, now it is known to hide in the body and in 1/3 of the victims, come back 30-50 years later as shingles. Which can be quite debilitating.
At this time there is absolutely no information on what Zika might do later in life, where it might hide in the body, and what the long term effects might be. And there probably won't be information for 10-20 more years, if that soon.
"The same" mosquito carries yellow fever and dengue, so even if it doesn't fly more than 1/4 mile from where it bred, somehow, they do manage to spread over a much larger area.
I'd also second the recommendation for medevac and repatriation insurance. Things we take for granted in the incredibly expensive US medical system, like Cat1 emergency rooms? Simply don't exist in many nations. If you're hit by a bus, you may want a medevac back to intensive care and specialists in the US. If you're in Venezuela or Columbia and your bus gets rolled by a mudslide, guess where they may medevac you to? Miami. The closest Cat1 ER they have.
I acknowledge that Zika seems relatively unknown. Shingles connection with chicken pox, however, was proven in the 1950s and suspected as far back as the late 1800s. It only struck me as an odd analogy, since I recall learning this connection in an EMT course 30 years a ago, so I looked it up.
The internet sucks for making statements of fact.........
"Shingles connection with chicken pox, however, was proven in the 1950s"
OK, let me rephrase that. Since we are not a medical research community, but rather "the general public" on this forum, I'll rephrase what I said as "the connection between shingles and chickenpox was UNKNOWN TO THE GENERAL PUBLIC only 30 years ago."
Doesn't matter if a sliver of the medical community knows about it, unless you're in that sliver. Twelve years ago there were only three or four specialists who dealt with celiac disease. Two in the US, one in Japan, another in...wherever. Today? Every supermarket has a gluten-free section, and pretty much every MD has some grasp on how to test for it. And yet, celiac was "known" in the 1950's and long before then. Just not known to or by the general public, either. Or course now the specialists are first looking into the microbiome, and whether THAT may actually be the cause of many problems, and they've come to suspect that the appendix shouldn't be removed, because it stores extra bugs to replenish the gut...
Or c. diff infections and fecal transplants, which are now widely accepted but merely ten years ago, considered to be Frankenstein work?
Forget the web, even the medical schools are routinely behind the times.
The CDC website is very useful. However, for more detailed guidance--based on specific information about your own anticipated activities, exposures, and background medical conditions, individualized medical advice can be much better. You can find this kind of expertise through at least 2 different sources, the International Society of Travel Medicine (ISTM), and the American Committee on Clinical Tropical Medicine and Traveler's Health (ACCTMTH), which is the clinical medicine subgroup of the American Society of Tropical Medicine & Hygiene. There is substantial overlap in membership between these 2 groups, but the groups do have slightly different emphases, as their names suggest. Both groups have a knowledge-based certification process. Each group has a directory that identifies practicing physicians with the relevant expertise--many of whom will also provide the needed vaccines and/or malaria preventive treatment. In some cases, they can provide expert evaluation and treatment of conditions acquired during your travels.
The ISTM directory is here:
With respect to high risk vs low risk--everyone has their own risk tolerance. If you haven't been vaccinated and you get yellow fever, you'll have 50% to 90% chance of dying--probably more toward the higher end of that. If you get the more virulent form of malaria, and don't get prompt proper treatment, as a typical North American you'd have better than 50% chance of dying. That's high risk. In contrast for Zika--5000 cases in Micronesia nine years ago (so presumably 5 to 10x that number of infections)--no deaths. 30,000 cases in Polynesia, again, presumably 5 to 10x that number of infections--no deaths. I know of at least one death in American with underling medical problems, but, again, out of what are most likely 1000's of infections.
Is there a possibility for very late (decades late) complications? Yes. On the other hand, the outbreak in Micronesia was almost 10 years ago...
I guess if you're willing to do extended blue water cruising, you're already willing to accept some level of risk.
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