Travel Health: Vaccinations, Medications & Staying Well

Before You Leave: The Travel Clinic#

Visit a travel clinic - not just your regular GP - 6 to 8 weeks before departure. Travel medicine is a specialty, and your family doctor may not know the current malaria prophylaxis recommendations for rural Laos or whether you need a Japanese Encephalitis booster for your specific itinerary.

A travel clinic consultation covers:

• Review of your itinerary - where you’re going, for how long, what activities you’re planning, and whether you’ll be in urban or rural areas.
• Vaccination history - what you’ve already had, what needs boosting, and what’s recommended or required for your destinations.
• Prescriptions - malaria prophylaxis, altitude sickness medication, standby antibiotics for traveler’s diarrhea, and anything else specific to your trip.
• Country-specific advice - current outbreak information, food and water safety, and environmental hazards.

Cost ranges from $100 to $300 depending on which vaccinations you need. Some travel vaccines aren’t covered by insurance, but many are. Call your insurer before the appointment. Even without coverage, this is cheaper than a single night in a hospital.

Vaccinations: What You Actually Need#

Your routine vaccines should be current regardless of travel plans: MMR (measles, mumps, rubella), tetanus-diphtheria-pertussis (Tdap), polio, and varicella. If you can’t remember when you last had a tetanus booster, you’re probably due.

COVID vaccination requirements have largely been dropped worldwide, but check your destination’s current rules before flying - a few countries still ask.

Malaria Prevention#

Three main prophylaxis options, each with trade-offs:

• Atovaquone-proguanil (Malarone) - fewest side effects, taken daily, start 1 - 2 days before entering a malaria zone and continue for 7 days after leaving. The downside: it’s expensive ($5 - 8 per pill in the US, much cheaper in Southeast Asia and Africa).
• Doxycycline - cheap (pennies per pill), taken daily, start 1 - 2 days before and continue for 4 weeks after. The downside: causes sun sensitivity (you will burn faster) and can cause stomach upset. Take it with food and plenty of water.
• Mefloquine (Lariam) - taken weekly, which is convenient for long trips. The downside: a subset of people experience vivid dreams, anxiety, or more serious psychological side effects. If you have a history of depression or anxiety, discuss this with your doctor.

Beyond pills - practical prevention:

• Sleep under insecticide-treated mosquito nets. Most hostels and guesthouses in malaria zones provide them.
• Wear long sleeves and pants at dusk and dawn, when Anopheles mosquitoes are most active.
• Use DEET-based repellent (30% or higher). Picaridin is an alternative that’s less greasy and doesn’t melt synthetic fabrics.
• Permethrin-treated clothing provides an extra layer of protection. You can treat your own clothes with a permethrin spray kit.

No prophylaxis is 100% effective. If you develop a fever within a year of visiting a malaria zone - even months after returning home - tell your doctor immediately and mention the travel history. Malaria is easily treatable when caught early and potentially fatal when it’s not.

Building a Travel Medical Kit#

You don’t need a pharmacy in your backpack, but you do need the basics. Most of this fits in a quart-sized zip bag.

The essentials:

• Loperamide (Imodium) - the single most important item. When traveler’s diarrhea hits, this buys you time to get somewhere comfortable. Not a cure, but a symptom manager that lets you actually get on a bus.
• Oral rehydration salts (ORS) - diarrhea dehydrates you fast in hot climates. These are available everywhere in the developing world for pennies, but having a few packets ready saves a miserable walk to a pharmacy.
• Antihistamines - for allergic reactions, insect bites, and as a mild sleep aid on overnight buses.
• Paracetamol/acetaminophen and ibuprofen - for headaches, fever, and general aches. Carry both; they work through different mechanisms and can be alternated.
• Antiseptic cream and adhesive bandages - cuts and scrapes in tropical climates get infected fast. Clean and cover every wound, no matter how minor.
• Tweezers - for splinters, sea urchin spines, and ticks.
• Sunscreen (SPF 30+) - expensive and hard to find in many developing countries.
• Insect repellent (DEET 30%+) - more effective than natural alternatives. Picaridin if you prefer something less aggressive.

Worth asking your travel clinic about:

• Ciprofloxacin or azithromycin - a standby antibiotic for severe traveler’s diarrhea. Your clinic may prescribe a short course to carry for emergencies. The rule: if diarrhea is bloody, accompanied by high fever, or lasts more than 3 days without improvement, take the antibiotic and find a doctor.
• Diamox (acetazolamide) - for altitude sickness prevention if you’re heading above 2,500m (Cusco, Lhasa, Kilimanjaro, Everest Base Camp trek).

Prescription medications: Carry them in their original packaging with the pharmacy label. Bring a letter from your doctor listing your prescriptions, especially for controlled substances. Some countries have strict rules about importing medications - Japan, for example, restricts many common cold medicines and ADHD medications.

Food and Water Safety#

The old advice - “boil it, cook it, peel it, or forget it” - is solid but overly cautious for most destinations. Here’s a more practical breakdown.

Water

• Drink bottled water in countries where tap water isn’t safe. This covers most of Asia, Africa, Central and South America, and parts of Eastern Europe.
• Ice is usually fine in tourist areas of Southeast Asia - it’s commercially made from purified water and delivered in standardized bags. The chunky, irregularly shaped ice at a rural market stall? Maybe skip that.
• A SteriPen (UV purifier) or water filter bottle (Lifestraw, Grayl) pays for itself quickly on a long trip and reduces plastic waste. The Grayl Geopress is the gold standard for travel water purification.
• Carry a reusable water bottle. Less plastic waste and it pays for itself in days. A bottle with a built-in filter (Grayl, Lifestraw Go) lets you refill from any tap. Without a filter, you can still refill from filtered water stations - increasingly common in hostels, airports, and cafes across Southeast Asia. Just don’t refill from the tap in countries where the water isn’t safe unless you’re filtering it yourself.

Food

• Eat where locals eat. High turnover means fresh ingredients and frequent cooking. A busy street cart is safer than an empty restaurant with a nice tablecloth.
• Street food cooked in front of you is generally safe. You can see the heat, the freshness, and the hygiene (or lack of it). A wok at 300°C kills most things you’d worry about.
• Be cautious with raw salads, uncooked vegetables, buffets that have been sitting out, fresh fruit you didn’t peel yourself, and raw seafood from questionable sources.
• The real danger isn’t usually the food itself - it’s the water used to wash it. In India, skip the salad. In Thailand, the salad is probably fine.

When You Get Sick Anyway

Traveler’s diarrhea affects 30 - 70% of travelers to developing countries. It’s practically a rite of passage. Most cases resolve in 2 - 3 days.

• Stay hydrated - oral rehydration salts (ORS) are your best friend. Buy them at any pharmacy for pennies.
• Loperamide (Imodium) if you need to function - a bus ride, a flight, a day you can’t spend near a bathroom. Doesn’t cure anything, just buys you time.
• Rest when you can and eat bland food (rice, bananas, toast) when your appetite returns.
• Avoid dairy and alcohol until things settle.
• If it lasts more than 3 days, involves blood, or comes with high fever - see a doctor.

When to See a Doctor on the Road#

Most travel illness resolves on its own. But some symptoms demand professional attention - don’t tough these out.

Get to a Doctor If You Have

• Fever that won’t break after 24 hours - especially in malaria zones. Get a malaria test. It’s a finger prick and takes 15 minutes.
• Persistent diarrhea lasting more than 3 days - or any diarrhea with blood or high fever. You may need antibiotics or a stool test.
• Any animal bite - rabies post-exposure treatment must start as soon as possible. Don’t wait to see if the animal was rabid. If you had the pre-exposure vaccine, you need two more doses. If you didn’t, you need the full series plus immunoglobulin (expensive and often unavailable in remote areas).
• Infected wounds - a cut that’s getting redder, more swollen, or producing pus needs antibiotics. Tropical heat and humidity make wound infections more common and more aggressive.
• Severe sunburn with blistering - second-degree sunburn needs medical treatment.
• Chest pain, difficulty breathing, severe allergic reactions - don’t assume it’s just the altitude or the spicy food.

Finding a Doctor Abroad

• Ask your hostel or guesthouse for a recommendation. They deal with sick travelers regularly and know who’s good.
• Private clinics in developing countries are affordable, competent, and accustomed to treating foreigners. A doctor visit in Thailand or India costs $10 - 50. Lab tests are similarly cheap.
• International clinics in major cities (Bangkok Hospital, Bumrungrad in Bangkok, Apollo in India) offer Western-standard care at a fraction of US prices.
• Call your travel insurance helpline - they can direct you to approved facilities and often arrange direct payment so you don’t pay upfront.

Next Steps#