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I looked on the CDC site about travel to Indonesia


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#1 Nakedwithoutcamera

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Posted 05 September 2008 - 07:27 AM

My doctor gave me 3 scripts last night: for Malarone, an anti typhoid drug (typhoid vivhot), and a broad spectrum antibiotic Levaquin, (just in case I needed it I really hate taking antibiotics unless I absolutely have to).

I read the other thread about anti-malarials but it didn't mention Wakatobi, Bali or Lembeh. Did anyone take an antimalarial and/or typhoid before/during/after travel to those places?

My travel companions are split as to whether or not you need them there. I will get the antibiotic filled because I'll be gone 3 weeks so its a good thing to have, I guess.

I heard the malarone is pretty expensive. Oh, my doc also gave me an Hep A vaccine last night.

Edited by Nakedwithoutcamera, 05 September 2008 - 07:36 AM.

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#2 reubencahn

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Posted 05 September 2008 - 08:03 AM

My doctor gave me 3 scripts last night: for Malarone, an anti typhoid drug (typhoid vivhot), and a broad spectrum antibiotic Levaquin, (just in case I needed it I really hate taking antibiotics unless I absolutely have to).

I read the other thread about anti-malarials but it didn't mention Wakatobi, Bali or Lembeh. Did anyone take an antimalarial and/or typhoid before/during/after travel to those places?

My travel companions are split as to whether or not you need them there. I will get the antibiotic filled because I'll be gone 3 weeks so its a good thing to have, I guess.

I heard the malarone is pretty expensive. Oh, my doc also gave me an Hep A vaccine last night.


My understanding is that Bali has no malaria risk. Information available in US is that there is malaria risk in Sulawesi but nothing to really pare it down to specific areas. So maybe there is or there isn't any risk in Lembeh. I did take Malarone for travel to Lembeh. I've taken it for numerous trips to various locations without any side effects.

#3 MikeO

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Posted 05 September 2008 - 08:14 AM

I would recommend the Malarone, though I can't decide for you on the cost. That's what I take when I go to that area. While Bali is fairly clear of malaria, it is not unknown there and you're probably safer than not taking an anti-malarial for Wakatobi and Lembeh just in case. The antibiotic is a also a good idea just in case. Not sure on the typhoid thing. I just went ahead and got vaccinated for that. When I was vaccinated for HepA, I had to get one shot and a booster. They told me that the first did offer some protection but I needed to make sure I came back and got the second. Disclaimer: I'm not a doctor and unable to give a medical opinion -- just relating my personal experience.

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#4 reubencahn

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Posted 05 September 2008 - 08:21 AM

I would recommend the Malarone, though I can't decide for you on the cost. That's what I take when I go to that area. While Bali is fairly clear of malaria, it is not unknown there and you're probably safer than not taking an anti-malarial for Wakatobi and Lembeh just in case. The antibiotic is a also a good idea just in case. Not sure on the typhoid thing. I just went ahead and got vaccinated for that. When I was vaccinated for HepA, I had to get one shot and a booster. They told me that the first did offer some protection but I needed to make sure I came back and got the second. Disclaimer: I'm not a doctor and unable to give a medical opinion -- just relating my personal experience.

Mike


I believe you're thinking of the Hep A with the shot and booster. Typhoid vaccine is a single shot that lasts 2yrs or you can take an oral vaccine that's good for either 3 or 5 years (one week of pills that must be kept refrigerated). I've also always been vaccinated for typhoid whenever traveling to Indo.

#5 philsokol

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Posted 05 September 2008 - 08:30 AM

You should get a Hep B vaccine for travel to those areas as well. That's 3 shots over a few months.

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#6 Drew

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Posted 05 September 2008 - 08:33 AM

That's the problem with inexperienced GPs who read Indonesia as one small country.
In Bali, there is no Malaria but as Mike V will attest to, there is dengue.
In Northern Sulawesi, Malaria still exists but has dropped a lot since the 70s. So long as you are not going to the jungle and stay in developed areas, watch yourself at dusk for mossies, you should be ok. I've stayed for weeks in Lembeh from 94-2006 and never took any prophylaxsis. That is your choice however.
Typhoid is something that is very dependent on what you eat/drink. Stick with bottled water and canned drinks, reputable restaurant food and you should be good.
Of course you choose whether to take all those meds. I find that taking preventative measures do more than assuming I'm covered. Obviously, it's a nice back up to have.

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#7 jeremypayne

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Posted 05 September 2008 - 08:54 AM

When I was vaccinated for HepA, I had to get one shot and a booster. They told me that the first did offer some protection but I needed to make sure I came back and got the second.
Mike

I believe (you should of course ask a doctor) that a gamma globulin shot can offer temporary (6 month) protection against Hep A if you need to travel before completing the full course.

Having anti-biotics is critical in my opinion where drinking water is at all suspect. I have done 15 trips to India over the last several years and 3 or 4 times my Cipro prescription saved the day.
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#8 vazuw

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Posted 05 September 2008 - 10:06 AM

I believe anyone that regularly travels regularly outside the country should have hepatitis A,and B vaccines. Cipro is also good for marine water related infections. The bugs that cause them don't respond to penicillin type drugs.

#9 Drew

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Posted 05 September 2008 - 10:21 AM

... 3 or 4 times my Cipro prescription saved the day.

3-4 times in 15 days? The course for cipro is 4-7 days no? Did you take it every day for the entire trip?

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#10 reubencahn

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Posted 05 September 2008 - 10:38 AM

3-4 times in 15 days? The course for cipro is 4-7 days no? Did you take it every day for the entire trip?


The travel doctors I've seen always recommend taking it twice a day for 3 to 4 days, if and only if Immodium or other measures don't work adequately.

Incidentally, I've always understood that hep B is primarily a blood borne virus--as opposed to hep A which can be water borne--so vaccination wasn't really a necessity. Here's the CDC page on hep B.

http://wwwn.cdc.gov/...okCh4-HepB.aspx

Edited by reubencahn, 05 September 2008 - 10:39 AM.


#11 vazuw

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Posted 05 September 2008 - 10:53 AM

Yes the risk of hepatitis B is low. But my personal bias is that it is worth getting if you travel 'regularly' to remote destinations.

#12 Nakedwithoutcamera

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Posted 05 September 2008 - 11:10 AM

I asked my doc about the Hep B since that was listed too, and he said if I'm going to have wild sex, use a condom. :) I love my doctor.

This list from the CDC also recommended rabies vaccination but we didn't go there.

He didn't have a typhoid vaccine in his office so instead of going back, I opted for the pills.

They didn't say anything about going back for a booster to the Hep A shot. Maybe the vaccine has changed?

Thanks for feedback. It is much appreciated.
Ellen B.

#13 jeremypayne

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Posted 05 September 2008 - 01:28 PM

3-4 times in 15 days? The course for cipro is 4-7 days no? Did you take it every day for the entire trip?

3 or 4 times over 15 different trips. Over a 2 and 1/2 year period (from 2003-2006) I went to India 15 times. My trips were typically 14-21 days each. My Cipro prescription was for one pill, twice a day for 10 days ... I just checked the cabinet as I still have a bottle.
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#14 jeremypayne

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Posted 05 September 2008 - 01:32 PM

The travel doctors I've seen always recommend taking it twice a day for 3 to 4 days, if and only if Immodium or other measures don't work adequately.

Incidentally, I've always understood that hep B is primarily a blood borne virus--as opposed to hep A which can be water borne--so vaccination wasn't really a necessity. Here's the CDC page on hep B.

http://wwwn.cdc.gov/...okCh4-HepB.aspx

While abstinence certainly will prevent sexually transmitted Hep B, I think the other Hep B concern is that if god forbid you get hospitalized or need other serious medical or dental care overseas you want to be immunized against Hep B.
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#15 jeremypayne

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Posted 05 September 2008 - 01:44 PM

They didn't say anything about going back for a booster to the Hep A shot. Maybe the vaccine has changed?

Maybe, but I know I had two of them six months apart.
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#16 ornate_wrasse

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Posted 05 September 2008 - 03:10 PM

My doctor gave me 3 scripts last night: for Malarone, an anti typhoid drug (typhoid vivhot), and a broad spectrum antibiotic Levaquin, (just in case I needed it I really hate taking antibiotics unless I absolutely have to).

I read the other thread about anti-malarials but it didn't mention Wakatobi, Bali or Lembeh. Did anyone take an antimalarial and/or typhoid before/during/after travel to those places?

My travel companions are split as to whether or not you need them there. I will get the antibiotic filled because I'll be gone 3 weeks so its a good thing to have, I guess.

I heard the malarone is pretty expensive. Oh, my doc also gave me an Hep A vaccine last night.


I'm one of your travel companions so I guess I'll respond :)

I just finished my course of Vivotif, the live oral Typhoid Vaccine. You should really start it right away because the last dose must be taken at least 1 week before you enter a high-risk area, according to the instructions. It's a week long course of 4 pills. One pill is taken every other day and it has to be taken on an empty stomach.

I was also prescribed Malarone which I'll start one day before entering the high risk area. Fortunately, because I'm with Kaiser, the Malarone only cost me $15 for the Rx :)

Other meds I purchased that Kaiser's Travel Clinic recommended were Loperamide anti-diarrheal tablets and Cipro in case I am unfortunate enough to get a case of diarrhea that Loperamide can't control. Also, I bought Oral Rehydration Salts that I can use if I get severely dehydrated. Also I bought an insect repellent containing controlled release Deet.

And, added to that were the Hepatitis and Polio injections I got a couple weeks ago. My arm is still dark purple around the site of the Polio injection. You'll probably see the remnants of the bruising when I see you on the 27h :-)

My whole philosphy on the preventative meds is that it's better to take them to avoid any potential problems. I've gotten quite sick in the past when traveling overseas and I sure as heck don't want to repeat that experience.

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#17 loftus

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Posted 06 September 2008 - 08:54 AM

There's quite a long list discussed here and each of the diseases mentioned is quite different. Malaria has already been discussed at length in a previous thread so I'll leave it out.
Hepatitis: Hepatitis A is generally a self-limiting disease that is picked up from contaminated food and drink, close contact with someone that has it etc. or otherwise known as the fecal-oral route. People who have grown up in third-world countries often have immunity from previous exposure. It's probably not a bad idea if you have lived your whole life in a developed country and then plan to travel extensively in third world countries to get the Hep A vaccine. Fortunately Hep A is not considered fatal in healthy individuals, just expect to be sick as a dog, jaundiced etc while you have it.
Hep B is another story, even though the initial event may not be fatal, the disease becomes chronic, ultimately resulting in liver failure unless you can get a liver transplant. Hep B is mostly contracted through sexual contact, contaminated needles in drug users, possibly poor sterilization techniques in third world clinics etc. I personally think that everyone should get the Hep B vaccine whether you travel or not, and get checked every few years for antibody levels as to whether a booster is required. Unfortunately there are non-A, non-B strains of Hepatitis(C,D etc) for which there are not presently available vaccines, so appropriate protection as for AIDS is smart. Interestingly, Hep B and it's variants is much easier to contract through sex, needles etc than HIV.
Antibiotics for travel: I think Cipro is the best single antibiotic, especially for the price (Levaquin is very expensive), and will cover most of the maladies associated with travel, travelers diarrhoea, ear and urinary tract infections etc. It is probably less effective for resistant skin type of infections caused by staph, and for this reason I carry Bactrim or Septra( which is also cheap). Cipro comes in 3 doses, generally in for most infections, the 500mg dose twice a day for 7-14 days is recommended. Cipro also treats Typhoid, gonorrhoea and anthrax.
Folks who decide to carry antibiotics, should really try to educate themselves as to the signs and symptoms of different likely diseases so as not to take antibiotics when they are not appropriate - influenza and the common cold are good examples - as this just builds resistance to these antibiotics and is ineffective. One other prescription medication that I have found very helpful and been thanked for by fellow divers on trips, is antibiotic eardrops like Cortisporin Otic. Finally if you are on a liveaboard and you get seasick, Scopalamine patches should be considered.
Then of course there are all the non-prescription medications like Afrin, Sudafed, Bonine, Dramamine, PeptoBismol, Loperidine etc which are slipped in to my kit. Sounds like a lot, but I just take a few of each not the whole box, so they take very little space in my toiletry bag.
ALWAYS consult with your physician before getting prescriptions for any of these medications. Do not get them online etc. There can be severe side effects that you should be educated about. If possible, when traveling to some of these exotic locations and you are unsure as to the requirements try to consult with an Infectious Disease specialist who specializes in Tropical Medicine. In the US, they are not that unusual if you look for them especially in the South, like Miami, Houston etc.
Please be clear that I provide this information to help provide a general overview of issues we might deal with while traveling and methods of treatment. This is not a substitute for a formal consultation with a physician.

Edited by loftus, 06 September 2008 - 09:06 AM.

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#18 okuma

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Posted 06 September 2008 - 06:08 PM

Here is one we always take - a bottle of 'Neomycin-Polymyxin 7 Dexamethasone Ophthalmic"

It is an antibotic for eye infections - stuff you can pick up from a mask rinse tank. Commonly called 'pink eye'.
And it will work for ear infections. Just don't try the ear based medicine in your eye!

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#19 secretsea18

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Posted 06 September 2008 - 07:01 PM

Plain old gentamycin or tobramycin eye drops are very good (especially good if there is any chance of various viral infections of the eye, as you don't want dexamethasone in that case).

For the common otitis externa from water exposure, good old vinegar/alcohol (50/50 mixture) is FAR better than any Rx ear drop.... and I am an ENT surgeon! Did never believe it until I, myself, came down with the affliction, and without ear drops had to rely on the old remedy. It works faster and more completely than any prescription ear drop.... and believe me, I have them all!

#20 webhead

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Posted 08 September 2008 - 11:25 PM

My doctor gave me 3 scripts last night: for Malarone, an anti typhoid drug (typhoid vivhot), and a broad spectrum antibiotic Levaquin, (just in case I needed it I really hate taking antibiotics unless I absolutely have to).
I read the other thread about anti-malarials but it didn't mention Wakatobi, Bali or Lembeh. Did anyone take an antimalarial and/or typhoid before/during/after travel to those places?
My travel companions are split as to whether or not you need them there. I will get the antibiotic filled because I'll be gone 3 weeks so its a good thing to have, I guess.
I heard the malarone is pretty expensive. Oh, my doc also gave me an Hep A vaccine last night.


I took similar stuff with me on trips to Bali, Sulawesi, RA and didn't use any of it. More common OTC meds can be really handy during diving trips too: anti-histamines, decongestants - think mild ears/eyes/throat infections etc
Absolutely need to take antibiotics with you just in case... and certainly get Hep B and heed other great info in replies. I'm not a doctor, and I don't play one on TV... blah blah :) but has anyone else noticed that real docs at travel health clinics don't really know the variety of conditions in a country as diverse as Indo?
By the way, please consider donating your unused medications (take original packaging with labels intact) to local free clinics...