Forewarned is forearmed

Aliens vs. Travellers

(Para ler este post em Português: Cautela e caldo de galinha nunca fizeram mal a ninguém)

An essential action to avoid annoyances while traveling is strengthen your body to make it capable of defending itself against potential invaders (no, I’m not talking about aliens… this is about your health). And if you don’t know exactly where you’re going, then you’ll need to be prepared for whatever it comes.

In Brazil there is incidence of yellow fever (in some regions) and for this reason there are many countries that require from people who originate from here an International Certificate of Vaccination against Yellow Fever, issued by our National Health Surveillance Agency (ANVISA). But for me far more important than to prove to others that I won’t jeopardize their health is to avoid contracting any unfamiliar illness during the trip. Europe? China? Morocco? Vietnam? Australia? Africa? Russia? Each region has its epidemiological characteristics and control requirements, and the traveler needs to be well informed – and well immunized.

Mundo doente

Below I present a list of the main vaccines available and how to obtain them (I’m afraid some information will be too specific for Brazil – I have no idea of how it works in other countries… Any complementary info will be appreciated!). The shots must be taken in advance because its action time varies from 10 days to 6 weeks. On the OMS website you will find the full list of vaccines required or recommended for each country & region. Pick up your vaccination card and check it out:

– Yellow fever. It should be taken only by people who will travel to high risk areas or by people originated from risk areas who intend to visit countries that may require the International Certificate of Vaccination, at least 10 days before travel.

– Triple bacterial for adults: tetanus, diphtheria and pertussis (Tdap). After infancy, everyone should receive a booster every 10 years. In Brazil it is offered for free by our public health system.

– Triple viral: measles, mumps and rubella. Any adult who does not present history of vaccination should receive two doses with an interval of three months between them. Available for free in Brazilian’s public health system.

Tetanus toxoid (diphtheria and tetanus). If it’s the first time you’ll receive this shot, it should be taken in three doses with an interval of one month between each one. Thereafter you must take one single booster dose once every 10 years. In Brazil it is offered for free by our public health system

kenny-doenteHepatitis A. It is transmitted through contaminated water or food, seafood. An adult with hepatitis A has symptoms that prevent professional activity for three to four weeks (discomfort, body ache, malaise, etc.). The vaccine must be taken in two doses with an interval of 6 months between them. In case you don’t have enough time to take both two doses before your trip, take at least one, as the 1st dose will give you a protection of about 80%. In Brazil each dose costs around US$ 60.00 at private immunization clinics.

Hepatitis B. It can develop into hepatic cirrhosis and liver cancer! In 30% of people it’s not possible to identify the source of transmission. It should be taken in three doses, in a 0-30 days-6 months scheme. With two doses it already provides good protection. It’s available for free in Brazilian’s Health System but only for risk groups and each dose costs here about US$ 30.00 at private immunization clinics.

– Hepatitis A + B. It’s an option to substitute isolated vaccination against Hepatitis A and Hepatitis B, but also offers less protection. In three doses, take it in a 0-30 days-6 months scheme.

– Rabies. Indispensable for those going to India! The protection time of this shot varies a lot from person to person, can be from one to five years, so it should be taken as close as possible to the departure date, the more fresh the best. In three doses, in a 0-7-28 days scheme. Each dose costs in Brazil about US$ 60.00 at  private immunization clinics.

Varicella (chickenpox). If you don’t have historical of having had the disease you should be vaccinated, even if you’re not planing any travels. In Brazil it’s offered for free by our public health system.

– Meningitis Type C. The meningococcus type C is responsible for meningitis outbreaks in Brazil. One single dose of this vaccine and you’ll be safe for lifetime. It costs around US$ 55.00 in vaccination clinics. (if you opt for the tetravalent meningo you won’t need to take this one).

– Meningitis Tetramune (A, C, Y, W135). It protects against four different types of meningococcus which circulates in our planet. Can be taken from the age of 11 in a single dose, even by people who have already been vaccinated against meningitis C, and it costs approximately US$ 130.00 at private immunization clinics. A little expensive but highly recommended even to a ride in Europe.

– Cholera and traveler’s diarrhea. It should be applied in 2 shots, in a 0-7 days scheme. It’s available for about US$ 65.00 in vaccination clinics.

– Influenza (flu). The influenza shot should be taken in the early fall and repeated annually due to variation of virus strains. It costs about US$ 40.00 at private vaccination clinics.

Zé Gotinha– Poliomyelitis (polio). I strongly believe that every single person in Brazil knows Joe Droplet (for us Zé Gotinha) – who is a popular mascot for vaccination campaigns. Well, if you’ve escaped from him until today, you should take the polio droplet at most 4 weeks before traveling to places like Russia or China. In Brazil it’s available for free in the public health system.

– In addition to all mentioned above, there are also shots against typhoid fever (prescription is needed) and Japanese Fever (if the trip extends for over 6 months).

supergirlWhoa!! Did you do the math?!?! What a thwack! Almost US$ 750.00 in immunization only!! – The cool thing is that taking this bunch of shots causes the feeling that you’re some kind of comic book super-hero, genetically enhanced to be more resilient than other mere mortals!

Yep, but to stay healthy on a trip is not just about taking all sorts of shots… I grew up hearing my mother talk about the importance of ‘Vitamin-Dirt’, that is through contact with foreign microorganisms that our body learns to defend itself, creating antibodies and such. In the environment where you live there is a plethora of bacteria, viruses, germs and other health-foes invisible to the human eye, but with which your body is so used to deal that most times you don’t even notice when you’re being attacked. But that only goes for the invaders of YOUR Remedios-e-viagensOWN place. Your body was not taught to manufacture the antibody that will fight against the germ that attacks the Chinese on the other side of the world… Of course it can get up to defend itself, but it will provoke a ‘malaise’ along the way, and all we DON’T WANT is to waste a wonderful trip day seeking medical assistance in a country where we barely speak the language, right?

A close girlfriend just got back from her honeymoon trip which began like a fairytale where she was the Enchanted Princess and ended up with she playing the part of the Queen of the Throne, because of a salmonella contamination that was not even a little bit funny. (I hope someday she’ll laugh at this…). An entire week of her romantic vacation locked inside the hotel room, walking from bed to toilet and back from toilet to bed! And all of this was caused by some miserable soft scrambled eggs eaten at breakfast! Afffff! And I need to mention that she was staying at a 5-star resort. Germs don’t choose people by their wealth…

A few tips to stay healthy on the trip:

– Go to the dentist. No one deserves toothache!! And not to mention that dentists in Brazil are sooo good, and much cheaper than in many other countries! In many places considered ‘civilized’ a simple tooth decay can result in a wacky extracting your entire tooth instead of doing a filling …

– Make a complete check-up before the trip – thus your chances of having an unexpected illness along the way will be lower…

– Always carry a 1st aid kit with you comprising all the medicines you are used to take and may eventually need: anti-flu, anti-histamine, pills for headaches, cramps, nausea … It will be easier to carry it from home than to have to figure out – during a malaise – what is the name in Arabic for the active ingredient of your medicine. Then to discover you’ll need a prescription to buy it! And you’re lucky if you can find out there the same medicine…

– Prescriptions. Though it’s not usual your prescriptions may be required by some surveillance authorities… They must contain the name of the passenger to be confronted with the one shown on the boarding pass. It is also important to have an allergy identification.

– To prevent being stuck to the toilet seat: avoid barely-cooked food; if you are unsure about water quality, chlorinate it with 2.5% sodium hypochlorite and stave off beverages containing ice. In some countries it is recommended to use bottled water even to brush your teeth!

– Wash your hands frequently and always carry some alcohol-gel with you for those moments when you’ll visit tourist spots where there’re people from all over the world circulating like Vegas, the Eiffel Tower or the Taj Mahal.

– Malaria. Unfortunately the shot against Malaria is still Mosquitomissing. In my research I discovered that there is a treatment called prophylaxis which is a kind of a pre-exposure to the disease, but it is not proven to work and it can only be indicated for those who live in regions with high incidence of the mosquito. Thus the recommendation if you’re planing to visit somewhere where the risk of contracting this disease is high (Africa and South Asia, for example) is to use repellents containing DEET or IR3535 (the Off! Johnson, for example, is made from DEET. Your citronella candle smells good but it’s not enough, ok?). Also use mosquito nets to sleep and long-sleeved clothes.

– I am adept to antibacterial soaps, those ones that say will protect you even hours after bathing. Not sure if they work for real, but for me who am always scrolling at the tatami mat it has already become a habit. (I don’t care when my sister says I’m smelling like sanitizer… At least I’m well guarded from germs!)

– Beware animals, taking bath into streams, lakes and waterfalls… Take care even with the unknown vegetation! Brazil has the nettle, U.S. has Poison Ivy

– Buy a health insurance that will cover eventual medical expenses.

Everything said, I want to add that if you’re going to spend all your time thinking about everything that can go wrong you’ll never leave home! To take care of your health is necessary but take it easy. If you suffer from OCD (obsessive-compulsive disorder) and you’re that kind of freak who washes your hands with boiling water and a brand new soap every 5 minutes like Jack Nicholson in the movie ‘As Good As It Gets‘ maybe to take a Round the World trip is not the best idea! There might be more germs wandering around the planet than you’ll be able to handle!

Safe Travels!

As Good As It Gets 2

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