LETTERS FROM TRAVELLERS
What vaccines are needed for a resort vacation in Mexico?
Travellers will find that the answer can differ from one travel clinic to another. At our clinic we will often recommend only a booster of tetanus-diphtheria-pertussis vaccine if due and hepatitis A vaccine. We will often recommend hepatitis B as we discuss below. We do not suggest typhoid vaccine nor Dukoral (for cholera or for travellers' diarrhea).
Is hepatitis A vaccine really necessary?
This can be debated. It is a viral liver infection transmitted through contaminated food and water. The older the patient the more severe the illness. However the risk of becoming infected is considered to be quite low on a resort.
No one has precise figures but the overall risk to people travelling in developing countries is about 1 in 5000 per month. Undoubtedly risk on a resort of good reputation is much lower than this. It then becomes a question of risk tolerance. If we estimate that a one-week resort trip carries an approximate risk of one in 40,000...is that low enough to decline the vaccine? It becomes a personal decision.
For people who expect to travel in the future, the decision weighs more in favour of the vaccine. For individuals who will eat off the resort and those who like shellfish (best-avoided), the risk of acquiring the disease rises.
Why is typhoid vaccine not recommended?
We consider the risk too low. Canada has a committee which makes recommendations for travel clinics on a range of topics. This group is the Committee to Advise on Tropical Medicine and Travel, most easily found by googling "About CATMAT". You will see CATMAT statements there including the typhoid paper. Their conclusion was that typhoid vaccine is not needed for most travel in the developing world other than the countries of the Indian subcontinent, or longer trips to areas with poor access to acceptable food and water. A rule of thumb often used at our clinic is "Two weeks or more in rural areas with poor sanitation."
Resort travel would certainly not qualify.
Why is Dukoral not recommended?
Dukoral is an effective vaccine against cholera but cholera would be a rare illness to contract on a resort. Dukoral is marketed more though as a preventive measure for travellers' diarrhea, which is a common affliction of tourists. Unfortunately its effectiveness is very low and it protects for a short period of time. We therefore seldom recommend it.
What about hepatitis B?
Hepatitis B is a liver infection transmitted sexually and via unclean needles and transfusions with unscreened blood. There are many travel medicine practitioners who believe that everyone who walks into a travel clinic should be offered this vaccine. It is difficult to argue with this. An accident can happen anywhere with subsequent suturing. How clean is the needle being used? Unanticipated sexual activity occurs, sometimes unprotected.
A series of injections is needed for hepatitis B. We tend to recommend it for people we consider to be at higher risk. For the rest we discuss it and give it if desired.
What is Twinrix?
It is a combined vaccine, hepatitis A and B.
Is there anything I can do to treat diarrhea?
Yes. Bring Imodium (loperamide) along. If you have been to a travel clinic, you will probably have been given a prescription for antibiotics to take in the event of severe diarrhea.
Is there malaria in Mexico?
In very limited areas now and not along the Mayan Riviera (Cancun, etc).
Are there other diseases to be aware of?
Yes, unfortunately. Dengue, Zika and chikungunya. These will be discussed.
Travellers will find that the answer can differ from one travel clinic to another. At our clinic we will often recommend only a booster of tetanus-diphtheria-pertussis vaccine if due and hepatitis A vaccine. We will often recommend hepatitis B as we discuss below. We do not suggest typhoid vaccine nor Dukoral (for cholera or for travellers' diarrhea).
Is hepatitis A vaccine really necessary?
This can be debated. It is a viral liver infection transmitted through contaminated food and water. The older the patient the more severe the illness. However the risk of becoming infected is considered to be quite low on a resort.
No one has precise figures but the overall risk to people travelling in developing countries is about 1 in 5000 per month. Undoubtedly risk on a resort of good reputation is much lower than this. It then becomes a question of risk tolerance. If we estimate that a one-week resort trip carries an approximate risk of one in 40,000...is that low enough to decline the vaccine? It becomes a personal decision.
For people who expect to travel in the future, the decision weighs more in favour of the vaccine. For individuals who will eat off the resort and those who like shellfish (best-avoided), the risk of acquiring the disease rises.
Why is typhoid vaccine not recommended?
We consider the risk too low. Canada has a committee which makes recommendations for travel clinics on a range of topics. This group is the Committee to Advise on Tropical Medicine and Travel, most easily found by googling "About CATMAT". You will see CATMAT statements there including the typhoid paper. Their conclusion was that typhoid vaccine is not needed for most travel in the developing world other than the countries of the Indian subcontinent, or longer trips to areas with poor access to acceptable food and water. A rule of thumb often used at our clinic is "Two weeks or more in rural areas with poor sanitation."
Resort travel would certainly not qualify.
Why is Dukoral not recommended?
Dukoral is an effective vaccine against cholera but cholera would be a rare illness to contract on a resort. Dukoral is marketed more though as a preventive measure for travellers' diarrhea, which is a common affliction of tourists. Unfortunately its effectiveness is very low and it protects for a short period of time. We therefore seldom recommend it.
What about hepatitis B?
Hepatitis B is a liver infection transmitted sexually and via unclean needles and transfusions with unscreened blood. There are many travel medicine practitioners who believe that everyone who walks into a travel clinic should be offered this vaccine. It is difficult to argue with this. An accident can happen anywhere with subsequent suturing. How clean is the needle being used? Unanticipated sexual activity occurs, sometimes unprotected.
A series of injections is needed for hepatitis B. We tend to recommend it for people we consider to be at higher risk. For the rest we discuss it and give it if desired.
What is Twinrix?
It is a combined vaccine, hepatitis A and B.
Is there anything I can do to treat diarrhea?
Yes. Bring Imodium (loperamide) along. If you have been to a travel clinic, you will probably have been given a prescription for antibiotics to take in the event of severe diarrhea.
Is there malaria in Mexico?
In very limited areas now and not along the Mayan Riviera (Cancun, etc).
Are there other diseases to be aware of?
Yes, unfortunately. Dengue, Zika and chikungunya. These will be discussed.