Diabetes And
Travel Immunisations

If you are travelling to another country, either on business or a holiday, you will need to find out what preventative measures you need to take against any diseases that may be present in that country.

Usually your travel agent can give you a list of suggested immunisations, or try sites like:-
traveldoctor.co.uk or cdc.gov/travel

However travel agents and also embassies may tell you that "no vaccination is needed" for the country to which you are going.

Be warned, this could mean that no official vaccination certificate is required for entry into that country but you may still need immunisation against certain diseases for your own protection.

The unwritten rule is – the further you are going and the longer the length of time you are planning to stay there the more important these are.

It is suggested that even normal healthy people visit their doctor at least a month before they plan to go away, to get their vaccinations done, as it can take time for some of the vaccines to take effect.

For a diabetic it is important to get them done as early as possible because they may upset your diabetes control and you want to leave yourself time to get it stable again before your trip.

Pregnant women MUST discuss their plans with their doctor as some vaccines are contra-indicated during pregnancy, as are many antimalarial drugs.

Immunisations can be divided into three categories, easily remembered as the 3R’s - Routine, Recommended and Required.

Lets deal with them one by one.

Routine.
These are the immunisations we usually get as children. They are:-
Measles, Mumps, Rubella (MMR)
Polio
Diphtheria & Tetanus

If you are travelling with children make sure their immunisations are all up to date.
If it has been more than 10 years since you last had a booster for Polio, Diphtheria and Tetanus and you are travelling to under-developed countries or countries where an outbreak of such diseases have occurred it would be sensible to get them redone. This is at your own discretion, it is not required by law.

Recommended.
These vaccinations are there to fill a twofold role. They are to protect you, the traveller, from catching a disease that may be prevalent in the country to which you are travelling and they are also there to prevent you importing an infectious disease into a country that does not suffer from it.

Risk factors vary depending on circumstances. For instance if you are going to stay in a 5 star hotel and never venture into the rural areas you will not need the same vaccinations as, say, an intrepid hiker who intends walking the length and breadth of Africa!

It is up to the individual traveller to assess their own risk. What you need to consider are:-
1. Which country/countries are you doing to visit.
2. What season is will it be when you are there.
3. Will you be visiting rural areas.
4. Your present state of health.
5. Your age.
6. What immunisations you have had previously.

Taking all the above factors into account you may need one, some or all of the following:-

1. Influenza and pneumococcal vaccines for people in high risk categories e.g. diabetics!
2. Hepatitis A – A good idea for all travellers, especially if travelling to areas with poor sanitation.
3. Hepatitis B – As A diabetic there is the chance of your needing emergency care and you cannot guarantee the sterility of the equipment or needle used. Therefore this vaccine is a good one to get. Also, though one does not like to consider this, rape is possible anywhere but is more prevalent in some third world countries. Hepatitis B can be passed on by unprotected sex. Better safe than sorry.
There is now a combined A&B vaccine called TwinRix.
4. Japanese encephalitis – a good vaccine to get if you are travelling to rural areas in Southeast Asia during the monsoon season. The zone where this disease is endemic extends from India and Nepal, completely across the whole of South East Asia as far as Japan and Korea.
UK residents please note that, though available, this one is NOT free on the NHS.
5. Meningitis – there is a vaccine that will provide protection against certain strains. It may be worth considering this one if travelling to Sub-Saharan Africa and Asia. For instance all pilgrims travelling to Saudi Arabia during the Hajj must, by Saudi Arabian law, be vaccinated.
6. Rabies – Usually this is not required but if you are planning to go on an extended outdoor adventure, like hiking or cycling, in rural areas of Africa, the Middle East, Asia ,Eastern Europe, Australia and the South Pacific, The Caribbean, South America and Central America or Mexico then you need to consider getting his vaccination.
7. Typhoid - If you are travelling anywhere besides North America, Northern Europe, Australia or New Zealand then this vaccination is suggested.

Required.
As of the present moment the only vaccination required by International Health Regulations is the Yellow fever one – this is mandatory if you are travelling to Central and West Africa (Equatorial Africa) and the northern part of South America which includes most of Brazil, Venezuela, Panama, Columbia, Guyana, Surinam and French Guiana and also parts of Ecuador, Peru and Bolivia.

You will be given a certificate which comes into effect 10 days after you have received the vaccination and this certificate will be valid for 10 years.

Do not lose this certificate as it will be required when you return to your own country from any country where yellow fever is endemic.

In many cases the law is in place more to prevent a disease entering a country than to protect you as an individual.

Meningococcal vaccination, though only a recommended vaccine for most places, is, as mentioned before, required by the government of Saudi Arabia for annual travel during the Hajj.

Then, while not strictly an immunisation, there is Malaria!
See traveldoctor.co.uk/malaria.htm

There is no vaccination against malaria and it is a disease that is endemic in over 100 countries.
These include:-
Much of Central and South America,
Haiti and the Dominican Republic,
Africa,
The Middle East,
The Indian subcontinent,
Southeast Asia,
Eastern Europe
South Pacific including Australia & New Zealand.

Though there is no vaccination there are antimalarial drugs that you can take.

Not all the drugs work in all the countries.

Below is a list as a general guide line but these drugs MUST be discussed with your doctor as many of them have side effects or cannot be taken for other medical reasons.

Also many are contra-indicated in pregnancy as they may harm the unborn child.

If you are going to Africa, South America, the Indian Subcontinent, Tajikistan, Asia, and the South Pacific you should take one of the following antimalarial drugs:-
Atovaquone/proguanil
Doxycycline
Mefloquine
Primaquine (only in special circumstances).

If you are going to in Mexico, Haiti, the Dominican Republic, and certain countries in Central America, the Middle East, and Eastern Europe you should take one of the following antimalarial drugs:-
Chloroquine - be aware that this has been known to increase hypoglycaemia.
Hydroxychloroquine sulfate

Besides these drugs the best bet is prevention.

As malaria is passed on by the bite of a mosquito the idea is not to get bitten, but this is much harder than it sounds and in some places nigh on impossible.

However there are some sensible precautions you can take:-
1. Wear long-sleeved shirts, long pants and a hat whenever you are outdoors. Clothing can also be treated with the insecticide Permethrin.
2. Peak biting times are dawn, dusk, and in the early evening, so remain indoors during those times, preferable in an area that is either screened against mosquitoes or is air-conditioned.
3. If mosquitoes are inside your room then spray them with a flying insect spray containing a pyrethroid insecticide.
4. Use a mosquito net around your bed while asleep, if possible a net treated with the insecticide permethrin. Permethrin will repels and kill mosquitoes and as a bonus also does the same to other biting insects and ticks.
5. Also use a net to cover your child’s pram, both indoors and out. Make sure it has an elastic edge for a tight fit.
6. Make sure any screens on your doors and windows are closed and have no holes in them.
7. Apply insect repellent to your skin when going outdoors, preferable one containing DEET (N, N-diethyl-m-toluamide). The greater the amount of DEET in a repellent the longer it will last. Remember to wash it off when you come inside.

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The content of this site is presented for informational purposes only, and is not in any way or form intended to replace the advice of your medical professional. Copyright 2005. All rights reserved. No reproduction without permission.