Travel Advice and Vaccination

  • Accommodation booked

  • Which famous places to visit

  • List of delicacies to try

  • What to do with a health concerns abroad

Most of us look forward to that well deserved year-end holiday or that work trip we prepared so much for.  But what happens when we encounter a health concern? Especially when abroad? How do we minimize the disruption to our schedule and activities? For such situations, the adage “prevention is better than cure”, certainly rings true.

Tag: travel vaccinations

Here are some frequently asked questions (FAQs) and top 5 things to consider as you prepare for your next trip abroad !

Pre-Travel Travel Vaccinations

1. Where are you going ?

It is advisable to check with your doctor the necessary vaccinations and medications you should be getting to protect yourself before the trip.

Furthermore you can visit  https://wwwnc.cdc.gov/travel/destinations/list for more country specific information. If we have been there before, we might even exchange tips on best places to visit or things to try! Tag: travel vaccinations

2. Purpose of travel and activities at destination

Routine vaccinations are those that you would have already received through your country’s immunization programme. Travel vaccines are usually not part of the schedule of vaccinations you would have received in the programme.

There is also a window to take note for the effectiveness of these vaccinations. Unfortunately, exceeding the duration would require a reimmunization.

DosesYears
Yellow Fever110 Years
Typhoid13 Years
Rabies35 Years
Polio110 Years
Tetanus110 Years
Influenza11 Year

If in doubt, there are confirmatory tests which can also be done to check for certain immunities, mainly –  MMR, Varicella, Hepatitis A, Hepatitis B.

Here is a non-exhaustive list of the available vaccinations for your protection. Click on each one to find out more !

Routine VaccinationsTravel Vaccinations
  1. Influenza vaccine
  2. Tetanus, diphtheria, and pertussis vaccine
  3. Measles, mumps, and rubella (MMR)
  4. Poliovirus vaccine
  5. Varicella vaccine
  1. Yellow Fever
  2. Meningococcal
  3. Typhoid
  4. Hepatitis A
  5. Hepatitis B
  6. Rabies
  7. Japanese Encephalitis
  8. Cholera
  9. Tick Borne Encephalitis

Malaria is a mosquito-borne disease caused by a parasite. It is transmitted through the bite of an Anopheles mosquito. In the body, these parasites replicate in the liver, and subsequently infect the red blood cells of the body.

Symptoms occur 1-2 weeks after the initial bite and may present with persistent fever, flu-like illness, stomach discomfort (bloating, nausea, diarrhoea, bloody stool), headache. As the infection persists, symptoms occur in cycles that last two to three days each time. There may also be a late presentation of symptoms several months after leaving an endemic area.

Left untreated, Malaria may cause life threatening complications.

Risk varies from place to place and also within a country. Your doctor will often check with the latest updates from CDC (communicable disease center) https://www.cdc.gov/malaria/travelers/country_table/a.html and discuss with you further, your options.

Protection from Mosquito-borne Diseases:

  • Wear light-coloured, long sleeve clothings especially at night.
  • Use insect repellent on exposed skin.
  • Sleep under a mosquito net.
  • Light a mosquito coil before going to bed.
  • malaria prophylaxis.

These are some of the commonly used malaria prophylaxis medications.

DrugReasons that might make you consider using this drugReasons that might make you avoid using this drug
Doxycycline
  • Some people prefer to take a daily medicine
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Tends to be the least expensive antimalarial
  • Some people are already taking doxycycline chronically for prevenetion of acne. In those instances, they do not have to take an additional medicine.
  • Doxycycline also can prevent some additional infections (e.g.,Rickettsiaw and leptospirosis) and so it may be preferred by people planning to do lots of hiking, camping, and wading and swimming in fresh water.
  • Cannot be used by pregnant women and children below 8 years old
  • Some people would rather not take a medicine every day
  • For trips of short duration, some people would not take medication for 4 weeks after travel
  • Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
  • Persons planning on considerable sun exposure may want to avoid the increased risk of sun sensitivity
  • Some people are concerned about the potential of getting an upset stomach from doxycycline
DrugReasons that might make you consider using this drugReasons that might make you avoid using this drug
Chloroquine
  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Some people are already taking hydroxychloroquine chronically for rheumatologic conditions. In those instances, they may not have to take an additional medicine
  • Can be used in all trimesters of pregnancy
  • Cannot be used in areas with chloroquine or mefloquine resistance
  • May exacerbate psoriasis
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Not a good choice for last-minute travelers because drug needs to be started 1-2 weeks prior to travel
DrugReasons that might make you consider using this drugReasons that might make you avoid using this drug
Mefloquine
(Lariam)
  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Can be used during preganancy
  • Cannot be used in areas with mefloquine resistance
  • Cannot be used in patients with certain psychiatric conditions
  • Cannot be used in patients with a seizure disorder
  • Not recommended for persons with cardiac conduction abnormalities
  • Not a good choice for last-minute traverlers because drug needs to be started at least 2 weeks prior to travel
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel.

Rabies is a disease that spreads from animals to humans. The mode of transmission is usually through the saliva after a bite from an infected animal.

The initial symptoms always mimick a flu-like illness but subsequently, patients with rabies develop the following symptoms

  • Agitation, Anxiety, Confusion
  • Hyperactivity
  • Difficulty swallowing, Excessive salivation
  • Fear of water (hydrophobia) because of the difficulty in swallowing
  • Hallucinations, Insomnia
  • Partial paralysis

Travellers to rabies-affected areas according to the level of risk in that area may also receive prophylactic vaccination. Since 2018, this is 2 separate vaccinations at day 0 and 7 and for those who are immunocompromised, a third vaccination at 21 or 28 days after the initial vaccination.

If however you suspect the bite of an animal which may have rabies, you may contact the TTSH traveler’s clinic within 7 days for Post Rabies Exposure treatment. You may find more details here https://www.ttsh.com.sg/patient-guide/medical-departments/page.aspx?id=831

We have comprehensive package tailored for our pilgrims going for their Haj/Umrah. These are the vaccines recommended by the Ministry of Health Saudi Arabia and Ministry of Health Singapore

The main vaccine required for travellers from Singapore is meningococcal vaccine.

All adults and children > 2 years must have received a single dose of this vaccine, which covers 4 strains (A/C/Y/W-135) 10 days before arrival. The vaccine is valid for 3 years.

 VACCINES WE RECOMMENDRISK / REASON FOR VACCINE
All pilgrimso    Hepatitis A (2 doses)o    Typhoid (1 every 2 years)

o    Polio (1 dose over age 18)

Food & water-borne infectionsChildren < 15 need polio vaccine certification
o    Hepatitis B (3 doses)Shaving with contaminated razor blades (blood-borne)
Age > 65 yearsDiabetes 
Heart disease 
Asthma/lung disease
Liver disease
Kidney disease
Lowered immunity
o    Pneumococcal (1 dose)o    Influenza (once a year)Common causes of respiratory infection
Tetanus-diphtheria-pertussis – Tdap (1 every 10 years)Cuts/injuries, whooping cough

References:

Memish ZA. The Hajjcommunicable and noncommunicable health hazards and current guidance for pilgrims. Euro Surveill. 2010 Sep 30;15(39):19671

At 2,500 metres (8,000 ft), the changes in altitude result in some people developing acute mountain sickness.

The symptoms include headache, lethargy and light-headedness, stomach symptoms (poor appetite, nausea, vomiting) and difficulty sleeping.

Some tips to overcome this would include ascending gradually if possible, staying hydrated, minimizing physically demanding activity and last but not least, inquiring with our team for Altitude Sickness medications such as Diamox (Acetazolamide).

We share with you more information through our write up on Travel Sexual Health and Travelling with HIV

3. What medications should I pack for my travel?

For your known chronic medical conditions (e.g. diabetes, high blood pressure, asthma),  ensure you have enough medication for the duration of your trip and a few days extra to spare (just in case!).

Prepare a travel kit. These are some commonly used items during travel:

  • Fever medication and painkillers
  • Vomiting and Diarrhoea pills
  • Oral re-hydration salts
  • Antihistamines (for runny nose and mild allergies)
  • Motion sickness pills
  • Antiseptic wash/cream
  • Plasters and bandages for small cuts and wounds
  • Thermometer
  • Condoms
  • Insect repellent (DEET 30% tried and tested)
  • Sun screen ​

Tag: travel vaccinations

If you need a travel kit, we have a specially doctor curated travel kit for your travel needs. < DTAP Travel Kit >

Besides travel insurance for the duration of your trip, take note of locations of nearest medical facilities near you.

4. Travel health hacks to improve your health during travels?

  • Flights can be quite a dehydrating affair to the body. It is always advisable to eat light, drink lots of fluids and avoid alcohol.
  • To prevent blood clots from forming in your leg (which can be nasty), exercise your leg muscles with regular stretches and take regular walks around the cabin every few hours if possible.
  • Lastly try to get as much rest and sleep as possible. It will help your body recover faster from the effects of traveling
  • To minimise the effects of jet lag, eat and sleep according to the local time at your destination as soon as you can. There are over the counter medications (melatonin) and prescription medications which you can take to aid you in your sleep as well if you have difficulty sleeping or adjusting jet lag.
  • At your destination, food and water precautions should be observed.

– Check that food is well cooked.
– Avoid undercooked food, salads and fruits.

– Eat food that is hot when served.
– Use a serving spoon when eating from a common plate.

– Avoid tap water and ice cubes.
– Drink only bottled water or boiled water

After Travel

5. Fever, Diarrhoea, Rashes Persistent Flu, further tests?

Travel Vaccinations Didn’t Work?

If you develop any symptoms any time after your travels, or have sexual health concerns, please approach any of our friendly DTAP doctors today.

Appendix: Essential Travel Medications – Travel Vaccinations

Upper Respiratory Tract Infection (cough, flu, cold, running nose, fever)

Name of MedicationIndicationDosage
BeartophanCough2 tablets 3x/day
NeufloSore Throat1 tablet 3x/day
PonstanPainkiller, High Fever1 tablet 2x/day
ParacetamolPainkiller, fever2 tablets 4x/day
ChlorpheniramineBlocked Nose, Anti Histamine for allergy1 tablets 3x/day

2. Gastro related medication

Name of MedicationIndicationDosage
Loperamide Diarrhoea1 tablet 3x/day
DimenhydrinateNausea, Vomiting OR Motion Sickness1 tablet 3x/day
FamotidineGastric Acidity, Gastritis1 tablet 2x/day
BuscopanAbdominal Colic, Stomach Cramps1 tablet 3x/day

Thanks!