Travel to Africa 2005General Advice:Recommended VaccinesAlso to consider vaccines:Medications:Mefloquine (brand name: Lariam™ and generic)Atovaquone/proguanil (brand name: Malarone™)Other medications:Scheduling visits at MIT MedicalCosts:Further information:Travel to Africa 2005Travel to Africa 2005David V. Diamond, MDDavid V. Diamond, MDMIT Medical DepartmentMIT Medical DepartmentGeneral Advice:General Advice:••Overall risks are low for diseases other Overall risks are low for diseases other than Traveler's diarrheathan Traveler's diarrhea••Preventative measures to avoid exposure Preventative measures to avoid exposure to mosquito bites and contaminated food to mosquito bites and contaminated food are important [see CDC advice]are important [see CDC advice]••Taking medications as directed bestTaking medications as directed best••Take care of this now, not last minuteTake care of this now, not last minuteRecommended VaccinesRecommended Vaccines••REQUIRED: Yellow Fever (good for 10 years, REQUIRED: Yellow Fever (good for 10 years, need certificate)need certificate)••Meningococcal (good for 10 years, dry season Meningococcal (good for 10 years, dry season through June)through June)••Hepatitis A: recommend vaccine (good for 6 Hepatitis A: recommend vaccine (good for 6 months, after 2months, after 2ndndbooster good lifetime) ; booster good lifetime) ; alternative alternative --globulin (good only for 3 months)globulin (good only for 3 months)••Typhoid: oral only available at present (good for Typhoid: oral only available at present (good for 5 years)5 years)Also to consider vaccines:Also to consider vaccines:••Polio (one booster as adult)Polio (one booster as adult)••Hepatitis B Hepatitis B ––risk depends on behaviorrisk depends on behavior••Tetanus update (need every 10 years, Tetanus update (need every 10 years, travel or not)travel or not)••Measles vaccination status (most Measles vaccination status (most immunized)immunized)Medications:Medications:••For TravelerFor Traveler’’s Diarrhea: Ciprofloxin 500 s Diarrhea: Ciprofloxin 500 mg twice daily for three days at onset of mg twice daily for three days at onset of symptomssymptoms••For Malaria: Mefloquine 250 mg once a For Malaria: Mefloquine 250 mg once a week, begin a week before, continue for 4 week, begin a week before, continue for 4 weeks after (10 pills); alternate weeks after (10 pills); alternate ––Malarone 250/100, one a day for day Malarone 250/100, one a day for day before, trip and 7 days after before, trip and 7 days after ––(~50 pills)(~50 pills)Mefloquine (brand name: LariamMefloquine (brand name: Lariam™™and generic)and generic)••The adult dosage is 250 mg salt (one tablet) once a week. The adult dosage is 250 mg salt (one tablet) once a week. ••Take the first dose of Mefloquine 1 week before arrival in the mTake the first dose of Mefloquine 1 week before arrival in the malariaalaria--risk area. risk area. ••Take Mefloquine once a week, on the same day each week, while inTake Mefloquine once a week, on the same day each week, while inthe malariathe malaria--risk area. risk area. ••Take Mefloquine once a week for 4 weeks after leaving the malariTake Mefloquine once a week for 4 weeks after leaving the malariaa--risk area. risk area. ••Mefloquine should be taken on a full stomach, for example, afterMefloquine should be taken on a full stomach, for example, aftera meal. a meal. ••Mefloquine Side Effects and WarningsMefloquine Side Effects and WarningsThe most common side effects reported by travelers taking MefloqThe most common side effects reported by travelers taking Mefloquine include headache, uine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, anausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances.nd visual disturbances.••Mefloquine has rarely been reported to cause serious side effectMefloquine has rarely been reported to cause serious side effects, such as seizures, s, such as seizures, depression, and psychosis. These serious side effects are more fdepression, and psychosis. These serious side effects are more frequent with the higher requent with the higher doses used to treat malaria; fewer occurred at the weekly doses doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria. used to prevent malaria. Most travelers taking Mefloquine do not have side effects seriouMost travelers taking Mefloquine do not have side effects serious enough to stop taking the s enough to stop taking the drug. (Other antimalarial drugs are available if you cannot toledrug. (Other antimalarial drugs are available if you cannot tolerate Mefloquine; see your rate Mefloquine; see your health care provider.)health care provider.)••ContraindicationsContraindicationsSome travelers should Some travelers should NOTNOTtake Mefloquine (other antimalarial drugs are available; see take Mefloquine (other antimalarial drugs are available; see your health care provider):your health care provider):••persons with active depression or a recent history of depressionpersons with active depression or a recent history of depression; ; ••persons with a history of psychosis, generalized anxiety disordepersons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other r, schizophrenia, or other major psychiatric disorder; major psychiatric disorder; ••persons with a history of seizures (does not include the typicalpersons with a history of seizures (does not include the typicalseizure caused by high fever seizure caused by high fever in childhood); in childhood); ••persons allergic to Mefloquine; persons allergic to Mefloquine; ••Mefloquine is not recommended for persons with cardiac conductioMefloquine is not recommended for persons with cardiac conduction abnormalities (irregular n abnormalities (irregular heartbeat). heartbeat).Atovaquone/proguanil (brand name: MalaroneAtovaquone/proguanil (brand name: Malarone™™))••Fixed combination of two drugs, atovaquone and proguanil. In theFixed combination of two drugs, atovaquone and proguanil. In theUnited States, it is available United States, it is available as the brand name, Malaroneas the brand name, Malarone™™..••Directions for UseDirections for Use••The adult dosage is 1 adult tablet (250mg atovaquone/100mg proguThe adult dosage is 1