I have had the good fortune to be able to travel a fair amount over the years. I have been places that require a certain amount of preparation and caution when it comes to disease avoidance and health care. Prior to spending a week in the bush along the border of South Africa and Mozambique, my guide insisted on knowing my blood type ahead of time "just in case." He also carried anti-venom for two different types of deadly snakes with us at all times. This was the first trip I recall that required taking an anti-malarial medicine.
Since that trip I have been to other parts of the world where Hepatitis A and Yellow Fever are a concern so being medically prepared for Panama was just a part of my normal planning. Those who have had to get special inoculations prior to traveling are probably familiar with the yellow WHO International Certificate of Vaccination. Some countries are quite insistent on knowing the status of your inoculations, while others are far more lax on this issue. Since you can't know for sure ahead of time, it is a good idea to keep it up-to-date and bring your Certificate with you.
Last week I went to get the last of my Hepatitis B shots (once you have had all three, you're good for life) and was advised that if I will be in the deep countryside or jungle areas of Panama I would need a Yellow Fever shot as well. I also found out that the Certificate itself has been updated, so I got a new one and the nurse recorded all of my current immunizations in it and pointed out that there are pages for other medications that I take on a regular basis. I filled that section out and had my doctor sign it; this provides me with an official record of my regular medicines so that it would be less likely that I would be questioned when traveling. There is also a place to list any medicines you may be allergic to. All of this information would be important if you had an accident, were bitten by something or became seriously ill while abroad.
As a part of my preparation, I went to the CDC web site to read up on malaria prevention. I have usually taken Malarone but it is expensive and I hoped to find an alternative. There are actually many anti-malarial medications and the one you use depends in part on what section of the world you are traveling to because there are two main types of malaria. Mosquitoes are the main carrier no matter where you go so a strong mosquito repellent is a part of a good prevention strategy. Since I won't be spending much time in and around Panama City, an anti-malarial is a necessity.
You take most anti-malarials a couple days before traveling, daily while on your trip and during the week after your return. In parts of Panama certain strains of the bug have developed a resistance to chloroquine and the various forms of it, which reduces your alternatives to Malarone. I learned that because of my history of seizures I should not take Mefloquine so I was left with Malarone or Doxycycline. The Doxycycline is a bit of a bother because in addition to taking it before and during the trip, you have to take it for 4 weeks after the trip. The big advantage of Doxycycline is the cost. I figured out that I need 44 doses for this trip. The grand total at CVS was $3.74.
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