Health checklist before travel to Philippines

[ssbib]

I have never been vaccinated against rabies or Japanese encephalitis, nor taken anti-malarial tablets ( there is no available vaccine against malaria ).
This may well be the case for most, if not all, other members. However, circumstances vary for each individual, depending on where they are visiting or living in the country.


There is much free advice available on the internet and one’s own doctor ( GP ), before considering private travel clinics.


While vaccinations ARE also usually free for conditions including cholera, diphtheria, polio, tetanus, hepatitis A ( perhaps combined with hep B ), and typhoid, others are NOT ( such as hepatitis B, rabies and Japanese encephalitis ; also antimalarial tablets ). Costs do vary, so it’s worth " shopping around " - preferably a couple of months before travelling.


Sensible precautions should STILL be taken to reduce risks of illnesses from food, water, insects ( especially mosquitoes ), animals and other humans, even if vaccinations / tablets are up to date. Full insurance cover is only valid if recommendations in the policy are followed.


Rabies is " 100% fatal but also 100% preventable " - causing around 200 deaths / year in the Philippines ( usually following dog bites ). Although it’s possible to have a course of vaccines ( " pre-exposure prophylaxis " ) it IS still necessary for urgent medical attention after any animal bite. Further vaccination / immunoglobulin is needed, and should be given to cure the patient, before any symptoms appear. There are nation-wide treatment centres in the Philippines.


Japanese encephalitis is mosquito-borne, most infections don’t have symptoms, but in a few there may be serious brain inflammation. There is an effective vaccine, but it’s not ( to my knowledge ) included in the schedule for children in the country.


Malaria ( see post #68 ) - for most travellers the risk is not usually considered high enough to recommend antimalarial tablets.

Thanks for all the information Alan. Have you ever been to the Philippines for any significant length of time? I'm asking because you said that you have never been vaccinated. Also, why bother ever having a rabies injection? If you get bitten from an animal you go straight to the hospital and get treatment so why bother having the rabies vaccine just to "have extra time to get to the hospital" as my GP put it? For me it is simply the cost of these vaccinations puts me off. I just simply can't afford it.

Good post Alan.

I think it is, like you say, best to just be aware of what 'could' happen. Prevention is the key.
For me, having lived there, I find mosquitos are always there year round. I always sleep under a mosquito net bought in the UK, it's a double so big enough to hang off the ceiling to below the mattress so it can be tucked in. I am not worried about malaria, but if I get bitten, I get large itchy lumps come up which are not pleasant. For bites like that get your girlfriend to buy a bottle of Apickacine oil, it does relieve the itch.
Watch out for red ants, these make nests in the ground, and if you stand in the wrong place they will climb over your foot and bite...
Advice for rabies is to stay clear of any dogs, even if friendly. We have our dogs vaccinated against rabies (free in our Brgy) but best not to take risks. We keep a few dogs at our house, but I am not a real dog person. Cats are also one to watch as they can bite too or scratch. I do have house cats at home, but I still go careful.

If if you have a weak stomach only drink bottled water, or soft drinks from cans/bottles, these are safe. If your gf's house has water from the water district you can drink that fine too. Well water for you I would stay away from, although I drink from ours but my stomach is quite strong and I have never had problems. What you must watch is if you go to someone's house where you can't regulate what you are given, so your gf is going to have to watch that for you, ice etc etc.

Sure you will be fine, just take some Imodium tabs with you just in case, some Jungle Formula roll on or spray and just enjoy yourself.

Hi Steve, thanks for the information. Can I ask if you have had the rabies or JE vaccinations? It will be interesting to hear if you have and living out there. I will take your advice about water onboard. When I have been there in the past I just drank bottled water to be safe, I only used the tap water for brushing my teeth. I do have a weak stomach so would hate to have an episode because of the water.

Funny story actually...my weak stomach caused me quite a bit of anxiety when i first went to the Philippines to meet my girlfriend. We stayed at Hotel H2O at Manila Ocean Park. Its a great hotel and I would recommend it for everyone but the room layout is a bit weird, with an open plan bathroom/bedroom and only a frosted glass door covering the toilet. First meeting with the girlfriend and she was going to have to listen to my weak .... every time I went to the toilet. Luckily my guts were on top form that week so it wasn't an issue. She's since learnt all about my rancid guts and still loves me so now it wouldn't be an issue but by God, it caused me some sleepless nights worrying about that before my first trip.

[Doc Alan]

Thanks for all the information Alan. Have you ever been to the Philippines for any significant length of time? I'm asking because you said that you have never been vaccinated. Also, why bother ever having a rabies injection? If you get bitten from an animal you go straight to the hospital and get treatment so why bother having the rabies vaccine just to "have extra time to get to the hospital" as my GP put it? For me it is simply the cost of these vaccinations puts me off. I just simply can't afford it.

My maximum time in the Philippines has been a month or less, over several visits since 1978 ( when I worked for a year at the University Hospital in Kuala Lumpur, Malaysia ). At no time did I consider it necessary to have rabies or Japanese encephalitis vaccines, or antimalarial tablets, because of the places I visited, and my home in Malaysia was on the University campus next to the hospital.



I can’t give advice to individual members, most of whom I don’t know personally. All I can do safely is to give information based on best available evidence. It’s a matter for each person to reach a decision according to their general health, where they plan to visit ( or live ), and what they intend to do during their visit - after consultation with their doctor / nurse, and reading reliable source(s).



So-called " pre-exposure prophylaxis " ( immunisation ) is different to " post-exposure prophylaxis ". Each depends on the age and general health of the patient, and ( after a bite ) whether or not the suspect animal can be shown to have rabies.


Essentially pre-exposure involves several intramuscular injections and booster dose(s) of vaccine. Post-exposure involves not only further vaccines but also immunoglobulin for immediate " passive " immunity.


Each regime is indeed expensive, either in UK or the Philippines. Of course, once there are symptoms - after a variable incubation period of usually 1 - 3 months, rabies is almost always fatal. It is preventable ONLY by vaccination ( and immunoglobulin ).

[ssbib]

My maximum time in the Philippines has been a month or less, over several visits since 1978 ( when I worked for a year at the University Hospital in Kuala Lumpur, Malaysia ). At no time did I consider it necessary to have rabies or Japanese encephalitis vaccines, or antimalarial tablets, because of the places I visited, and my home in Malaysia was on the University campus next to the hospital.



I can’t give advice to individual members, most of whom I don’t know personally. All I can do safely is to give information based on best available evidence. It’s a matter for each person to reach a decision according to their general health, where they plan to visit ( or live ), and what they intend to do during their visit - after consultation with their doctor / nurse, and reading reliable source(s).



So-called " pre-exposure prophylaxis " ( immunisation ) is different to " post-exposure prophylaxis ". Each depends on the age and general health of the patient, and ( after a bite ) whether or not the suspect animal can be shown to have rabies.


Essentially pre-exposure involves several intramuscular injections and booster dose(s) of vaccine. Post-exposure involves not only further vaccines but also immunoglobulin for immediate " passive " immunity.


Each regime is indeed expensive, either in UK or the Philippines. Of course, once there are symptoms - after a variable incubation period of usually 1 - 3 months, rabies is almost always fatal. It is preventable ONLY by vaccination ( and immunoglobulin ).

Forgive my ignorance Alan but does that mean if I get bitten by a rabies infected animal while in the Philippines and I have NOT had the pre-exposure vaccination then I am essentially screwed? if I get to the hospital straight away and take the post-exposure vaccinations ONLY will I be ok?

[Doc Alan]

Forgive my ignorance Alan but does that mean if I get bitten by a rabies infected animal while in the Philippines and I have NOT had the pre-exposure vaccination then I am essentially screwed? if I get to the hospital straight away and take the post-exposure vaccinations ONLY will I be ok?

You would NOT be " screwed " if bitten by a rabid animal without having had pre-exposure vaccination. The wound should be cleaned carefully and thoroughly with soap and water, and left open. A course of post-exposure vaccines should be started and immunoglobulin should be given as soon as possible after the bite.

Of course there are far more animal bites than cases of rabies in the Philippines. The management of each situation needs judgement according to circumstances and what is known ( or becomes known ) of the animal's rabies status ( positive, previously immunised, or negative ).

[ssbib]

You would NOT be " screwed " if bitten by a rabid animal without having had pre-exposure vaccination. The wound should be cleaned carefully and thoroughly with soap and water, and left open. A course of post-exposure vaccines should be started and immunoglobulin should be given as soon as possible after the bite.

Of course there are far more animal bites than cases of rabies in the Philippines. The management of each situation needs judgement according to the circumstances and what is known ( or becomes known ) of the animal's rabies status ( positive, previously immunised, or negative ).

Am I right in thinking that even after having the pre-exposure vaccinations you still go and have the post-exposure vaccinations. So the hospital will still try and find out information about the animals rabies status etc and act accordingly? Basically what I'm asking is having the pre-exposure vaccinations doesn't mean you are immune to rabies, just that you have longer to seek medical attention?