Malaria prevention meds for Nicaragua and Guatemala port calls?

As I've mentioned elsewhere, we'll be making our first transit of the Panama Canal in January, a westbound cruise from Miami to LA with port calls in Colombia (Cartagena), Costa Rica (Puntarenas), Nicaragua (Corinto), Guatemala (Puerto Quetzal), and Mexico (Puerto Chiapas, Huatulco, Puerto Vallarta, Mazatlan, and Cabo).

We went to our travel clinic the other day to meet with a travel doctor and get the recommended immunizations for our itinerary. I had alreadly concluded from reading the CDC web pages that Hep A and typhoid immunizations were recommended; we've had the former (a good idea anyway since Hep A is so prevalent now, even in the U.S.), and so we got our typhoid shots.

But the doctor did say one thing that surprised me. The Travax maps that they use to show malaria risks in specific countries show that the ports we visit in Guatemala and Nicaragua are in the "red zone" -- where malaria prophylaxis is recommended "for all travelers." (That is, meds that you take to help prevent malaria.) We discussed this with her, and she gave us prescriptions for Malarone. (You take one pill daily starting two days before your visit, and for seven days after.)

I have to say, the jury is still out for me on those meds, given that we just have a daytime port call in those two places, and the meds can have some side effects. Certainly we are going to use sufficient insect repellent (containing DEET or Picaridin).

Any sense from medical advice that others have gotten for those ports (Corinto and Puerto Quetzal) whether this doctor might just be a little overzealous? I'm normally a big believer in following medical advice, just wondering if this might be overkill. (BTW, in Nicaragua we are going on a tour to Leon, and in Guatemala we are going to Antigua.)

Thanks for any insights and experience.

Have been to every one of those ports at least once, and as we are doing a SF-FLL Canal cruise next October, will be visiting some of them again. Have never received any innocculations or taken any anti-malarial meds. The cruise lines are not recommending them, to my knowledge.

To be fair, I should note I have Hep A and B vaccinations from work.

I have medical issues that cause a lowered immune system, so i spoke to the Travel Clinic at the medical center that oversees my care. They suggested Hep A, Typhoid and Yellow fever (which i cannot get, but my husband did). They also suggested malaria meds. Don't know if that is because of my health issues or is just a general recommendation that they would give everyone.

Cheryl (and Phil) Corcoran

Keep in mind that Hep A & B and thyphoid would mostly be contracted from local foods. When I am on port stops, I fill up on brunch and coast till I'm back on the ship!

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she gave us prescriptions for Malarone. (You take one pill daily starting two days before your visit, and for seven days after.)

 

I have to say, the jury is still out for me on those meds, given that we just have a daytime port call in those two places, and the meds can have some side effects. Certainly we are going to use sufficient insect repellent (containing DEET or Picaridin).

 

I took Malarone when I went to West Africa, Ghana, Togo and Benin, a few years ago, the malaria risk there was relatively high so I opted to take the preventative meds. I got very ill from the Malarone after I got back, I was off work for another week. Its up to you, and you have a good point about being in ports during the daytime when mosquitos are much less active, as they bite most at dawn and dusk and through night time hours. Good idea on the hep A and typhoid, I have those two, also a dtap booster is good if you haven't had one in 10 years. I also have yellow fever vaccination, surprised your doc didn't recommend that given Panama Canal is in the yellow fever zone. I believe it a relatively low risk vaccination, I had no problems with it.

Leon and Antigua are great colonial towns, as well as Granada. I've been throughout Nicaragua and Guatemala. In Guatemala there's also Lake Atitlan, which is spectacular, and Chichicastenango is another interesting town, many go for the colorful markets twice a week. In Nicaragua, there' also the Esteli area, many of the cigar makers in the area, and there's some beautiful national parks, we were in Miraflor.

Have a great trip, it sounds fabulous!

Keep in mind that Hep A & B and thyphoid would mostly be contracted from local foods. When I am on port stops, I fill up on brunch and coast till I'm back on the ship!

 

Hep b is contracted through sexual contact, sharing needles, contact with blood. Turtles06 should be fine as long as he/she avoids a drug infused orgy, but boy that would be quite a travel story :D

I forgot to mention, the absolute best insect repellent that I have found is called Jungle Juice, sold by REI. Its 98% deet, I've used it in the jungles of Africa, South and Central America and nothing bites through it. Its greasy though, comes in a spray bottle or a squirt bottle, either one is fine because you have to essentially apply it like sun screen by putting it in your hand and apply to all exposed areas. Never forget between your toes and bottoms of your feet if wearing flip flops or other open shoes. Get under your clothes, you can also buy a repellent for your clothing, REI sells a Permethrin spray. The Jungle Juice is sold in 2-2.5oz bottles, and a little goes a long way, 1 bottle should be enough for 2 of you for the trip. It does have a strong smell, although not horrible, but you may also repel people, sometimes that's not a bad thing :D

We also opted for Malarone. Now I'm hoping we don't get sick from it! We bought permethrin insect repellent, both spray and wipes. Hope it's enough, mosquitos seem to just love me.

thanks for ll the info I am getting from theses posts! Down to something like 25 days to sailing!

Cheryl Corcoran

We also opted for Malarone. Now I'm hoping we don't get sick from it! We bought permethrin insect repellent, both spray and wipes. Hope it's enough, mosquitos seem to just love me.

 

 

 

thanks for ll the info I am getting from theses posts! Down to something like 25 days to sailing!

 

Cheryl Corcoran

Not everyone gets ill from Malarone, my travel companion also took it and had no problems at all. Unfortunately, its something you can only find out the hard way. For myself, I'll never take it again. However, malaria is no picnic to get either. Its a tough call. Permethrin is to spray on your clothes, you also should get a strong repellent like Jungle Juice or Amazon sells a similar brand called Repel 100, to apply to your skin.

I also have yellow fever vaccination, surprised your doc didn't recommend that given Panama Canal is in the yellow fever zone. I believe it a relatively low risk vaccination, I had no problems with it.

...

 

Have a great trip, it sounds fabulous!

Thanks for the good wishes for our trip. As for Panama, we are only transiting the Canal, we have no port calls in Panama, thus no Yellow Fever risk. Also, the Yellow Fever vaccine *can* be a big problem for people over 60 (which we are), it's not a low risk vaccine. Bottom line, not medically indicated for us here and in fact contraindicated.

Hep b is contracted through sexual contact, sharing needles, contact with blood. Turtles06 should be fine as long as he/she avoids a drug infused orgy, but boy that would be quite a travel story :D

:):):)

We've been to all you named as port stops and have never taken anything for malaria.

Enjoy your cruise! :)

Not everyone gets ill from Malarone, my travel companion also took it and had no problems at all. Unfortunately, its something you can only find out the hard way. For myself, I'll never take it again. However, malaria is no picnic to get either. Its a tough call. Permethrin is to spray on your clothes, you also should get a strong repellent like Jungle Juice or Amazon sells a similar brand called Repel 100, to apply to your skin.

Just ordered a bottle of Repel 100 and some wipes. We now have enough insect repellent for 2 cruises, at least. Had never read that permethrin was for clothes only. Thanks for the heads up.

Cheryl

Thanks for the good wishes for our trip. As for Panama, we are only transiting the Canal, we have no port calls in Panama, thus no Yellow Fever risk. Also, the Yellow Fever vaccine *can* be a big problem for people over 60 (which we are), it's not a low risk vaccine. Bottom line, not medically indicated for us here and in fact contraindicated.

 

 

 

:):):)

There's more to the yellow fever vaccine. Some countries require it to enter if you have been in a yellow fever zone country. I've encountered this entering Thailand. We flew there from Ethiopia, everyone coming off that Ethiopian Air flight had to go through a health inspection prior to passport control, which consisted of showing your yellow fever certificate, if you didn't have one you were either going to get one in the airport or be refused entry. In some cases, you don't even need to be traveling directly from a yellow fever zone country, but if a sharp eyed immigration officer even sees a recent stamp in your passport from a yellow fever zone country they will turn you around and send you to the health inspector as well.

In your case, since you're only transiting the canal you'll have no Panama stamp in your passport so none of this will be an issue. But just passing this info along for future reference for future travels. If you're unable to receive the vaccine due to age or health concerns I guess you'd have to get some kind of exemption certificate from your doctor, if one exists, I don't know. At any rate, you're good to go for this trip and should be really fantastic, great areas this ship is calling in.

There's more to the yellow fever vaccine. Some countries require it to enter if you have been in a yellow fever zone country. I've encountered this entering Thailand. We flew there from Ethiopia, everyone coming off that Ethiopian Air flight had to go through a health inspection prior to passport control, which consisted of showing your yellow fever certificate, if you didn't have one you were either going to get one in the airport or be refused entry. In some cases, you don't even need to be traveling directly from a yellow fever zone country, but if a sharp eyed immigration officer even sees a recent stamp in your passport from a yellow fever zone country they will turn you around and send you to the health inspector as well.

 

In your case, since you're only transiting the canal you'll have no Panama stamp in your passport so none of this will be an issue. But just passing this info along for future reference for future travels. If you're unable to receive the vaccine due to age or health concerns I guess you'd have to get some kind of exemption certificate from your doctor, if one exists, I don't know. At any rate, you're good to go for this trip and should be really fantastic, great areas this ship is calling in.

Thanks for pointing out the bolded issue, as it will be useful for others; I was aware of this and have been assured in writing by NCL that we do not need proof of Yellow Fever immunization for this cruise. (And our travel doctor in any event gave us waiver letters.)

As I've mentioned elsewhere, we'll be making our first transit of the Panama Canal in January, a westbound cruise from Miami to LA with port calls in Colombia (Cartagena), Costa Rica (Puntarenas), Nicaragua (Corinto), Guatemala (Puerto Quetzal), and Mexico (Puerto Chiapas, Huatulco, Puerto Vallarta, Mazatlan, and Cabo).

 

We went to our travel clinic the other day to meet with a travel doctor and get the recommended immunizations for our itinerary. I had alreadly concluded from reading the CDC web pages that Hep A and typhoid immunizations were recommended; we've had the former (a good idea anyway since Hep A is so prevalent now, even in the U.S.), and so we got our typhoid shots.

 

But the doctor did say one thing that surprised me. The Travax maps that they use to show malaria risks in specific countries show that the ports we visit in Guatemala and Nicaragua are in the "red zone" -- where malaria prophylaxis is recommended "for all travelers." (That is, meds that you take to help prevent malaria.) We discussed this with her, and she gave us prescriptions for Malarone. (You take one pill daily starting two days before your visit, and for seven days after.)

 

I have to say, the jury is still out for me on those meds, given that we just have a daytime port call in those two places, and the meds can have some side effects. Certainly we are going to use sufficient insect repellent (containing DEET or Picaridin).

 

Any sense from medical advice that others have gotten for those ports (Corinto and Puerto Quetzal) whether this doctor might just be a little overzealous? I'm normally a big believer in following medical advice, just wondering if this might be overkill. (BTW, in Nicaragua we are going on a tour to Leon, and in Guatemala we are going to Antigua.)

 

Thanks for any insights and experience.

we just went to our travel clinic yesterday and they also recommended malaria prophylaxis. They said my family doctor would have to order it and it should be either

Malarone 350mg by mouth start 2 days before the trip and take 7 days after Mexico or Doxycycline 100 mg 2 days prior to start of trip and 28 days after Mexico. The big thing was to wear long sleeves and long pants and spray self with lots of insect repellent. Since we also has to worry about Zika Virus, Chikungunya and Dengue fever. which are now also in Asia and the Pacific Islands. I am too not sure about taking these medications.

We did the Panama Canal cruise late Sept early October, stops is Costa Rica, Nicaragua, Columbia. Never gave a thought to vaccinations. I've been thru it 3 times now, no problems. About 2 weeks after we got home my husband came down with muscle aches, swollen knee, general malaise, he feels terrible. He went to the doctor and her immediate thought was malaria. He had the blood test it came back negative. He's had 3 blood tests and all come out negative! The next one is for Chikungunya! Never even heard of that one. We never ate at any of the ports, we mostly got off the ship walked to the flea market and back to the ship, it was too hot and humid! We did take a bus tour in San Juan Del Sur, Nicaragua to Rivas and Lake Nicaragua to a church and a big home where they gave out juice and tortillas, then you could walk down to the lake but we only got about part way before the flying insects were too much. So maybe he got bit?? I didn't?? I don't know. He didn't complain about bug bites. I'm hoping we find a cause soon. I would check out vaccines if I were to go again, it just didn't cross my mind at the time.

The next one is for Chikungunya! .

While I don't think it's as prevalent in Central America as it is in the Caribbean it could also be dengue- similar symptoms. (I used to live in the Caribbean, and it was a part of life)

The problem is, too many tropical and other diseases begin with these generic "flu-type symptoms", but dengue and chikunguya definitely affect the joints.... But so do many other things, as well!

Get well soon!

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