For those of you who read my blogs or have met me on various cruises, you know that I am an avid traveler. I am not homeless, but I am never at home. I have always loved adventure and doing things that many wouldn’t consider and I have some great stories. Ask me sometime and I will tell you about applying to be an astronaut, running for school board or buying unseen land in West Texas on E-Bay.

For those who know me well, you know that I had a professional career in both the Civil Service and in the Military. My job in both of these careers was assessing risk and dealing with chemical, radiological and biological concerns throughout the world. My original career in the military was as a Bioenvironmental Engineer and later as a Medical Administrator running medical squadrons. I served in the military for 33 years and I absolutely loved it. The people, the adventure and the mission gave me inspiration for many of the things I have taken on over the years.

One of my tasks, which I absolutely loved, was doing “advance cadre tours”. This is where a small team would go to a remote area in the world and assess the risks and hazards, before military personnel were deployed to provide humanitarian services or preform other function. That mission took me to places like Honduras, El Salvador, Ecuador and other remote locations. I worked closely with world experts on disease and illness. I was pretty good at getting people and myself safety into places and safely back home again.

The reason, I wanted share some of my background here is to explain why I feel that I am well qualified to discuss risk prevention measures for travel. Public health professionals, CDC and WHO websites provide a wealth of valuable information, but that needs to be tailored to specific situations. Each of us needs to be able to digest this information and make solid risk management decisions for ourselves. If you just read these websites and talk to medical professionals, you may never leave your house again. (If you don’t believe me, next time you take a cruise, look at the CDC and WHO recommendations for the countries you are visiting.) The major risk is that you will either over medicate/vaccinate or under estimate the risk and under prepare. Now, before I go further, I need to throw out a disclaimer. I am sharing how I approach risk for me and my family, and you need to evaluate your situation and make your own decisions utilizing the best advice you can get.

Some of our next cruises stop in Mexico, (Roatan) Honduras and Spain. Using the CDC website, its recommended that we be vaccinated for: Routine Diseases (Chickenpox, DPT, Flu, MMR, Polio and Shingles), Covid-19, Hepatitis A, Hepatitis B, and possibly Rabies and Typhoid. Additionally, we should be taking medication to prevent Malaria. Also, we are warned to avoid bug bites and unclean water in order to prevent: Chanas disease, Dengue Fever, Leishmaniasis, and Zika. JUST FOR MEXICO! Pretty scary! Also, when you add Spain you need to worry about Parovirus B19 – what ever in the world that is….avoid sand fleas!

I think its safe to say the majority of cruise passengers don’t need to worry about these hazards, but my point is, if you read just the CDC guidelines you are going to be at least confused if not scared out of your mind. I will say, it does make sense to be cautious and be aware of the potential hazards. For me, I will use insect repellent if I am in the jungle, I will avoid eating street foods and as many sick people as possible. Another consideration is that these cruises and follow-on tours tend to be short and there is good access to medical professionals and modern medicine. Additionally, I will make sure that I have the most recent Flu and Covid 19 vaccinations before we head out.

However, planning for a two month round the world adventure its slightly more complicated and requires additional evaluation. There are three major health considerations when you plan travel around the world. First, are the risks associated with the actual travel. Second, are the requirements for the countries you will enter or transit. Lastly, what will you do if you do become ill while traveling. Let me discuss these in order. For our round the world trip. We will be visiting Kenya, United Arab Emirates, China and Singapore. We also have a trip in January to Ecuador which I have also included as well in the planning. We will visit another half dozen countries, but they will be via a cruise ship and rely on their recommendations….if any.

In preparation for our trip, Reva and I met with the Military Public Health Office at Hill Air Force Base to discuss all the medical concerns and recommended vaccines. Additionally, we specifically discussed Yellow Fever and its vaccine over with our two resident physicians (daughter and son-in-law). Our daughter also discussed everything with an Infectious Disease Physician friend of hers. Based on all this, and I have tons of data and recommendations. This is our plan for medical preparation for this adventure (use at your own discretion):

Routine vaccinations: We are up to date on everything. We will get our normal annual shots for flu and covid. The highest priority was making sure we are up-to-date on TDAP vaccination.

Cholera: Last cases were 9-12 months ago in areas we will not be. Avoid street food and bad water.

Typhoid: Also, spread by fecal contaminated food and water. This vaccine is recommended for most travelers, but we are staying in high-end lodges. So, I am on the fence with this one. I have taken this shot (at least 5 times) and it can suck. However, there are also pills that you can take and complete before you travel. I have done these once and they were no problem. So, we may go for the pills or do nothing at all. FYI: Doxycycline (which I love!….more on this later) is used to treat Typhoid.

Rabies: We are going to avoid petting dogs that are foaming at the mouth and we not going to eat live bats. I recommend you do the same and not get this vaccine.

Yellow fever: YF is not a concern in Nairobi. In 2022 there were YF cases in the far north of Kenya (near Ethiopia and Somalia). We will be spending most of our time near the border with Tanzania in the far south of Kenya. Tanzania has never had a reported case of Yellow Fever. That said, Kenya is listed among the countries where YF could be transmitted. It is not recommended that anyone over 60 get this vaccine. It can cause death. One vaccination is good for life….lucky me, I have been vaccinated for YF three times. However, be aware of travel restrictions after leaving Kenya. Some countries will not let you enter without having a “yellow card” showing that you have been vaccinated, if you have been in Kenya or another country that has YF. Most transit countries present no issue and the US has no requirements. (Did see a passenger denied boarding in Rio because he was flying through Columbia to the US. He had been in another South America Country without being vaccinated for Yellow Fever.) We will be using Permethrin on our clothes and insect repellent to avoid mosquitoes. (Permethrin is an insecticide used on your clothes. Its relative inexpensive and available on Amazon.)

Malaria: We will be in areas where this is a concern. We will be treating our clothes with Permethrin and using DEET based insect repellent. We will also be taking Doxycycline as a prophylactic. I have taken it as long as 4 months at a time when I was bouncing in and out of various questionable places and think its great! Its a good antibiotic and will even clear up acne! It is good for most bacterial diseases including stomach issues…like traveler’s diarrhea.

Hepatitis A: This is another disease transmitted through food or water contaminated with feces. We will be in high-end lodges and not eating street food. However, this is not a bad vaccine to have and the two shot series is probably good for life. So, I don’t think its particularly necessary, but its not a bad one to consider.

Hepatitis B: Stay away from contaminated body fluids and you won’t need this vaccine.

Requirements for the countries you will enter or transit: I have already mentioned the limitations on travel if you have not had the Yellow Fever Vaccine. The majority of the African and South American Countries (along with Panama) have some risk of Yellow Fever and may trigger entry restrictions in other countries. In our case, India will not unvaccinated personnel to enter the country for six days if they have been in a Country where Yellow Fever could be transmitted. Do your homework and avoid unpleasant surprises. Presently, Covid 19 vaccination requirements have been removed from all the countries we are entering.

Medical Insurance Overseas: Luckily for us, our military retiree healthcare is good anywhere in the world unlike Medicare and many private plans. Medical care overseas tends to be much cheaper than in the US but it is good to research and purchase some form of protection. Several of the high end credit cards can provide you coverage for emergency treatment and evacuation. I am familiar with he Chase Sapphire Reserve and the Capital One Venture X cards. The Chase card provides the best coverage. You also have the option to purchase trip insurance or stand alone overseas health travel insurance. Neither of these are terribly expensive, but there have been complaints and concerns with every company I investigated. You really need to do your own research on these companies. If something bad were to happen, having a plan ahead of time can remove a lot of stress and cost later.

Medical preparation for travel is expensive and hurts a little bit, fortunately we do have access to a military base and they were willing to vaccinate us at no cost. That is not true for most people.

I think it makes sense to take as much precaution as you afford and endure. But the main approach needs to be avoid the hazard when ever possible without impacting your plans. For example, it’s not difficult to wear long sleeves when you are out at dusk, or take the time refresh your insect repellent…and do you really need too eat the warm ceviche from the street vendor on the beach?

Enjoy your travels, but be careful out there!