Travel Medicine: Vaccines, Malaria Prophylaxis, and Safe Food Practices

Every year, over 1.4 billion people travel internationally. Many come back sick-not from bad luck, but from avoidable mistakes. The truth is, you don’t need to be a scientist to stay healthy on the road. You just need to know what to do before you leave, what to take with you, and what to avoid once you arrive. This isn’t about fear. It’s about smart preparation.

Get Your Vaccines Right-Not Just Any Vaccine

Most people think, "I’ll just get the shots they recommend." But not all vaccines are created equal. The hepatitis A vaccine is the most common vaccine travelers need-and it’s also the most often skipped. One dose gives you 95% protection. Two doses, given 6 to 12 months apart, give you protection for at least 25 years. That’s not just a shot. That’s a lifelong shield.

Then there’s typhoid. The old oral vaccine? It only works about 50-80% of the time and lasts 3 years. The newer typhoid conjugate vaccine (TCV)? It’s 87% effective, lasts longer, and works in kids as young as 6 months. If you’re going to India, Pakistan, or parts of Africa, this isn’t optional. It’s essential.

And don’t forget routine vaccines. If your MMR, Tdap, or varicella shots are outdated, you’re at risk-even if you’re not going to a "high-risk" country. Measles outbreaks still happen in Europe. Polio lingers in parts of Africa and Asia. A simple blood test or checking your immunization record can save you from weeks of fever, isolation, or worse.

Timing matters. Most vaccines need weeks to build immunity. Hepatitis A? Give yourself at least 2 weeks. Yellow fever? You need to get it at least 10 days before you travel-and you’ll get an official certificate that 194 countries require. Skip this, and you might be turned away at the border-or quarantined for six days.

Malaria Prophylaxis: Pick the Right Drug, Not the Cheapest One

Malaria kills over 600,000 people a year. Most of them are travelers who thought, "I’ll just take pills if I get sick." That’s not how it works. Malaria prevention isn’t about treatment. It’s about stopping the parasite before it takes hold.

There are four main drugs used today:

• Atovaquone-proguanil (Malarone): 95% effective. Take one pill daily, starting 1-2 days before travel. Side effects? Mild stomach upset for a few people. Cost? Around $220 for a 3-week trip.
• Doxycycline: 90% effective. Costs about $45 for the same trip. But it makes your skin burn in the sun-30% of users get bad sunburns. And you can’t take it if you’re pregnant or under 8.
• Mefloquine (Lariam): Weekly dose. Started 2-3 weeks before travel. But it can cause nightmares, anxiety, dizziness, and even hallucinations. There are real stories of travelers ending up in emergency rooms because of it.
• Tafenoquine (Krintafel): Newer, approved for kids over 16 in 2025. Weekly dose. Only needs 3 days before travel. But you MUST get tested for G6PD deficiency first. If you’re deficient, this drug can destroy your red blood cells. It’s safe-if you’re screened.

Here’s the hard truth: only 62% of travelers who are prescribed malaria pills actually take them correctly. That’s why 3,000 to 5,000 cases of imported malaria still happen in the U.S. every year. It’s not that the drugs don’t work. It’s that people forget, skip doses, or stop early because they feel fine. Malaria doesn’t care how you feel. It only cares if the drug is in your system.

Safe Food Practices: The One Rule That Saves Lives

Travelers’ diarrhea hits 30% to 70% of people depending on where they go. In Southeast Asia? It’s closer to 70%. Most cases are caused by Escherichia coli-a bacteria you can’t see, smell, or taste.

The rule is simple: boil it, cook it, peel it, or forget it.

• Water? Only drink bottled, boiled, or treated. Ice? Avoid it unless you know it was made with purified water.
• Fruit? Eat only things you peel yourself-bananas, oranges, mangoes. Don’t trust the vendor who "washed it."
• Meat? Make sure it’s piping hot. Poultry needs to hit 165°F (74°C). Ground beef? 160°F (71°C). Fish? 145°F (63°C). If it’s lukewarm, it’s unsafe.
• Street food? It’s not the enemy. But it needs to be cooked fresh in front of you, served hot, and eaten right away. Cold salads? Skip them.

There’s one more trick: bismuth subsalicylate (Pepto-Bismol). Taking two tablets four times a day can cut your risk of diarrhea by 65%. It’s not a cure. It’s a shield. And unlike antibiotics, it doesn’t kill good bacteria or cause resistance.

But here’s the catch: some travelers still get sick even when they follow all the rules. A woman in Mexico got hepatitis A from contaminated ice. A man in Thailand got sick from a salad washed in tap water. That’s why prevention isn’t just about rules-it’s about awareness. If you’re in a place with poor sanitation, assume everything is risky until proven otherwise.

What to Pack: Beyond Pills and Vaccines

You don’t need a pharmacy on wheels. But you do need a few key things:

• Standby antibiotics: Azithromycin is now the first-line treatment for travelers’ diarrhea. But it’s getting harder to find. Many pharmacies in the U.S. have run out of pediatric doses, so adult prescriptions are harder to get. Ask your doctor for a prescription before you leave.
• Oral rehydration salts: Diarrhea isn’t just uncomfortable-it can dehydrate you fast. These packets are cheap, light, and lifesaving.
• Original medication containers: If you take ADHD meds, opioids, or antidepressants, keep them in their original bottles with the prescription label. Some countries consider these illegal without a doctor’s note. Carry a letter from your doctor listing the generic names.
• Hand sanitizer: With at least 60% alcohol. Use it before eating, after using the bathroom, and after touching high-contact surfaces.

And don’t forget your travel insurance. Some policies cover emergency medical evacuation. Others don’t. Check now. Don’t wait until you’re stuck in a remote clinic with a fever.

Why So Many People Still Get Sick

Here’s what’s really going on:

• Only 55% of travelers to high-risk areas get pre-travel advice.
• 73% of people wait less than two weeks before their trip to see a doctor-too late for vaccines to work properly.
• Doctors in the U.S. often don’t know the latest guidelines. One survey found 30% of travelers couldn’t get prescriptions for antibiotics because their GP had never heard of azithromycin for diarrhea.
• Antibiotic resistance is rising. In Southeast Asia, over 30% of E. coli strains are now resistant to azithromycin. That means the go-to drug might not work where you need it most.

And climate change? It’s making things worse. Malaria is spreading to higher altitudes in East Africa. Floods in South Asia are contaminating water supplies. Foodborne illnesses are increasing as temperatures rise. The CDC’s 2026 Yellow Book now includes guidance for high-altitude malaria risk and climate-driven food safety threats. This isn’t future talk. It’s happening now.

What You Can Do Today

You don’t need to become an expert. But you do need to act.

1. Check the CDC Yellow Book 2026. It’s free online. Search by country and see exactly what vaccines and drugs you need.
2. Book a travel clinic appointment at least 4-6 weeks before you leave. Even if you think you’re fine, you might need a booster.
3. Ask your doctor for a prescription for azithromycin and oral rehydration salts.
4. Write down the generic names of your regular meds. Print a doctor’s note.
5. When you’re abroad, follow the rule: boil it, cook it, peel it, or forget it. No exceptions.

Travel medicine isn’t about paranoia. It’s about control. You can’t control the weather, the food vendors, or the local water system. But you can control whether you get vaccinated, whether you take your pills, and whether you eat that salad. Make the right choices, and you’ll come home not just with memories-but with your health intact.