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Diseases / Viruses - Vaccinations

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Morning, I wonder if you could answer a question on vaccination for me please? The PADI manual mentions tetanus and typhoid are necessary vaccinations. However the travel clinic I visited recently thought that typhoid was low risk for the area I am planning to visit (diving in Thailand, on Koh Tao). Is there something specific to scuba that makes the typhoid injection necessary?

A - There is one thing about scuba diving that means you should have your shots more than say a surfer or a golfer. Nitrogen bubbles in the blood. This is the only sport where these are created and have to be eliminated from the body. What gets rid of them are safety stops on a dive, and making sure you have enough circulating blood to take the nitrogen to the lungs for exhalation. Anything decreasing the volume of fluid in the body can increase the chance of a bend, as less nitrogen is eliminated. What decreases fluid in the body? Full on holiday turbo-diarrohea brought on by Salmonella Typhi, that’s what. So, it’s best to get immunised if you are in a plagued country. But some places change as they clean up their sewage systems, so check before you go to see if it is recommended or only ‘suggested’. I think Koh Tao is fairly safe.

Q - I came across your articles in the Sport Diver magazine and thought I should consult you since I didn't seem to get a straight answer here in Malta.

I shall be visiting India in mid March and I am going through the process of taking all the innoculations required for the trip and I also need to take Malaria pills.

My main concern is that I am a diver and wanted to dive in the Andaman Islands and in Lakshadweep. I dive on a regular basis on the weekends mainly 2 dives Saturday and 1 on Sunday, is it advisable that I stop whilst I am taking the inoculations? How would the inoculations of Hepatitis A & B, Typhoid, Diphteria/Tetanus be effecting my body?

Also I do not take any medications and neither do I drink alcohol since I dive and since it is not recommended. What should I do regarding the Malaria pills, I was told to take Mefloquine ( 250mg weekly ), would these pills effect my diving ability in any way?

A - Fairly simple really. You are fine to dive after the shots, they should not knock you off your stride too much. However watch out for the typhoid. It makes your arm feel as heavy as hell afterwards for a day or so. That’s because you get a local reaction in the lymph nodes in your armpit. You can avoid this by taking the oral typhoid vaccine. That’s a tablet, not swallowing the needle. So see what your plans are but try to get the shots early in the week, before you are diving at the weekend.

As for the malaria, “mefloquine makes you mad”, as they said on the overland trucks across Africa in the early 90’s. Best go for malarone or doxycycline, if there’s no resistance out there. However if mefloquine is the only one recommended for those islands, then you must take a test dose before you go. If you are the rare percent who are side effect free, then go for the diving, but stay out of narcosis depths. Just in case.

Q - I live and work as an Instructor on Gozo, Malta. Is it recommended that I get vaccinated against Bird Flu?

A - Glad you asked, as it throws up a lot of issues, especially for divers heading east this winter. There is no bird flu vaccine. We are waiting for the avian flu virus or H5N1 to mutate into the human to human form, from what it is now, i.e. the bird to bird, with some species leap to human after a lot of close contact. Close contact being bird farmers, or those whom choose to sleep with chickens. When it does mutate, and that will be when someone with regular flu also contracts H5N1, we are in for the worrisome pandemic. So for now there are 2 things you can do. Not get regular flu. And the flu vaccine will stop this, though it seems there a few left in the UK. Or get Tamiflu. This drug won’t cure bird flu, but it will limit its nastiness. Disability rather than death. When the H5N1 does its stuff, they can then make the vaccine, but there will be a delay until we all get it. Manufacture, distribution and sticking it in your arm will take up to 2 months. Pandemics spread in days.

So what of Gozo. For now do not worry. You are not on a goose flight path. We in London and other travel hubs from the East are in the firing line. Remember SARS, Canada seemed to get it a lot.

Thank the Lord fish do not spread disease, though if we all felt sharks could spread Ebola, that would stop the finning. Now there’s a thought. Where’s my spin doctor…

Q - My girlfriend and I are travelling to India to work as Diving Instructors for up to twelve months from the end of December 2003.

We have both had jabs for various conditions within the last 5 years. As far as I can remember we've had, Polio, Tetanus, Hep A+B combined, Typhoid, Diptheria, Meningitis. I had all three Rabies jabs but my partner only had two. Would you mind letting us know what we are missing please.

Secondly we are having difficulty getting information regarding Malaria tablets and which are recomended for divers. Also we have heard that some Malaria tablets have antibiotic properties and we are concerned about the effect this may have on the performance of the oral contraceptive my partner takes (Cilest).

We would appreciate your advice on these questions and thank you in advance for your time.

A - I think you both have had more pricks than Mrs Tiggywinkle. You have had the lot for India. The only thing is how out of date some might be after you have had them. Tetanus is 10 yearly, typhoid 2 to 3 yearly. The Heps should be good for 10 years if you had the boosters before the 12 month run off period after the shots.

That leaves the rabies really. This is necessary if you are both in the remote wilds of India. However if you are in the dive zone then I guess that you are in Goa where local hospitals will have all the proper rabies shots if you were bitten by a mad salivating dog.

So you probably don't need that shot any more. Forget meningitis for India, you will be safe there.

Malaria is the big question. You have 3 or 4 options. One is mefloquine, but that will make you barmy at times. Best to go for malarone in the short term. But this is expensive as it has to be taken daily and is not off-patent yet. As you are there for a whole year you are best off with the combination of paludrine and chloroquine. The former daily, the latter weekly. Go for that, but remember that not getting malaria is more than just taking tablets. Long sleeved shirts, mossie nets and repellant are needed too. You could always just keep wearing your wetsuits all night for total protection.

Q - Off to Cancun, Mexico, could you tell me which injections are mandatory if any and which are recommended. Also are they checked and could I be refused entry if I cannot prove compliance.

A - Well perhaps only a reality shot mate. Cancun, probably the farthest we can send the Millwall pie-throwers for a holiday without destroying a fragile ecosystem. Actually I have flown there and the key is to go as South as possible asap. The coral is in Cozumel, the culture inshore from Tulum. All you need is a Hep A shot as you are out of real rabies/malaria/dengue country. As for the certification of shots don't worry. Mexico has this weird system of arrival etiquette. You will get to push a button on a red/green flashing traffic light thing. Red, an it's off for the rectal with sniffer dog back up, green and its go straight through to the land of Montezuma. But whatever colour you get no-one is going to ask for the vaccinations you have had. How do I know? Well as a good doc I mostly travel in a state of medical disorganisation, and have fought my way past blokes with 5 litres of Factor 8 and Duty Free Voddy at the passport queue, to be never asked about what shots I've had before Mexican entry. I shouldn't knock it of course, Cancun is the point of disembarkation for all that cave diving in the crystal clear cenote waters, it's just a shame that most visitors don't get farther than their hotel bar.

(other dive medical questions)



   


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