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

Every year, over 1.4 billion people cross international borders. Many of them will get sick-not from plane crashes or lost luggage, but from something far more common: food, water, or insects they never thought to worry about. Travel medicine isn’t about fancy clinics or exotic treatments. It’s about simple, proven steps that keep you healthy when you’re far from home. And if you’re planning a trip to a place with different risks, skipping these basics could mean a hospital stay instead of a vacation.

Why Travel Vaccines Matter More Than You Think

You don’t need a vaccine for every country. But for some destinations, skipping one shot can land you in serious trouble. The CDC reports that Hepatitis A is the #1 vaccine-preventable illness among travelers. It’s not rare. Around 1.4 million cases happen globally each year, and most come from food or water contaminated with feces. You won’t know it’s there. A single bite of undercooked shellfish or an ice cube in your drink can be enough.

The Hepatitis A vaccine is simple: two doses, six to twelve months apart. But here’s the catch-most people wait until the week before departure. That’s too late. The first dose gives you strong protection within two weeks, but the second dose locks in lifelong immunity. If you only get one, you’re still at risk. After two doses, protection lasts at least 25 years. That’s not just for your next trip-it’s for every trip after that.

Typhoid is another big one. The old typhoid shot (injected) only works for about two years and is 50-80% effective. The newer typhoid conjugate vaccine (TCV), given as a single shot, lasts three years and is 87% effective. It’s now the CDC’s top recommendation for travelers to South Asia, Africa, and parts of Latin America. If your doctor still offers the old version, ask for the new one.

And don’t forget the basics. If you haven’t had a Tdap shot in the last 10 years, get one before you leave. Same with MMR. These aren’t “travel” vaccines-they’re routine ones that some adults skip. But measles outbreaks still happen in Europe, and whooping cough can hit you hard overseas. Make sure your childhood shots are up to date.

Malaria Prophylaxis: Choosing the Right Drug

Malaria isn’t just a tropical disease anymore. Climate change has pushed mosquito zones higher and farther. The Lancet Planetary Health journal predicts 200 million more travelers could be at risk by 2030. That’s not a future scare-it’s already happening. In 2024, over 3,000 cases of imported malaria were reported in the U.S. alone. Most were preventable.

There are four main drugs used to prevent malaria. Each has trade-offs:

• Atovaquone-proguanil (Malarone): Take one pill daily, starting 1-2 days before travel. 95% effective. Side effects? Mild stomach upset for a few people. But it costs about $220 for a 3-week trip.
• Doxycycline: A $45 option. Take one daily, starting two days before. 90% effective. But it makes your skin burn in the sun-30% of users get bad sunburns. Also, you can’t take it if you’re pregnant or under 8.
• Mefloquine (Lariam): One pill a week, starting 2-3 weeks before. 90% effective. But it’s risky. Some people get nightmares, dizziness, or even panic attacks. Reddit threads are full of stories like “mefloquine sent me to the ER in Thailand.” The CDC still lists it, but most specialists avoid it now.
• Tafenoquine (Krintafel): Newer, weekly dose, started 3 days before. 95% effective. But you MUST get tested for G6PD deficiency first. If you have it, this drug can destroy your red blood cells. About 10% of people in malaria zones have this genetic trait. It’s now approved for kids over 16, thanks to a January 2025 FDA update.

Adherence is the real problem. Studies show only 62% of travelers take their pills consistently. That’s why most malaria cases happen-not because the drug failed, but because someone skipped a dose. Set a daily phone alarm. Keep pills in a pill organizer. If you forget one, don’t double up. Just resume the next day. You’re still protected.

Safe Food Practices: The Rule That Saves Lives

Travelers’ diarrhea affects 30-70% of people depending on where they go. In Southeast Asia? It’s closer to 70%. Bacteria-mostly E. coli-cause 80% of those cases. And no, it’s not always “street food.” Sometimes it’s the ice in your cocktail. Or the salad washed in tap water. Or the fruit peeled by someone who didn’t wash their hands.

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

• Boil it: Water should be boiled for at least one minute (three minutes at high altitudes). Bottled water? Check the seal. Some brands refill bottles. Stick to sealed, branded bottles.
• Cook it: Food must be steaming hot. Not warm. Not lukewarm. Steam should rise off it. Poultry? 165°F (74°C). Ground meat? 160°F (71°C). Fish? 145°F (63°C). If it’s not hot enough, don’t eat it.
• Peel it: Bananas, oranges, mangoes? Fine. Apples, grapes, tomatoes? Only if you peel them yourself. Don’t let someone else peel it for you.
• Forget it: Raw salads, uncooked seafood, street-side smoothies, tap water ice, unpasteurized dairy. Skip them. Even if everyone else is eating it.

There’s one more tool: bismuth subsalicylate (Pepto-Bismol). Taking two tablets four times a day can cut your risk of diarrhea by 65%. It’s not a cure, but it’s a shield. And it’s available without a prescription in most countries. Just don’t take it for more than three weeks. It can cause black tongue or stools-harmless, but weird.

What No One Tells You: The Hidden Risks

Most travelers think the big risks are malaria and Hepatitis A. But here’s what’s getting worse:

• Antibiotic resistance: Azithromycin is the go-to for treating travelers’ diarrhea. But in Southeast Asia, over 30% of E. coli strains are now resistant. That means your usual pill might not work. Carry a backup-like ciprofloxacin-if your doctor prescribes it. But don’t self-medicate. Use it only if you’re sick for more than 48 hours with fever or bloody stool.
• Medication bans: Some countries ban common U.S. drugs. ADHD meds, opioids, even some allergy pills. If you’re carrying them, bring the original prescription with the generic name. A doctor’s letter helps. Otherwise, you could get arrested at customs.
• Climate change: Mosquitoes are moving into new areas. High-altitude towns in the Andes, parts of southern Europe, even mountain resorts in Nepal are now at risk. Check the CDC Yellow Book 2026 for updated maps. It’s updated every two years, and the 2026 edition came out April 23, 2025.

And here’s the hardest truth: Only 55% of travelers to high-risk areas get pre-travel advice. That means nearly half are flying blind. You don’t need a travel clinic. But you do need to talk to your doctor at least 4-6 weeks before you go. Vaccines take time. Some need multiple doses. Some need blood tests. Waiting until the last minute isn’t just risky-it’s reckless.

What to Do Before You Leave

Here’s your checklist:

1. Check the CDC Yellow Book 2026 for your destination. Type your country into their travel health page. It’s free. It’s updated. It’s the gold standard.
2. Get your routine vaccines up to date: MMR, Tdap, varicella.
3. Get Hepatitis A and typhoid vaccines if you’re going to Asia, Africa, or Latin America.
4. For malaria zones: Talk to your doctor about the right prophylaxis. Don’t pick based on price alone. Consider side effects and your health history.
5. Carry Pepto-Bismol and a standby antibiotic if prescribed. Keep them in your carry-on.
6. Label all medications with generic names and your doctor’s contact info. Pack extras.
7. Drink only bottled or boiled water. Avoid ice. Eat only hot, freshly cooked food.

There’s no magic formula. No secret trick. Just consistency. The people who stay healthy? They’re not lucky. They’re prepared.

Final Thought: It’s Not About Fear. It’s About Control.

Travel medicine isn’t about scaring you. It’s about giving you back control. You don’t have to avoid the world. You just need to know the rules. The people who come home sick? They didn’t know. The people who come home healthy? They planned. And now, so can you.