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Q. We are planning a missionary trip to Guatemala this summer. Do my kids need any special shots or medications before we leave?
A. This is a common question, which is easy to answer if you visit the Center for Disease Control's Travelers' Health website, where you can enter your destination and get information and recommendations before you travel anywhere in the world.
When traveling to Guatemala, the risk of malaria is 'rural only, except no risk at altitudes higher than 1,500 meters.' So if you are traveling to a large metropolitan city or a rural area that is above 1,500 meters, then you don't have to worry about malaria. However, if you will be visiting rural areas, then your family will likely need malaria prophylaxis, which when visiting Guatemala consists of the drug chloroquine (brand name Aralen®). You should start taking chloroquine one week before you leave, once a week while you are in a high risk area of Guatemala, and then continue it once a week for 4 weeks after you return home.
To avoid malaria, you should also take steps to avoid mosquito bites, including using an insect repellent with DEET. Although the CDC recommends an insect repellent with 30-35% DEET, keep in mind that when used on children, it is usually recommended that you use a product with less than 10% DEET.
A more common question comes up when families travel to resorts in Mexico, such as Cancun, Alcapulco, Cozumel, etc. Fortunately, the CDC reports that there is 'no malaria risk in the major resorts along the Pacific and Gulf coasts.' Still, although you don't need malaria prophylaxis if traveling to these resorts in Mexico, you should follow all of the other recommendations to keep your kids from getting sick.
Before traveling, you should also make sure that your child's immunizations are up to date. The CDC recommends that travelers to Central America receive the following vaccines:
- Hepatitis A
- Hepatitis B
- Diphtheria and Tetanus
- Measles
Except for Hepatitis A, your child has likely had all of these vaccines if his shots are current. Other vaccines that may be recommended include rabies (if you will be exposed to wild or domestic animals), typhoid, and yellow fever (but only in rural areas of Panama).
In addition to making sure your child's vaccines are current, to stay healthy, do...
- Wash hands often with soap and water.
- Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an 'absolute 1-micron or less' filter AND adding iodine tablets to the filtered water. 'Absolute 1-micron filters' are found in camping/outdoor supply stores.
- Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
- If you will be visiting an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
- Protect yourself from insects by remaining in well-screened areas, using repellents (applied sparingly at 4-hour intervals) and permethrin-impregnated mosquito nets, and wearing long-sleeved shirts and long pants from dusk through dawn.
- To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
- Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
To avoid getting sick...
- Don't eat food purchased from street vendors.
- Don't drink beverages with ice.
- Don't eat dairy products unless you know they have been pasteurized.
- Don't share needles with anyone.
- Don't handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague).
- Don't swim in fresh water. Salt water is usually safer.
What you need to bring with you:
- Long-sleeved shirt and long pants to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, and leishmaniasis).
- Insect repellent containing DEET (diethylmethyltoluamide), in 30%-35% strength for adults and 6%-10% for children. Unless you are staying in air-conditioned or well-screened housing, you should purchase a bed net impregnated with the insecticide permethrin. (Bed nets can be purchased in camping or military supply stores.)
- Over-the-counter antidiarrheal medicine to take if you have diarrhea. {Pediatrics Guide Note - antidiarrheal medications are usually not recommended for children with diarrhea}
- Iodine tablets and water filters to purify water if bottled water is not available. See Do's above for more details about water filters.
- Sunblock, sunglasses, hat.
- Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s).
Adapted from the CDC's Health Information for Travelers to Mexico and Central America, which includes information on traveling to Belize, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Hopefully the information on using condoms and sharing needles won't apply to your children, but it is included for completeness sake.
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