Recommendations for Travelers going on Cruise ships 2002-3
Winter We recommend that travelers take precautions for two environments- the cruise itself as well as the itinerant countries.
For cruises we first recommend medical insurance as well as evacuation insurance. People with Health concerns should be stabilized before they travel and see their family doctor or a physician specializing in travel medicine.
For cruises we recommend the following vaccines:
Tenaus Diphtheria (Td) should be up to date and given every 10 yrs. Polio (IPV) This may also be combined with Td (Td-polio) or separate (IPV), and should be given every 10 yrs for travelers traveling outside North America. Because of the recent cases of Polio disease in the Dominican Republic all travelers are strongly recommended to consider polio vaccination boosters.
Hepatitis A vaccine is also strongly recommended. Hepatitis A is acquired from contaminated food or water and can make people very sick. The vaccine gives protection for 12 months. A second dose, which must be given no sooner than 6 months, will boost this protection to at least 10-20 yrs.
Hepatitis B is a different virus also causing hepatitis although it is acquired through blood and body fluids. It is more common, easier to catch and kills more people than HIV. Risk factors for Hepatitis B include: contact with bodily fluids, unclean needles, unprotected sex (although even condoms do not reduce the risk to zero), iv drugs, and blood transfusions. People who will be staying longer than 6 months in countries where Hepatitis B is very high are also recommended to have this vaccine. Hepatitis B should be given in 2 full doses one month apart with a booster dose after 6 months.
All the different brands of Hepatitis A and B are equally effective. Some people prefer the pre mixed vaccine of Twinrex but if they use this one they must receive 2 full doses to be adequately protected against either Hep A or B. Typhoid is a bacterial infection from contaminated food and water and should be considered for short stays and especially for extended or off the beaten path travels.
Two types of vaccines are used:
1) Injectable Typhoid (Typherix or Typhim Vi) is good for 3 years.
2) Oral typhoid (Ty21a) is 4-vaccine capsules, which are taken on days 0,2,4, and 6. Antibiotics and alcohol interfere with the vaccine. This vaccine gives 7 years of coverage.
Influenza (the flu shot) is highly recommended as outbreaks often occur aboard ships.

People should also have a supply of their own medications, as it may be expensive to replace them. Always keep them in their original packaging or labeling. Passengers may wish to bring their own first aid kit, as the infirmary is usually expensive. A simple first aid kit would include: Band-Aids, Tylenol or aspirin, gravol (or other antinauseant for sea sickness) and sunscreen. For people with significant illnesses they should bring with them a letter from their doctor with a copy of their most recent EKG.

Most countries on cruises will have little additional risks. We encourage people to carefully check their lists of ports and call us to determine if they need anything else. On some cruises there may be exposure to dengue and yellow fever.
Dengue fever is a viral illness transmitted by daytime biting mosquitoes. At present there is no good vaccination or treatment. Many parts of Mexico may have dengue. We recommend that you check if the area you are going to has dengue and take appropriate precautions. We recommend good clothing (light loose fitting and covering the limbs), DEET 30% applied to exposed skin, and Permethrin insecticide applied to clothing. Permethrin kills insects on contact but is safe for people. Yellow fever is caused by a different daytime biting mosquito and some countries demand that travelers entering their country be already vaccinated against this.
Malaria is a severe parasite transmitted by night biting mosquitoes. Most cruises have day time excursions so there is no list of malaria but if the ship is close to shore in heavily infested areas it may be recommended to take anti malarial. If you will be exposed to malaria we strongly recommend appropriate anti malarial medication, which needs to be prescribed before your trip. It is necessary to take anti malarials before exposure. Medication does NOT PREVENT malaria but prevents severe life threatening malaria from happening. We urge anyone who has traveled to a malarious area in the past year to SERIOUSLY CONSIDER THE POSSIBILITY OF MALIA IN THEMSELVES. THIS IS REGARDLESS OF WHETHER THEY TOOK ANTI MALARIALS OR NOT. We do not treat malaria in our clinic but can make rapid assessments if there is a concern
Other STDs like HIV, gonorrhea, and chlamydia are present and travelers should use the same precautions as they do at home.
Traveler's Diarrhea is diarrhea caused during travel by exposure to bacteria, viruses and parasites, although traveler's diarrhea is usually referred to the development of extreme symptoms following a bacteria infection. We recommend of course that people be careful what they eat but traveler's diarrhea also even happens to those who are careful since they may be infected through another's careless preparation of food. Pepto-Bismol and Imodium may be taken for mild symptoms. We prescribe antibiotics to take at the early stages of traveler's diarrhea. We aim to prevent the loss of fluids and body salts, which will make one very sick in a tropical environment. Travelers having diarrhea starting after their trip may have an intestinal parasite. If you suspect that you may have a parasite check with our clinic.

Last Updated Dec first 2002