Malaria, Diarrhea, Oh My...

If you read our post about RTW travel vaccines, you know that we got our vaccinations at a travel clinic called PassportHealth (Important Reminder: for some vaccines you need to start the process 6 month in advance). However, we also knew it was important to visit our dentist, eye doctor, and primary care physician in advance of our around the world travels. We visited our doctors last year and they suggested that we come back when we get a bit closer to our departure date, so we both scheduled appointments 3 months out. The main topics we wanted to cover were:

  1. Should we get the Japanese Encephalitis and Rabies vaccines?
  2. What anti-malarial drugs should we bring?
  3. What anti-diarrheal drugs should we bring?
  4. Did our doctors have any other recommendations for us?
Japanese Encephalitis & Rabies Vaccinations

These vaccines were “to be determined” after our visit to PassportHealth, in large part due to their very high expense versus the relatively low risk. Both my doctor and Rachel’s doctor agreed that these were not necessary based on our travel and activity plans. 

$$$ Considerations

Our friends in Australia were pretty amazed at how expensive our vaccines were so they inquired with their doctor to find out what the costs would be to get the Japanese Encephalitis vaccine. The price difference is pretty amazing. 

  • United States (Passport Health)
    • $80 consultation fee, plus two doses at $375 per dose = $830 per person
  • Australia (Doctor’s Office)
    • $88 consultation fee, plus one dose at $300 = $388 AUD per person ($297 USD)
    • (Or) $88 consultation fee, plus two doses (different vaccine) at $77 per dose = $242 AUD per person ($187 USD)

If we wanted to, we could simply wait until we get to Australia (the first country on our RTW) and get the Japanese Encephalitis vaccine for 1/3 to 1/4 of the price here in the US. That is crazy! We don’t even want to think about how much we spent on all of the other vaccines. Oh well. 

Anti-Malarial Drugs

There are a TON of different options out there on this topic. Based on our research done on the CDC web site, of the countries we potentially plan to visit anti-malarial drugs are recommended for six of them:

  • VanuatuMost Travelers – Moderate Risk
  • Peru Some Travelers – Moderate Risk
  • VietnamSome Travelers – Low Risk
  • Cambodia Some Travelers – Low Risk
  • Thailand Some Travelers – Low Risk
  • Laos – Some Travelers – Very Low Risk

My doctor recommended taking doxycycline as a prophylactic (preventative) treatment daily starting 1-2 days before arrival and 30 days after departure. It is very low cost and quite commonly used for other purposes. As an example, people are often prescribed doxycycline for severe acne. One negative and common side effect is that it can make you sun sensitive and more susceptible to sunburn. The one HUGE negative would be that we would be on antibiotics for 6+ months. 

Rachel’s doctor recommended not taking a prophylaxis anti-malarial since transmission risk is quite low, especially considering the time of year and regions we plan to visit. Rather, she suggested that we bring Atovaquone/Proguanil (Malarone) with us. Should we start experiencing a fever or feel ill, then begin taking the Malarone. Side effects of are uncommon, although Malarone is relatively expensive. 

Details on these and other malaria drugs are available on the CDC web site at

So what are we going to do?

We are going to bring a supply of both doxycycline and Malarone with us. Prior to entering the countries listed above, we will go to the CDC web site (which is full of great info) to see what the risk levels are for the areas we plan to visit. Based on that information, and whether we are traveling to the countries during peak transmission season, we will then determine whether we will take any preventative anti-malarials. For us, this is a more common sense approach than taking antibiotics for 6 months. 

Bug Spray & Permethrin

Since malaria (as well as yellow fever, Japanese Encephalitis, etc.) is transmitted by mosquitos, we will be consistent users of bug spray during our travels to countries with a malaria risk. In addition, we plan to treat our backpacks, sleeping bag liners, and some of our long-sleeve clothing with permethrin as additional protection. 

Anti-Diarrheal Drugs

Traveler’s diarrhea. Not fun, but something we will likely deal with at some point. 

My doctor recommended the antibiotic Cipro (Ciproflaxin), which is used to treat a variety of bacterial infections and is quite successful in treating traveler’s diarrhea. He mentioned that for many people just one day’s dose is often enough to get rid of the issue. I will point out that he also recommended starting with over-the-counter solutions such as Pepto Bismol or Imodium for mild cases, and holding the Cipro for moderate/severe cases.

Rachel has an allergic reaction to Cipro so that is not an option for her. Fortunately, Azithromycin (Zithromax, Z-Pack) is another good solution, as recommended by her doctor. An added benefit is that Azithromycin is often used to treat lung and respiratory infections. Having this with us won’t be a bad thing. 

With this in mind, we will be bringing a supply of Cipro and Azithromycin with us. 

Any Other Recommendations?

As I mentioned, my doctor recommended bringing some over-the-counter Pepto Bismol or Imodium. We both mentioned that we plan to bring small medical kits with us with basics like those items, aspirin, bandaids, etc., and they thought that was a good idea. Other than that, they didn’t have any additional suggestions. 

We do understand that in many countries we will have easy access to these medications. However, we do want to have a supply with us in case they are needed.

Do you have any thoughts to share about hitting the life reset button? Please post below or contact us directly!


Todd · April 12, 2018 at 6:56 am

Gday guys. Wow that is quite a difference in US vs Aussie pricing! Definitely take your anti diarrhoea! We think Doxy is best for malaria as we know a large number of people who got terrible dreams and skin sensitivity after taking Larium. Oh and Chantelle also contracted malaria while taking Larium, soooooo…….

The count down is on now hey?! Woohoo!!

    Peter · April 12, 2018 at 7:33 pm

    Hey guys! We think we may go ahead and get the Japanese Encephalitis vaccine while in Australia. You’re right, the price difference is shocking! Where did Chantelle contract malaria? Hope the recovery was ok!!

    We’re counting down the weeks, days, house, etc.! Barely maintaining our sanity!

      Todd · April 13, 2018 at 4:54 am

      She managed to pick up a particularly nasty gastric strain of malaria while we were in Malawi. Luckily our hosts knew what it was otherwise we may have not gotten to hospital as quick! Lesson learnt. When travelling in foreign lands, as soon as you feel sick and know it isn’t food poisoning, get to a hospital!

        Peter · April 13, 2018 at 6:43 am

        Glad it worked out!!

Pam · September 8, 2018 at 12:05 pm

Great post! Rachel, how did you learn that you’re allergic to Cipro?

    Rachel · September 15, 2018 at 5:51 am

    Hi Pam! I was prescribed Cipro for something several years ago (can’t remember what) and broke out in a pretty bad rash as a result! Glad it was then and not on the road!

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