This article is a repeat article I wrote last year. I thought it is best to reiterate this now that school holidays is about to start and it is also the tourist season.

Before we left Vancouver, we had all our recommended vaccinations through the local clinic, and one through a specialized clinic. The yellow fever requires a certificate to be issued, hence only qualified clinics can do this. We were certain which countries we will be passing through, but in sailing, you never know. So we had the yellow fever vaccination done, just in case. In hindsight, this wasn't required after all. Some vaccinations were already given when we were born, and some during our childhood days. I would advise that you check with your doctor, especially if you have other illnesses, i.e. diabetes, HIV.

Here in the Philippines, we highly recommend vaccinations against Hepatitis A and B if you haven't already done so. Hepatitis is a viral disease that attacks your liver.  Hepatitis A is infectious via contaminated food or drinking water, and hepatitis B through exposure to infectious blood or body fluids containing blood.  We were given the vaccine combined for both A and B when we left, and another one was required months after as a booster. If you had this booster, then you are good for life, we were told.

Not knowing what to expect, it was scary to read about some of the diseases. Some, I've never even heard of. For example, Japanese encephalitis. This is a a disease caused by the mosquito-borne Japanese encephalitis virus, domestic pigs and wild birds are reservoirs of the virus, and it is prevalent in Southeast Asia and the Far East. I've lived here and I've never even heard of this. Apparently, the virus is closely related to the West Nile virus or the St, Louis encephalitis. The good news is that there is a vaccine for this, and it does not usually occur in urban areas.

Unfortunately, there are mosquito-borne diseases that do not have vaccines for, such as malaria and dengue fever. Even though there are prophylactic medications for malaria, one cannot be sure if they are effective, and in most cases, there are side effects to taking them. We have chosen not to take any, instead we increased our protection from mosquito bites - i.e. strong deet repellents and screening all our hatches. Malaria is prevalent in rural areas, and I am not too worried here.  However, in Solomon Islands and in Papua New Guinea, we were, as malaria is endemic everywhere. We did go to the pharmacy to get a locally made (probably home-made) medication in case the parasite was already in our blood system before we left. We don't have anti-malarial drugs onboard, and we were told that this locally made medication is effective and given by the local hospitals there. Fortunately, we were not infected.

As for dengue, I DO worry about it here. Dengue fever is no laughing matter and it can kill. Unlike malaria, dengue is often found in urban areas. It is transmitted by the Aedes Aegypti mosquitoes which is a day-biting type of mosquito. The mosquito has longer legs and can be recognized by white markings on its legs. Not all of them carry dengue, of course, but if there are dengue victims around, then the chances increase that the mosquitoes that bit them are around in the area. Dengue is also known as breakbone fever because it is manifested by sudden onset of severe headache, muscle and joint pains, fever and rash. Mild cases with no rashes will appear as flu-like symptoms. The severe cases will include hemorrhaging, bruising, low platelet and white blood cell count, severe dizziness, all the way to dengue shock syndrome. This is a very painful fever, and if you suspect dengue, head immediately to the hospital. Day 2 to 7 is very critical, and you may need IVs and platelet transfusion if the count goes too low or if there is significant bleeding. DO NOT take aspirin or non-steroidal anti-inflammatory drugs as they will worsen the bleeding tendency associated with this fever. Here in the Philippines, the locals use the weed called tawa-tawa. You can google this word and find out more. I have heard it is very effective, and even the local government hospitals are giving it to the patients. There is no known medication for dengue, only pain relievers to ease the symptoms.

To prevent being bitten by mosquitoes, it is best to get rid of stagnant water around your area, protect yourself by using repellents, especially in grassy areas (broadleaf grass) where they like to breed, burn mosquito coils and use mosquito screens. I have sprayed our screens with pyrmethrin, and supposedly this is good for at least 6 months. As mentioned before, other cruisers we know have taken Vitamin B1 pills to prevent mosquito bites. Others just drink a lot of beer!

In the tropics, one must always be wary of bacteria, i.e ecoli, the strep and staph bacteria. Then there is amoeba. Always cook your food well, treat your water and cover all wounds. We carry hydrogen peroxide onboard and wash all cuts and wounds with it. We also have iodine for this. Since we do not have a water maker, we collect rainwater and this is safe. If there is no rain, then we are forced to jerry jug water from shore which we always treat before transferring into our tanks. We have 2 separate tanks, so if one is accidentally contaminated, we still have the other one to use. Open wounds should be covered. The flies must have super power sensory antenna because they quickly zoom into the wound, and they carry all sorts of bacteria, i.e. ecoli. Several cruisers were stuck in Vanuatu due to infections - and all of them were because they did not protect and cover their wounds. Cellulities is also one thing to watch out for. It is caused by the strep or staph bacteria that enters into the blood stream through even the tiniest skin opening. Kjartan got this while we were cruising through the Cook Islands. We suspect he got it from scraping the corals in Bora Bora while diving to release the anchor chain from the bommies.

Last that I should also mention, is ciguatera poisoning. Ciguatera is a foodborne poisoning caused by eating tropical marine fish contaminated with the toxin, ciguatoxin. Since the toxin accumulates, the predators in the top of the food chain, such as barracudas, parrotfishes, groupers and amberjacks, are those that are likely to cause this poisoning. The effects and symptoms include nausea, vomiting and diarrhea, headaches, muscle aches, numbness, hallucinations. It is often misdiagnosed by doctors not familiar to tropical diseases as multiple sclerosis. So, this is not to be taken lightly as well. We avoid catching and eating reef fish, especially the barracuda. Locals generally know if the fish in their area is contaminated. French Polynesia for some reason has a high alert for this. Here in Davao, I've never heard of this case.

Nowadays, it seems like it is the era of the "Superbugs". It is scary to hear that the "superbug" is triple / quadruple resistant to antibiotics. I don't mean to scare anyone here. If one is prudent, stays healthy, takes necessary precautions and is prepared, there is really nothing to worry about.