The Philippines is an archipelago consisting of 7100-plus islands located in the western Pacific Ocean. The country brings in foreign travelers for a diverse number of reasons ranging from the cool climate of Baguio in the mountains to the pristine beaches of Boracay; from the ecotourism opportunities to the nightlife of Manila.
As beautiful as the country is, there are some serious infectious disease risks for the international traveler and education and preparation are a necessity to prevent getting seriously ill.
If you are planning to travel to the Philippines, you should see your personal physician, or preferably a travel medicine physician at least 4 weeks prior to departure but preferably 6-8 weeks prior.
When you see the travel medicine specialist, ensure you give this professional, detailed information about your trip including immunization history, any underlying health issues, what areas of the Philippines you plan on visiting and specific activities you will partake. Given this information, your travel medicine specialist will be able to best determine what you’ll need to protect yourself from a plethora of infectious agents.
I will go over some key diseases, activities and preventive measures that can help you before you travel to the Philippines.
Food and Water
Traveler’s diarrhea (TD) is the most common medical issue that people complain of while traveling in less developed countries.
A number of pathogens are associated with TD including bacteria, parasites and viruses. Vaccination can protect against certain infections like hepatitis A and typhoid fever.
Your travel medicine specialist may prescribe prophylactic antibiotics and antidiarrheals for your trip. However, taking prophylactic antibiotics are not recommended for routine use in preventing TD except in certain circumstances (immunocompromised). However, these drugs should be started if significant diarrhea happens.
Less commonly known parasites can be contracted through eating raw or undercooked foods. The roundworm, Capillaria philippinensis can cause severe intestinal problems and even death. You are infected with this parasite through raw and undercooked fish.
The oriental lung fluke, Paragonimus westermani is also seen in the Philippines and people are infected through eating raw or undercooked crabs.
In addition to the use of vaccination and antibiotics, tropical and travel medicine expert Dr. Elaine Jong offers the following ten tips for selecting safe food and water:
1. Drink purified water or bottled carbonated water.
2. Eat foods that are thoroughly cooked, and served piping hot.
3. Eat fruits that have thick skins (they should be peeled at the table by the traveler).
4. Do not use ice cubes in any beverages including alcohol.
5. Only eat or drink dairy products that have been pasteurized.
6. Avoid salads made with raw vegetables, in particular, leafy greens.
7. Avoid shellfish, and raw or undercooked seafood.
8. Do not buy or eat food sold by street vendors.
9. If canned beverages are cooled by submersion in a bucket of ice water or a stream, ensure you dry the outside of the container before drinking.
10. Use purified water for brushing teeth and taking medications.
According the US Centers for Disease Control and Prevention (CDC) the vaccines that are recommended prior to traveling to the Philippines include:
1. Routine vaccines such as measles, mumps and rubella (MMR), diphtheria/pertussis/tetanus (DPT), polio and influenza.
2. Hepatitis A and B
3. Typhoid if you are visiting smaller towns and villages where exposure may occur via food and water.
4. If you are planning to visit rural areas, the Japanese encephalitis vaccine might be recommended.
5. Rabies for travelers who will be involved in outdoor activities like camping or hiking.
Malaria is endemic in Luzon, Mindanao, Mindoro and Palawan in rural areas less than 600m.
Your travel medicine specialist, depending on where you will visit, will recommend prophylactic antimalarials.
The CDC says the following drugs can be used as prophylaxis for malaria in the Philippines: Atovaquone-proguanil, doxycycline, or mefloquine.
The CDC specifically notes that Chloroquine is not an effective antimalarial to take prior to traveling to the Philippines.
In addition, it is strongly advised to buy your antimalarial drugs prior to travel due to counterfeit drugs.
Antimalarials should be used in combination with using insect repellents, sleeping in screened rooms or using bednets. This will not only help in preventing malaria, but also other mosquito-borne diseases found in the Philippines such as dengue fever and lymphatic filariasis.
The website MD Travel Health offers the following recommendations in insect protection:
Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don’t sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.
Swimming, kayaking and other fresh water recreational activities should be avoided due to schistosomiasis. Schistosoma japonicum is still endemic in parts of the Philippines. According to the CDC, because there is no practical way for the traveler to distinguish infested from noninfested water, travelers should be advised to avoid wading, swimming or other contact with freshwater in disease-endemic countries.
In addition to the above risks, there are many others including leptospirosis (waterborne), strongyloides and sexually transmitted infections.