Expedition Preparation: Vaccines & Medications

I have noticed over the past weeks and months that there is a wealth of online information on certain areas of Himalayan travel. Every blog and every guide service has multiple posts dedicated to gear and training. (I will too very soon!) These are important but only a part of the overall preparation scope.

You know what these sites don't seem to spend time on? The required vaccines and medications. I can only imagine that this is either glossed over or ignored due to their overall lack of shininess. No one wants to include the potential side effects of dexamethasone and whether or not to get the rabies shot in their summit fantasies. And, while I completely understand this impulse, this remains an overlooked but highly critical part of expedition preparation.

Not My Actual Pill Bottles - Too Few

Your required vaccines and medications are a very important topic - no one wants typhoid - requiring a great deal of upfront planning, risk analysis, and significant financial investment. This is top of mind as I will be journeying to get my second of three Hepatitis A/B vaccines this afternoon. We also filled most of our required medications a little over a week ago - the pile is impressive! (not my actual pill bottles)

NOTE: These information is provided to represent my experience alone and not intended as a source of medical advice. Always consult your physician to access your individual medical needs.

There are three primary sources of information in determining what vaccines are required for international travel. The first source to consult is the CDC Travel section. This amazing resource is a great first step in determining your traveler profile, destination, and overall risk profile for disease exposure. A traveler to the rural interior of Brazil will have very different needs from a traveler to the high altitude areas of Nepal. This resource will provide you with a list of Recommended and Optional (Some Travelers) vaccinations for most world destinations and excellent guidance on general travel health considerations.

So Shiny and Pointy

The second resource is your local Travel Physician Clinic and/or a qualified General Practitioner. We are lucky in the Seattle to have access to the Travel Clinic at the University of Washington. Most other major metropolitan areas and/or medical schools should have similar resources. We worked with the University of Washington to schedule a consultation with a Physician experienced in both travel medicine and high altitude preventative and acute care. We were pleasantly surprised to learn that our physician had previously been to over 18,000 ft. and was very versed in AMS related regimens.

The third resource is your guide service. International Mountain Guides maintains a high level list of recommended vaccines and medications within their larger expedition form packet. (see section 5 - Physician's Certificate) Most larger guide services seem to provide similar conversation starting points for physicians. Your guides can also provide you with an excellent resource on their own preparation approaches, client stories, and expedition specific advice.

So, where did all of these bring us you ask? Our final list of vaccines and medications are noted below with a brief description of each. The total cost of these items, over and above our expedition cost, is expected to be $700. Note that this amount does not count the potential rabies vaccination we may also elect to receive. This vaccination, addressing a low risk but very serious and fatal disease, would add an additional $1,300 to the existing $700 total.

I am sharing these here to emphasize the reality of the risks and medical preparation requirement, in practical, financial, and emotional fronts, of a climb over 5,500 meters / 18,000 ft. This is an amazingly serious adventure but also impressively serious business.

• Vaccinations:
• Routine Childhood / Maintenance Vaccines: Polio, MMR, TDap, Flu, etc.
• Hepatitis A & B - Twinrix: The Twinrix hepatitis A / B combination vaccine is administered over a period of one month in three doses. This vaccine is administered in your upper arm. The CDC notes an expected > 98% protection against both types of hepatitis one month after the third dosage. We elected for the accelerated option in the interest of time. Cost: $105 /per Dose - $315 Total

• Medications:
• Azithromycin / Zithromax: Zithromax is a general purpose antibiotic used to combat a range of conditions from respiratory infections to general bacterial gastrointestinal distress. (Ex. travelers diarrhea)
• Ciprofloxacin: This is a much more powerful bacteria fighting antibiotic. This is used only in more serious situations as this drug can have a powerful negative side effect on the strength of tendons.  This is obviously not desired on a highly physical adventure.
• Tinidazole: The intended purpose of this antibiotic is in response to an infection of Giardia or Beaver Fever. Isn't that a fun thought in rural facilities?
• Advair HFA: This is a steroid inhaler intended for the purposes of combating the 'Khumbu Cough' or respiratory irritation, accompanied by cough, brought on by exertion in cold and dry air. 
• Acetazolamide / Diamox: This drug is the first of three in the arsenal against AMS - Acute Mountain Sickness. This condition can start in some individuals at quite low attitudes and can present itself as nausea, headache, disorientation, and/or swelling of the brain and/or heart. This condition can be fatal. Diamox works as a preventative by acidifying the blood, which causes an increase in respiration and arterial oxygenation and thus aids acclimatization.
• Dexamethasone: This is the second of three in the arsenal against AMS. This particular medication is focused on the treatment and stabilization of symptoms of HACE - High Altitude Cerebral Edema. We clearly hope not to need this medication - at all.
• Nifedical: This is the third in the arsenal against AMS. This particular medication is focused on the treatment and stabilization of the symptoms of HAPE - High Altitude Pulmonary Edema. This we also do not want to need - at all.

I hope this was helpful to you. I promise a more fun and lighthearted post for our next visit. In the meantime, happy medication reading!

NOTE: These information is provided to represent my experience alone and not intended as a source of medical advice. Always consult your physician to access your individual medical needs.