Vaccinations, third world countries, and pregnancy

Patient

Q: I am planning a mission trip for January 2011 to Haiti and I will do a Fetal Embryo transfer in February 2011. Would any vaccines I would need to travel to Haiti or any medications I would need to take put my pregnancy at risk?

Doctor

A:   I understand your concern about your travel near travel to Haiti. As you may already know, some vaccines are recommended as well as prophylaxis medications due to the condition of endemic zone where you are going to travel.
The following vaccines are strongly recommended for workers traveling to areas affected by the recent earthquake:

hepatiis
Polio (one-time booster recommended for any traveler who never received polio vaccine as an adult)
Typhoid (oral or injectable)
Tetanus-diphteria-pertusis (booster recommended if last tetanus shot was 5 years ago or more)
seasonal influenza vaccine
novel H1N1 influenza vaccine ("swine flu" vaccine)
Rabies (requires at least 3 weeks to complete; no benefit from incomplete vaccination; recommended for those who may have contact with dogs, cats, bats, mongooses, or other carnivores)

Also all travelers to earthquake-affected areas should bring along the following:

Malaria prophylaxis ( chloroquine)
A quinolone antibiotic, such as Levaquin or Cipro (unless pregnant or allergic; effective against traveler’s diarrhea, as well as cholera and typhoid)
Loperamide (Imodium) or diphenoxylate (Lomotil) (in case of diarrhea)
Insect Repellent (25-50% DEET for adults)

Of all these medications, since you are having an embryo transfer right after your travel, in the case that you need to take your anti-Malaria medications and they must need to be taken for up to 4 weeks after your return, this might cause problems in your pregnancy. There are no adequate and well-controlled studies evaluating the safety and efficacy of chloroquine in pregnant women. Usage of chloroquine during pregnancy should be avoided except in the suppression or treatment of malaria when in the judgment of the physician the benefit outweighs the potential risk to the fetus. For this reason I would suggest you to consult your physician for another option in malaria prophylaxis or possible re schedule of your travel. Returning form an endemic area and almost immediately having an embryo transfer in my opinion is in some way risky. I wish you the best.

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