What vaccine recommendations are advised for a 37-year-old white male with a past medical history (PMH) of obesity class II, Metabolic Associated Steatohepatitis Liver Disease (MASLD), and psoriasis, traveling to Uganda, Kenya, and Tanzania in July?

From the Guidelines

For travel to Uganda, Kenya, and Tanzania in July, I strongly recommend receiving vaccines for hepatitis A, hepatitis B, typhoid, yellow fever, and routine vaccines including MMR, Tdap, influenza, polio, and COVID-19, as these are essential for preventing infectious diseases in these regions. When considering the Japanese Encephalitis (JE) vaccine, according to the recommendations of the Advisory Committee on Immunization Practices 1, it is not necessarily recommended for all travelers to JE-endemic countries, but rather for those with increased risk based on their planned itinerary, such as longer duration of travel, travel during the JE virus transmission season, spending time in rural areas, participating in extensive outdoor activities, and staying in accommodations without air conditioning, screens, or bed nets. Given the traveler's planned destinations and activities, the decision to vaccinate against JE should be individualized, taking into account the risks related to the specific travel itinerary, likelihood of future travel to JE-endemic countries, and the traveler's personal perception and tolerance of risk 1. Some key points to consider for travel to these countries include:

• Receiving all recommended vaccines, including those for yellow fever, which is required for entry
• Taking preventive measures against malaria, such as atovaquone-proguanil (Malarone) 250/100mg daily, starting 1-2 days before travel, continuing throughout the stay, and for 7 days after return
• Practicing careful food and water hygiene to prevent traveler's diarrhea
• Packing insect repellent with DEET (20-30%), wearing long sleeves/pants, and using bed nets to prevent mosquito-borne diseases
• Considering rabies vaccination if planning outdoor activities or wildlife encounters
• Scheduling a pre-travel consultation at least 4-6 weeks before departure to ensure adequate time for vaccines to become effective.

From the Research

Travel Vaccinations and Medications

The individual in question is planning to travel to Uganda, Kenya, and Tanzania in July. Given the destinations, there is a risk of malaria, and therefore, prophylaxis is recommended.

• The Centers for Disease Control and Prevention (CDC) recommend atovaquone-proguanil, doxycycline, or mefloquine for malaria prophylaxis in these regions 2, 3, 4.
• Atovaquone-proguanil is a fixed-dose combination tablet that provides effective prophylaxis of Plasmodium falciparum malaria, including drug-resistant strains 2.
• Mefloquine is also effective but has been associated with neuropsychiatric adverse effects, such as abnormal dreams, anxiety, and depressed mood 3.
• Doxycycline is another option, but it may have gastrointestinal side effects and photosensitivity 4.

Considerations for the Individual

Given the individual's medical history, including obesity class II, MASLD, and psoriasis, it is essential to consider the potential interactions between the antimalarial medications and their current medications.

• Atovaquone-proguanil may be a suitable option, but there is a reported case of acute hepatitis associated with its use 5.
• Mefloquine may not be the best option due to the potential for neuropsychiatric adverse effects, which could be exacerbated by the individual's medical conditions 3.
• Doxycycline may be a viable alternative, but its use should be carefully considered due to the potential for gastrointestinal side effects and photosensitivity 4.

Recommendations

Based on the available evidence, atovaquone-proguanil or doxycycline may be suitable options for malaria prophylaxis in this individual. However, it is crucial to consult with a healthcare professional to determine the best course of treatment, considering the individual's medical history and potential interactions with their current medications.

• The individual should discuss their medical history, including obesity class II, MASLD, and psoriasis, with their healthcare provider to determine the most appropriate antimalarial medication 2, 3, 4.
• The healthcare provider should also consider the potential for drug interactions and adverse effects when selecting an antimalarial medication for this individual.