Couple Wonders Which Vaccinations Are Necessary For Their Trip
DEAR DR. ROACH: My husband and I booked a cruise for March with stops in Singapore; Vietnam; Hong Kong; Taipei, Taiwan; and Japan. We are healthy 67 year-old Nevada residents with no medical problems. I've checked with my personal physician, our travel agent, and several websites, including the Centers for Disease Control and local health care agency websites, for required vaccinations/immunizations. The recommended list is very long. However, I haven't seen anything that is required.
My doctor said we should be fine since we will be staying on a cruise ship with only short-term time on shore. But we are planning to eat locally since my husband is Japanese and can't wait to eat the local food offerings.
Would you recommend that we receive any shots? We want to be safe, yet it seems unwise to schedule everything on the recommended list. Our preference would be to skip anything that is not required. -- D.M.
ANSWER: I hope you have an enjoyable trip. Planning ahead can help ensure a safe vacation that is free from untoward medical events.
Of the vaccines that are recommended for people over 65 in general, I most strongly recommend the flu and COVID vaccines. The pneumonia vaccine is not critically important for the cruise, even though I generally recommend it for healthy people over 65. Cruise ships are notorious for COVID and flu transmission.
Respiratory syncytial virus is another virus that now has a vaccine. It is recommended for people over 60 who have risks for respiratory illnesses such as any chronic heart or lung disease. It's also recommended for anyone over 75. It's not mandatory that you get it, but it's another one to keep in mind.
The other vaccine I'd highly recommend is hepatitis A. It is highly prevalent in South Asia, can commonly be found in food prepared by someone who has the illness, and would ruin your vacation.
DEAR DR. ROACH: I've asked my general physician this question, but he didn't have an answer. I'm a 65-year-old male who takes 1 mg of finasteride daily for hair loss. They did not specify sexual side effects, but I believe that mine may be related to the medicine. I have low to no seminal fluid, but getting an erection is not impaired.
My dad had prostate cancer. My PSA level is unchanged, and my annual blood work is normal. -- Anon.
ANSWER: The most common adverse effects of finasteride are sexual side effects. Low libido, erectile dysfunction, and ejaculatory disorders, especially low volume, are all well-described. At the lower 1-mg dose of finasteride used for hair loss, these side effects are less common than the 5-mg dose used to reduce prostate size, but they can still happen.
According to the manufacturer, 2% to 4% of men will develop the same side effect as you, which goes away after stopping the medicine. Only you can determine whether the improvement in your hair is worth it.
A recent study showed that minoxidil, the active ingredient in Rogaine, was just as effective when given as a low-dose oral tablet as it is when used topically, which may be another option for you.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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