How many will get something despite their vaccinations? I predict five out of 100 entrants will contract a performance-limiting microbe during Sabah 2000. One in that five will overcome it and finish.

Of those who take every precaution, my low estimate is one percent to a high estimate of 50 percent will contract some form of sickness; it will most likely come from a food or water microbe.

Microbes in Food and Water
Food and water-borne diseases are the number one cause of illness in travelers. Travelers' diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the region and can contaminate food or water. Infections may cause diarrhea and vomiting (E. coli, salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis). Food and drinking water must be made absolutely safe. Drinking, eating or coming in contact with infected food or liquid raises the risk of disease from zero to 50 percent.

Reducing the Risk
The Center for Disease Control recommends the following vaccines (as appropriate for age): [See your doctor at least four to six weeks before your trip to allow time for the shots to take effect]:

-Hepatitis A or immune globulin (IG).

-Hepatitis B if you might be exposed to blood, have sexual contact with the local population, stay longer than six months in the region, or undergo a medical procedure.

-Japanese encephalitis, only if you plan to visit rural areas for four weeks or more (except under special circumstances, such as a known outbreak of Japanese encephalitis). -Rabies, if you might be exposed to wild or domestic animals through your work or recreation.

-Typhoid vaccination is particularly important because of the presence of 'S. typhi' strains resistant to multiple antibiotics in this region. -Tetanus-diphtheria, a one-time dose of polio for adults, and measles[As needed, booster doses]

-Hepatitis B vaccine is now recommended for all infants and for children aged 11 to 12 years who did not complete the series as infants.

Malaria
The estimated risk of a traveler acquiring malaria varies markedly from area to area. This variability is a function of the intensity of transmission within the various regions and of the itinerary, time and type of travel. From 1980-1993, 3,005 cases of P. falciparum among U.S. civilians were reported to the CDC. From the CDC reports, eight percent malaria risk was acquired in Asia. If a traveler takes malaria medications, the risk factors decrease to 99 percent. Mefloquine, the prefered anti-malaria drug, has few side effects. Doxycycline, when taken as prescribed, can prevent malaria in travelers who cannot or choose not to take mefloquine. Chloroquine and proguanil represents a less effective alternative to mefloquine for travelers (especially in Africa).

Malaysia's remote areas of peninsular Malaysia and Sarawak (NW Borneo) and Sabah (NE Borneo) have malaria risk throughout. The urban and coastal areas are risk-free. If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. Dengue, filariasis, Japanese encephalitis, and plague are diseases carried by insects that also occur in this region.

Other Preventative Measures:
Deet (N,N-diethylmetatoluamide) is a must for the outside.

Permethrin contains repellents that are highly effective as an insecticide/acaricide and as a repellent. Permethrin-treated clothing and camping gear repels and kills ticks, mosquitoes, and other arthropods and retains this effect after repeated laundering. There appears to be little potential for toxicity from permethrin-treated clothing.

"Prevent-event defense" vaccinations include tetanus, diphtheria, typhoid, hepatitis A, hepatitis B, a tuberculin skin test, and rabies, especially for the jungles in Sabah.