Ask the Doctor: October 2026 Travel Health Questions, Answered

Every month, our clinical team at Wandr Health answers real questions from travelers planning trips in the weeks ahead. This month: whether 11 days is enough lead time to start malaria pills before a safari, why the CDC puts traveler's diarrhea attack rates at 30% to 70% depending on destination, whether turning 68 lowers your risk of altitude sickness in Cusco, and what actually helps with flight anxiety and seasickness. Alec Freling, MD, co-founder of Wandr Health, answers each question with the same guidance our providers give during a Wandr visit, citing CDC, WHO, NIMH, and State Department data throughout. Start your visit on Wandr to get a plan built around your actual itinerary.

By Alec Freling, MD Last updated: October 1, 2026

These are lightly edited versions of real questions our clinical team fields during Wandr visits and consultations. If you have a question for a future column, you can send it through your Wandr visit.

"I leave for my Kenya safari in 11 days. Did I wait too long to start malaria pills?"

No, and this is one of the most common worries we hear. Some older antimalarials, like mefloquine, need to start two to three weeks before departure, which is exactly where this misconception comes from. Malarone (atovaquone-proguanil) is our clinical team's first choice for exactly this situation: it only needs to start one to two days before you arrive in a malaria-risk area, continue daily through the trip, and finish just seven days after you leave.

The stakes are real enough to take seriously. The World Health Organization estimates 282 million malaria cases and 610,000 malaria deaths across 80 countries in 2024, with the African region carrying roughly 95% of that global burden. Eleven days is plenty of time for our providers to review your itinerary and get Malarone started before you fly. What is not a good plan is waiting until you land to figure it out, or assuming a short trip means you can skip prevention altogether.

"My last trip to Mexico ended with three days of diarrhea in my hotel room. What should I actually pack this time?"

Traveler's diarrhea is the most common illness among international travelers, and the CDC's own Yellow Book puts attack rates at 30% to 70% of travelers over a two-week trip, depending on destination and season. It is also more common in younger adult travelers than older ones, so "I've traveled plenty and never had an issue" is not a reliable predictor either.

Our clinical team's standard kit covers three angles. For the infection itself, azithromycin is our first-line antibiotic, with ciprofloxacin as an alternative when azithromycin is not the right fit. For the cramping that often comes with it, an antispasmodic like dicyclomine helps. And for the nausea that frequently rides along, ondansetron is worth packing regardless of what caused it. Carrying all three before you leave means you are treating on day one instead of losing two or three days of a trip waiting to see a local doctor.

"I'm terrified of my 14-hour flight to Tokyo. Is there something other than a couple of drinks on the plane?"

Fear of flying is more common than most people assume, and it is not something to white-knuckle through with alcohol, which dehydrates you faster at altitude and tends to make anxiety worse once it wears off mid-flight. The National Institute of Mental Health estimates that specific phobias affect about 9.1% of US adults in a given year and 12.5% at some point in a lifetime, and flight-specific anxiety is one of the most frequently reported.

Our clinical team's usual option is hydroxyzine, an antihistamine that also works well for short-term anxiety and sleep support on long-haul flights, without the next-day grogginess some sedatives cause. It is not a sedative in the sleeping-pill sense, so you can combine it with a plan to actually rest instead of just numbing out the fear. If this is a recurring issue for you, our full guide to flight anxiety medication covers dosing timing in more detail.

"We're doing Machu Picchu in November. Do I really need the altitude medication if I'm only 68?"

Yes, and age is not the protective factor people assume it is. The CDC's Yellow Book notes that travelers over 50 have only slightly less risk of acute mountain sickness than younger adults, and fitness level and training do not reduce risk at all. What matters is how fast you ascend and how high you sleep, not your age or how many miles you run at home.

Cusco sits around 3,400 meters (11,150 feet), and the CDC cites altitude illness rates approaching 30% to 40% for destinations that require a fast ascent to that elevation without gradual acclimatization, compared with roughly 25% of visitors sleeping above 2,450 meters in a slower-ascent setting like Colorado. Acetazolamide is our clinical team's standard prevention medication for Cusco and Machu Picchu itineraries, started the day before ascent. Our full altitude sickness guide walks through dosing and the acclimatization-day strategy that pairs well with it.

"I get seasick just thinking about a cruise. Patches or pills?"

Both work, and which one fits depends on your trip. A peer-reviewed study in the Journal of Travel Medicine on cruise ship passengers found that the prevalence of motion sickness approaches 100% in genuinely rough seas, meaning the question for most people is not "will I get seasick" but "how will I manage it when it happens."

Scopolamine comes as a patch that lasts up to 72 hours, which makes it convenient for a multi-day cruise since you are not remembering a daily dose. Meclizine is an oral option that works well for shorter transfers, like a day trip by boat, or for travelers who prefer not to use a patch. Our clinical team can walk through which one fits your itinerary during your Wandr visit, and our full motion sickness guide covers side effects and timing for both.

"I keep putting off calling around for a yellow fever vaccine before my trip to Kenya in January. Where do people even get that anymore?"

This is one of the most common reasons trip prep stalls out. Calling multiple travel clinics to check who has a yellow fever vaccine in stock, then working around their appointment hours, is genuinely a hassle, and the good news is that it only has to happen once. The WHO confirmed in 2016 that a single dose of yellow fever vaccine provides lifelong protection for most travelers, so this is not a vaccine you will need to repeat for future trips.

Our providers book vaccine appointments through Wandr online, without the back-and-forth of calling pharmacies to check availability. Our clinical team recommends getting this done at least 10 days before departure so your certificate is valid at the border when you land in a country that requires it, which Kenya does for most arriving travelers. Our complete yellow fever vaccine guide covers country-by-country requirements if you have more than one stop on your itinerary.

"Is travel insurance actually worth it for a short trip, or am I just paying for something I'll never use?"

This question comes up constantly for shorter trips, and it is a fair one. The US Department of State is direct about the gap standard health insurance leaves: medical evacuation by air ambulance back to the United States can cost anywhere from $20,000 to $200,000 depending on where you are and your condition, and most domestic health plans do not cover that expense at all, regardless of trip length.

A short trip does not reduce your risk of a broken ankle on a hike or a sudden illness that needs treatment beyond what a local clinic can provide. Our clinical team recommends travel insurance through Wandr that specifically includes medical evacuation coverage, not just trip cancellation, for any international trip where you would otherwise be paying that evacuation cost entirely out of pocket. Our guide to when travel insurance is worth it breaks down the specific situations where it matters most.

Medical Disclaimer

This column is for general educational purposes and does not replace individualized medical advice. Every question above reflects a real pattern our clinical team sees, but your specific health history, medications, and itinerary may change what we recommend for you. Our providers review your health profile and travel dates before prescribing anything through a Wandr visit. Visa and immigration requirements are set by the relevant foreign government and the US Department of State; this column does not make visa or immigration determinations, so confirm current entry requirements directly with the embassy of your destination or travel.state.gov before you travel.

Frequently Asked Questions

How many days before travel should I start Malarone? Malarone (atovaquone-proguanil) should start one to two days before you arrive in a malaria-risk area, continue daily through your trip, and finish seven days after you leave, a notably shorter lead time than older antimalarials like mefloquine require.

What percentage of travelers get traveler's diarrhea? The CDC's Yellow Book reports attack rates of 30% to 70% of travelers over a two-week trip, depending on the destination and season, making it the most common travel-related illness.

Does age reduce the risk of altitude sickness? Only slightly. The CDC notes travelers over 50 have marginally less risk than younger adults, but fitness and training do not reduce risk at all. Ascent speed and sleeping altitude matter far more than age.

Is hydroxyzine a sedative for flight anxiety? Hydroxyzine is an antihistamine with anti-anxiety and sleep-support properties rather than a traditional sedative, which is why our clinical team favors it for short-term flight anxiety without the heavier next-day grogginess some sedatives cause.

What's the difference between a scopolamine patch and meclizine for seasickness? A scopolamine patch lasts up to 72 hours, making it convenient for multi-day cruises, while meclizine is an oral option better suited to shorter trips or travelers who prefer not to use a patch.

Do I need a new yellow fever vaccine for every trip? No. The WHO confirmed in 2016 that a single dose provides lifelong protection for most travelers, so this is typically a one-time appointment rather than a recurring one.

How much can a medical evacuation abroad cost without insurance? The US Department of State cites a range of $20,000 to $200,000 for air ambulance evacuation back to the United States, depending on location and medical condition, a cost most standard health insurance plans do not cover.

Can I submit a question for a future Ask the Doctor column? Yes. Questions in this column come from real conversations during Wandr visits and consultations; you can raise a question of your own the next time you start a visit on Wandr.

Sources

• World Health Organization, malaria fact sheet: https://www.who.int/news-room/fact-sheets/detail/malaria
• CDC Yellow Book, Travelers' Diarrhea: https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html
• CDC Yellow Book, High-Elevation Travel & Altitude Illness: https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness
• National Institute of Mental Health, Specific Phobia statistics: https://www.nimh.nih.gov/health/statistics/specific-phobia
• WHO Regional Office for Africa, "A single dose of yellow fever vaccine provides lifelong protection": https://www.afro.who.int/news/single-dose-yellow-fever-vaccine-provides-lifelong-protection
• US Department of State, Medicine and Health guidance for travelers: https://travel.state.gov/en/international-travel/planning/guidance/medicine-health.html
• Journal of Travel Medicine, "Cabin Location and the Likelihood of Motion Sickness in Cruise Ship Passengers": https://academic.oup.com/jtm/article-pdf/7/3/120/5081241/jtm7-0120.pdf

Related Wandr Content

• Malaria Prevention for Travelers: The Complete Guide
• Flight Anxiety Medication: What Actually Helps
• Altitude Sickness: Symptoms, Prevention & Treatment for Travelers
• Yellow Fever Vaccine for Travelers: Country-by-Country Requirements
• Do I Need Travel Insurance? When It's Worth It and When It's Not

Have a travel health question of your own? Start your visit on Wandr, browse the full medication catalog, or book vaccine appointments and travel insurance before your next trip.