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Vaccinations and Risks for Southeast Asia Travel

By Dr. Mark Wise

When it comes to vaccinations, the good news is that there are no shots required. But. a few might be recommended, depending upon the nature of your trip. Remember, the middle aged couple doing the Bangkok, Singapore, Hong Kong, Bali eighteen day run with three credit cards in hand has different needs than the trekking, adventurous, impoverished longer term traveller. For couple number one, a routine tetanus-diphtheria-polio booster might suffice. Considering the safety and efficacy of inoculation against hepatitis A, it might also be prudent to offer travellers protection against this viral infection.

Our higher risk traveller deserves further attention. More and more Canadians are being vaccinated against hepatitis B in the schools now. But for those who missed the boat, and are at risk due to the length or the nature of their travel, vaccination is warranted. Typhoid vaccine is worthwhile as the risk of exposure to contaminated food and water is significant. Pre-exposure rabies vaccine is also worth considering in the highest risk travellers. "Don't go near dogs" should rank right up there with "don't drink the water" when it comes to sage advice.

The last vaccine to mention is Japanese encephalitis. This is aimed at the longer term adventurer who prefers rice paddies to Bangkok gridlock, as described above.

Insect-borne infections such as malaria and dengue are of great importance in Southeast Asia, so don't forget the Muskol! Dengue is probably more common in travellers than malaria as it is transmitted by an urban dwelling mosquito to which more tourists are exposed. With dengue, there is no vaccine, and no specific treatment... just one hell of a headache.

While malaria certainly is important in this part of the world, fortunately, it is not usually found in urban areas, nor along most of the coastal and other tourist spots. Therefore, the vast majority of travellers to this area do not require malaria prophylaxis. Those who take day trips into rural areas are at minimal risk as they are usually tucked back into their urban hotel before dusk. For those who venture into the "rural hinterlands" as they are described by CDC, mefloquine prophylaxis is advised. The exception to this recommendation is in Thailand, along the borders with Myanmar and Cambodia, where due to the high degree of mefloquine resistance, daily doxycycline is advised.

One cannot venture to Southeast Asia without being aware of the great risk of sexually transmitted diseases, including HIV. Latex condoms, but preferably abstinence, are recommended.

In counselling the Southeast Asia bound traveller, the need to assess each individual's risk is paramount. Once again, it's not just the destination that determines one's medical needs. It's other factors such as the duration of stay and living conditions abroad that are also important to consider.


©Dr. Mark Wise is the director of The Travel Clinic (TM) in Thornhill, Ontario, Canada and the Medical Director of The Travel Wise (TM) Clinic in Scarborough, Ontario, Canada. He is a family physician with training from the London School of Tropical Medicine in Tropical Diseases. He is a parent himself and often see potential adoptive parents in his clinic. Dr. Wise gives lectures and writes articles on the subject of travel medicine, for both medical and non-medical groups.


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