Vaccinations and Risks for Southeast Asia Travel
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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