CDC reccomendations for Travel in this region. Recommended Vaccinations and Preventive Medications The following vaccines may be recommended for your travel to Southeast Asia. Discuss your travel plans and personal health with a health-care provider to determine which vaccines you will need. * Hepatitis A or immune globulin (IG). Transmission of hepatitis A virus can occur through direct person-to-person contact; through exposure to contaminated water, ice, or shellfish harvested in contaminated water; or from fruits, vegetables, or other foods that are eaten uncooked and that were contaminated during harvesting or subsequent handling. * Hepatitis B, especially if you might be exposed to blood or body fluids (for example, health-care workers), have sexual contact with the local population, or be exposed through medical treatment. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants. * Japanese encephalitis, if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis. * Malaria: your risk of malaria may be high in some of the countries in this region. See your health care provider for a prescription antimalarial drug. For details concerning risk and preventive medications, see Malaria Information for Travelers to Southeast Asia. * Rabies, if you might have extensive unprotected outdoor exposure in rural areas, such as might occur during camping, hiking, or bicycling, or engaging in certain occupational activities. * Typhoid, particularly if you are visiting developing countries in this region. Typhoid fever can be contracted through contaminated drinking water or food, or by eating food or drinking beverages that have been handled by a person who is infected. Large outbreaks are most often related to fecal contamination of water supplies or foods sold by street vendors * As needed, booster doses for tetanus-diphtheria and measles and a one-time dose of polio for adults. Required Vaccinations * None. Diseases found in Southeast Asia (risk can vary by country and region within a country; quality of in-country surveillance also varies) Malaria Anopheles freeborni mosquito feeding on a human finger. An Anopheles freeborni mosquito takes a blood meal. Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Your risk of malaria may be high in some of the countries in this region. Travelers to malaria-risk areas, including infants, children, and former residents of Southeast Asia, should take an antimalarial drug. Prevent this serious disease by seeing your health care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below). There is no malaria risk in Singapore and Brunei. For additional information on malaria risk and prevention, see Malaria Information for Travelers to Southeast Asia. Yellow Fever There is no risk for yellow fever in Southeast Asia. A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa. For detailed information, see Comprehensive Yellow Fever Vaccination Requirements. Also, find the nearest authorized U.S. yellow fever vaccine center. Food and Waterborne Diseases Image: Street vendor Avoid buying food or drink from street vendors, because it is relatively easy for such food to become contaminated. Make sure your food and drinking water are safe. Food and waterborne diseases are the primary cause of illness in travelers. Travelers’ diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout Southeast Asia 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). Additional information: see the Safe Food and Water page for a list of links. Other Disease Risks Dengue, filariasis, Japanese encephalitis, and plague are diseases carried by insects that also occur in this region. Protecting yourself against insect bites (see below) will help to prevent these diseases. Avian influenza is also present throughout this region. Polio has resurfaced in Indonesia. Rabies is common in the region and poses a risk to travelers, especially to rural areas. Do not swim in fresh water (except in well-chlorinated swimming pools) in certain areas of Cambodia, Indonesia, Laos, Philippines, and Thailand to avoid infection with schistosomiasis. (For more information, please see Swimming and Recreational Water Precautions.) Leptospirosis, a bacterial infection often contracted through recreational water activities in contaminated water, such as kayaking, is common in tropical areas of this region. An outbreak was reported among expedition travelers in 2000. Other Health Risks Injuries Motor vehicle crashes are a leading cause of injury among travelers. Protect yourself from motor vehicle injuries: avoid drinking and driving; wear your safety belt and place children in age-appropriate restraints in the back seat; follow the local customs and laws regarding pedestrian safety and vehicle speed; obey the rules of the road; and use helmets on bikes, motorcycles, and motor bikes. Avoid boarding an overloaded bus or mini-bus. Where possible, hire a local driver. What You Need To Bring With You * Long-sleeved shirt, long pants, and a hat to wear whenever possible while outside, to prevent illnesses carried by insects (e.g., malaria, Dengue, filariasis, leishmaniasis, and onchocerciasis). * Insect repellent containing DEET * Bed nets treated with permethrin. For use and purchasing information, see Insecticide Treated Bednets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes. * Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes. * Iodine tablets and portable water filters to purify water if bottled water is not available. See Preventing Cryptosporidiosis: A Guide to Water Filters and Bottled Water for more detailed information. * Sunblock, sunglasses, and a hat for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information. * Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s) or letter from your health-care provider on office stationery explaining that the medication has been prescribed for you. * Always carry medications in their original containers, in your carry-on luggage. * Be sure to bring along over-the-counter antidiarrheal medication (e.g., bismuth subsalicylate, loperamide) and an antibiotic prescribed by your doctor to self-treat moderate to severe diarrhea. See suggested over-the-counter medications and first aid items for a travel kit. * New security measures were implemented on August 10, 2006, regarding what passengers may carry onto the airplane. Up-to-date information may be obtained at the Transportation Security Administration’s Guidance For Airline Passengers Fact Sheet and Frequently Asked Questions. Staying Healthy During Your Trip Travelers should take the following precautions To stay healthy, do... * Mother carefully puts insect repellent on her child, being careful of his face. When using repellent on a child, apply it to your own hands and then rub them on your child. Avoid children's eyes and mouth and use it sparingly around their ears. Wash your hands often with soap and water or, if hands are not visibly soiled, use a waterless, alcohol-based hand rub to remove potentially infectious materials from your skin and help prevent disease transmission. * In developing countries, drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink. * Take your malaria prevention medication before, during, and after travel, as directed. (See your health care provider for a prescription.) * To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, even on beaches. * Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases. * Protect yourself from mosquito insect bites: o Wear long-sleeved shirts, long pants, and hats when outdoors. o Use insect repellents that contain DEET (N, N-diethylmethyltoluamide). For more information about insect repellents and correct use, see What You Need to Know about Mosquito Repellent on the CDC West Nile Virus site. o If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones. o If you are visiting friends and relatives in your home country, see additional special information about malaria prevention in Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives on the CDC Malaria site. Do not * Do not eat food purchased from street vendors or food that is not well cooked to reduce risk of infection (i.e., hepatitis A and typhoid fever). * Do not drink beverages with ice. * Avoid dairy products, unless you know they have been pasteurized. * Do not swim in fresh water to avoid exposure to certain water-borne diseases such as schistosomiasis. (For more information, please see Swimming and Recreational Water Precautions.) * Do not handle animals, especially monkeys, dogs, and cats, to avoid bites and serious diseases (including rabies and plague). Consider pre-exposure rabies vaccination if you might have extensive unprotected outdoor exposure in rural areas. For more information, please see Animal-Associated Hazards. * Do not share needles for tattoos, body piercing or injections to prevent infections such as HIV and hepatitis B. * Avoid poultry farms, bird markets, and other places where live poultry is raised or kept. After You Return Home If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history. For More Information For more information about these and other diseases, please check the Diseases page and CDC Health Topics A-Z * Diseases carried by insects o Dengue: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=dengue.htm o Japanese encephalitis: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=jenceph.htm: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=lyme.htm o Malaria information for Travelers to Southeast Asia: http://www.cdc.gov/travel/regionalmalaria/seasia.htm o Malaria Frequently asked questions: http://www.cdc.gov/malaria/faq.htm o Malaria Prescription Drugs: http://www.cdc.gov/travel/malariadrugs.htm: http://www.cdc.gov/ncidod/dvbid/arbor/index.htm o Plague: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=plague.htm: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=yellowfever.htm * Diseases carried in food or water: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=madcow.htm o Cholera: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=cholera.htm o Escherichia coli diarrhea: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/escherichiacoli_g.htm o Hepatitis A: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=hav.htm o Schistosomiasis: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=schisto.htm o Typhoid fever: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=typhoid.htm * Diseases from person-to-person contact o Hepatitis B: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=hbv.htm o HIV/AIDS prevention: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=hivaids.htm o HIV-infected travelers (in The Immunocompromised Traveler): http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=special&obj=hivtrav.htm&cssNav=browseoyb Important: This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. Date: February 23, 2007 Content Source: National Center for Infectious Diseases, Division of Global Migration and Quarantine Topic Contents * Destinations * Vaccinations * Diseases * Insect and Arthropod Protection * Safe Food and Water * Illness and Injury Abroad * Travel Medicine Clinics * Yellow Book * Avian Influenza and Travel * Yellow Fever Vaccination Clinics * References and Resources Information for Specific Groups * Traveling with Children * Cruise Ship and Air Travel * Special Needs Travel * Traveling with Pets Contact Info Travelers' Health Automated Information Line PHONE: 877-FYI-TRIP toll free (Information about ordering the Yellow Book and International Certificates of Vaccination and recorded messages on travel-related health topics) VIA E Remembering Coombesy....always...5/27/06
