for Southeast Asia
By Dr. Mark Wise
There is no doubt, that
these days, Southeast Asia is the magnet for travellers of all ages.
And the price is right! But after watching Forest Gump, or scary TV
documentaries on even newer malaria strains, it is probably worth looking
at the health risks and precautions before jumping on the plane.
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.
higher risk traveller deserves further attention. Typhoid vaccine is
worthwhile as the risk of exposure to contaminated food and water is
significant. 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. 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
© Copyright 2000 Dr. Mark Wise
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.