Preparing for Your Trip to Thailand

This information is current as of May 15, 2008

Before visiting Thailand, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.)To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it.

Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling.CDC recommends that you see a health-care provider who specializes in Travel Medicine. Find a travel medicine clinic near you. If you have a medical condition, you should also share your travel plans with any doctors you are currently seeing for other medical reasons.If your travel plans will take you to more than one country during a single trip, be sure to let your health-care provider know so that you can receive the appropriate vaccinations and information for all of your destinations. Long-term travelers, such as those who plan to work or study abroad, may also need additional vaccinations as required by their employer or school.

Although yellow fever is not a disease risk in Thailand, the government requires travelers arriving from countries where yellow fever is present to present proof of yellow fever vaccination. If you will be traveling to one of these countries where yellow fever is present before arriving in Thailand, this requirement must be taken into consideration.

Be sure your routine vaccinations are up-to-date. Check the links below to see which vaccinations adults and children should get.

Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule.

Routine vaccines are recommended even if you do not travel. Although childhood diseases, such as measles, rarely occur in the United States, they are still common in many parts of the world. A traveler who is not vaccinated would be at risk for infection.
Vaccine-Preventable Diseases:

Vaccination or Disease Recommendations or Requirements for Vaccine-Preventable Diseases
Routine Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, etc.
Hepatitis A or immune globulin (IG) Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus infection (see map) where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with “standard” tourist itineraries, accommodations, and food consumption behaviors.
Hepatitis B Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map) and who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment, such as for an accident, and for all adults requesting protection from HBV infection.
Typhoid Recommended for all unvaccinated people traveling to or working in Southeast Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water.

Rabies Recommended for travelers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, hiking, or work. Also, children are considered at higher risk because they tend to play with animals and may not report bites.

Japanese encephalitis Recommended if you plan to visit rural farming areas and under special circumstances, such as a known outbreak of Japanese encephalitis, see country-specific information.
Polio Recommended for adult travelers who have received a primary series with either inactivated poliovirus vaccine (IPV) or oral polio vaccine (OPV). They should receive another dose of IPV before departure.

Malaria

Drugs to Prevent Malaria (Antimalarial drugs)

If you will be visiting a malaria risk area in Thailand, you will need to take one of the following antimalarial drugs: atovaquone/proguanil or doxycycline (see map).

Malaria risk area in Thailand: Risk in rural areas that border Cambodia, Laos, and Myanmar (Burma). Very limited risk in Phang Nga and Phuket therefore prophylaxis is not recommended for these two areas. No risk in cities and in major tourist resorts. No risk in Bangkok, Chiang Main, Chiang Rai, Pattaya, Ko Samui, and Ko Phangan. (Updated September 19, 2007)

A Special Note about Antimalarial Drugs

You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

For detailed information about these antimalarial drugs, see Information for the Public: Prescription Drugs for Malaria.
More Information About Malaria

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. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).

Travelers to malaria risk-areas in Thailand, including infants, children, and former residents of Thailand, should take one of the following antimalarial drugs listed above.
Symptoms

Malaria symptoms may include:

• fever
• chills
• sweats
• headache
• body aches
• nausea and vomiting
• fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip.

Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
Items to Bring With You

Medicines you may need:

• The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the medicines are liquids.
• Antimalarial drugs, if traveling to a malaria-risk area in Thailand and prescribed by your doctor.
• Medicine for diarrhea, usually over-the-counter.

Note: Some drugs available by prescription in the US are illegal in other countries. Check the US Department of State Consular Information Sheets for the country(s) you intend to visit or the embassy or consulate for that country(s). If your medication is not allowed in the country you will be visiting, ask your health-care provider to write a letter on office stationery stating the medication has been prescribed for you.

Other items you may need:

• 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 and Safe Food and Water for more detailed information.
• Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Skin Cancer Questions and Answers for more information.
• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
• To prevent insect/mosquito bites, bring:
• Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
• Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
• Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

See other suggested over-the-counter medications and first aid items for a travelers’ health kit.

Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.

Other Diseases Found in Southeast Asia
Risk can vary between countries within this region and also within a country; the quality of in-country surveillance also varies.

The following are disease risks that might affect travelers; this is not a complete list of diseases that can be present. Environmental conditions may also change, and up to date information about risk by regions within a country may also not always be available.

Dengue, chikungunya, 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.

Highly pathogenic avian influenza (H5N1) continues to cause outbreaks in domestic and wild bird populations and has caused human cases in several countries in Southeast Asia. In 2006, the virus continued to spread in poultry populations in Indonesia. Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds, and avoid places such as poultry farms and bird markets where live birds are raised or kept. For a current list of countries reporting outbreaks of H5N1 among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE), and for total numbers of confirmed human cases of H5N1 virus by country see the World Health Organization (WHO) Avian Influenza website.

Do not swim in fresh water (except in well-chlorinated swimming pools) to avoid infection with schistosomiasis. Leptospirosis, a bacterial infection often contracted through recreational water activities in contaminated water, such as kayaking, is common in tropical areas of Southeast Asia. (For more information, please see Swimming and Recreational Water Safety.) An outbreak was reported in Borneo among expedition travelers in 2000.

Measles transmission persists in the region, although vaccination coverage is improving in some countries in Southeast Asia. Influenza infections can occur throughout the year in tropical areas.

Polio resurfaced in Indonesia in 2005. Imported cases in neighboring countries have occasionally occurred.

For more information, see the Geographic Distribution of Potential Health Hazards to Travelers and Goals and Limitations in determining actual disease risks by destination.
Staying Healthy During Your Trip

Prevent insect bites

• Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:
• Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
• Wearing long-sleeved shirts, long pants, and a hat outdoors.
• Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
• Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
• Spraying rooms with products effective against flying insects, such as those containing pyrethroid.

For detailed information about insect repellent use, see Insect and Arthropod Protection.

Be Careful about Food and Water

• Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:
• Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
• 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.
• Do not eat food purchased from street vendors.
• Make sure food is fully cooked.
• Avoid dairy products, unless you know they have been pasteurized.

Diseases from food and water often cause vomiting and diarrhea. Make sure to bring diarrhea medicine with you so that you can treat mild cases yourself.
Avoid Injuries

Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:

• Not drinking and driving.
• Wearing your seat belt and using car seats or booster seats in the backseat for children.
• Following local traffic laws.
• Wearing helmets when you ride bikes, motorcycles, and motor bikes.
• Not getting on an overloaded bus or mini-bus.
• Hiring a local driver, when possible.
• Avoiding night driving.

Other Health Tips

• To avoid animal bites and serious diseases (including rabies and plague) do not handle or pet animals, especially dogs and cats, If you are bitten or scratched, wash the wound immediately with soap and water and seek medical attention to determine if mediation or anti-rabies vaccine is needed.
• To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections.
• To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms.
• To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, especially on beaches where animals may have defecated.

Dengue fever is a common disease caused by a virus that humans get by being bitten by infected mosquitoes (usually Aedes aegypti); it is the most common cause of fever in travelers returned from the Caribbean, Central America, and South Central Asia.¹
Symptoms of dengue include fever, severe headache, pain behind the eye
(retro-orbital eye pain), joint and muscle pain, and rash. Sometimes
dengue fever is a mild illness, but it can be severe and even cause
dengue hemorrhagic (bleeding) fever (DHF) which can be fatal if not
treated. People who have had dengue fever before are more at risk of
getting DHF. Travelers are at risk for getting dengue fever if they
travel to or live in areas where dengue virus is present. Travelers can
take steps (see below) to reduce their risk of getting sick.

Dengue Risk Areas

The
range of areas where dengue virus is located has rapidly grown in
recent years. Today it includes many tropical countries in Southeast
Asia, the Indian Subcontinent, the South Pacific, the Caribbean, South
and Central America, northeastern Australia, and Africa. See the Distribution of dengue maps
for areas where cases have been reported in previous years. Risk of
getting sick with dengue is related to mosquito bites, which can vary
with the season. The mosquitoes that transmit dengue often breed in
man-made and natural containers, which are especially common in and
around houses; therefore, dengue is common where many houses are
clustered.

Many countries reported high numbers of dengue
infections during 2007. This trend has continued in 2008, notably with
the large outbreak currently being reported in Brazil. As of March 28,
2008, a national total of 120,570 cases of dengue fever, including 647
DHF cases and 48 deaths have been reported by Brazilian Health
Authorities.²
As of April 10, 2008, a total of 75,399 cases of dengue fever,
including 80 confirmed deaths have been reported in Rio de Janeiro this
year.³ In a statement
posted on their website on March 19, 2008, the Brazil Ministry of
Health announced the creation of a crisis office to handle the
outbreak, with support from the state government and the Armed Forces.
There is particular concern about this current outbreak in Brazil and
travelers to Brazil should take extra precautions. In addition, this
outbreak highlights the importance of taking appropriate steps to
prevent dengue fever when traveling to all dengue risk areas.

Prevention Measures for Travelers

• No vaccine is available to prevent dengue, and there is no specific medicine to cure people who are sick with dengue. Those who become ill with dengue fever can be offered medications (acetaminophen) to reduce fever and may require oral rehydration or intravenous fluids and insevere cases, treatment to support their blood pressure.
• Travelers can reduce their risk of getting dengue fever by protecting themselves from mosquito bites. Aedes mosquitoes, the main type of mosquito that spreads dengue, usually are active at dusk and dawn, but may feed at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.

Unlike malaria, dengue is often transmitted in urban as well as in rural areas. Recommendations for preventing mosquito bites include:

• Use insect repellent on uncovered skin surfaces when outdoors, especially during the day. When using sunscreen, apply it before insect repellent.
• Repellents containing 30% to 50% DEET (N,N-diethyl-m-toluamide) are recommended for adults and children over 2 months of age and effective for several hours. Repellents with lower amounts of DEET offer shorter-term protection and must be applied more often.
• Repellents containing up to 15% picaridin, which must be applied often, are available in the US. Repellents with higher concentrations of picaridin may be available in some regions outside the US.
• infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. For more information about the use of repellent on infants and children, please see the “Insect and Other Arthropod Protection” section in Traveling Safely with Infants and Children and the “Children” section of CDC’s Frequently Asked Questions about Repellent Use.

Protect

• Wear loose, long-sleeved shirts and long pants when outdoors.
• Clothing may also be sprayed with repellent containing permethrin or another EPA-registered repellent for greater protection. (Remember: don’t use permethrin on skin.)

Where possible, stay in hotels or resorts that are well screened or air conditioned and take measures
to reduce the mosquito population.

Additional Information

Proper
diagnosis of dengue is important; many other diseases may mimic dengue.
Health-care providers should consider dengue, malaria, and (in South
Asia and countries bordering the Indian Ocean) chikungunya in the
differential diagnosis of patients who have fever and a history of
travel to tropical areas during the 2 weeks before symptom onset. See Dengue and Dengue Hemorrhagic Fever: Information for Health-Care Practitioners
for information regarding reporting dengue cases and instructions for
specimen shipping. Serum samples obtained for viral identification and
serologic diagnosis can be sent through state or territorial health
departments to CDC’s Dengue Branch, Division of Vector-Borne Infectious
Diseases, National Center for Zoonotic, Vector-Borne and Enteric
Diseases, 1324 Calle Cañada, San Juan, Puerto Rico 00920-3860;
telephone, 787-706-2399; fax, 787-706-2496.

For more information about dengue and protection measures, see the following links:

• Dengue Fever in CDC Health Information for International Travel 2008
• Insect and Arthropod Protection
• Questions and Answers: Insect Repellent Use and Safety
• Overview of Dengue from CDC Division of Vector-Borne Infectious Diseases

For more information about dengue in travelers, see

• Travel-Associated Dengue—United States, 2005 [MMWR 2006, 55 (25)].
• Travel-Associated Dengue Infections—United States, 2001-2004 [MMWR 2005, 54 (22)]