Preparing for Your Trip to Thailand

This information is current as of May 31, 2009

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 combination’s 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.

2009 Measles Update
This information is current as of, May 31, 2009 at 01:40 EDT

Measles remains a common disease in many parts of the world. According to the World Health Organization (WHO), more than 20 million people worldwide are affected by measles each year. Measles outbreaks are common in many areas, including Europe. For many U.S. travelers and expatriates, the risk for exposure to measles can be high, but the illness can be prevented by a measles-containing vaccine.
Current Measles Activity

Since the beginning of 2009, CDC has received reports of several outbreaks of measles worldwide, including?

* An outbreak of measles in the Swiss cantons of Vaud and Lucerne
* Reports of increased numbers of measles cases in Victoria and Queensland, Australia
* An outbreak of measles in Vietnam, including the city of Hanoi

From December 1, 2008, through January 31, 2009, CDC received reports of nine imported cases of measles; six of these cases were imported from the United Kingdom.

Because of the risk of measles in both developed and developing countries, all international travelers should be up-to-date on immunizations, regardless of the travel destination. In addition, U.S. citizens living in other countries (expatriates) should make sure they are vaccinated against measles, especially in areas where outbreaks are occurring, such as the countries listed above.
Recommendations for Travelers and Expatriates

* Be up-to-date on all routine vaccines, including measles (see the child and adolescent vaccination schedule and routine adult vaccination schedule).
* If you are traveling with a child, make sure he or she is up-to-date on all recommended vaccines. Measles-containing vaccine, usually given as the combined measles-mumps-rubella vaccine (MMR), is generally given at 12 months of age in the United States, but is recommended for children as young as 6 months of age who are traveling outside the United States. If your child is older than 6 months of age and is traveling internationally, talk to the doctor about getting the measles vaccine.
* Keep a copy of your immunization records with you as you travel.
* If you are an expatriate, make sure that you are immune to measles. If you are not immune, consider getting a measles-containing vaccine from a reliable local health-care facility.
o U.S. Embassies or Consulates maintain lists of local medical facilities. See the Doctors/Hospitals Abroad webpage for more information.
o The International Society of Travel Medicine (ISTM) has member clinics in many different countries with doctors who can speak English and are familiar with treating expatriates. You can search the ISTM clinic directory for more information.

Information about Measles

Measles is one of the most highly contagious infectious diseases. It is spread by contact with an infected person, through coughing and sneezing. Measles virus can also remain active and contagious for up to 2 hours in the air or on surfaces.

People with measles usually have a rash, high fever, cough, runny nose, and red, watery eyes. Some people who become sick with measles also get an ear infection, diarrhea, or a serious lung infection, such as pneumonia. Many times people with measles are hospitalized. Although it is rare, measles can become severe enough to cause swelling of the brain (encephalitis) and even death. Measles can cause especially severe disease in infants and in people who are malnourished or who have weakened immune systems from a medical condition (such as a result of HIV infection, leukemia, lymphoma, or cancer) or from certain drugs or therapies.
Information about the Vaccine
Vaccines that protect against measles are live-virus vaccines. Currently, the recommended vaccine and the only available vaccine for purchase is the measles/mumps/rubella vaccine (MMR). Since offices may still stock other types of vaccines with reduced components (e.g. measles-rubella), you can ask your provider to ensure that you receive the recommended MMR vaccine and not another vaccine that has fewer components.

Information for Health-Care Providers

It is important to ensure that travelers are immune to measles before they travel internationally.

* Children 6–11 months of age who are traveling outside the United States
o Patients should receive a first dose of measles-containing vaccine. (See above.)
o Remember: Measles or MMR vaccines given before 12 months of age should not be counted as part of the routine series. Children who receive measles or MMR vaccines before age 12 months will need 2 more doses of MMR vaccine, the first of which should be administered at 12–15 months of age (12 months if the child remains in a high-risk area), and the second at least 28 days later.
* Children 12 months or older, Adolescents, and Adults
o People who have received 2 doses of MMR or live measles-containing vaccine are considered immune to measles.
o People are also considered immune to measles if they have had the diagnosis of measles documented by a physician, have laboratory evidence of immunity, or were born before 1957.
o People who cannot be considered immune based on the above criteria should receive MMR vaccine. See the adult vaccination schedule to determine if one or two doses (separated by at least 28 days) are needed.

If a patient has symptoms of a fever, cough, red eyes, runny nose and a red, raised rash and has a history of any recent international travel, measles should be considered in diagnosis.

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.

Outbreak Notice

Update: Dengue, Tropical and Subtropical Regions

This information is current as of, May 31, 2009 at 01:40 EDT

Situation Information

Dengue fever is the most common cause of fever in travelers returning from the Caribbean, Central America, and South Central Asia.1 This disease is caused by four similar viruses (DENV-1, -2, -3, and -4) spread through the bites of infected mosquitoes.

Dengue infections are frequently reported from most tropical countries of the South Pacific, Asia, the Caribbean, the Americas, and Africa. See the Distribution of Dengue maps for areas where cases have been reported in previous years. The following reports demonstrate some recent examples of dengue activity worldwide:

In 2009, several areas of Central and South America have seen rising cases of dengue fever:

Argentina: As of May 19, 2009, the Ministry of Health has reported over 25,000 dengue cases and 5 deaths. The provinces most affected are Catamarca and Chaco.
Bolivia: As of May 20, 2009, over 59,900 suspected cases of dengue have been reported, and 25 deaths from dengue hemorrhagic fever. For additional information, listen to this podcast from the World Health Organization (WHO).
Brazil: Over 226,500 suspected cases of dengue and 87 deaths were reported through April 15, 2009. The state of Bahia has been particularly hard hit, with over 56,000 reported cases.
Mexico: On April 24, 2009 the Secretary of Health for the Mexican state of Sinaloa reported 255 cases of dengue.
Paraguay: As of May 20, 2009, the Ministry of Health has confirmed over 3,000 dengue cases, of which over 1,100 are from the Central department..

Since the beginning of 2009, cases of dengue have been increasing in the Pacific region:

Australia: As of May 5, 2009, Queensland Health reported 993 confirmed cases of dengue fever in the northern part of that state, which is located in northeastern Australia. Additionally, it was reported on March 4, 2009, that an elderly woman in the city of Cairns became the first dengue-associated death from this outbreak.
French Polynesia: As of April 12, 2009, just over 300 cases of dengue have been confirmed on the islands of Tahiti, Tahaa, Bora-Bora, Raiatea, Moorea, Tahaa, and Ua Pou.
Malaysia: As of May 11, 2009, health officials have reported over 19,200 dengue cases and 48 deaths from dengue fever.

In 2009, Saudi Arabia has also been reporting dengue cases in areas popular with travelers, including Jeddah and Mecca.

Dengue is transmitted in regions throughout the tropics and subtropics. Although dengue transmission often occurs in both rural and urban areas, dengue infections are most frequently reported from urban settings. See Dengue Fever from CDC’s Division of Vector-Borne Infectious Diseases and the World Health Organization’s (WHO) Dengue webpage for more information on dengue and updates on worldwide activity.

Symptoms and Treatment

Symptoms of dengue include:

fever
severe headache
pain behind the eyes
joint and muscle pain
rash
nausea/vomiting
hemorrhagic (bleeding) manifestations

Usually dengue fever causes a mild illness, but it can be severe and lead to dengue hemorrhagic fever (DHF), which can be fatal if not treated. People who have had dengue fever before are more at risk of getting DHF./p>

No vaccine is available to prevent dengue, and there is no specific medicine to cure illness caused by dengue. Those who become ill with dengue fever can be given medicine to reduce fever, such as acetaminophen, and may need oral rehydration or intravenous fluids and, in severe cases, treatment to support their blood pressure. Early recognition and treatment of severe dengue with impending blood pressure failure can reduce the risk of death.

If you return from a trip abroad and get sick with a fever, you should seek medical care. Be sure to tell the doctor or other health care provider about your recent travel.

Prevention Measures for Travelers

Travelers can reduce their risk of getting dengue fever by protecting themselves from mosquito bites. The mosquitoes that spread dengue usually bite at dusk and dawn but may bite at any time during the day, especially indoors, in shady areas, or when the weather is cloudy.

Travelers should follow the steps below to protect themselves from mosquito bites:

Where possible, stay in hotels or resorts that are well screened or air conditioned and that take measures to reduce the mosquito population. If the hotel is not well screened, sleep under bed nets to prevent mosquito bites.
When outdoors or in a building that is not well screened, use insect repellent on uncovered skin. If sunscreen is needed, apply before insect repellent.
- Look for a repellent that contains one of the following active ingredients: DEET, picaridin (KBR 3023), Oil of Lemon Eucalyptus/PMD, or IR3535. Always follow the instructions on the label when you use the repellent.
- In general, repellents protect longer against mosquito bites when they have a higher concentration (percentage) of any of these active ingredients. However, concentrations above 50% do not offer a marked increase in protection time. Products with less than 10% of an active ingredient may offer only limited protection, often no longer than 1-2 hours.
- The American Academy of Pediatrics approves of the use of repellents with up to 30% DEET on children over 2 months old.
- Protect babies less than 2 months old 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.
- For more information on the use of insect repellents, visit Insect and Arthropod Protection in the CDC Health Information for International Travel 2008.
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.)

Information for health-care providers

Proper diagnosis of dengue is important, as 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 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: