Asia Immunizations
 

My husband and I are going to Thailand, Cambodia, and Laos. I don't think we need immunization for Thailand but do we need shots for Laos and/or Cambodia? And, if so, what would they be for?
Thanks.

You are not required to have any immunizations to visit these countries unless you are coming from a Yellow fever country (in Africa or South America). However, it would be wise for you to make sure your routine vaccines are up to date and that you have appropriate travelers vaccines. You will also want to consider antimalairals.

Read all about it at www.cdc.gov/travel Once you know what the issues are, make an appointment with a good travel medicine doctor. Medical schools typically have such clinics. In some locations, Public Health clinics also offer these services.

Ive never bothered with immunizations. It's an individual thing, ask your doctor for advice. I would be most concerned about Malaria and hepatitis.

http://www.travelsinasia.com

i am always concerned when people say, "i have never bothered with immunizations..."
i guess that guy with TB in atlanta did not "bother" either and now may have infected many people....

we consult a travel clinic prior to all major overseas countries especially "3rd world" types...

It is much more important, IMO to have updated Tetanus and Hepatitis A and B shots than to worry about rare tropical diseases. You can get Hep A anywhere, including the US (people get it from seafood, it’s not really that uncommon, esp in Hawaii and other hot places). On the well-beaten tourist track in SE Asia, your chances of encountering a tropical disease are pretty slim; however an encounter with a rusty bicycle may not be, and the Tetanus shot would be appreciated at that time. Get an update for all the standard childhood diseases, TB being another good one, as that is not uncommon in tropical countries where people live closely together.

Malarias are another issue. You are going to have to use bug spray in any event, as anti-malarias will not protect you against things like Dengue fever, and no anti-malarial is 100% effective. My experience with friends coming over to visit is that they stop taking them once they return home, thereby negating the effectiveness of the drug in the first place. (You have to start before you leave and continue after you get home, most people simply don’t have the discipline to do this.). All drugs also have side effects. Therefore, I would say just use the bug spray. Malarial mosquitoes are most active at sunrise and sunset. At sunrise most tourists are safely ensconced in their air-conditioned hotels, most of which come complete with mosquito coils and bug spray as well. At sunset, use the bug spray, and/or consider long pants and long sleeves (as this is where the little blighters like to bite). If you are camping or will be staying in hotels without air con, then consider using them.

Cicerone, you know I have the utmost respect for your travel recommendations, but I must say that some of your medical information is off-base.

If you read the cdc website, you'll find that their focus is not on "exotic" diseases, but on day to day risks. Yes, they do give info for the traveler spending long periods of time in farming areas that have endemic JE, but their advice for the traveler on the tourist track emphasizes routine vaccines everyone should have (tetanus, MMR) as well as immunizations like Hep A (and B, depending on risk factors) and typhoid (another food and water bourne illness like Hep A). Also, the typhoid vaccine is important because there are antibiotic-resistant strains in SE Asia. TB vaccine has a low effectiveness and is not given in the US. One's risks are low unless one is, say, working in a refugee camp. Some European countries do offer a TB vaccine.

The cdc is clear about the need to prevent mosquito bites as there are a number of illnesses spread by mosquitos, including, as you note, dengue, as well as malaria and JE. I disagree with your stance that because some people do not take their anti-malarials as prescribed one shouldn't bother. It takes only a single bite from an infected mosquito to contract malaria. While it is true that no anti-malarial medication is 100% effective (indeed, no vaccine, no medication is 100% efffective), the recommended anti-malarials are all in the 95-98% effectiveness range. The newest anti-malarial, malarone, requires that one take it for a day before entering the malarial risk area and a week after leaving the area, not an onerous task. The side effect profile of malarone is very low. Most people can take it wihout any significant side efects. It's not the anti-malarial for everyone. Doxycycline is an option that many take, which must be started two days before entering the malarial risk area and continued for a month after leaving the malarial risk area. Larium (which is what it sounds like you are talking about) is typically taken for a number of weeks ahead of the trip to test for side effects as it has the most and the most severe side efects of any of the anti-malarials, and it must be taken for a month after leaving the area. There is Larium-resistant malaria in areas of SE Asia, so many travel professionals will not prescribe it for any of mainland SE Asia.

The decisions about vaccines and antimalarials are serious ones and should be made in consultation with a qualified health care professional, not on the basis of postings (even the postings of well-informed people) on a public forum.

Right now in Thailand there is a outbreak of Dengue fever for which there is no protection against other than repellent spray and wearing long pants and long sleeved shirts to avoid mosquitoes bites.