Immunizations - Northern Thailand
 

Any recommendations for immunizations for Northern Thailand--trekking, waterfalls, caving, etc.? Especially curious about Japanese encephalitis and rabies.

A link to the UK NHS website http://www.fitfortravel.nhs.uk/desti.../thailand.aspx . It recommends vaccination for JE if visiting rural areas which I guess you are. Rabies is recommended if you will be remote from decent medical facilities where the Vaccines are available. I have had the vaccines and it is important to note that the pre exposure vaccines do NOT protect from the disease, they merely provide more time for you to get to a medical facility and get the vaccine.

www.cdc.gov/travel

JE is recommended only if you are staying in rural areas for 4-6 weeks or more. Rabies is not a recommended vaccine for Thailand. (BTW, there is an excellent facility that specializes in rabies in Bangkok. People get med evac'ed from all of SE Asia to Bangkok for treatment).

The Centers for Disease Control will tell you lots about malaria, too. There is no inoculation or vaccine for the most widespread killer. The disease has a marvellous and terrifying ability to mutate; factors such as urban/rural and altitude are also at play. Be sure you check with authoritative sources for up-to-date information on Thailand.

This is very helpful. I think we will not sleep out, nor be trekking after dusk, in the rural areas and stick with one day trip trek to the Lahu hilltribe, outside of Pai, where our guide is from. We are definitely going with Typhoid and Malaria prevention. Any more thoughts?

go to a travel clinic before you leave home.. some shots do not become effective for a stated period of time, i believe

yes, good thought. thanks!

That's good advice too. Think of malarial prophylactics as you would birth control pills. They have to be taken in a regular cycle that starts before you leave and continues after you have departed the area. There is plenty of speculative information on the Internet, some of it downright harmful, so look for an up-to-date travel clinic and go prepared with what you have read at the CDC or equivalent agency. Thailand has been a hot spot for malaria over many decades, where the disease has continually evolved. Once you are infected, its yours forever and can come back even if you survive the first sickness.

Southam, I fear you are spreading incorrect information.

1. It is not true that once you get malaria you have it forever. Some types of malaria have a liver stage, which must be cleared, so may require two courses of treatment.

2. How long you take the anti-malarial depends on which kind you take. For malarone, you begin the course one day before entering the malarial risk area, and continue for 7 days after leaving the area. For doxycycline, you begin a day before entering the area and continue for four weeks after leaving the area. Larium, an anti-malairal taken weekly is not recommended for this area, as there is resistance. Likewise, chlorquinine resistance has been present in SE Asia for decades. For both doxy and malarone, it is important to take the medication at about the same time each day to keep steady blood levels. One of the active ingredients in Malarone is fat-soluble so it is important to take it with food that contains some fat to be most effective.

3. Most of Thailand is low risk for malaria. Only the border areas with Cambodia, Laos and Burma are considered malarial risk.

All of this information is one the cdc website. The best maps of malarial risk areas are from Fit For Travel. Take a look at the Thailand map here:
http://www.fitfortravel.nhs.uk/desti...laria-map.aspx

Southam - where did you get this information from: <i>"Thailand has been a hot spot for malaria over many decades, where the disease has continually evolved"</i>???

This chart from the CDC http://www.cdc.gov/malaria/travelers...y_table/t.html indicates that travellers in more urban Thai settings are at low risk for malarial infection. It also shows that two of the standard prevention medicines in the later decades of the 20th Century are no longer effective, indicating the evolution of the disease-carrying mosquitos.
As to the disease itself, the CDC consider it the fifth most deadly around the world. The Gates Foundation has made eradication a top priority. Those opinions are enough to keep me wary.
As the disease has evolved, so have treatments and it is good news that a full cure is possible in an increasing number of cases. But it remains sneaky, and vigilance against recurrence seems wise.
I apologize if some feel I exaggerated the dangers in Thailand. I would return to that country any time and for any reason. But I have swatted enough mosquitoes in the centre of Bangkok that I would at least look further into a prophylaxis regimen before I went.

I think it's more than exaggeration, more like misinformation. From the CDC website:

<i>Areas of Thailand with Malaria: Rural, forested areas that border Burma (Myanmar), Cambodia, and Laos. Rural, forested areas in districts of Phang Nga and Phuket. <b>None in the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, Pattaya, Phang Nga, and Phuket. </b>(Updated September 2, 2011) </i>

Southam, thanks for responding to tell us how you came to your conclusions. But you've made some leaps in your reasoning.

Malaria is continually evolving world-wide. In most of the world, including Thailand, chlorquinine-resistance evolved decades ago. Resistance to larium (melfoquine) evolved in SE Asia in Cambodia (it has evolved in other areas of the world as well) Cambodia is also a place where a "new" strain of malaria which had previously been present only in monkeys has made the leap from monkeys to humans. If you wanted to point to a "hotspot" in SE Asia, you would point to Cambodia, not Thailand.

Thailand is one of the countries in mainland SE Asia that has made great strides in reducing malaria. VN has as well. Indeed, most visitors to Thailand need not take anti-malarials.

While the words on the cdc website mean what the map on the nhs website reveals, it sounds worse in words than it does on the map. If you look at the nhs map, you will see that only very small border areas are considered at risk for malaria. virginia will be visiting some of those border areas, so anti-malarial medication is wise.

The mosquitos in Bangkok are very unlikely to be carrying malaria. They are much more likely to be carrying dengue. The the type of mosquito that carries dengue are urban mosquitos (can breed in the water in the bottom of a discarded can) and are active during the day. The type of mosquito that carries malaria are more prevalent in rural areas, where they breed in larger bodies of stagnant water (like rice paddies) and are most active at dawn and dusk.

PS With proper diagnosis and treatment, all strains of malaria are curable.

Malaria is, indeed, a serious illness and should not be taken lightly.

Wow. Thanks all! Yes, going to doc for anti-malaria meds. Spoke with a pharmacist who feels doxycycline is not as effective in Thailand, currently. We will see what the travel doc recommends and I will let you know. Yes, we will be in Mae Hong Son and Soppong, so this is indicated. Will be vigilant with bug spray, too, due to dengue fever and decided not to go with Japanese Encephalitis protection, I think. More info to report soon.

I'm surprised your pharmacists thinks doxy is not as effective in Thailand. There has not been any documented doxy resistance by the malarial parasite world-wide. However, people who take doxycycline are slightly more likely to develop malaria because they are more likely to discontinue the doxy too soon. You must continue taking it for 4 weeks after leaving the risk area.

And, I have taken it before to travel to Honduras (Roatan) with no side-effects, so it will be an important consideration for me.