Disclaimer: I am not a medical professional (though I have seen almost every episode of ER, and I almost always win at ‘Operation’). My opinions come from my own travel experience, talking to other travelers and expats, and asking the locals. I’m not qualified to be giving medical advice, but I will give you a realistic, unbiased overview of vaccines and antibiotics without any hidden agenda. Take it or leave it, here’s my advice on what vaccines you need for traveling throughout Southeast Asia.
You’ll probably read all about vaccines, anti-malaria pills, and rabies shots for travel in South East Asia, and you’ll probably hear from your doctor that you should be fully inoculated before you leave for your travels. More than likely, you’ll have to go to a special travel clinic to get your shots and antibiotics, and you’ll have to pay a pretty penny. On average, it seems like the general fee for getting the basic recommended vaccines (not counting all of the fancy ones!) is around $1,000 US that you pay out of pocket (I’m not sure if some countries subsidize this cost via national health plans).
I would argue that many travel clinics scare you into getting shots you don’t really need, just so they can bill you for them. They present the dangers as being more imminent than they really are (just because you technically can get Japanese encephalitis in Cambodia, doesn’t mean that you will!).
The problem with going by the advice of General MP’s or family doctors, is that they usually aren’t experts in travel medicine and infectious diseases. They also have to cover their own asses, so that they aren’t liable down the road when you come home with a bad case of Typhoid and want to sue. They’ll generally recommend whatever the travel clinic recommends. Or, they’ll simply refer to the guidelines set out by the Centre of Disease Control and Prevention (CDC). The CDC is equally responsible for covering their own ass, so they’ll describe ALL of the potential health risks associated with travel to a particular country. They also subscribe to the ‘better safe than sorry’ approach, and advise travelers to get vaccinated even when there’s a very low chance of getting sick.
For the record, the number of vaccines I got in preparation for my travels is: zero. The number of times I’ve gotten sick on my travels is: once (food poisoning, but that’s to be expected). I already had my Hep B and Polio shots from when I was a kid, and I had recently gotten a tetanus shot when I had an accident and needed stitches. The fact that we were short on time made up our minds for us, but even with the option of getting inoculated now that we’re in Thailand, I’m choosing to go vaccine-free.
It comes down to a personal choice, and what you feel comfortable with. If you have the time, money, and can physically withstand all of the vaccinations and antibiotics, then go for it. But, if you’re a bit confused on the whole topic and aren’t sure which vaccines are ‘nice to have’ and which are ‘you’d be stupid not to get this’, then here’s my unbiased, non-medical opinion.
Here is an overview of the most common vaccines that travel clinics and doctors will try to recommend
[Note: Prices quoted are based on prices in Toronto, Canada. They will vary depending on your location]
DETAILED SUMMARY OF VACCINES
Recommendation: Skip if you don’t already have it and are short on time. If you have time, it’s a good vaccine to get in general (outside of traveling).
Timing: 3 shots over 7 months: You have to wait 1 month before getting your second shot, and then 6 months before getting your last shot.
Risks: Spread only via bodily fluids; high percentage of carriers throughout SE Asia. Symptoms can include abdominal pain, fatigue, lethargy, fever, etc.
Price: $180 for all three shots.
In Canada, Hep B vaccines are mandatory when you’re in middle school, so I already have mine, and it seems like most folks do as well. I’d file this one under ‘good to have’ in general, not just if you’re traveling. But if you don’t already have one, I wouldn’t bother getting it just for your trip. Hep B is only spread through bodily fluids, so if you use and share needles, or are looking to have unprotected sex while you’re here, then definitely consider getting the shot.
Timing: 2 shots, 6 months apart
Risks: Spread through contaminated foods and improper hygiene when preparing food. Some people have no symptoms at all, some people have typical food poisoning symptoms (fatigue, nausea, vomiting, etc.), and in very rare cases people can suffer permanent liver damage.
Price: $120 for both shots.
It’s a no-brainer that you shouldn’t be drinking tap water in most parts of Southeast Asia (if you aren’t sure about water cleanliness, err on the side of caution and buy bottled water). Prevention when it comes to food is difficult, because you’re just as likely to get sick from a 5 star restaurant as you are a night market vendor. For the record, I had severe food poisoning from an innocuous looking chicken pizza from a nice hotel restaurant in Koh Lanta, but I’ve eaten some pretty sketchy food stall meals and not had any problems. In the majority of cases, Hep A isn’t severe. If you have 6 months of prep time before your trip, go for it. If you don’t, don’t sweat it.
Recommendation: Get it if you haven’t gotten one in the last 10 years, but if pressed for time, don’t worry about it.
Timing: 1 jab every 10 years
Risks: Spread through bacteria found in dirt, manure, soil and dust. Cannot be transmitted via another person. In 30% of cases, Tetanus is fatal. In all others, symptoms include severe muscle spasms and breathing problems.
Price: Free in Canada from family doctor
You should be updating your tetanus shot every 10 years regardless of travel plans – Tetanus is a global risk that isn’t just confined to developing countries. The good news is that if you aren’t up to date on your vaccine, but have an accident that leads you to believe you’re at risk of Tetanus (e.g. stepping on a rusty nail, getting cut by a wire fence), you can go to a hospital and get the shot to prevent any infection.
Recommendation: Most people are vaccinated as children and don’t need further doses. If you’ve never received polio vaccine, there is low risk of polio in SE Asia.
Timing: 3 doses- second dose 1-2 months after first doe; third dose 6-12 months after second dose.
Risks: Spread orally; through fecal matter entering the mouth. For most people, there won’t be any symptoms. Minor cases can cause respiratory tract infection, nausea, vomiting, and flu-like symptoms. Severe cases can lead to muscle weakness and paralysis.
Price: Free in Canada from family doctor
Severe cases of polio leading to paralysis are rare: around 1 in 1,000 if you contract the virus. Also, Southeast Asia has fewer polio cases than other parts of the developing world, so it’s not the threat it once was. If you don’t already have this vaccine, I’d consider skipping it – the odds are in your favor. But, you should consider getting it when you have time/resources, as it’s one of the good ones to have in general.
Recommendation: Skip, unless you are worried about becoming a carrier and infecting a vulnerable person (child, elderly, chronically ill person)
Timing: 1 month before travel
Risks: Bacteria spread by contaminated food and water. The incubation period is around 1-2 weeks and symptoms can last for up to 4 weeks. Minor symptoms include fever, flu-like symptoms, loss of appetite, aches and pains, and diarrhea. Severe symptoms include internal bleeding, and in rare cases, even death can occur.
To me, the most worrisome thing about Typhoid is that if you contract it, you can become a carrier (about 3-5% of affected people will become carriers). If you live with or are in regular close contact with young children or the elderly, then there’s a risk that you can pass the disease on to them, and their immune systems may have more difficulty fighting off the bacteria. But, if you don’t have children, and that’s not a worry for you, I’d skip this one.
Recommendation: Skip, if you’ll be in areas where you can reach a hospital in 24 hours if needed. Get it if you’re going to be in very remote areas with no access to health care.
Timing: 1-1.5 month(s); 3 doses, with the second given a week after the first, and the last given 21-28 days after the second.
Risks: Spread through contact with the saliva of an infected animal, most likely via a bite or scratch. Rabies can be spread by wild animals or by pets who haven’t been inoculated. In humans, rabies left untreated is always fatal. Early symptoms include headache, fever, weakness, etc., but when the disease progresses paralysis, hallucinations, insomnia, etc. occur.
Price: Anywhere from $500 for all three.
No matter where you go in Southeast Asia, you’re bound to encounter a wild animal. Even in big urban cities like Ho Chi Minh or Bangkok, you can encounter street dogs and cats that can be carriers of the disease. These animals live on the streets and are used to being chased away and sometimes beaten by locals, so their instincts towards humans are probably not the same of a dog you may encounter in the park back home. If you’re planning on going into more rural areas or jungles, then don’t try to pet or touch monkeys, bats or other animals. The good news about rabies, is that if you are bitten or scratched by any wild animal, you have a 24 hour window in which you can be treated before the onset of any symptoms. Most hospitals in big cities throughout Asia will be able to provide treatment for rabies. However, if you are doing any kind of trekking or camping in the jungle, and will not be within a couple of hour’s driving distance to a good hospital, then definitely get the rabies vaccine.
Recommendation: Skip for Southeast Asia
Risks: There’s no risk of Yellow Fever in Southeast Asia.
Recommendation: Skip all of the anti-malaria pills and just be smart about prevention.
Timing: There are various drugs available, and they require you to start your dose 1-7 days prior to travel. Some are taken daily, some are taken weekly.
Risks: Malaria is transmitted through mosquito bites. There are different strains, but symptoms start to manifest with a month of infection, and can include flu-like symptoms. Severe cases may experience respiratory distress, cerebral malaria (seizures and coma, among other complications), enlarged spleen or liver, and stillbirth. Death can also occur if untreated.
Price: $60 for 1 week’s worth of pills.
From what I’ve heard, unless you are traveling in very remote and high-risk areas, such as in the forested areas near the Thai-Laos border, Malaysia/Borneo, Indonesia, the risk of malaria is low. If you aren’t planning on spending time in the jungle or forests, don’t bother with the pills. I’ve heard they have unpleasant side affects (nausea, weakness, fatigue, blurred vision, etc.), and ultimately aren’t worth it. If you’re going to be staying in areas with lower risk of malaria (such as heavily populated tourist cities, towns and islands), then arming yourself with a good mosquito repellent and using a mosquito net is probably good enough. Wear layers if you can, ensure that your windows have screens (if not, don’t open them), and use mosquito coils or citronella candles if you’re drinking beers on the porch of your bungalow.
Timing: 1 month; 2 doses. The second dose should be given at least one week before travel.
Risks: Also spread by mosquitoes, and oddly enough- pigs. Pigs act as the host, and they multiply the virus and keep it in circulation, but mosquito bites is what spreads it to humans. Less than 1% of infected people will develop the illness, so symptoms are rare. But, when present, they include fever, headache, vomiting, neurological disorders, and seizures.
Price: $450 for both doses.
If you’re going to be visiting rural areas where there are pigs around, then consider getting this vaccine. Otherwise, skip it, because the odds of contracting it are very low.
And there you have my rundown of the various vaccines that travel clinics may try to sell you on. Again, it’s a decision you have to make for yourself; is it worth the risk to contract a possibly dangerous disease so you can save several hundred dollars? Is it worth postponing your trip to get all of your jabs in? Take the time to do your own research, and talk to people who’ve traveled where you want to go. And most of all, remember that there’s no ‘right’ or ‘wrong’ approach, and that your odds of getting any of these diseases will depend a lot on your travel itinerary and preventative measures. You can always get sick by sheer dumb luck, but if you exercise precautions and are educated going into your travels, you should be able to manage just fine without ANY vaccines.