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Thailand is a Third World country.  That means there are a few things one should consider when they're planning a trip.  Learn about the areas you're going to visit.  Are they in a Malaria zone?  Dengue Fever?  I'm not trying to scare you away, I'm just suggesting you be prepared.

The information below was taken from the CDC site.  Check with the CDC and your doctor for the latest information.

Food and waterborne diseases are the number one cause of illness in travelers.  Travelers’ diarrhea can be caused by viruses, bacteria, or parasites, which are found throughout the region and can contaminate food or water.  Infections may cause diarrhea and vomiting (E. coli, Salmonella, cholera, and parasites), fever (typhoid fever and toxoplasmosis), or liver damage (hepatitis).  Make sure your food and drinking water are safe. (See below.)

Malaria is a serious, but preventable infection that can be fatal.  Your risk of malaria may be high in these countries, including some cities.  Prevent this deadly 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, including infants, children, and former residents of Southeast Asia, should take an antimalarial drug. 

Dengue, 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.

Do not swim in fresh water (except in well-chlorinated swimming pools) in certain areas of Cambodia, Indonesia, Laos, Philippines, and Thailand to avoid infection with schistosomiasis. 

Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively.  Avoid travel at night if possible and always use seat belts.

There is no risk for yellow fever in Southeast Asia.  A certificate of yellow fever vaccination may be required for entry into certain of these countries if you are coming from countries in South America or sub-Saharan Africa.  

CDC recommends the following vaccines (as appropriate for age):

See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect.

Hepatitis A or immune globulin (IG). 
 

Hepatitis B if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months in the region, or be exposed through medical treatment. 
 

Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis. 

Rabies, if you might be exposed to wild or domestic animals through your work or recreation. 
 

Typhoid vaccination is particularly important because of the presence of S. typhi strains resistant to multiple antibiotics in this region. 
 
As needed, booster doses for tetanus-diphtheria and measles, and a one-time dose of polio for adults. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not complete the series as infants. 

To stay healthy, do...

Wash hands often with soap and water. 

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, make water safer by BOTH filtering through an “absolute 1-micron or less” filter AND adding iodine tablets to the filtered water. “Absolute 1-micron filters” are found in camping/outdoor supply stores. 
 
Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it. 
 
If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.) 

Protect yourself from mosquito bites: 

Pay special attention to mosquito protection between dusk and dawn.  This is when the type of mosquito whose bite transmits malaria is active. 

Wear long-sleeved shirts, long pants, and hats. 

Use insect repellents that contain DEET (diethylmethyltoluamide).
Read and follow the directions and precautions on the product label.

Apply insect repellent to exposed skin. 

Do not put repellent on wounds or broken skin. 

Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed).  If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth. 

Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin.  Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.  
DEET may be used on adults, children, and infants older than 2 months of age.  Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit. 

Children under 10 years old should not apply insect repellent themselves. Do not apply to young children’s hands or around eyes and mouth. 

To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot. 

Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases. 

To avoid getting sick...

Don’t eat food purchased from street vendors. 
Don’t drink beverages with ice. 
Don’t eat dairy products unless you know they have been pasteurized. 
Don’t share needles with anyone. 
Don’t handle animals (especially monkeys, dogs, and cats), to avoid bites and serious diseases (including rabies and plague). 
Don’t swim in fresh water. Salt water is usually safer. 

What you need to bring with you:

Long-sleeved shirt, long pants, and a hat to wear while outside whenever possible, to prevent illnesses carried by insects (e.g., malaria, dengue, filariasis, and Japanese encephalitis). 

Insect repellent containing DEET. 

Bed nets impregnated with permethrin.  (Can be purchased in camping or military supply stores.  Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.) 

Flying-insect spray or mosquito coils to help clear rooms of mosquitoes.  The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes. 

Over-the-counter antidiarrheal medicine to take if you have diarrhea. Iodine tablets and water filters to purify water if bottled water is not available.

Sunblock, sunglasses, hat. 

Prescription medications: make sure you have enough to last during your trip, as well as a copy of the prescription(s). 

After you return home:

If you have visited a malaria-risk area, continue taking your antimalarial drug for 4 weeks (chloroquine, doxycycline, or mefloquine) or seven days (atovaquone/proguanil) after leaving the risk area

Malaria is always a serious disease and may be a deadly illness.  If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

For more information:

Ask your doctor or check the CDC web sites for more information about how to protect yourself against diseases that occur in Southeast Asia, including the following:

Diseases carried by insects

Dengue Japanese encephalitis Malaria - General information - Prescription drugs Plague Diseases carried in food or water

Cholera Escherichia coli diarrhea Hepatitis A Schistosomiasis Typhoid fever Diseases from person-to-person contact

Hepatitis B HIV/AIDS - Prevention - HIV-infected travelers

For more information about these and other diseases, please check the Diseases page and CDC Health Topics A–Z.

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This document is not a complete medical guide for travelers to this region. Consult with your doctor for specific information related to your needs and your medical history; recommendations may differ for pregnant women, young children, and persons who have chronic medical conditions. In addition, you may also check the following CDC sites:

Malaria: General Information Preventing Malaria in the Pregnant Woman (Information for the Public) Preventing Malaria in the Pregnant Woman (Information for Health Care Providers) Preventing Malaria in Infants and Children (Information for the Public) Preventing Malaria in Infants and Children (Information for Health Care Providers) Prescription Drugs for Preventing Malaria (Information for the Public) Prescription Drugs for Preventing Malaria (Information for Health Care Providers) Vaccine Recommendations for Infants and Children Food and Water Precautions and Travelers' Diarrhea Prevention

Injuries: Injuries, especially those from motor vehicle crashes, pose the greatest risk of serious disability or loss of life to international travelers. The risk of motor vehicle-related death is generally many times higher in developing countries than in the United States. Motor vehicle crashes result from a variety of factors, including inadequate roadway design, hazardous conditions, lack of appropriate vehicles and vehicle maintenance, unskilled or inexperienced drivers, inattention to pedestrians and cyclists, or impairment due to alcohol or drug use; all these factors are preventable or can be abated. Defensive driving is an important preventive measure. When driving or riding, request a vehicle equipped with safety belts, and, where available, use them. Cars and trucks should be carefully inspected to assure that tires, windshield wipers, and brakes are in good condition and that all lights are in good working order. Where available, also request a vehicle equipped with air bags. As a high proportion of crashes occur at night when drivers are returning from "social events," avoid nonessential night driving, alcohol, and riding with persons who are under the influence of alcohol or drugs. This risk of death in a motor vehicle crash is greater for persons sitting in the front seat than for those in the rear seat. Where possible, travelers should ride in the rear seats of motor vehicles. Pedestrian, bicycle, and motorcycle travel are often dangerous, and helmet use is imperative for bicycle and motorcycle travel. In developing countries, helmets will likely not be available, so bring your own with you if you plan to ride bicycles or motorcycles. For travel with young children, you should bring your own child safety seat.

Fire injuries are also a significant cause of injuries and death. Do not smoke in bed, and inquire about whether hotels have smoke detectors and sprinkler systems. Travelers may wish to bring their own smoke detectors with them. Always look for a primary and alternate escape route from rooms in which you are meeting or staying. Look for improperly vented heating devices which may cause carbon monoxide poisoning. Remember to escape a fire by crawling low under smoke.

Other major causes of injury trauma include drowning (see the Swimming Precautions below) and injuries to water skiers and divers due to boat propellers. Boats equipped with propeller guards should be used whenever possible. Wear a personal flotation device (PFD) whenever you ride on a boat.

Travelers should also be aware of the potential for violence-related injuries. Risk for assault or terrorist attack varies from country to country; heed advice from residents and tour guides about areas to be avoided, going out at night, and going out alone. Do not fight attackers. If confronted, give up your valuables. For more information, contact the U.S. Department of State, Overseas Citizens Emergency Center at (202) 647-5225, or visit the U.S. Department of State web site for specific country Travel Warnings and Consular Information Sheets.

Animal-Associated Hazards Animals in general tend to avoid human beings, but they can attack, particularly if they are protecting their young. In areas of endemic rabies, domestic dogs, cats, or other animals should not be petted. Wild animals should be avoided; most injuries from wild animals are the direct result of attempting to handle or feed the animals.

The bites, stings, and contact with some insects cause unpleasant reactions. Medical attention should be sought if an insect bite or sting causes redness, swelling, bruising, or persistent pain. Many insects also transmit communicable diseases. Some insects can bite and transmit disease without the person being aware of the bite, particularly when camping or staying in rustic or primitive accommodations. Insect repellents, protective clothing, and mosquito netting are advisable in many parts of the world. (See the Insect Protection section for more information.)

Poisonous snakes are hazards in many parts of the world, although deaths from snake bites are relatively rare. The Australian brown snake, Russell's viper and cobras in southern Asia, carpet vipers in the Middle East, and coral and rattlesnakes in the Americas are particularly dangerous. Most snakebites are the direct result of handling or harassing snakes, which bite as a defensive reaction. Attempts to kill snakes are dangerous, often leading to bites on the fingers. The venom of a small or immature snake may be even more concentrated than that of larger ones; therefore, all snakes should be left alone.

Fewer than half of all snake bite wounds actually contain venom, but medical attention should be sought any time a bite wound breaks the skin. A pressure bandage, ice (if available), and immobilization of the affected limb are recommended first aid measures while the victim is moved as quickly as possible to a medical facility. Specific therapy for snakebite is controversial, and should be left to the judgment of local emergency medical personnel. Snakes tend to be active at night and in warm weather. As a precaution, boots and long pants may be worn when walking outdoors at night in snake-infested regions. Bites from scorpions may be painful but seldom are dangerous, except possibly in infants. In general, exposure to bites can be avoided by sleeping under mosquito nets and by shaking clothing and shoes before putting them on, particularly in the morning. Snakes and scorpions tend to rest in shoes and clothing.

Anthrax-Contaminated Goatskin Handicrafts Anthrax is a disease caused by a bacterial organism that produces spores that are highly resistant to disinfection. These infectious spores may persist on a contaminated item for many years. Anthrax spores have been found on goatskin handicrafts from Haiti. Travelers to Caribbean countries are advised not to purchase Haitian goatskin handicrafts. Because of the risk, importation of goatskin handicrafts from Haiti is not permitted at U.S. ports of entry; such items will be confiscated and destroyed.

Swimming Precautions Swimming in contaminated water may result in skin, eye, ear, and certain intestinal infections, particularly if the swimmer's head is submerged. Generally for infectious disease prevention, only pools that contain chlorinated water can be considered safe places to swim. In certain areas, fatal primary amebic meningoencephalitis has occurred following swimming in warm dirty water. Swimmers should avoid beaches that might be contaminated with human sewage or with dog feces. Wading or swimming should be avoided in freshwater streams, canals, and lakes liable to be infested with the snail hosts of schistosomiasis (bilharziasis) or contaminated with urine from animals infected with Leptospira. Biting and stinging fish and corals and jelly fish may be hazardous to the swimmer. Never swim alone or when under the influence of alcohol or drugs, and never dive head first into an unfamiliar body of water.

See the sections on Safe Food and Water and on Diseases for more information about waterborne diseases such as schistosomiasis, E. coli, leptospirosis, and cryptosporidiosis.

This page was last updated on 04 November, 2004

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