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Capital: Kuala Lumpur

Time Zone: +8 hours. No daylight savings time in 2008.
Tel. Country Code: 60
USADirect Tel.: 1
Electrical Standards: Electrical current is 240/50 (volts/hz). United Kingdom Sytle Adaptor Plug. Grounding Adaptor Plug C.

Resource Links

World Health Organization
Travel Health Services
Country Insights
Travel Warnings
Consular Information
Foreign Commonweatlh Office


• U.S. Embassy
376 Jalan Tun Razak
Kuala Lumpur
Tel: [6] (3) 2168-5000;

• High Commission of Canada
17th Floor, Menara Tan & Tan
207 Jalan Tun Razak
Kuala Lumpur
Tel.: [6] (03) 2718-3333

Entry Requirements

HIV Test: Required for foreigners seeking work permits as unskilled laborers.

Required Vaccinations: A yellow fever vaccination cetificate is required if traveling from an endemic zone and >1 year of age. A certificate is also required from travelers who have transited an endemic area within the preceding 6 days.

Passport Information

Passport/Visa: Malaysia is a constitutional monarchy with an elected federal parliamentary government. The country is comprised of 13 states, 11 on the Malay Peninsula and two, Sabah and Sarawak, on the island of Borneo. There is also a federal district, which contains the capital city of Kuala Lumpur, the administrative center of Putrajaya, and the island of Labuan (located off the southwest coast of Sabah). Malaysia is a multi-ethnic country of 27 million people. Malays form the predominant ethnic group. The two other large ethnic groups in Malaysia are Chinese and Indians. Islam is the national religion. Bahasa Malaysia is the official language, although English is widely spoken. Travelers to Malaysia may access information on areas of interest through the Malaysian government•s website at and Tourism Malaysia•s website at Read the Department of State•s Background Notes on Malaysia for additional information.


Vaccinations: Recommended and Routine


Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all travelers who might be exposed to blood or body fluids from unsafe/unprotected sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes; from unscreened blood transfusions; from contact with open skin sores of another person. Recommended for any traveler requesting protection against hepatitis B.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Japanese Encephalitis: Recommended for travelers planning to visit rural farming areas for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.

Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.

Hospitals / Doctors

Medical facilities and services are adequate in the larger cities, where Western-trained doctors can be found.
All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers• diarrhea or other infections; they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Serious illness or injury may require medical evacuation to Singapore or the United States

Decompression chambers are located in Kuantan, Lumut, Ipoh, Sabah and Labuan.

Medical facilities in Malaysia used by travelers:

• Tawakal Hospital
Jalan Pahang
Kuala Lumpur
Tawakal Hospital which is a 147-bed facility is located in the heart of Kuala Lumpur. Tawakal Hospital was established in 1984 by a group of doctors with only 66 beds. Tawakal Hospital is part of the largest chain of private hospitals under the flagship of Kumpulan Perubatan (Johor) Sdn Bhd.
Tawakal Hospital provides a full range of diagnostic and treatment services, including four Operating Theatres, an ICU and Coronary Care Unit, Maternity Unit, Laboratory, Physiotherapy, 24-hours Accident and Emergency Unit, Renal Dialysis, Cardiology, Medical Screening, Lithotripsy and a Pharmacy Department.

• Subang Jaya Hospital
Kuala Lumpur (244 beds)
Tel. 3-734-1212
Most specialties; ICU; 24-hour emergency services; used by U.S. Embassy personnel.

• Gleneagles Intan Medical Center
Kuala Lumpur
Tel: [60] (3) 4255 2775
General medical/surgical facility; 24-hour emergency services.

• Columbia Asia Medical Center
292 Jalan Haruan 2
Oakland Commercial Park
Negeri Sembilan, Malaysia
Tel: [60] 06-6011988
DIRECT LINE 06-6011898
Fax: 06-6011848
City: Seremban

• Gleneagles Medical Centre
Tel: 4-227-6111
General medical/surgical facility with most specialties and a 24-hour emergency department.

• Penang Adventist Hospital
465, Burma Road
Pulau Pinang,
Tel: [60] (4) 222-7200
General medical/surgical facility; ICU. Penang Adventist Hospital is a not-for-profit medical institution that is part of an international network of more than 500 hospitals and healthcare facilities operated by the Adventist Health Network.

Destination Health Info for Travelers

AIDS/HIV: Malaysia’s HIV epidemic is largely driven by injecting drug use. Other than injecting drug users (IDUs) HIV is spreading quickly amongst women, fishermen, lorry drivers and factory workers. A senior health official in Malaysia has warned that the number of people living with HIV in the country – currently around 73,000 – could rise to 300,000 by 2015 if nothing is done. The government launched a five-year strategic plan to tackle HIV in 2006, which includes drug substitution therapy and needle exchange programs for drug users.
Proportion of adults aged 15-49 who were living with HIV/AIDS in Malaysia is estimated at 0.1%.
• Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions.
• The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

Animal Hazards: Animal hazards include snakes (kraits, vipers, cobras), centipedes, scorpions, and black widow spiders. Other possible hazards include rabid dogs, tigers, bears, and wild pigs.

Avian Influenza (Bird Flu): Malaysia has declared itself free of H5N1 avian influenza late in 2007, although a few cases occurred in chickens earlier in the year. No human cases have been reported.
• H5N1 avian influenza is predominantly a disease of birds. The virus does not pass easily from birds to people and does not to pass from person to person (except in very rare cases of close contact with an infected blood relative).
• The risk to humans from avian influenza is believed to be very low and no travel restrictions are advised, except travelers should avoid visiting animal markets, poultry farms and other places where they may come into close contact with live or dead poultry, or domestic, caged or wild birds and their excretions. In addition, travelers are advised to:
1. Cook poultry and egg dishes thoroughly. (Well-cooked poultry is safe to eat.)
2. Wash hands frequently with soap and water if around poultry.

• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of H5N1 avian influenza, including those countries which have reported associated cases of human infection.

The usual vaccines against influenza are not protective against “bird flu.”
Oseltamivir (Tamiflu) is somewhat effective in the treatment of H5N1 avian influenza. It seems to be effective in some cases, but may fail in others. Recently, resistant strains have been reported. In addition, the dosage and duration of treatment appear to be different in severe H5N1 cases.

Chikungunya Fever: As of September 26, 2012, the Ministry of Health in Malaysia has reported over 3,185 cases of chikungunya fever. The most affected areas are the northern provinces of Kedah, followed by Kelantan, Selangor, Perak, and Sarawak. Since January 2009, a growing number of cases of chikungunya fever has been reported in parts of Asia, including Thailand, Malaysia, and India.
This mosquito-transmitted viral illness causes fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. Acute Chikungunya fever typically lasts a few days to several weeks, but as with dengue, West Nile fever, and other arboviral fevers, some patients have prolonged fatigue lasting several weeks.
• To prevent this disease, and other arboviral illnesses, you should take measures to prevent mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet at night.
• Other mosquito-borne diseases, such as dengue fever and malaria, can be confused with chikungunya fever. If you develop a fever while in Malaysia, it is important to consider the diagnosis of malaria.

Cholera: This disease is reported active in this country but the threat to tourists is very low. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States.
• The main symptom of more severe cholera is copious watery diarrhea.
• Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization.
• A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:

Crime/Security/Civil Unrest: Eastern Sabah: We strongly advise you to reconsider your need to travel to the islands, dive sites and coastal areas of Eastern Sabah because of the high threat of kidnapping by terrorists and criminals. In the past, foreigners have been kidnapped from the east coast of mainland Sabah, the islands and surrounding waters. If you do decide to travel to this region, you should exercise extreme caution.
Between 2000 and 2005, kidnappings occurred from Sipadan, Mataking and Pandanan islands (off the south-eastern coast), near Lahad Datu on the east coast and at sea off the east coast.
Malaysian security authorities have arrested a number of terrorist suspects and put in place strong counter-terrorism measures, including increased security in Sabah, but there is a continuing risk of incidents.
• Civil Unrest/Political Tension: Do not travel at this time to the far southern Thai provinces of Yala, Pattani, Narathiwat and Songkhla, including overland travel from and to the Malaysian border through these provinces. Police permission is required for public gatherings and demonstrations. You should avoid all protests and demonstrations as they may turn violent and involve arrests.
• Crime: Petty crime is common. Snatch and garb attacks against pedestrians from passing vehicles, such as motorcycles, occur frequently and often result in injury to the victim. Although uncommon, violent crime against foreigners does occur. Drink spiking occurs. Victims lose consciousness and have been assaulted and robbed.
Credit card fraud and scams involving gambling are common.

Dengue Fever: Occurs countrywide, with increased risk in urban and periurban areas. The most cases in 2007 awere from Kelantan, Penang, and Sabah. Peak infection rates occur in the late monsoon season (October through February in east peninsular Malaysia, Sabah, and Sarawak; July through August in west peninsular Malaysia.)
Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Asia. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A shock syndrome and hemorrhage can occur.
• Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.

Filariasis: Malayan and Bancroftian filariasis are endemic countrywide in freshwater swampy areas and inland hilly forested areas. Moderate risk occurs in rural areas. Travelers should take measures to prevent mosquito bites.

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation.
• Hepatitis E is endemic but the levels are unclear. Sporadic cases may occur but go underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals, such as swine, and also deer and wild boar, may serve as a viral reservoirs. (HEV is one of the few viruses which has been shown to be transmitted directly from animals through food.) In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine.
• The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at5%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus.
• Hepatitis C is endemic at high level with a prevalence of 3% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.

Insects: All travelers should take measures to prevent both daytime and nighttime insect bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping.

Japanese Encephalitis (JE): As 7 Jul, 2014 17 JE cases have been reported nationwide, of which 8 were reported in Sarawak, 4 in Sabah, 3 in Penang and one each in Selangor and Kelantan, of which 4 had been fatal .

Sporadic cases occur year-round, especially in Sarawak, Penang, Perak, Selangor, and Johore. Risk occurs primarily in areas with rice growing and pig farming. The Centers for Disease Control and Prevention (CDC) recommend JE vaccination for travelers spending more than 30 days in an endemic environment or less than 30 days in areas with epidemic transmission. Knowledge of trip details is necessary to give the best advice; for example, is travel occurring during the peak transmission season? In general, travelers to rural areas (especially where there is pig rearing and rice farming) should be vaccinated if the duration of their trip exceeds 3 to 4 weeks. They may consider vaccination for trips of shorter duration if more intense exposure is anticipated. In addition:

• Vaccination is advised for expatriates living in this country.
• All travelers should take measures to prevent mosquito bites, especially in the evening and during the night.

Geographic Distribution of Japanese Encephalitis:

Malaria: Risk exists in remote areas of peninsular Malaysia that are off usual tourist routes. Urban and coastal areas are risk free, and those making day trips to rural tourist areas have no risk. East Malaysia has risk of P. falciparum throughout.
• Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine is recommended for travel to risk areas.

A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to and select Malaria Map from the Malaysia page on the Destinations menu.

Malaria is transmitted via the bite of an infected Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellent (20% formulation) is now recommended by the CDC as an acceptable alternative to DEET to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies.
• You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country.

Marine Hazards: Swimming-related hazards include sharks, jellyfish, including the Indo-Pacific man-of-war, stonefish, scorpion fish, stingrays, sea snakes, spiny sea urchins, sharp coral and poisonous cone shells. Swimmers should take sensible precautions to avoid these hazards. Stonefish, scorpion fish and stingrays congregate in shallow water along the ocean floor and can be difficult to see. Wearing booties may help protect you, but should not be relied upon as complete protection, as many of the spines are sufficiently rigid and long to penetrate wetsuits, booties, and gloves.
• The jellyfish population appears to be increasing, due in part to overfishing of jellyfish predators, rising water temperatures, and pollution. Jellyfish travel in groups, so looking before you leap into water may be protective.
Treatment guidelines for jellyfish stings:
• To avoid a shark attack, swim or dive with a group. Avoid swimming during hours of darkness or twilight, in fog, or in murky waters. Avoid swimming in the vicinity of sea lions, harbor seals or elephant seals. Avoid swimming near the mouths of rivers where sharks hunt for fish. When diving, minimize time spent at the surface. Wearing a wetsuit and fins or lying on a surfboard creates the silhouette of a seal to a shark below you. Shallow water is not a deterrent to sharks; attacks have occurred in less than 5 ft/1.5 m of water.

Ciguatera poisoning: Any reef fish can cause ciguatera poisoning, but species such as barracuda, moray eel, grouper, red snapper, jack, sturgeon and sea bass are the most commonly involved. The occurrence of toxic fish is sporadic, and not all fish of a given species or from a given locality will be toxic. The ciguatoxin is not destroyed by cooking.

The most serious hazards:
Sea snake venom is highly toxic and the mortality has been reported to be 25% in untreated cases. In severe envenomations, symptoms can occur within 5 minutes, but typically evolve over 8 hours. It is possible that the victim may not have been aware of the bite, since there is little or no pain on envenomation.
Symptoms often include anxiety, muscle aching, salivation and a sensation of tongue swelling, followed by nausea, vomiting, muscle spasms, ascending paralysis, ocular palsy and sometimes loss of vision. Respiratory collapse may ensue, and the need for endotracheal intubation and mechanical ventilation should be anticipated. Sea snake antivenom (older name: antivenin) should be administered in all actual and suspected cases.
• A sea snake bite is always a medical emergency, even if the victim does not appear ill.
• You must get the victim to an emergency department, as fast as possible.
• En route, attempt to keep the bite site in a resting position, while keeping the victim as still as possible.
• Apply a broad pressure bandage over the bite about as tight as an elastic wrap to a sprained ankle. This is intended to slow the spread of the venom through the lymphatic system. Apply a splint to the limb. Make sure that arterial circulation is not cut off, by making sure fingers or toes stay pink and warm.
• Never cut open a sea snake bite and try to suck venom from the victim.
• Sea snake toxin is not inactivated by changes in temperature or pH. Application of ice, hot packs, or vinegar only wastes time.
Read more:

The box jellyfish is the most dangerous jellyfish in the world. Box jellyfish belong to the class Cubozoa, and are not a true jellyfish (Scyphozoa), although they show many similar characteristics. When people talk about the extremely dangerous Australian box jellyfish they refer to the species Chironex fleckeri. Chironex fleckeri (sometimes simply called “the box jellyfish”), is the largest and best-known species of box jellyfish, and is only one of a category which actually contains about 19 different species. The name sea wasp is also applied to some species of Cubozoans, including the aforementioned Chironex fleckeri.
The other species that is known to have caused deaths is Carukia barnesi, commonly called Irukandji. This tiny jellyfish is only about thumbnail size.
Chironex fleckeri is present in the waters of Australia, the Indo-Pacific region, including Vietnam, Papua New Guinea, the Phillipines, and Hawaii. Their exact distribution has not been fully determined.

• Box jellyfish stings are extremely painful, potentially lethal and require immediate treatment with antivenom. Cardio-respiratory arrest may occur within 20 minutes of envenomation.
Box jellyfish treatment and antivenom information:

The stonefish is a rather unattractive squat fish with a mostly rough “skin” that assists its superb camouflage as it sits on old coral or debris. There is a series of erectile dorsal spines, which, with the associated venom glands, provides the creature means of envenoming potential predators. Stonefish are mostly encountered in shallow water, where they may be stepped on by accident, or picked up by the unwary. Instant and severe pain is a constant feature of stings, followed by local swelling, which may be marked, tenderness and a blue discoloration of skin surrounding the sting site. Dizziness, nausea, hypotension, collapse, cyanosis and pulmonary edema have been described, though are by no means common. Tissue ischemia at the sting site is possible.
• Antivenom: Stonefish antivenom should only be given if there is clear evidence of envenomation. It should be given only IM, not IV.
• The use of stonefish antivenom in stings by other species of scorpionfish is not clearly recommended, but there is limited evidence that it may be beneficial (e.g. possibly bullrout stings, Notesthes robusta). The potential risks of immediate and delayed adverse reactions to antivenom should be carefully considered before using this antivenom for other than stonefish stings.

Emergency treatment guidelines for marine stings are here:

Clinical Toxicology Resources
University of Adelaide

Reviewed and edited by Paul S. Auerbach, MD, FACEP
Author: Wilderness Medicine and Field Guide to Wilderness Medicine

Other Diseases/Hazards:
• Amebiasis
• Angiostrongyliasis (may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF; human infections are usually acquired by purposeful or accidental ingestion of infective larvae in terrestrial mollusks, planaria, which are non-parasitic flatworms, and fresh-water crustacea. There is no effective specific treatment)
• Intestinal helminthic infections (ascariasis, hookworm, strongyloidiasis, trichuriasis)
• Chikungunya fever (reported in 2007)
• Clonorchiasis (liver fluke disease, caused by the liver fluke Clonorchis sinensis. Infection is acquired through the consumption of raw or undercooked freshwater fish. Light infections are usually asymptomatic; heavier infections may cause fever, chills, upper abdominal pain, tender hepatomegaly, diarrhea, and mild jaundice. Diagnose by identifying eggs in the feces or duodenal contents or by percutaneous transhepatic cholangiography. Treat with praziquantel or albendazole)
• Leptospirosis (countrywide risk, except in urban areas)
• Paragonimiasis (Oriental lung fluke disease; transmitted when humans ingest raw or undercooked, infected crustaceans, such as crayfish and crabs; infection has also occurred following ingestion of raw pork from wild pigs that contained the juvenile stages of Paragonimus species)
• Scrub typhus (mite-borne; risk elevated in grassy rural areas)
• Tuberculosis (highly endemic)

Schistosomiasis: Slight risk of infection (from Schistosoma malayensisis) is present in Perak and Pahang States. The human health significance of this organism is unclear. It may not be pathogenic. Schistosomiasis is transmitted through exposure to freshwater streams, rivers or lakes during activities such as wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, or streams. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. We recommend that you boil all drinking water or drink bottled water, and avoid ice cubes and raw and undercooked food. Seek medical advice if you have a fever or are suffering from diarrhea. A quinolone antibiotic, azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis.

Tuberculosis: Tuberculosis is a major public health problem in this country. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact with an infected individual. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people (with the exception of short-term visitors who restrict their meals to hotels) traveling to or working in Malaysia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.