Time Zone: 8 hours. No daylight saving time in 2008.
Tel. Country Code: 86
USADirect Tel.: 10811
Electrical Standards: Electrical current is 230/50 (volts/hz). North American Style Adaptor Plug. Grounding Adaptor Plugs C, F.
Travel Advisory - China
Malaria, Japanese encephalitis, and dengue fever occur throughout SE Asia and the Indian sub-Continent. Insect-bite protection is essential. Hepatitis E, spread by contaminated water, is also a threat. There is no vaccine. Pregnant women are at special risk. Take measures, as needed, to purify your water outside of first-class hotels.
Dr. Rose Recommends for Travel to China
The Embassy consular district includes the following provinces/regions of China: Beijing, Tianjin, Shandong, Shanxi, Inner Mongolia, Ningxia, Shaanxi, Qinghai, Xinjiang, Hebei, Henan, Hubei, Hunan, and Jiangxi.
If you are an American citizen in China with an after-hours emergency, please call 010-8531-4000. If you are calling from the United States, dial (011-8610) 8531-4000.
HIV Test: A health declaration card must be completed upon arrival in China. HIV-positive status is grounds for refusal of entry or deportation. Individuals applying for permanent residence, or intending to stay or study for longer than one year, must produce an HIV/AIDS test certificate on arrival (approved by a Chinese Embassy or Consulate abroad) or undergo a test within 20 days of arrival. Testing is not required for entry or residency in Hong Kong. Persons found to be carrying anti-HIV drugs (antiretrovirals) may be detained at customs and denied entry.
Required Vaccinations: Yellow fever vaccination is required for all travelers arriving from a yellow fever endemic zone country in Africa or the Americas.
Passport/Visa: A valid passport and visa are required to enter China and must be obtained from Chinese Embassies and Consulates before traveling to China. Visit the Chinese Consulate Website in Washngton, DC for the most current visa information.
- U.S. Passport – You must provide your signed passport. Your passport must be valid for at least 6 months and have two adjacent blank pages available.
- China Visa Application Form – Effective September 3rd, 2013, the China Embassy requires that all applications for China visas submitted in the United States be typed (no handwritten applications will be accepted). The Visa Application V2013 Form is available online at China Embassy Website. Applicants will have to print a copy of their application form, sign and date it. *Please note – no handwritten corrections are allowed. If an error is made, you must go back online and start over.
- Visa expeditor form – filled out completely if you are utilizing a visa expeditor service.
- Photograph – Please provide two color, passport size photos. The photograph must be printed on photo paper, it must be 2″ by 2″ and have a white background, and it must have been taken in the last 6 months.
- Personal invitation – if visiting friends or family, you must provide a letter of invitation from your host in China. The letter must contain personal information of the applicant, details of the visit, and details of the inviting party.
- Copy of your airline ticket or travel agent itinerary showing your name as well as travel information.
- Copy of driver’s license, state issued ID, or major utility bill (Water, Gas, Electric, Sewage), showing the applicant’s name and current address.
Visas are required to transit China. Persons transiting China on the way to and from Mongolia or North Korea or who plan to re-enter from the Hong Kong or Macau Special Administrative Regions should be sure to obtain visas allowing multiple entries. Permits are required to visit Tibet as well as many remote areas not normally open to foreigners. Every foreigner going to Tibet needs to get a travel permit which can be done through local travel agents. Permits cost RMB 100, are single-entry and valid for at most three months. Most areas in Tibet are not open for foreigners. Foreigners can be fined, taken into custody and removed for visiting restricted areas.
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 non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.
Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
Japanese Encephalitis: The vaccine is recommended for persons living in endemic and epidemic areas and for at-risk travelers planning extended trips to rural areas (arbitrarily defined as 30 days). Persons visiting areas with active epidemic Japanese encephalitis should be considered for vaccination even if their projected stay is less than 30 days. Vaccination for persons staying fewer than 30 days may be considered if they expect unprotected nighttime outdoor exposure in endemic areas.
Rabies: Recommended for travelers spending time outdoors in rural areas where there is an increased the risk of animal bites. Children are considered at higher risk because they tend to play with animals and may not report bites. Pre-exposure vaccination eliminates the need for rabies immune globulin in the event of a high-risk animal bite, but does not eliminate the need for treatment with the 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.
• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years.
Note: ADACEL is a new tetanus-diphtheria-pertussis (Tdap) vaccine that not only boosts immunity against diphtheria and tetanus, but has the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccine can be administered in place of the Td vaccine when a booster is indicated.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to hotels or resorts.
Yellow Fever: Yellow fever vaccine is required for all travelers >1 year of age arriving from, or transiting through, any country in the yellow fever endemic zones in Africa or the Americas. Not recommended or required otherwise.
Hospitals / Doctors
Western-style medical facilities with international staffs are available in Beijing, Shanghai, Guangzhou and a few other large cities. Many other hospitals in major Chinese cities have so-called VIP wards. These feature reasonably up-to-date medical technology and physicians who are both knowledgeable and skilled. Most VIP wards also provide medical services to foreigners and have English-speaking doctors and nurses. Most hospitals in China will not accept medical insurance from the United States, with the exception of some hospitals on the BlueCross/BlueShield worldwide network providers list. Travelers will be asked to post a deposit prior to admission to cover the expected cost of treatment. Hospitals in major cities may accept credit cards for payment. Physicians and hospitals have sometimes refused to supply patients with complete copies of their Chinese hospital medical records, including laboratory test results, scans, and x-rays.
• For all emergencies, from anywhere in China, dial 120 for emergency medial service, 110 for all other emergencies.
Ambulances do not carry sophisticated medical equipment. Injured or seriously ill travelers may be required to take taxis or other immediately available vehicles to the nearest major hospital rather than waiting for ambulances to arrive. In rural areas, only rudimentary medical facilities are generally available with often poorly trained medical personnel who have little medical equipment and medications. Rural clinics are often reluctant to accept responsibility for treating foreigners, even in emergency situations.
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 - the equivalent drugs may not be available or may be of unreliable quality. Note: China's Research and Development-based Pharmaceutical Association estimated that about 8% of over-the-counter drugs sold in China are counterfeit. (Source: ISTM NewsShare, May/June 2008)
• 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. For serious illnesses or complex medical procedures, travelers may wish to be medically evacuated to a destination with appropriate facilities.
Additional information on medical providers specializing in treating foreigners for general medical, dental and orthodontic problems are available through the U.S. Embassy.
Note: There is a risk of exposure to unsafe blood and blood products in regional China. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics. You should consider bringing with you a supply of sterile needles and syringes, such as a Steri-Kit•.
Foreign-operated medical providers catering to expatriates and visitors are available in China. Facilities frequented by travelers and expatriates include:
• International SOS operates modern medical and dental clinics and provides medical evacuation and medical escort services in Beijing, Nanjing, Tianjin and Shekou as well as 24-hour Alarm Centers in Beijing and Shanghai. Through clinics in Beijing (24 hours), Tianjin, Nanjing and Shekou, International SOS offers family practice services, emergency medical services and a range of clinical services. Each Alarm Center provides 24-hour hotline services with multilingual coordinators and doctors are on duty to respond to all manners of emergencies.
For medical emergencies anywhere in mainland China, travelers can call the International SOS 24-hour Alarm Center in Beijing at  (10) 6462-9100 or in Shanghai at  (21) 6295-0099 for advice and referrals. International SOS Alarm Centers can also be contacted in Hong Kong at (852) 2428-9900 and in the United States at  (1) 245-4707.
Suite 105, Wing 1, Kunsha Building
16 Xinyuanli, Chaoyang District
Clinic appointments: +86 (0)10 6462 9112
Dental appointments: +86 (0)10 6462 0333
Monday to Friday 8:00am - 8:00pm
Saturday to Sunday* 9:00am - 6:00pm
Emergency room services open 24 hours, every day of the year
The Beijing International SOS Clinic is run by a specialized team of medical professionals which ensures that you receive quality and comprehensive medical care while in Beijing. In the event that you need it during your stay in Beijing we are here to provide you with peace of mind by making sure all of your health care needs, from basic primary medical concerns to emergency care, are dealt with.
- Family medicine clinic (urgent or routine consultations and health checks)
- In-house specialists (Paediatrician, Gyneacologist, Internal medicine specialists)
- Dental clinic
- Physiotherapy clinic
- Counseling and Mental Health Department
- Visiting specialists (Gynaecology, Dermatology, Orthopaedics, Surgery, ENT)
- Eye clinic (Optometry and Ophthalmology)
- Emergency Room (24/7)
- Ultrasound and X-Ray facilities
- International standard ambulance for patient transfer
Global Doctors China is a medical service group which started in 1999. They are uniquely positioned to provide medical care with international practice standards for the expatriate community in China. Medical services are supported by experienced and English speaking doctors & nurses around the clock, and now are recognized and accepted globally.
Global Doctor China is part of network clinics in Asia, including Malaysia, Thailand, and Indonesia. Our Asian medical network combines local expertise with international know-how to offer better services to our customers.
Global Doctor China has established 8 western style medical centers in Beijing, Shenyang, Changsha, Chengdu, Chongqing, Dongguan, Guangzhou and Nanjing. Offering outpatient medical services, 24/7 emergency call, hotel visit, hospital referral and admission, vaccination & travel immunization, physical medicine, health check up, screening packages, in house lab & pharmacy, insurance direct-billing & medical reports, case management etc.
We have through our Beijing Alarm Center provided medical evacuation / repatriation / travel assistance etc services for over 10 years.
Beijing United Family Hospital and Clinics (BJU)
#2 Jiangtai Lu
BJU is the first and remains the only foreign-invested full service international standard 50-bed hospital operating in Beijing, China. Specialties include family practice, internal medicine, surgery, obstetrics/gynecology, pediatrics, dentistry, psychiatry and physiotherapy, in addition to a 24-hour Emergency Room staffed solely by expatriate specialists who are board qualified (or equivalent) in their respective fields. The staff is fluent in a wide range of languages, including English French, German, Japanese, Spanish, Swedish, and Finnish.
Facilities include 2 operating theatres, 5 birthing suites, Neonatal ICU, a 4-bed adult ICU, general inpatient facilities, and standard support services including digital radiology, ambulance services, pharmacy, laboratory and a 24-hour on-site blood bank with emergency blood pre-screened to the American Blood Bank standard.
International Medical Center
Lufthansa Center Office Building
A registered nurse is always available for consultation 24 hours/day if an emergency arises.
Bayley & Jackson Beijing Medical Center
#7 Ritan Dong Lu, Chaoyang District
Peking Union Medical Hospital
1 Shuai Fu Yuan, Dong Cheng District
Modern facility with English-speaking staff.
Separate ward for foreign patients.
Listing of Interntional Hospitals & Clinics in Shanghai
Shanghai United Family Hospital and Clinics
Clinics operated by International SOS are located in Beijing, Nanjing,
Shekou/Shenzin and Nanjing. Each clinic offers primary care, diagnostic care and 24/7 emergency care. Doctors are available to provide all types of treatments, ranging from simple vaccination to emergency heart attack treatment. Specialist care is also available in the many fields, including gynecology, pediatrics and ophthalmology.
Destination Health Info for Travelers
Dr. Rose Recommends
A Recent Risk Analysis from GeoSentinel: GeoSentinel is a worldwide communication and data collection network for the surveillance of travel-related morbidity. It was initiated in 1995 by the International Society of Travel Medicine (ISTM) and the Centers for Disease Control (CDC) as a network of ISTM member travel/tropical medicine clinics. GeoSentinel Sites participate in surveillance and monitoring of all travel related illnesses seen in their clinics.
Recent findings for China (2008):
• Upper respiratory tract infection and acute bronchitis were the top two diagnoses among patients seen during and after travel to China. Pneumonia and influenza were not common among those seen during travel but were among the top five diagnoses among those seen after travel.
• For dermatologic problems, eczema was the most common diagnosis among those seen during travel, and dog bite was the most common diagnosis among those seen after travel.
• According to GeoSentinel, China travelers were more likely to present with a dog or cat bite if they did not have a pre-travel medical consultation (3.9 times more likely), were 1 year of age (1.1 times more likely), were travelers visiting friends and relatives (VFRs) (9.8 times more likely), or were students (6.7 times smore likely).
• GeoSentinal compared the spectrum of disease and relative probability of common syndromes between China travelers and those who had traveled to Southeast Asia or India. Among patients seen during travel, systemic febrile illness and acute diarrhea were the most common syndromes experienced by travelers to Southeast Asia and India, respectively, whereas respiratory ailments were the most common syndrome reported by China travelers.
• Importantly, among all travelers exposed in China over 10 years, there were no cases of malaria, dengue, leishmaniasis, or Japanese encephalitis (JE). There was one case of leptospirosis and two cases of unspecified rickettsial disease.
AIDS/HIV: The number of reported HIV/AIDS cases in China grew by nearly 30 percent in 2007, according to the Ministry of Health, who also warned that the virus seems to be spreading from high-risk groups to the general public. Intravenous drug use and unsafe sex remain the biggest sources of infection.
Source: For more information on HIV/AIDS in China, got to: http://www.avert.org/aidschina.htm
• 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.
Note: There is a risk of exposure to unsafe blood and blood products in regional China. Travelers may need to specifically request the use of sterilized equipment. Additional charges may be incurred for the use of new syringes in hospitals or clinics.
• 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: Road accidents and drownings cause the most fatalities in travelers. Important safety rules to follow are 1) Do not drive at night, 2) Do not rent a motorcycle, moped, bicycle, or motorbike, even if you are experienced, and 3) Don't swim alone, at night, or if intoxicated.
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.
Acute Mountain Sickness (AMS): Marked variations in altitude occur within this country. Lhasa is at an altitude of 12,000 feet (3,700 meters). Most towns in Tibet, Qinghai, parts of Xinjiang, and western Sichuan are at altitudes over 3000 meters. Tibet occupies a barren plateau bounded to the south and southwest by the Himalayas and north by the Kunlun Mountains, traversed west to east by the Bukamagna, Karakoram, and other mountain ranges, and having an average elevation of 4,000 - 4,500 meters. Risk of altitude sickness is present for tourists, and especially trekkers and alpinists going to these destinations.
Acute mountain sickness (AMS), also known as altitude illness, is a common malady above 2,400 m (8,000 ft), especially if you have not had a chance to acclimatize by ascending gradually. The prevalence of AMS varies between 15% and 75%, depending on your speed of ascent, altitude gained, sleeping altitude, and individual susceptibility. Acute mountain sickness can progress to high altitude cerebral edema (HACE) or be associated with high altitude pulmonary edema (HAPE). You should intersperse your ascent with rest days and avoid, if possible, increasing your sleeping altitude by more than 1,000 - 1,500 feet each night. To reduce further your risk of AMS, take acetazolamide (Diamox), starting the day prior to beginning your ascent. Acetazolamide is a respiratory stimulant that speeds acclimatization and is about 75% effective. It may also reduce the risk of HAPE.
• Symptoms of AMS include mild to moderate headache, loss of appetite, nausea, fatigue, dizziness and insomnia. Mild AMS usually resolves with rest plus medication for headache and nausea. You can also take acetazolamide to treat mild AMS.
• Under no circumstances should you continue to ascend (especially to a higher sleeping altitude) if you have any persistent symptoms of altitude illness. In the absence of improvement or with progression of symptoms you should descend (at least 500 m) to a lower altitude.
• Dexamethasone (Decadron) is a steroid drug used for treating AMS and HACE. You should carry stand-by treatment doses. You can take dexamethasone together with acetazolamide to treat mild- to moderate-AMS.
• More severe AMS (increasing headache, vomiting, increasing fatigue or lethargy) may indicate the incipient onset of high-altitude cerebral edema (HACE)—recognized by confusion, difficulty with balance and coordination, staggering gait. Start treatment with dexamethasone and descend immediately.
• Increasing dry cough and breathlessness at rest may indicate high altitude pulmonary edema (HAPE). Nifedipine, sildenafil (Viagra), or tadalafil (Cialis) can be used for both the prevention and treatment of HAPE. Dexamethasone and the asthma drug salmeterol (Serevent) also will prevent HAPE.
• Descent, combined with medication (and oxygen, if available) is the best treatment for more severe AMS, HACE or HAPE. Consider helicopter evacuation if the situation is urgent.
Caution: Prior to departing for a high-altitude trip, consult with a physician about the use of medications for preventing/treating altitude illness.
Air Pollution: Severe air pollution exists in Beijing and most other cities. Pollutants include windblown dust and dirt, increased in Beijing by recent (May 2008) sandstorms in Mongolia, soot from coal burning stoves and furnaces, and exhaust from motor vehicles. Due to the widespread burning of soft coal, especially in cities with heavy industry, there is the potential for exacerbation of respiratory illnesses such as bronchitis, asthma, and emphysema.
Influenza: Chinese health officials in 2014 have confirmed what appears to be the first known H5N6 avian influenza infection in a human, a farmer from Sichuan province who had severe pneumonia and died, according to a post yesterday from ProMED-mail, the online reporting system of the International Society for Infectious Diseases.
According to a machine translation of a May 4 statement from Sichuan's health department, the 49-year-old man from Nanchong had been exposed to sick and dead poultry before he got sick. His close contacts are under medical observation, and so far no other illnesses have been detected.
The health department said the virus was detected because of enhanced monitoring for flu and pneumonia cases of unknown causes. It said China's Center for Disease Control and Prevention confirmed the finding.
ProMED-mail also flagged a report from China's agriculture ministry that said it investigated of the man's sick chickens on Apr 23 and that the national reference laboratory isolated H5N6 from the samples.
Flu surveillance in China occasionally turns up uncommon flu strains in humans and birds. For example, at the end of 2013 and in early 2014 China reported three H10N8 cases, two of them fatal, in humans.
Global flu activity near interseasonal level. Influenza activity in the Northern Hemisphere is approaching inter-seasonal levels in most countries, the World Health Organization (WHO) said in an update yesterday as influenza B continues to increase its share of circulating viruses.
Flu levels are slowly declining in North America, the agency said, while most European nations either approached or reached interseasonal levels. The highest levels were reported in eastern Europe, though they were still low. H3N2 predominated in Europe, followed by 2009 H1N1. The B strain was at low levels.
Influenza B predominated in East Asia, western Asia, and northern Africa, and all three regions reported low levels. Flu remained at low levels in the Southern Hemisphere as well, the WHO reported.
• The World Health Organization (WHO) does not recommend travel restrictions to countries experiencing outbreaks of influenza A (H5N1) in birds, including those countries which have reported associated cases of human infection.
To date, no cases of avian influenza A (H5N1) illness have been identified among short-term travelers visiting countries affected by outbreaks among poultry or wild birds.
The usual vaccines against influenza are not protective against bird flu. Oseltamivir (Tamiflu) is somewhat effective in the treatment of avian influenza A (H5N1). 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 cases.
The World Organisation for Animal Health (OIE) has confirmed cases of avian influenza in birds in a number of countries throughout the world. For a list of these countries, visit the OIE website.
Chikungunya Fever: In October 2012, at least 38 people in Dongguan, an industrial city in south China, Guangdong Province, were diagosed chikungunya virus, the local health department has confirmed.
• Chikungunya fever is a viral disease transmitted to humans by day-biting Aedes mosquitoes. Chikungunya virus was first isolated in Tanzania in 1953, and is now the cause of numerous human epidemics in many areas of Africa and Asia, and most recently in a limited area of Europe. Symptoms include fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain. This disease is rarely fatal.
• Acute chikungunya fever typically lasts a few days to a couple of weeks, but as with dengue, West Nile fever, and other arboviral fevers, some patients have prolonged fatigue lasting several weeks.
• No vaccine is available. Prevent this disease by avoiding mosquito bites. Apply a DEET-containing repellent (such as Ultrathon) to exposed skin and use permethrin spray or solution on clothing and gear.
Cholera: As of November 2008, 37 confirmed cases of cholera were reported in Hainan Province; in addition, hundreds of other suspected cases were also reported ifrom the same province. Although this disease is sporadically active in this country, the threat to tourists is 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.
Crime/Security/Civil Unrest: Incidents of violence can occur. Two bombs exploded on public buses in the city of Kunming on 21 July 2008 that resulted in a number of fatalities. On 5 March 2008 a bus carrying ten Australians was taken hostage in Xian.
Xinjiang: We advise you to exercise a high degree of caution if travelling to Xinjiang Province. A number of recent bombings have occurred in the region, including in Kashgar on 4 August and Kuqa on 10 August 2008, both attacks resulted in a number of fatalities.
Tibet: We advise you to exercise a high degree of caution if travelling to Tibet. Protests by Tibetan monks in Lhasa turned violent on 14 March, with reports of deaths and injuries. While the Chinese authorities have now re-opened Tibet to foreign tourists and journalists, demonstrations and violence could occur with little warning. You should not attempt to travel to Tibet without permission from the Chinese authorities. Foreigners wishing to travel to Tibet must apply for a Tibet Entry Permit issued by the Tibet Tourism Bureau in Lhasa. Applications for Tibet Entry Permits can only be lodged through local travel agents. Photographing or videoing protests, or carrying letters or packages from Tibetan nationals to be posted in other countries, could be regarded as provocative by authorities in Tibet and elsewhere in China.
Crime: Petty crime directed at foreigners, particularly pick pocketing, purse snatching and theft of laptops and mobile phones continues to increase. Resisting can lead to violence or injury. Travelers have been targeted on overnight long distance trains and buses and on public transport. Foreigners have been assaulted and robbed, particularly in popular expatriate gathering areas including the bar and shopping precincts of Beijing, Shanghai, Guangzhou, Shenzhen and other major cities.
• There is a risk of armed bandit attacks in remote areas bordering Pakistan, Burma (Myanmar), Laos, Vietnam and Russia. You should be vigilant if travelling in these areas.
Foreigners have also been targets of a number of scams when travelling in China. An increasing number of tourists are being approached and invited for a drink at a teahouse, cafe or bar nearby to“practice English”. Afterwards the tourist is presented with a vastly inflated bill and is not permitted to leave until they pay the bill by credit card. In some cases, accompanying threats of violence and credit card skimming or duplication have also been reported.
There have been reports of various ATM scams including the use of fake ATMs that then take your card. ATM robberies are also common. It is recommended you use ATMs when accompanied and during daylight hours to reduce risks.
There has been an increase in the number of reports of taxi drivers charging inflated prices and exchanging counterfeit money for change from large bills. It is recommended you carry small bills (RMB 10, 20 and 50) and hail taxis from official queues to reduce your risk of getting into trouble. You may also receive counterfeit money as change from hawkers, particularly in Beijing.
Local Travel: Foreigners wishing to travel to Tibet must apply for a Tibet Entry Permit issued by the Tibet Tourism Bureau in Lhasa. Permits cost around RMB100, are single-entry and valid for no more than three months. Applications for Tibet Entry Permits can only be lodged through local travel agents in China.
• Tibet, Qinghai, parts of Xinjiang, and western Sichuan are situated at altitudes over 3000 metres. Travellers in these areas may suffer from altitude sickness.
Travel and living conditions vary greatly between city areas and less developed rural areas. You may have trouble finding services such as banking, internet access and telephones in rural areas.
Poorly maintained roads and aggressive driving can make travel by road in China dangerous.
For further advice, see the bulletin on Overseas Road Safety from Smartraveller:
Dengue Fever: Dengue occurs as frequent, often widespread, outbreaks. The incidence of dengue is highest in southeastern China. In September 2006, an outbreak of dengue fever was reported in Guangdong Province. In 2007, multiple cases were reported from Guangdong, Zhuhai, and Fujiian Provinces. In 2008, more cases were reported from Fujian Province. Most disease transmission occurs during the summer months; in the tropical provinces, however, the transmission period extends from March through November. Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in South East Asia. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases.
• 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 (such as Ultrathon or Ben's 30) to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.
Worldwide disrtribution of dengue fever
Echinococcosis: Human alveolar hydatid disease, a potentially fatal disease caused by larvae of the canine tapeworm E. multilocularis, is common throughout western and northwestern China. This disease is caused by the larval stage of the fox tapeworm and is spread to humans by close contact with infected domesticated dogs and cats or by contact with infective fox/canine feces. (The adult tape-worm usually lives in the intestine of wild canines, predominantly foxes, and the usual intermediate hosts are rodents. Humans become infected as accidental intermediate hosts by ingesting eggs of the parasite passed in the feces of the definitive hosts.) Prevention is by avoiding uncooked or contaminated food and water.
Filariasis: Both the Bancroftian and Malayan forms are reported in the southwestern provinces. Travelers to these areas should take measures to prevent mosquito bites.
Hand, Foot and Mouth Disease: According to the Chinese Ministry of Health, over 75,000 cases of hand-foot-mouth disease (HFMD) have been reported since March 2010, with the majority occurring in eastern and southern regions of China (Shendong, Henan, Guangdon, and Guanxi Provinces). Epidemics lasting 2-3 months occur annually during the spring and summer. HFMD is caused by intestinal Enterovirus 71 (EV 71) and mainly affects small children. HFMD is transmitted via respiratory droplets and is characterized by fever, blisters and rashes on the hands, feet and buttocks. Travelers are reminded to exercise particular care in hygiene habits, including frequent handwashing. The World Health Organization (WHO) provides information on preventative measures. (http://www.who.int/csr/don/2008_05_01/en/index.html)
• According to the WHO recommendations, it is NOT necessary to restrict travel or trade on account of this illness.
Helminthic Diseases: These diseases are moderately to highly endemic in rural and urban areas. Diseases caused by soil-transmitted helminths (hookworm disease, strongyloidiasis) can be prevented by wearing shoes and not walking barefoot outdoors.
• Food-transmitted roundworm infections (ascariasis, trichuriasis) can be prevented by washing salads and/or vegetables or thoroughly cooking food to destroy infective eggs.
• Lung fluke and liver fluke disease (paragonimiasis, clonorchiasis) can be prevented by not eating raw freshwater crabs, crayfish, or fish.
• Fasciolopsiasis (large intestinal fluke disease) and fascioliasis (sheep liver fluke disease) can be prevented by not eating undercooked or raw water plants, such as watercress and other aquatic vegetables.
• Anisakiasis can be avoided by not eating raw saltwater fish, including raw octopus and squid.
• Capillariasis can be prevented by avoiding raw or undercooked freshwater fish.
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 a leading cause of sporadic acute viral hepatitis in China. 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. Hepatitis E is usually a self-limiting disease, except in pregnant women, where there is a 20% to 25% mortality rate.
• Hepatitis B is highly endemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >10%. In Guangdong Province, the southernmost province of China, the hepatitis B virus may infect up to 75% of the populace. Elsewhere, up to two-thirds of the populace may be carriers of the hepatitis B virus. 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 a moderately 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.
Human Anaplasmosis: Health authorities in China report that a tick-borne disease, human granulocytic anaplasmosis (HGA), has killed more than 30 people since 2007. (HGA was previously called human granulocytic ehrliciosis. The disease is now usually called human anaplasmosis)
As of September 2010, HGA has spread to 12 provinces, including Henan in central China and Shandong in the east. A total of 182 cases have been identified in Shandong since May 2008. HGA was 1st detected in Anhui province in 2006.
HGA is a tick-borne disease that is caused by a rickettsia-like bacterium, Anaplasma phagocytophilum. The disease is treatable if detected early. Doxycycline is the antibiotic of choice.
Symptoms include fever, muscle aches, weakness and headache. Patients may also experience confusion, nausea, vomiting and joint pain. Unlike Lyme disease or Rocky Mountain spotted fever, a rash is not common. Infection usually produces mild to moderately severe illness, with high fever and headache, but may occasionally be life-threatening or even fatal. Low white blood cell (WBC) and platelet counts are suggestive of the diagnosis.
In the United States, HGA is transmitted to humans by the bite of the deer tick and western blacklegged tick. Deer ticks infected with A. phagocytophilum are found in the New England and North Central United States while blacklegged ticks infected with A. phagocytophilum are found in northern California. States reporting the highest incidence of HGA in 2001-2002 were Rhode Island, Minnesota, Connecticut, New York, and Maryland. Overseas, cases of HGA have been documented in many countries in Europe, as well as Argentina, China, Japan, Malaysia, and Venezuela.
Prevention consists in avoiding tick bites. There is no vaccine. For maximum protection, apply a DEET-containing repellent to exposed skin (30%–50% concentration recommended) and apply permethrin spray or solution to your clothing and gear.
• DEET-based repellents have long been the gold standard to prevent mosquito and tick bites. The CDC and the World Health Organization now recommend 20% picaridin repellents as an effective DEET alternative.
Influenza: Influenza ("the flu") is transmitted November through March. Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.
In May 2009, China implemented a policy that allows it to quarantine arriving passengers who exhibit fever or flu-like symptoms if they are arriving from a country which has cases of 2009-H1N1, including the U.S. Although the overall percentage of Americans being quarantined remains low, the seemingly random nature of the selection process makes it almost impossible to predict when a traveler may be placed into quarantine. Travelers with even a slightly elevated body temperature risk being placed into hospital quarantine, while passengers sitting in close proximity to another traveler with fever or flu-like symptoms may be taken to a specially-designated hotel for a quarantine of approximately seven days, even if they show no symptoms themselves.
Japanese Encephalitis (JE): This mosquito-transmitted disease is present in all regions, except in Qinghai Province, Xinjiang Province, and Tibet (Xizang). Cases were reported in August 2006 from the provinces of Henan, Shaanxi, and Shanxi (including Yuncheng City), which share borders in the central part of China. Risk of JE is greatest in rural pig-breeding agricultural areas of the central and eastern provinces, especially during the warm, rainy months from May to September. Risk of JE is year-round in the tropical southern provinces. There is low risk of transmission in urban areas due to the relative absence of mosquitoes.
The Centers for Disease Control and Prevention (CDC) recommends JE vaccination for travelers spending more than 30 days in an endemic environment, or less than 30 days in areas with epidemic transmission. However, the use of an arbitrary cutoff cannot protect all travelers. Advance knowledge of trip details, accommodation and purpose, as well as local geography, is warranted to give adequate advice. 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, especially during unprotected outdoor activities in the evening. Vaccination is advised for expatriates living in this country.
• Japanese encephalitis is transmitted by night-biting Culex mosquitoes. All travelers should take measures to prevent mosquito bites, especially in the evening and overnight. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon or Ben's 30) to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Geographic Distribution of Japanese Encephalitis:
Leishmaniasis: Visceral leishmaniasis (kala-azar) occurs in the temperate central and northeastern provinces, mainly Gansu, Shaanxi, Shanxi, Shandong and Sichuan provinces, and Xinjiang (case reporte in 2007) and Nei Mongol Autonomous Regions. Most cases are reported from Gansu Province. Risk of disease transmission is elevated from May through October, when sandflies are more active. Cutaneous leishmaniasis has been reported from the Xinjiang Autonomous Region.
• The parasites that cause leishmaniasis are transmitted by the bite of the female phlebotomine sandfly. Sandflies bite mostly in the evening and at night. They breed in ubiquitous places: in organically rich, moist soils, such as rain forest floors, animal burrows, termite hills, and the cracks and crevices in stone or mud walls, and earthen floors, of human dwellings.
• All travelers should take measures to prevent sandfly bites. Insect-bite prevention measures include applying a DEET-containing repellent (such as Ultrathon or Ben's 30) to exposed skin, permethrin (spray or solution) to clothing and gear, and sleeping under a permethrin-treated bednet.
Lyme Disease: Lyme disease occurs mostly in northern and northeastern provinces through the warmer months. Sporadic cases are reported from other forested regions. All travelers who engage in hiking, camping, or similar outdoor activities in rural wooded regions of endemic areas should take measures to prevent tick bites. Tick-bite prevention measures include applying a DEET-containing repellent to exposed skin and permethrin spray or solution to clothing and gear.
• A single 200-mg dose of doxycycline is effective in preventing Lyme disease if taken within 72 hours of being bitten by an infected tick. (Reference: http://content.nejm.org/cgi/content/abstract/345/2/79).
Dr. Rose Recommends
In addition to the southern mountainous area of Hainan and the border area of Yunnan, malaria is also prevalent in several provinces of central China.
There is no malaria risk at all in the northern provinces: Heilongjiang, Jilin, Nei Monggol, Beijing, Shanxi, Ningxia, Qinghai, nor in the western provinces Gansu, Xinjiang (except in the valley along the Yili river), and Xizang (except for one area in the extreme south-east in the valley of the Zangbo river, towards the border with Myanmar). Protective measures against mosquito bites are sufficient in these provinces.
• The main tourist areas of China, including cruises on the Yangtze river, are very low risk.
Chloroquine-resistant falciparum malaria is confirmed in the provinces of Hainan and Yunnan. Other provinces are not currently reported to have chloroquine-resistant malaria.
• For the provinces of Hainan and Yunnan, prophylaxis with atovaquone/proguanil (Malarone), doxycycline, or primaquine (G6PD test required) is recommended.
For all other risk areas, under 1500 meters elevation, chloroquine is the drug of choice. Chemoprophylaxis is not recommended for the main tourist areas, including cruises on the Yangtze river, however, travelers should be aware of the small risk of malaria.
A malaria map is located on the Fit for Travel website (www.fitfortravel.nhs.uk), which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the China (mainland) page on the Destinations menu.
An up-dated CDC map showing the geographic distribution of mefloquine-resistant malaria in South East Asia is at: http://wwwn.cdc.gov/travel/yellowBookCh4-Malaria.aspx#648
Malaria is transmitted via the bite of an infected female 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 (such as Ultrathon or Ben's 30) 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 insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing.
NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives 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 malaria endemic areas of this country.
Melamine: In September 2008, the Chinese government announced that the industrial chemical melamine had been discovered in infant formula produced in China. As of October 22, 2008, melamine-contaminated products manufactured in China have been found in several countries throughout the world, and the list of affected countries and products continues to grow. Melamine, in high doses, is a chemical that can cause health problems such as kidney disease.
Melamine has been found in several products produced in China, including liquid milk, frozen yogurt, instant coffee, coffee creamer, ice cream, chocolate cookies, candies, eggs and more.
• Advice for Consumers Worldwide: The U.S. Food and Drug Administration is advising consumers worldwide to continue to avoid using any infant formula made in China, as well as any milk products or products with milk-derived ingredients made in China.
• CDC advice for Travelers to China here: http://wwwn.cdc.gov/travel/contentMelamineChina.aspx
Meningitis: An outbreak of meningococcal disease was reported in January 2005 from 11 cities in Anhui Province in eastern China. Most cases occurred in students. A smaller number of cases were reported from the provinces of Henan, Hebei, Jiangsu, and Xichuan. The outbreak appeared to have ended by August 2005. Meningococcal vaccine is not currently recommended for travelers to China but updated information on outbreaks should be obtained before departure.
Milk Products: The Chinese government has announced that traces of a chemical contaminant, melamine, have been found in a number of products and may be linked to cases of renal (kidney) problems in infants. A Chinese Health Ministry official has reported the number of infants affected by contaminated product produced in China has risen to nearly 40,000 cases.
The Chinese government has issued recalls for infant formula from 22 companies after tests turned up traces of melamine. Two of these companies exported their products to Bangladesh, Burundi, Mongolia, Myanmar, Gabon and Yemen. While contamination in those exported products remains unconfirmed, a recall has been ordered from China.
Chinese authorities are also testing other dairy products. Low levels of melamine contamination have been identified in liquid milk from three of China’s largest milk processors. Testing of milk produced by smaller processors is continuing.
Chinese authorities have also tested samples of imported dairy products from 18 countries and regions and have confirmed that no melamine was detected.
Japan, Hong Kong, Malaysia, Brunei, Bangladesh and Singapore have banned imports of all dairy products from China and have issued product recalls for certain brands of infant milk formula, milk, yoghurt, ice cream, candy, canned coffee drinks and buns. Singapore and Japan have extended the ban to include confectionery such as chocolate, biscuits and sweets, as well as any other product containing milk from China as an ingredient.
Travelers overseas are advised to avoid all milk products manufactured in China, until further information is available, unless the manufacturers have confirmed their products are free from contamination.
Source: Smartraveler.gov.au Sept 2008
Natural Disasters, Severe Weather & Climate: We advise you to exercise caution if traveling to Sichuan Province in south-western China after a major earthquake in May 2008. The quake was centered 92 kms north-west of Chengdu, the capital of Sichuan Province, and caused tens of thousands of deaths and injuries. Extensive damage to property, including transport and communications infrastructure remains. You should monitor the media and the instructions of local authorities.
The rainy season occurs between April and October. Severe rainstorms can cause flooding and mudslides which may interrupt essential services. Typhoons can occur along the southern and eastern coasts between May and November. You should monitor weather reports if travelling in affected areas.
Other Diseases/Hazards: Angiostrongyliasis (caused by Angiostrongylus cantonensis, a rat lungworm; human infections are acquired by ingestion of raw or undercooked snails or slugs, prawns, or contaminated vegetables that contain the infective larvae of the worm. During the past few years, several outbreaks of human angiostrongyliasis have been reported in mainland China)
• Anthrax (mostly cutaneous; associated with contact with infected animals).
• Brucellosis (from consumption of unpasteurized dairy products and infected meat of farm animals).
• Crimean-Congo hemorrhagic fever (low endemicity; in Xinjiang Province only).
• Chikungunya fever (mosquito-transmitted; reported in Hong Kong).
• Gnathostomatiasis (reported in 2008 in a 59-year-old woman had a history of eating undercooked freshwater fish raised in Beijing. Symptoms included creeping eruption and erythematous plaques associated with high fever and systemic symptoms. Twenty-three cases in 12 provinces have been reported in the Chinese literature but none have been reported in English).
• Leptospirosis (periodic outbreaks countrywide; highest incidence in Yunnan Province).
• Lyme disease (human cases reported from Henan, Jiangsu, Fujian, Anhui, and Heilomgiang Provinces, and Xinjiang Autonomous Region).
• Measles (The Chinese media reported that ten people died of measles in the Xinjiang Uygur Autonomous Region in January 2008).
• Melioidosis (endemic in Guangdong and Hainan Provinces, and Guangxi Autonomous Region; risk elevated June through August).
• The Ministry of Health (MoH) in China has reported an outbreak of pneumonic plague in Qinghai Province, China. As of August 6, 2009, there have been 12 confirmed cases, of which three have died. The local health authorities in the remote village of Ziketan have also quarantined 332 contacts of those with plague, and implemented other measures such as controlling traffic to the area to further contain the outbreak.
Travel Medicine advises travellers to avoid exposure to persons suspected of infection with plague. Travellers should also avoid contact with rodents and take precautions to reduce the risk of exposure to flea bites.
• Russian spring-summer encephalitis (occurs in northern China, especially Inner Mongolia).
• Siberian tick typhus (this is a tick-borne, rickettsial spotted fever-group disease, similar to Mediterranean spotted fever).
• Tuberculosis (highly endemic).
• Trachoma (widespread).
• Murine and epidemic (louse-borne) typhus (low risk).
Plague: The Ministry of Health (MoH) in China has reported an outbreak of pneumonic plague in Qinghai Province, China. As of August 6, 2009, there have been 12 confirmed cases, of which three have died. The local health authorities in the remote village of Ziketan have also quarantined 332 contacts of those with plague, and implemented other measures such as controlling traffic to the area to further contain the outbreak.
The Public Health Agency of Canada advises travellers to avoid exposure to persons suspected of infection with plague. http://www.phac-aspc.gc.ca/tmp-pmv/2009/p-plague-090818-eng.php
Travellers should also avoid contact with rodents and take precautions to reduce the risk of exposure to flea bites.
There are three forms of the plague: bubonic (most common), septicemic, and pneumonic. They are all caused by the same bacteria, Yersinia pestis, but present differently depending on what part of the body the bacteria has infected.
Pneumonic plague, occurs when the bacteria spread into the lungs causing respiratory illness. It is easily spread from person to person by inhalation of respiratory droplets (i.e., coughing).
All forms of the plague cause high mortality unless diagnosed and treated early.
Take about 1 to 7 days to appear, shorter for pneumonic form.
Initially are “flu-like”, for example: fever, chills, head and body-aches, vomiting and nausea.
Fever and painful swollen lymph nodes- in the bubonic form
Include pneumonia, water on the lungs, chest inflammation, and coughing up blood.
Without early diagnosis and treatment, septicemic and pneumonic plague are almost always fatal.
Plague is typically transmitted by fleas or through direct contact with infected animals.
Pneumonic plague is spread by airborne droplets (sneezing or coughing). You can catch it by coming into contact with secretions from the nose or throat of a person who is infected.
Pneumonic plague can also occur as a secondary stage of bubonic plague. In this instance, transmission occurs through the bite of an infected flea followed by the bacteria spreading to the lungs.
Recommendations for Travellers
Avoid exposure to persons suspected of infection with pneumonic plague
Take precautions to reduce risk of exposure to flea bites
Wear light-coloured, long-sleeved, tucked-in shirts, long pants, shoes (not sandals) and a hat.
Use insect repellent on exposed skin:
Insect repellents that contain DEET are the most effective;
Use as directed by the manufacturer;
Do not apply to cuts, scrapes, abrasions or irritated skin;
Do not spray directly on your face;
Wash your hands after you apply insect repellent to avoid contact with your lips and eyes;
Do not use products that contain both insect repellent and sunscreen;
If you want to use sunscreen and an insect repellent with DEET, apply the sunscreen first. Let it soak into your skin for about 20 minutes, then apply repellent with DEET; and
Wash off repellent at the end of the day, before you go to bed.
Consider your accommodations:
You have proof of immunity (e.g. through blood testing).
More information on precautions to take to avoid flea bites while travelling
Avoid rodent nests and burrows, and sick or dead animals
If travelling to Qinghai Province, China, discuss the benefits of taking an antibiotic medication (chemoprophylaxis) with a health care professional before leaving
Travellers should visit a travel health clinic at least six weeks before travel.
It is recommended that you also protect yourself from flea bites even if you use an antibiotic medication (chemoprophylaxis).
Discuss your risks with a health care professional to determine whether to take antibiotic medication and which one to take.
If your doctor, nurse or health care provider prescribes antibiotic medication, it is important that you take it as directed in order to protect yourself fully.
Rabies: A higher than average incidence of rabies is reported in urban and rural areas of China, with stray dogs the main threat. In 2012, over 200 cases of human rabies were reported monthly, including some cases from Beijing.
All animal bites, scratches, or licks of broken skin, especially from a dog, should be thoroughly cleansed and then medically evaluated for possible post-exposure treatment. Rabies vaccination may be required. Although rabies is rare among tourists—there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals.
• Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites.
• Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status. Note: If adequate rabies treatment is not available locally, medical evacuation is advised to a facility that can provide treatment.
NOTE: Animal bites are common in China, with 140, 000 animal bites reported in Beijing in 2006. China currently has the second highest number of cases of human rabies in the world. Rabies has, since May 2006, become China’s leading cause of reportable infectious disease mortality, killing 3, 293 people in 2006, 27% more than in 2005.
Read more: http://www.istm.org/geosentinel/documents/GeoS_China_Davis_AJTMH_08Jul.pdf
Rickettsial Diseases (Q Fever, Scrub & Murine Typhus, Spotted Fevers) : At least five rickettsioses exist in China: scrub typhus, murine (endemic) typhus, epidemic typhus, Q fever, and one or more spotted fever-group (SFG) rickettsioses (e.g., Rocky Mt. spotted fever*). Although epidemic typhus has been controlled and scrub typhus has abated in many areas, murine typhus, Q fever, and SFG rickettsiosis are important public health problems. Serologic surveys indicate high prevalences of antibodies to Coxiella burnetii, Rickettsia tsutsugamushi, and SFG rickettsiae in some regions; these rickettsiae have been isolated from humans, arthropods, and animals. Doxycycline has emerged as the best treatment for murine typhus, epidemic typhus, and scrub typhus.
* Other spotted fever group rickettsiae that produce human rickettsioses include R. conorii, R. mongolotimonae and R. slovaca (boutonneuse fever and similar illnesses), R. akari (rickettsial pox), R. japonica (Japanese spotted fever), R. sibirica (North Asian tick typhus), R. africae (African tick bite fever), R. helvetica (perimyocarditis), R. australis (Queensland tick typhus) and R. honei (Flinders Island spotted fever). The spotted fever rickettsiae have been found on every continent except Antarctica.
Read mre: http://www.textbookofbacteriology.net/Rickettsia.html
Schistosomiasis: Year-round risk occurs in southern tropical areas and June through August in temperate areas. Schistosomiasis is widespread south of 35 degrees north latitude, including the provinces of Anhui, Hubei, Jiangsu, Hunan, Jiangxi, Sichuan, Yunnan, and Zhejiang. Major endemic areas include the Yangtze River Valley, including tributaries and adjacent lakes.
• Schistosomiasis is transmitted through exposure to contaminated water while 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, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.
Scrub Typhus: Year-round incidence occurs in the warmer southern areas. Scrub typhus is an acute, febrile, infectious illness that was first described by the Chinese about 2000 years ago. This rickettsial-type disease is transmitted by the bite of chiggers, the larvae of mites. The term scrub is used because of the type of vegetation (terrain between woods and clearings) that harbors the mite vector; however, the name is not entirely correct because certain endemic areas can also be sandy and semiarid.
Symptoms: Patients experience abrupt onset of high fever (104-105°F), severe headache, myalgia, and an eschar (resembling a cigarette burn) at the bite site, and tender regional lymphadenopathy. Less frequently, ocular pain, productive cough, malaise, and injected conjunctiva are present. A rash may occur in about half of the cases.
A small number of patients have CNS involvement, with tremors, nervousness, slurred speech.
• Treatment with either doxycycline or chloramphenicol is effective. Rifampin and azithromycin have been used successfully in areas where scrub typhus is resistant to the conventional therapy.
Read more: http://www.emedicine.com/PED/topic2710.htm
Severe Acute Respiratory Syndrome (SARS): The World Health Organization (WHO) does not currently consider Severe Acute Respiratory Syndrome (SARS) to be a significant threat to public health at this time. For further information on SARS, access the World Health Organisation website http://www.who.int/csr/sars/en/.
Tick-Borne Encephalitis (TBE): Over the past decades, tick-borne encephalitis (TBE) has become a growing public health concern in Europe and Asia and is the most important viral tick-borne disease in Europe. It is also important in the Far East and in other parts of Asia. Vaccination can effectively prevent this disease. No TBE vaccines are licensed or available in the United States. FSME-IMMUN is licensed in Canada and Europe; FSME-IMMUN Junior, Encepur-Adults, and Encepur-Children are also licensed in Europe.
TBE is reported in northeast China. In 2007, an American student contracted TBE while visiting rural Tianjin Province and sustained significant neurological injury. Nonvacinated travelers need to prevent tick bites by applying a DEET-containing insect repellent (such as Ultrathon or Bens 30) to exposed skin and apply permethrin to clothing and gear.
Travelers' Diarrhea: Moderate to high risk. In urban and resort areas, most hotels have generally safe restaurants and potable water. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits.
• Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%.
• A quinolone antibiotic, or 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.
• Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.
Tuberculosis: Tuberculosis is highly endemic in China with an annual occurrence was greater than or equal to 40 cases per 100,000 population. 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, prolonged contact with the local population. 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 vaccine is recommended by the CDC for all people (with the exception of short-stay visitors who restrict their meals to hotels or resorts) traveling to or working in China, 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.