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Thailand



Capital: Bangkok

Time Zone: +7 hours GMT.
Tel. Country Code: 66
USADirect Tel.: 1
Electrical Standards: Electrical current is 220/50 (volts/hz). North American Style Adaptor Plug. European Style Adaptor Plug. Grounding Adaptor Plugs A, D.


Travel Advisory - Thailand

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 Thailand


Resource Links

NaTHNaC
World Health Organization
CDC
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Consular Information
Foreign Commonweatlh Office

Embassies

U.S. Embassy
Bangkok

The U.S. Citizen Services
Best contact for a range of important services, including passports and medical emergencies.




Entry Requirements

Passport/Visa: Thailand tourist visa is not required for citizens of the United States for a stay up to 30 days.

• For further information on entry/exit requirements, contact the Royal Thai Embassy in Washington, D.C.

HIV Test: Not required for entry to this country.

Required Vaccinations: Yellow fever vaccination required for all travelers arriving from a yellow fever endemic zone country in Africa or the Americas. Not recommended otherwise.

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 who might be exposed to blood or body fluids from unprotected sex and sex with a high-risk partner or commercial sex worker; from injecting drug use with shared/re-used needles and syringes; from medical treatment with non-sterile (re-used) needles and syringes; from contact with open skin sores. Recommended for 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:
 Recommended for travelers planning to visit rural farming areas (especially where there is pig rearing and rice farming) for >4 weeks and under special circumstances, such as a known outbreak of Japanese encephalitis.


Polio:
 See routine immunizations (below). Not routinely recommended except for countries where polio is currenlty active. There is no polio active in Thailand.


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:
 Childhood immunizations against tetanus-diphtheria (Td), polio, 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 Tdap vaccines, ADACEL, BOOSTRIX, also protect against pertussis (whooping cough) in adolescents and adults and should be considered when a tetanus booster is indicated. Only a single Tdap is needed lifetime. After 10 years, further boosters revert to Td.


Typhoid: Typhoid vaccine is recommended for all unvaccinated people traveling to or working in Southeast Asia, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. 


Yellow Fever:
 Yellow fever vaccination is required for all travelers >1 year of age arriving from any country in the yellow fever endemic zones in Africa or the Americas, but is not recommended or required otherwise.

Hospitals / Doctors

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.
• We strongly recommend that travelers obtain comprehensive travel and medical insurance before departure. Be sure the policy provides for medical evacuation to an advanced medical facility in the event of serious illness or injury.

Decompression chambers are located near popular dive sites in Koh Tao, Koh Samui, Phuket, Pattaya and Bangkok.

Thailand is the current leader in Asian medical tourism. The medical system was built on the US model. Today a significant number of Thai physicians are at least partially educated abroad. Many hold US professional certification. Thailand (and Singapore) physicians have a long track record of successfully performing complex medical procedures. Thailand began performing heart and liver transplants in the 1980s. Both Thailand and Singapore see a significant number of patients from developed countries. Bumrungrad hospital in Bangkok sees a large number of patients from the US and Canada seeking total disc replacement spinal surgery and other complex procedures.
Blue Cross Blue Shield of South Carolina and Blue Choice Health Plan of South Carolina now offer medical care at Bumrungrad International.

Bumrungrad International
Bumrungrad International is an internationally accredited, multi-specialty hospital located in the heart of Bangkok, Thailand. It is the largest private hospital in Southeast Asia, with 554 beds. Bumrungrad (pronounced Bahm-roong-RAHT) is staffed by over 700+ nurses and 945 doctors, covering 55 sub-specialties. Bumrungrad is a tertiary care center with capability in invasive cardiology, cardiac surgery, and neurosurgery.
The hospital has a 24-hour emergency room; 19 operating theatres; four types of intensive care units (adult, pediatric, cardiac and a Level III neo-natal ICU); and a rehabilitation center.
Surgical facilities include two cardiac catheterization labs, 19 operating theaters (two specifically set up for cardiac surgery), a surgical navigation system; plus endoscopy, arthroscopy, lithotripsy and interventional radiology capabilities.

BNH Hospital
The BNH Hospital (Bangkok Nursing Home Hospital) is a modern 225-bed hospital accredited to international standards. The hospital provides service in both inpatient and outpatient departments with physicians in every field of medicine available on a 24-hour basis.
• BNH Hospital doctor & ambulance call-out (hotel/house call) service.

International Travel Medicine Clinic (ITMC)
The International Travel Medicine Clinic (ITMC), located at the BNH Hospital, is the only clinic in Thailand which provides all routine and tropical vaccinations and can provide referral advice and counseling regarding all health-related matters.


Bangkok Hospital Medical Center
One of the biggest hospitals in Thailand providing tertiary health care. The hospital was established in 1972 by a group of doctors and pharmacists, starting with 5 specialists and 30 full-time nurses. Today Bangkok Hospital has more than 400 full-time & consultant physicians and 600 nurses.
The International Medical Center (IMC) at Bangkok Hospital is a department especially for foreigners. The team of multi-lingual interpreters is ready at all times to help overseas visitors and expatriates overcoming the barriers of language and culture while visiting the hospital. The IMC also has its own International Clinic, where highly educated nurses and doctors serve patients from all over the world.

Thai Red Cross Society
Bangkok.
This facility operates a snake farm (with daily lectures and demonstrations in English), an animal bite clinic, and a • travelers• advisory• bulletin board listing current health hazards and preventive medicine recommendations for tourists.

Samitivej Hospitals

Bangkok

Samitivej hospitals are a group of international class hospitals located in Bangkok that provide tertiary care, from cosmetic surgery to major operations such as open heart surgery and organ transplantations.


Chiang Mai Ram Hospital
Chiang Mai Ram hospital is a private hospital with high standards and state-of-the art facilities. It is largest and most modern of all hospitals in Chiang Mai, with many US-trained physicians. The 350-bed facility includes:
Fourteen operating rooms, 12 I.C.U. rooms, 4 C.C.U. rooms, Helicopter landing pad.

Destination Health Info for Travelers

AIDS/HIV: An explosive increase of HIV infection has occurred in commercial sex workers, of whom up to 70% test positive for HIV. The majority of people infected are heterosexual. Men having sex with men (MSM) are currently a major risk group in Thailand, accounting for about one-fifth of all HIV infections. In Bangkok, HIV prevalence among MSM rose from 17% to 28% between 2003 and 2005. It was not until February 2006 that Thailand’s first campaign to prevent HIV among MSM was initiated.

Thailand now has the highest number of officially-reported AIDS cases in Southeast Asia.
 
Blood used for transfusion in Thailand is checked for the AIDS virus. HIV prevalence in Thailand is estimated at 1% of the general population.

• 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.
• NOTE: Bangkok is sometimes called Gridlock City because of its chaotic traffic. The traffic is left hand (as in England) and there is a high incidence of accidents and pedestrian injury. All drivers should be alert, and seat belts should be worn at all times.

Angiostrongyliasis: ProMED reports in March 2009 an outbreak of angiostrongyliasis in Thai workers. Angiostrongylus cantonensis is transmitted to humans eating raw fresh water snails and lettuce contaminated with infected slugs. Human infection with Angiostrongylus cantonensis is common in Thailand and is seen especially in the northeastern region, where it is associated with the habit of eating koi-hoi, which contains raw snail meat.
• Snails are usually the primary host of the worm, also known as the rat lungworm -a parasite endemic to Southeast Asia and the Pacific region. Humans become infected by ingesting parasie larvae, which are then carried in the blood to the central nervous system. This can result in eosinophilic meningitis, which is characterized in the early stages by severe and acute headaches, fever, nausea and vomiting, and stiffness of the neck, and can result in death or permanent brain damage.
• Eosinophilic meningitis usually resolves after treatment with albendazole and corticosteroids.

Animal/Marine Hazards: Animal hazards countrywide include snakes (cobras, kraits, vipers, coral snakes are present countrywide), centipedes, scorpions, and black widow spiders (large and aggressive species are present countrywide; they are capable of inflicting painful bites or stings, or secreting fluids that can blister skin; snake bite antivenom is available from the Thai Red Cross.)
Prevention: Shake out boots/bedding/clothing prior to use; never walk barefoot; avoid sleeping on the ground; seek medical attention if bitten.
• Other possible hazards include tigers, leopards, crocodiles, pythons, poisonous toads and frogs, and large, aggressive lizards.
• Stingrays, jellyfish, venomous cone shells and several species of poisonous fish (puffer, goblin, stonefish, toad, scorpionfish, porcupine, and box jellyfish) are common in the coastal waters and are potentially hazardous to unprotected or careless swimmers. Box jellyfish stings are potentially lethal and require treatment with antitoxin. Cardio-respiratory arrest may occur within 20 minutes of envenomation.

Emergency treatment guidelines for marine stings


• Large sharks are common on the Andaman (Indian Ocean) side. There are no saltwater crocodiles in Thailand.
• Leeches are common in freshwater ponds and streams and on plant foliage during the monsoon season.
Prevention: Avoid wading in freshwater ponds and streams.
• Toxic plants can cause skin/lung irritation if touched/burned; poisoning can occur if these plants are chewed/eaten.
Prevention: Do not touch, chew, eat, or burn unfamiliar plants; wash contaminated skin/clothing after contact.

Avian Influenza (Bird Flu): Since November 2003, the World Health Organization (WHO) has confirmed human cases or deaths from avian influenza in Azerbaijan, Bangladesh, Cambodia, China, Djibouti, Egypt, Indonesia (including Bali), Iraq, Laos, Burma, Nigeria, Pakistan, Thailand, Turkey and Vietnam. The WHO has not advised against travel to any of the affected countries.

Avian influenza H5N1 virus, excreted in the droppings of infected birds, is endemic in Thailand. Outbreaks in poultry and three human cases were reported between July and September 2006. More outbreaks in chickens, ducks, birds, and fighting cocks were reported in 2007 from the province of Phitsanulok, north of Bangkok and from numerous other provinces. A possible outbreak was also reported in September 2007 from the northern province of Phichit. No human cases were reported in 2007.
• 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 in birds, including those countries which have reported associated cases of human infection.

More here from the New England Journal of Medicine:

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, 29, 2009, a large outbreak of chikungunya fever has affected the country, particularly the southern region including some tourist destinations, such as Phuket. According to the Ministry of Public Health in Thailand, over 42,300 cases have been documented this year in 50 provinces. Reports from Thailand show that chikungunya virus continues to circulate throughout the country. 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 daytime 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 at night.
• Other mosquito-borne diseases, such as dengue fever and malaria, can be confused with chikungunya fever. If you develop a fever while inThailand, it is important to consider the diagnosis of malaria.

Cholera: Multiple outbreaks were reported during 2007 in Khon Kaen, Udon Thani, Sakhon Nakhon, Lamphun, Roi Et, Maha Sarakham, Kalasin, Nakhon Phanom, Samut Sakhon, Nong Khai, Ayutthaya, and Mukdahan. Cholera is a rare disease in travelers from developed countries. 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: We advise you to exercise a high degree of caution because of the political instability in Thailand. Large-scale political demonstrations and related incidents have resulted, over recent months, in some fatalities and injuries in Bangkok and other parts of Thailand. You should avoid demonstration sites, political rallies, military deployments and concentrations of security personnel.
The demonstrations have been disruptive, have blocked access to key buildings and roads, and have temporarily affected some air and rail services in recent months.
• Following the closures of Suvarnabhumi International and Don Muang airports due to demonstrations from late November to early December 2008, both airports have now re-opened and are operational.
• Border regions: There is ongoing fighting and banditry along some sections of the Burma/Thai border. This includes fighting between the military and armed opposition groups as well as clashes between Thai security forces and armed criminal groups, such as drug traffickers. Bandits may target foreigners travelling through national parks or border regions.
• There is an ongoing border dispute between Thailand and Cambodia relating to land adjacent to the Khao Pra Viharn temple (Preah Vihear in Khmer) located on the border region between Sisaket Province in Thailand and Preah Vihear Province in Cambodia. There were instances of fighting between Thai and Cambodian military troops in October, resulting in some injuries and fatalities. The temple is currently closed to tourists. You are urged to avoid travel to the area and to monitor the local media. You should also be alert to possible outbreaks of violence at other points along the Thai-Cambodia border.
• Crime: Sexual assault, food and drink spiking, assault and robbery against foreigners occurs in Thailand, including around popular backpacker destinations such as Khao San Road in Bangkok and the night-time entertainment zones of Bangkok and Pattaya. The Full Moon Parties at Koh Phangan and in other locations regularly result in reports of deaths, arrests, sexual assault, robbery, injuries, drug abuse and lost travel documents. Travellers contemplating attendance should carefully consider personal safety issues and take appropriate precautions.
Petty crime is common. Money and passports have been stolen from rooms (particularly in cheaper hotels and hostels) and from bags on public transport (including on overnight bus services, particularly between Bangkok and Surat Thani). Items have been removed from luggage stored below buses and travellers have reported being drugged and robbed during bus journeys. Tourists have also been robbed after the bags they were carrying were sliced open by razor blades in tourist areas.
• Credit card and ATM fraud involving skimming machines, which can store card data, can occur. You should monitor transactions statements and only use ATMs in secure locations such as banks, shops or malls.
Many travellers fall victim to scams after accepting offers from people recommending or offering various goods or services, particularly with shopping for jewellery and gems. The Tourism Authority of Thailand (TAT) can provide official advice on purchasing jewellery and gems.

Source: http://www.smartraveller.gov.au/zw-cgi/view/Advice/Thailand

Dengue Fever: Over 58,000 cases of dengue fever have been reported so far in 2010, primarily from the Northeastern, Central, and Southern regions—and a significant increase over the average incidence has been reported since June 2010. Travelers are advised to practice daytime insect precautions. Peak infection rates occur in the rainy season, between June and August, countrywide, but particularly in northeastern Thailand.
Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in throughout much of 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 to exposed skin and applying permethrin spray or solution to clothing and gear.
• There is no vaccination or medication to prevent or treat dengue.

Dengue fever risk map 


Filariasis: Both the Malayan and Bancroftian varieties occur in scattered areas, primarily the southern peninsular coastal provinces, the central provinces of Sisaket and Surin, and the forested areas along the Thailand–Burma border. Travelers should 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 with up to 20% of adults testing positive for previous exposure to the hepatitis E virus (HEV). Waterborne outbreaks have been reported, but may go unrecognized. Transmission of 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 B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. 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 6.1% 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 >age 6 months who have not received a flu shot in the previous 12 months.

Japanese Encephalitis (JE): Highly endemic nationwide, especially in the central and northern provinces; sporadic cases occur in the south. There is risk of infection in the suburban areas of major cities, except Bangkok, where JE is uncommon. Highest risk in the south occurs during the rainy and early dry season; in the north, during late summer and autumn.
• 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. 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. In general, travelers to rural areas (especially where there is pig rearing and rice farming) should consider vaccination if the duration of their trip exceeds 3 to 4 weeks.

However, in 2010 new guidelines (Hills SL, Griggs AC, Fischer M. Japanese encephalitis in travelers from non-endemic countries, 1973-2008. Am J Trop Med Hyg. 2010; 82:930-936. Buhl MR, Lindquist L. Japanese encephalitis in travelers: review of cases and seasonal risk. J Travel Med. 2009; 16:217-219.) suggest that vaccination could be recommended for all travelers to Thailand with a rural or beach destination regardless of duration of travel and season of year-except, perhaps, in the mountainous northwest. The need for vaccination should be strongly reinforced for travelers with an itinerary >2 weeks and for VFRs, students on study abroad programs, and other expatriates.
• 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:



Leptospirosis: Leptospirosis is an endemic disease in Thailand, with most cases occurring during the rainy season, June through December. Epidemics and common-source outbreaks (from contaminated drinking and swiming water) are reported, the last outbreak being in the northeastern province of Nakhornratchasrima.

Malaria: This disease rarely occurs in people visiting the usual tourist sites in Thailand. In the past two decades, malaria endemic regions have been shrinking, now involving mostly land near the borders with Myanmar and Cambodia. There are small pockets on a few islands and along the Malaysian border.
Recommendations from the CDC: There is risk in rural areas that border Cambodia, Laos, and Myanmar (Burma). Very limited risk in Phang Nga and Phuket; therefore, prophylaxis is not recommended for these two areas. No risk in cities and in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Ko Samui, and Ko Phangan.
• Travelers to malarious border areas are advised to take an antimalarial prophylactic drug, either atovaquone/proguanil (Malarone), doxycycline, or primaquine (G6-PD test required).

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). 


In 2007, there was an increase in the number of malaria cases reported along the Thai/Myanmar border in Burmese refugees. Countrywide, Plasmodium falciparum causes about 60% of malaria, P. vivax about 40%. There is a high incidence of multidrug-resistant falciparum malaria. P. falciparum resistance to standard treatment doses of mefloquine is reported as >50%. Mefloquine prophylaxis is not recommended.

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) 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 this country.
• Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.

Marine Hazards: News reports in 2007 alerted travelers to the fact that food vendors in Thailand were selling puffer fish meat and calling it salmon. According to a reporting physician in Thailand, this disguised (dyed in some cases) puffer fish meat has caused at least 15 deaths. Certain puffers (for example blowfish, globefish, swellfish, porcupinefish) contain tetrodotoxin, one of the most potent poisons in nature. The toxin is found in the entire fish, with greatest concentration in the liver, intestines, reproductive organs, and skin. After the victim has eaten the fish, symptoms can occur as quickly as 10 minutes later or be delayed by a few hours. These include numbness and tingling around the mouth, lightheadedness, drooling, sweating, vomiting, diarrhea, abdominal pain, weakness, difficulty walking, paralysis, difficulty breathing, respiratory arrest and collapse.
• If someone is suspected or known to be suffering from puffer poisoning, he or she should immediately be transported to a hospital. Mouth-to-mouth breathing may be necessary in cases of respiratory arrest if emergency services are not immediately available.
• Unfortunately, there is no antidote for tetrodotoxin poisoning, and the victim will need sophisticated medical management until the toxin is eliminated from the body. Persons should be extremely careful when purchasing fish from vendors in Thailand. (Source: Dr. Paul Auerbach, Heathline.com, Sept. 2007)

• Fatalities from box jellyfish envenomations are reported. Two kinds of potentially deadly jellyfish are confirmed in Thai waters: chirodropid box jellyfish and Irukandji box jellyfish. Hundreds of other jellyfish species are present but are not considered life threatening.
Chirodropids are large box-shaped jellyfish with multiple tentacles arising from each of the four lower corners of the bell. Envenomation causes sudden severe skin pain, obvious whip-like skin marks, rapid reduction in consciousness, and life-threatening breathing and/or cardiac problems. Respiratory or cardiac arrest can occur in as little as 2 to 3 minutes.
Irukandji are easily distinguished from chirodropids, as their box-shaped body has just a single tentacle at each lower corner. Irukandji-like species cause a sting that may or may not cause skin pain, followed some 10 to 30 minutes later by severe systemic symptoms that include severe back pains, muscle cramping, headache, nausea, vomiting, sweating, shortness of breath, anxiety and a feeling of restlessness and impending doom.

Other Diseases/Hazards: Angiostrongyliasis (primarily in north-northeastern provinces; associated with eating raw seafood, snails, or vegetables)
• Anisakias (from raw seafood) reported in 1993
• Anthrax (an unlikely hazard for tourists, who should avoid uncooked or poorly cooked meat)
• Capillariasis (associated with eating raw fish)
• Gnathostomiasis (associated with eating raw freshwater fish such as eels, frogs, birds, or snakes)
• Cestode infections (roundworm and hookworm disease)
• Fascioliasis (liver fluke disease; transmitted by eating contaminated water vegetables)
• Leptospirosis (high rates during the rainy season)
• Melioidosis (highest risk in northeastern Thailand; may cause a variety of infections, such as pneumonia or an abscess, or be the source of an obscure fever). An outbreak of melioidosis was reported in August 2010, causing 1307 cases and six deaths, mostly among farmers.
• Opisthorchiasis and clonorchiasis (liver fluke diseases; transmitted by raw seafood; travelers should especially avoid Koi Pla—uncooked, pickled freshwater fish)
• Paragonimiasis (lung fluke disease; endemic in central, north, and northeastern Thailand, including Chiang Rai; travelers should avoid raw freshwater crabs)
• Pinworms (E. vermicularis infection has a prevalence of 41.6% among children in hill tribe villages of the Mae Suk District, Chiangmai Province)
• Trichinosis (avoid undercooked pork sausages)
• Typhus (both tick-borne and murine)

Rabies: There is a high incidence of dog rabies in Thailand. Dogs account for about 95% of rabid animals, cats about 3-4 percent. Cases in other mammals and wildlife have been reported (cattle, monkeys, gibbons, bears, civets, bats, and large rats). Rabid, stray dogs are common in Bangkok, as well as other urban and rural areas. 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. Human diploid cell rabies vaccine is available, but is very expensive and no more effective than the newer “second generation” tissue culture vaccines. These include the Vero cell and purified chick and duck embryo cell vaccines. Human and equine rabies immune globulin (HRIG and ERIG) are manufactured by the Thai Red Cross in limited quantity for local use only. Since the European manufacturers of ERIG have ceased production, immune globulin for post-exposure treatment is in very short supply.

All animal bite wounds, especially from a dog, should be thoroughly cleansed with soap and water and then medically evaluated for possible post-exposure treatment, regardless of your vaccination status. Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine.

Rabies pre-exposure vaccination is recommended for long-term residents, particularly children, and for travelers who plan to venture off the five-star hotel trail and expose themselves to the large stray dog population. Vaccination is strongly recommended for travelers who plan extensive touring to neighboring countries including India, Cambodia, Laos, Burma, and Vietnam, where tissue-culture vaccines, and particularly rabies immune globulin, may not be available. The State Department recommends vaccination for all expatriate corporate employees and their families, especially the children. A rabies clinic is operated by the Queen Saovabha Institute/Thai Red Cross Society Hospital in Bangkok.

Schistosomiasis: There is potential risk of schistosomiasis, albeit minimal, in the southern province of Nakhon Si Thammarat, where intermediate snail hosts exist. Schistosomiasis is a parasitic flatworm infection of the intestinal or urinary system caused by one of several species of Schistosoma. 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, or streams. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: Moderate risk. Campylobacter bacteria cause over 50% of cases travelers diarrhea in US military personnel in Thailand, and over 90% of these campylobacter species are now reported to be resistant to quinolone antibiotics. In non-military travelers (primarily going to Chiang Mai and Phuket), Aeromonas, salmonella, ETEC, and Vibrio appear to be the more common pathogens.
Note: The Journal of Travel Medicine (March 2010) reports that Aeromonas accounted for 13% of pathogens in tourist restaurants in Bangkok. A large majority of the isolates were resistant to azithromycin but sensitive to the quinolone antibiotic ciprofloxacin.

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 milk and dairy products. Do not eat raw or undercooked food (especially meat, fish, raw vegetables—these may transmit intestinal parasites, as well as bacteria). Peel all fruits.
• Wash your hands with soap or detergent, or use a hand sanitizer gel, before you eat. Good hand hygiene helps prevent travelers’ diarrhea.
• 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: The clinical incidence of tuberculosis (TB) in Thailand has been increasing. This is probably due to the high incidence of HIV infection. There is also an increasing rate of multi-drug-resistant tuberculosis. Tuberculosis is common in all developing countries. However, this country has a prevalence of over 100 cases per 100,000 population, the highest WHO risk category.
• 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: The incidence of typhoid (enteric) fever is slowly decreasing. Typhoid is reported countrywide, with the highest incidence in the northern and the southern regions, and the incidence greater in the summer and during the rainy seasons (between March and October). Typhoid is the most serious of the Salmonella infections. Typhoid vaccine is recommended for all people (with the exception of short-stay visitors who restrict their meals to hotels or resorts) traveling to or working in Southeast Asia, 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. Travelers should practice strict food, water and personal hygiene precautions even if vaccinated.