Time Zone: +7 hours. No daylight saving time in 2008.
Tel. Country Code: 84
USADirect Tel.: 1
Electrical Standards: Electrical current is 220/50 and 110/60 (volts/hz). North American Style Adaptor Plug and United Kingdom Style Adaptor Plug. Grounding Adaptors Plugs C, D.
Travel Advisory - Vietnam
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 Vietnam
7 Lang Ha
The U.S. Citizen Services Unit assists the U.S. citizens in emergencies and provides routine services such as
- providing overseas voting assistance,
- giving information on Soc
- processing passport applications,
- ial Security and Veterans' benefits,
- distributing income tax forms,
- notarizing documents,
- registering U.S. citizens living or traveling in Vietnam.
The U.S. Citizen Services unit cannot act as your travel agent, bank, lawyer, investigator or law enforcement agent. Please do not expect the office to find you employment, get you residence or driving permits, act as interpreters, search for missing luggage, or settle disputes with hotel managers. You may not stay at the U.S. Embassy or the Consulate General if you are stranded. However, the office can tell you how to obtain help on these and other matters.
HIV Test: Not required.
Required Vaccinations: Yellow fever vaccine 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.
A valid passport and Vietnamese visa are required. A visa must be obtained from a Vietnamese Embassy or Consulate prior to traveling to Vietnam; entry visas are not available upon arrival. Current information on visa and entry requirements may be obtained from the Vietnamese Embassy, the Vietnamese Consulate General, San Francisco, CA, or from the nearest Vietnamese Embassy or Consulate overseas.
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 sexual contact; from injecting drug use; from medical treatment with non-sterile (re-used) needles and syringes. Recommended for any traveler requesting additional protection from HBV 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 for >4 weeks during the peak transmission season, May to October, and under special circumstances, such as a known outbreak of Japanese encephalitis. The highest rates of JE are reported in and near Hanoi.
Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).
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.
• The new Tdap vaccine, ADACEL, which also boosts immunity against pertussis (whooping cough) should be considered when a tetanus-diphtheria booster is indicated.
A measles outbreak was reported from Viet Nam in early 2009, including the city of Hanoi.
Measles, mumps, rubella (MMR) immunity is especially important for any female of childbearing age who may become pregnant.
Who should receive the MMR vaccine?
• All infants 12 months of age or older
• Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.
• People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.
Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers and cruise passengers.
Hospitals / Doctors
Medical care in Vietnam is extremely limited except in Ho Chi Minh City (Saigon) and Hanoi, where more advanced care is available, designed primarily to serve the expatriate community, tourists, and business travelers. Medical emergencies, e.g., heart attack or severe trauma, may require air evacuation to Thailand, Singapore, or Hong Kong after initial stabilization.
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; may be counterfeit, or be of unreliable quality.
• Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage. Policies should cover: ground and air ambulance transport, including evacuation to home country; payment of hospital bills; 24-hour telephone assistance. Serious illness or injury may require aeromedical evacuation to Bangkok.
Hyperbaric chambers are located in Nha Trang, Quy Nhon and Vung Tau.
Hospitals & Clinics in Ho Chi Minh City and Hanoi
The FV Hospital (French-Vietnamese Hospital) has over 65 French and Vietnamese doctors and 18 specialty departments and is the preferred facility for in-patient treatment for expatriates. Emergency care is available 24 hours.
International SOS Clinics
International SOS is part of a worldwide international service that you can join for a fee and be covered anywhere they offer their services. It is not necessary to be a member to be treated at their clinics. The organization has a capable staff of expatriate and Vietnamese doctors, with specialists providing a full spectrum of care, including Ob/Gyn, tropical/infectious diseases, eye care, and dental. SOS can also monitor your hospital care and assist in medical evacuation to another country, if this becomes necessary.
Centrally located in downtown Ho Chi Minh City, Family Medical Practice also maintains clinics in Hanoi and Danang. They also provide dental services.
Provides professional, efficient, and affordable service. Most doctors speak English.
Destination Health Info for Travelers
AIDS/HIV: Around 40,000 people are becoming infected with HIV each year in Vietnam, mostly through injecting drug use or commercial sex. The number of people living with HIV in Vietnam doubled between 2000 and 2006, and this rise included a large increase in the number of people who became infected through injecting drug use. Levels of HIV among injecting drug users reached as high as 63% in Hanoi, and 67% in Hai Phong. Estimated adult prevalence of HIV/AIDS at the end of 2005 was 0.5% (Source:http://www.avert.org/aids-asia.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.
• 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 another person’s body fluids or 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. 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) Do not swim alone, at night, or if intoxicated.
• Heart attacks cause most fatalities in older travelers.
• Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness.
• MEDICAL INSURANCE: Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.
Animal/Marine Hazards: Animal hazards include snakes (vipers, cobras, kraits), scorpions, and black widow spiders. Other hazards include crocodiles, pythons, and large, aggressive lizards, poisonous frogs and toads, all abundant in and near swamps and rivers; tigers, leopards, bears, and wild pigs are found in the forested and hilly regions of the country. Stingrays, jellyfish, and several species of poisonous fish are common in the country's coastal waters and are potentially hazardous to swimmers. Crocodiles have been reported in the Hau River, a tributary of the Mekong in An Giang province. The crocodiles were thought to have migrated from Cambodia after flooding.
Avian Influenza (Bird Flu):
Avian influenza A (H5N1) 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 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.
Seasonal Influenza: India and Viet Nam, activity decreased in 2014 and was predominantly caused by influenza B viruses.
Cholera: Between March and 22 April, 2008 the Ministry of Health reported >2400 cases of severe acute watery diarrhea including 377 that were proven due to cholera. The majority of people infected are residents of the Hanoi region. Although this disease is reported active, most travelers are at low risk for infection. 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: Internal conflict is rare in Vietnam, although some localised violent clashes between protesters and police have, in the past, resulted in a small number of casualties. You should avoid taking photographs of demonstrations, the military or police as this may not be tolerated by the Vietnamese authorities.
• Crime: Street crime and harassment occur, especially in larger cities. Aggravated theft and assault occur, particularly in Hanoi, Ho Chi Minh City, Nha Trang, Sapa (particularly on the train to/from Lao Cai) and Cat Ba Island (near Ha Long Bay). Petty theft is also common in tourist areas, markets, on crowded trains, buses and at supermarkets. Snatch-and-grab crimes against pedestrians by thieves on motorcycles have resulted in occasional injury to victims.
Foreigners have been robbed and sexually assaulted after accepting spiked food and drinks. There have been reported break-ins to hotels, even while guests are in their rooms. You should take care to ensure your valuables are secure at all times.
• Scams targeting tourists have been known to occur. There have been reported cases of tourists becoming victims of gambling and taxi scams. Be sure you know the price of any service in advance, even have the driver of the taxi or bicycle rickshaw show it in writing. Use airport taxis or pre-arranged hotel transfer services from the airport. Check that any person holding a placard with your name on it knows your destination.
• Local Travel: Traffic conditions throughout Vietnam are hazardous and road accidents, resulting in death or injury, are common. Driving standards and vehicle and road maintenance are generally poor. Motorcycle and intercity bus travel have particularly high accident rates. Do not rent your own vehicle: always arrange for a qualified driver and vehicle.
• Streets are crowded in major cities and road rules are routinely ignored. Be very careful when crossing busy streets as traffic can appear from any direction. Travellers should be aware that transport infrastructure in Vietnam can be in poor condition. Provincial authorities have warned that the Dong Nai Bridge (linking Ho Chi Minh City with Dong Nai, Ba Ria-Vung Tau and other north-eastern provinces) is at risk of collapsing. Vehicles seating seven passengers or less heading towards Ho Chi Minh City are being diverted to the Hoa An bridge to avoid overloading.
• Travel is restricted near military installations and in some parts of the Central Highlands and some border areas.
Unexploded landmines and ordnance are a continuing hazard in former battlefields, particularly in central Vietnam. Mine-free roads and paths are well marked.
• Tour operators might not meet the safety standards expected in the U.S. and Canada, especially for adventure sports such as mountain climbing.
• Piracy occurs in the coastal areas of Vietnam.
Dengue Fever: As reported in ProMED November 2009, Viet Nam had more than 77 000 dengue fever patients in 33 out of 63 provinces and cities in January-October  period. The number of patients rose by 7.3 percent year-on-year
while the number of deaths fell by over 11 percent. Notably, the number of dengue fever patients in the southern region was reduced in both the number of cases and deaths while there were increases in other regions in the country, especially the north, where figures were 4-fold.
[Although the monsoon ends and winter has started to set in, the number of dengue cases is still increasing in the northern part of Viet Nam. As of 24 Oct 2009, 74,242 cases and 58 deaths were identified since January 2009, with 17,140 cases and 14 deaths reported during September 2009. To date, more than 77,000 cases of dengue infection have been reported in Viet Nam from January to October 2009.
Dengue occurs year-round, with peak transmission in the warmer rainy season, April through October in the north and June through December in the south. Elevated risk occurs throughout the Red River Delta and Mekong Delta, and the coastal district and provincial capitals of central Vietnam.
• Dengue fever is a mosquito-transmitted, flu-like viral illness widespread in Asia. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A 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) to exposed skin and applying permethrin spray or solution to clothing and gear. There is no vaccination or medication to prevent or treat dengue.
• A dengue fever map is at:http://www.nathnac.org/ds/c_pages/documents/dengue_map.pdf
Fascioliasis (liver fluke disease): Fascioliasis is a disease caused by an infestation of parasitic liver flukes - is affecting more people in the central and central highlands regions, with some 3000 cases recorded in 2009. The latest figure is 45 percent more in 2008.
• Fascioliasis is spread by cattle that are allowed to wander freely in the region and disperse larvae into water. The disease is transmitted by water vegetables and contaminated drinking water. It is estimated that 40 to 70 percent of local cattle are infected with the disease.
Hand, Foot and Mouth Disease: There have also been reported cases of Hand, Foot and Mouth Disease in Vietnam, mostly from Ho Chi Minh City, Dong Nai to the city's east, and Kien Giang, Dong Thap, Vinh Long and Ben Tre in the Mekong Delta. 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.
• Normal hygiene precautions should be taken including careful and frequent hand washing. According to the WHO recommendations, in certain situations, it may be advisable to close child-care facilities and schools to reduce the intensity of transmission. Advice for travelers: It is NOT necessary to restrict travel or trade because of this illness.
Read more: http://www.who.int/csr/don/2008_05_01/en/index.html
Helminthic Infections (flukes and worms): Oriental lung fluke disease (paragonimiasis) and liver fluke diseases (clonorchiasis, fascioliasis) are prevalent in the Indochina peninsula. Travelers should avoid eating raw, salted, or wine-soaked crustacea such as freshwater crabs or crayfish (which can transmit clonorchiasis and paragonimiasis) and also avoid un-cooked aquatic vegetables, such as watercress, which can transmit fascioliasis (See above). Fasciolopsiasis (large intestinal fluke disease) can also be acquired through eating undercooked aquatic plants such as water chestnuts, bamboo shoots, and caltrops. These, too, should be avoided, if uncooked. Anisakiasis and capillariasis are other intestinal infections acquired through eating raw or undercooked fish (including fresh catch, crab, or squid). Cases have been reported from Southeast Asia.
• Food-borne trematodes (worms), hookworm, roundworm, whipworm, and strongyloides are highly prevalent in most rural areas of SE Asia. Travelers should wear shoes to prevent the hookworm and strongyloides larvae from penetrating the skin of the foot, and food should be thoroughly washed and/or cooked to destroy roundworm and whipworm eggs.
Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Hepatitis A is transmitted through 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 and accounts for about 5% of acute cases of hepatitis. Sporadic cases may be underdiagnosed or underreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. Farm animals (primarily pigs) may serve as a viral reservoir. 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 >12%. 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 over age 6 months.
Japanese Encephalitis (JE): JE is plaguing 31 provinces and cities in Vietnam, having affected 325 people and killed 5 of them in 2014. Risk is present in rural and peri-urban lowland areas countrywide. There is increased risk around Hanoi.
• In Vietnam, two patterns of transmission coexist: In the tropical South, disease risk is year-round but peak levels occur June through July. An epidemic pattern in the more temperate North occurs from May to October. In 2005, the number of children hospitalized for JE in North Vietnam increased by 20% to 30% compared with 2004. The risk for travelers to rural destinations during the rainy season is estimated as high as 1:5,000 cases per month.
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 to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet.
Malaria: Attack rates are highest in the central mountainous areas below 1,500 meters elevation, followed by the central plains and the lowland deltas, respectively. (International SOS doctors in Ho Chi Minh City state that malaria is not currently endemic in the Mekong Delta.) Elevated risk occurs during the warmer rainy months, May through October. The risk of malaria in major urban areas is low, probably non-existent. Falciparum malaria accounts for 70%-75% of cases countrywide. Prophylaxis with atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), or primaquine is advised for travelers visiting malarious areas.
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 to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents (such as Ultrathon) 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: Picaridin repellents (20% formulation, such as Sawyer Picaridin 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: Swimming-related hazards include sharks, jellyfish, stonefish, scorpion fish, stingrays, sea snakes, spiny sea urchins, sharp coral and poisonous cone shells. Swimmers should take sensible precautions to avoid these hazards. Stonefish, scorpion fish and stingrays congregate in shallow water along the ocean floor and can be difficult to see. Wearing booties may help protect you, but should not be relied upon as complete protection, as many of the spines are sufficiently rigid and long to penetrate wetsuits, booties, and gloves.
• The jellyfish population appears to be increasing, due in part to overfishing of jellyfish predators, rising water temperatures, and pollution. Jellyfish travel in groups, so looking before you leap into water may be protective.
Treatment guidelines for jellyfish stings: http://www.emedicine.com/derm/topic199.htm
• To avoid a shark attack, swim or dive with a group. Avoid swimming during hours of darkness or twilight, in fog, or in murky waters. Avoid swimming in the vicinity of sea lions, harbor seals or elephant seals. Avoid swimming near the mouths of rivers where sharks hunt for fish. When diving, minimize time spent at the surface. Wearing a wetsuit and fins or lying on a surfboard creates the silhouette of a seal to a shark below you. Shallow water is not a deterrent to sharks; attacks have occurred in less than 5 ft/1.5 m of water.
The most serious hazards:
Sea snake venom is highly toxic and the mortality has been reported to be 25% in untreated cases. In severe envenomations, symptoms can occur within 5 minutes, but typically evolve over 8 hours. It is possible that the victim may not have been aware of the bite, since there is little or no pain on envenomation.
Symptoms often include anxiety, muscle aching, salivation and a sensation of tongue swelling, followed by nausea, vomiting, muscle spasms, ascending paralysis, ocular palsy and sometimes loss of vision. Respiratory collapse may ensue, and the need for endotracheal intubation and mechanical ventilation should be anticipated. Sea snake antivenom (older name: antivenin) should be administered in all actual and suspected cases.
• A sea snake bite is always a medical emergency, even if the victim does not appear ill.
• You must get the victim to an emergency department, as fast as possible.
• En route, attempt to keep the bite site in a resting position, while keeping the victim as still as possible.
• Apply a broad pressure bandage over the bite about as tight as an elastic wrap to a sprained ankle. This is intended to slow the spread of the venom through the lymphatic system. Apply a splint to the limb. Make sure that arterial circulation is not cut off, by making sure fingers or toes stay pink and warm.
• Never cut open a sea snake bite and try to suck venom from the victim.
• Sea snake toxin is not inactivated by changes in temperature or pH. Application of ice, hot packs, or vinegar only wastes time.
Read more: Sea snake envenomation
The box jellyfish is the most dangerous jellyfish in the world. Box jellyfish belong to the class Cubozoa, and are not a true jellyfish (Scyphozoa), although they show many similar characteristics. When people talk about the extremely dangerous Australian box jellyfish they refer to the species Chironex fleckeri. This is the largest box jellyfish species. The other species that is known to have caused deaths is Carukia barnesi, commonly called Irukandji. This tiny jellyfish is only about thumbnail size. Besides Australia, Chironex fleckeri is present in the waters of the Indo-Pacific region, including Vietnam, Papua New Guinea, the Phillipines, and Hawaii. Their exact distribution has not been fully determined.
• Box jellyfish stings are extremely painful, potentially lethal and require treatment with antivenom. Cardio-respiratory arrest may occur within 20 minutes of envenomation. Four other varieties of jellyfish (jimble, Carukia, mauve stinger, and hairy stinger) should also be avoided.
The stonefish is a rather unattractive squat fish with a mostly rough skin that assists its superb camouflage as it sits on old coral or debris. There is a series of erectile dorsal spines, which, with the associated venom glands, provides the creature means of envenoming potential predators. Stonefish are mostly encountered in shallow water, where, owing to their excellent camouflage, they may be stepped on by accident, or picked up by the unwary. Instant and severe pain is a constant feature of stings, followed by local swelling, which may be marked, tenderness and a blue discoloration of skin surrounding the sting site. Dizziness, nausea, hypotension, collapse, cyanosis and pulmonary edema have been described, though are by no means common. Tissue ischemia at the sting site is possible.
• Antivenom: Stonefish antivenom should only be given if there is clear evidence of envenomation. It should be given only IM, not IV.
• The use of stonefish antivenom in stings by other species of scorpionfish is not clearly recommended, but there is limited evidence that it may be beneficial (e.g. possibly bullrout stings, Notesthes robusta). The potential risks of immediate and delayed adverse reactions to antivenom should be carefully considered before using this antivenom for other than stonefish stings.
Emergency treatment guidelines for marine stings are here:
Clinical Toxicology Resources
University of Adelaide
AIDS/HIV (endemic at low, but increasing, levels)
• Anthrax (health authorities suspect anthrax from contaminated beef caused an outbreak of food poisoning in Meo Vac district in the mountainous Ha Giang province near the Chinese border in June 2008)
• Angiostrongyliasis (may present as transient meningitis or a more severe disease involving the brain, spinal cord and nerve roots, with a characteristic eosinophilia of the peripheral blood and CSF; human infections are usually acquired by purposeful or accidental ingestion of infective larvae in mollusks, planaria (non-parasitic flatworms) and fresh-water crustacea. There is no effective specific treatment). Five cases of Angiostrongylus meningitis were reported among children in the Hanoi area in the year 2008.
• Clonorchiasis (liver fluke disease, caused by the liver fluke Clonorchis sinensis. Infection is acquired through the consumption of raw or undercooked freshwater fish. Light infections are usually asymptomatic; heavier infections may cause fever, chills, upper abdominal pain, tender hepatomegaly, diarrhea, and mild jaundice. Diagnose by identifying eggs in the feces or duodenal contents or by percutaneous transhepatic cholangiography. Treat with praziquantel or albendazole)
• Fascioliasis (liver fluke disease; the mode of transmission is the faecal oral route. Parasite eggs are passed in the faeces of infected animals or humans and contaminate water where they develop within snails. The snails release mature larvae that attach to aquatic plants and vegetation, such as watercress, water lettuce, mint, parsley, or khat. Humans typically become infected by eating these aquatic or semi-aquatic plants, or drinking water contaminated by the parasites. Infection may also occur by ingesting larvae attached to the surface of food or kitchen utensils washed with contaminated water. Triclabendazole 10 mg/kg body weight single dose is the regimen of choice against fascioliasis)
• Fasciolopsiasis (giant intestinal fluke disease; acquired by eating aquatic plants, such as water chestnuts)
• Helminthic infections (ascariasis, hookworm disease, strongyloidiasis)
• Filariasis (Bancroftian filariasis endemic throughout southern Vietnam; Malayan filariasis is endemic in the Red River Delta in northern Vietnam)
• Melioidosis (endemic countrywide)
• Meningitis (endemic)
• Paragonimiasis (Oriental lung fluke disease; transmitted when humans ingest raw or undercooked, infected crustaceans, such as crayfish and crabs; infection has also occurred following ingestion of raw pork from wild pigs that contained the juvenile stages of Paragonimus species)
• Plague (339 cases reported in 1994, mostly from the central highlands, but may occur countrywide)
• Typhus (louse-borne and flea-borne)
• Scrub typhus (mite-borne; risk elevated in mountainous, wooded southeastern areas)
Rabies: Rabies is a significant threat outside of urba areas. Eighty-one people have died of rabies between 1 Jan and 31 Aug 2007 compared to an
annual average of 80. Most of the cases were from the northern provinces of Tuyen Quang, Phu Tho, Ha Tay and Yen Bai. All bites, scratches, or licks of broken skin, especially from a dog, should be taken seriously, and immediate medical attention sought.
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.
Road Safety: The roads in Vietnam are choked with traffic, especially swarms of motorbikes, and the flow of traffic is largely unregulated and chaotic. Serious road safety issues exist; traffic signs are few and not in English, and roadway assistance is barely avaiable. Travelers are advised not to drive themselves, but to hire a qualified driver with well-maintained vehicle for any motor trip within this country.
Schistosomiasis: Endemic status unclear. Risk may occur along the Mekong River. Schistosomiasis mekongi is endemic to Laos (Khong Island) and areas of Cambodia. The parasite is transmitted by aquatic snails. Travelers should avoid swimming, bathing, or wading in freshwater lakes, ponds, streams, or irrigation ditches.
• 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.
Travelers' Diarrhea: Moderate- to high-risk of diarrhea occurs in this country. Water- and food-borne outbreaks of diarrheal disease occur, especially during the rainy season. 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 and 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 medical advice if you have severe or bloody diarrhea, diarrhea associated with fever and abdominal pain, or dehydration. Do not take Imodium if you have bloody diarrhea with fever.
Tuberculosis: Tuberculosis is highly endemic in Viet Nam 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 fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all unvaccinated people traveling to or working in South East 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, 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.