International Health Guide Thailand
Thailand Embassy: 202-4944-3600 Bangkok GMT +7 hrs
Passport/Visa: A valid passport is required.
HIV Test: “Those suspected of carrying AIDS” may be denied entry. Travelers should contact the Thai Embassy in Washington for further information and advice.
VACCINATIONS: A yellow fever vaccination certificate is required if arriving from infected areas or from countries in the Yellow Fever Endemic Zones in Africa and South America.
Hepatitis A vaccine is recommended for all travellers to SE Asia.
Hepatitis B vaccine is recommended for all travellers, regardless of where they may be travelling.
Routine immunizations against diphtheria, tetanus, polio (DTP); measles, mumps, rubella (MMR), and Haemophilus influenza should be up to date before your departure. An assessment of your need for vaccines against chicken pox (varicella), influenza, and pneumococcus should be done with a health care professional.
Telephone Country Code: 66
Embassies/Consulates: U.S. Embassy (consular section), Bangkok. 95 Wireless Road; Tel. (2) 205-4000. U.S. Consulate, Chiang Mai. 387 Vidhayanond Road; Tel. (53) 252-629.
Hospitals / Doctors:
International Travel Medicine Clinic, BNH Hospital, Bangkok (Tel: 632-0570); this clinic provides all routine and tropical vaccinations and can provide referral advice and counseling regarding health-related matters.
Queen Saovabha Memorial Institute (Thai Red Cross Society); 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.
Bangkok General Hospital & Heart Institute.
Phyathai Hospital; often used by expatriates
University Hospital, Bangkok; extensive neurosurgical, cardiovascular, and trauma capability; Tel. 252-0570.
Samitivej Hospital; this is a luxurious hospital located in an expatriate neighborhood; highly recommended for its excellent care.
Bangkok/Pattaya Hospital (southeast of Bangkok).
Bangkla Baptist Hospital (Bangkla Chacheungsao).
Chiang Mai—McCormick Hospital; well set-up to treat foreigners.
Chiang Mai Ram Hospital; the most modern of all hospitals in Chiang Mai, with many US-trained physicians.
Lanna Hospital; especially well-known for its OB/GYN services.
Current Advisories & Health Risks:
AIDS/HIV: An explosive increase of HIV infection has occurred in commercial sex workers, of whom 14–72% are now seropositive. The majority of patients are heterosexual. 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.
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 “the 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.
Animal Hazards: Animal hazards include snakes (kraits, vipers, cobras), centipedes, scorpions, and black widow spiders. (Snake bite antivenom is available from the Thai Red Cross.) Other possible hazards include tigers, leopards, crocodiles, pythons, poisonous toads and frogs, and large, aggressive lizards. Stingrays, jellyfish, and several species of poisonous fish (puffer, goblin, stone, toad, scorpion, pig, porcupine, and box jellyfish) are common in the country’s coastal waters and are potentially hazardous to unprotected or careless swimmers. Large sharks are common on the Andaman (Indian Ocean) side. There are no saltwater crocodiles in Thailand.
Cholera: Sporadic cases may occur. Cholera is an extremely rare disease in travelers from developed countries. Cholera vaccine is recommended primarily for people at high risk (e.g., relief workers) who work and live in highly endemic areas under less than adequate sanitary conditions.
The manufacture and availability of the injectable cholera vaccine in the United States ceased in June 2000.
Many countries, including Canada, license an oral cholera vaccine. The oral vaccine is not available in the United States.
Cholera vaccine is not "officially" required for entry into, or exit from, any country. Despite this, some countries, on occasion, require proof of cholera vaccination from travelers coming from cholera-infected countries. Anticipating such a situation, certain travelers may wish to carry a medical exemption letter from their health-care provider. Travel Medicine, Inc., recommends that travelers use the International Certificate of Vaccination (Yellow Card) for this purpose, having their health-care provider state "exempt from cholera vaccine" and validate the exemption with both their signature and their official stamp (the "Uniform Stamp" in the United States).
Dengue Fever: Highly endemic, and a risk for travelers. Peak infection rates occur in the rainy season, between June and August, countrywide, but particularly in northeastern Thailand. Dengue and dengue hemorrhagic fever are major health problems both in Thailand and throughout SE Asia. Prevention is by avoiding daytime mosquito bites.
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: Hepatitis A vaccine is recommended for all nonimmune travelers. Hepatitis E is endemic, with seroposivity rates of 22% in adults. There is no vaccine for hepatitis E. The hepatitis B carrier rate in the adult general population is about 9%. The usual traveler without lifestyle problems is at virtually no risk of acquiring hepatitis B virus (HBV), but vaccination is recommended for sexual tourists, long-term visitors, and anybody wanting increased protection. Hepatitis C is endemic and is largely transmitted by blood products and body fluids. Like HBV, hepatitis C carries no increased risk for travelers who have a normal lifestyle.
Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 50; all travelers with any chronic disease or weakened immune system; travelers of any age wishing to decrease the risk of this illness; pregnant women after the first trimester.
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.Vaccination is recommended for travelers who will be staying in rural-agricultural areas longer than 2 weeks during the peak transmission season. In addition, all travelers should take measures to prevent mosquito bites, especially in the evening. The Regional Medical Officer of the American Embassy currently recommends JE vaccination for all expatriate Americans.
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.
There is no risk of malaria in Bangkok and other major urban areas (Chiangmai, Chiangrai) or the large coastal resort cities (Phuket, Pattaya, Haadya, and Sonkhla). Prophylaxis is recommended for Koh Chang island. The central part of Thailand and the cities, usually visited by tourists, have been free of malaria for over 10 years, with the exception of Kanchanaburi Province and the River Kwai region.
Although malaria is mostly eradicated from urban areas and the plains, there is some risk of malaria in the forested foothills, jungles, rubber plantations, and fruit orchards. The northern part of the country contributes 44% of all malaria in Thailand, with Tak and Mae Hongsorn leading the list. In northeast Thailand, most cases come from Ubon Ratchathani and Srisaket. Southern Thailand has an increasing incidence of malaria, in contrast to the rest of the country, where it is decreasing.
Countrywide, Plasmodium falciparum causes about 60% of malaria, P. vivax about 40%. P. malariae causes less than 1% of cases. There is a high incidence of multidrug-resistant falciparum malaria. P. falciparum resistance to standard treatment doses of mefloquine runs as high as 50%.
The Thai Ministry of Health currently recommends no prophylaxis because the incidence of malaria in tourists is so low.
Travelers to malarious areas, however, are advised to take an antimalarial prophylactic drug, either atovaquone/proguanil (Malarone) or doxycycline. Atovaquone/proguanil is also useful for the treatment of malaria if it has not been taken for prophylaxis, or it could be carried as standby treatment if no prophylaxis is used.
Protection against insect bites, especially between dusk and dawn, is a high priority.
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), 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 hilltribe villages of the Mae Suk District, Chiangmai Province), trichinosis (avoid undercooked pork sausages), and typhus (both tick-borne and murine.
Rabies: There is a high incidence of dog rabies in Thailand, and about 60 cases of human rabies were reported in 2000. Dogs account for about 95% of rabid animals, cats about 3.5%. 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. 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. To be safe, travelers should avoid swimming or wading in freshwater lakes, ponds, or streams in these areas.
Travelers' Diarrhea: Moderate risk. Campylobacter bacteria cause over 50% of cases travelers' diarrhea in Thailand, and over 90% of campylobacter species are now reported to be resistant to quinolone antibiotics. Quinolones, however, are still recommended as the first choice for the treatment of acute diarrhea, since a good clinical response may still be obtained. Azithromycin (Zithromax) is the best alternative antibiotic. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis or amebiasis, but these infections rarely affect tourists.
Tuberculosis: The clinical incidence of tuberculosis in Thailand has been increasing since 1987. This is probably due to the high incidence of HIV infection. There is also an increasing rate of multidrug-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. Travelers planning to stay more than 3 months should have pre-departure PPD skin test status documented. Travelers should avoid crowded public places and public transportation whenever possible. Domestic help should be screened for TB.
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 vaccine is recommended for extended travel outside of tourist areas. The typhoid vacccines are 60% to 70% effective. Food and drink precautions should continue to be observed.