Travel Immunizations - What you Really Need in Asia

Worldwide | Thu, 23 Jul 2009 | 14519 views | 5 Comments

No matter what country you're from and what you call immunizations (jabs, shots, pricks, inmunización, nadel) the bottom line is you probably need to get some before you do any traveling to third world countries. We asked our adventure friends around the world what they thought and below are their recommendations for travel to Asia.

(Photo courtesy of One World Trekking)

Andy Crisconi of One World Trekking recommends:

I receive immunization questions all the time from clients. Personally, I believe in getting the minimum recommended or required by the country being visited. Most people hate shots and they are/have become a rather expensive part of trip preparations. Most of my treks are in the Himalayan countries of South Asia.

Minimums I recommend to my clients are:

  • Adult polio booster
  • Tetanus / diphtheria
  • Hepatitis A
  • Typhoid        
  • Yellow Fever (required for all South America trips)
  • Malaria medication only if visiting the jungle areas of these countries.

Doctors and travel clinics tend to err towards more shots to cover all possible situations, so I think it important that each individual traveler and the tour operator do the research and discuss the options. Also, many times different shot or pills are recommended depending on the time of year you visit a certain country. For folks wanting to visit Nepal during the monsoon months, I may recommend they also get a Meningitis shot.

In terms of general travel safety in Asia, a few tips I would also offer are:

1. Water safety: Assume all water to be contaminated. Drink bottled or properly boiled water only. Brush your teeth with bottled or properly boiled water only and keep your mouth closed while taking a shower.

2. Be a compulsive hand washer.
A bottle of hand sanitizer should be carried with you during the trek and be used after visiting the restroom, before each meal, after handling paper bills and coins, before putting-in or taking-out contact lenses... Hepatitis A and Typhoid are passed in human feces, so be a compulsive hand cleaner.

3. Typhoid
The Typhoid vaccine is strongly recommended for Asia and is available in both pill and shot form.

Dr. Erik McLaughlin, World Nomads’ Adventure Doc also recommends


1. Get a rabies vaccine beforehand!
Did you know that Rabies is 99.9999% fatal once contracted?  And there is a worldwide rabies vaccine shortage at the moment?

Trekkers in developing nations are in an area where the is a much higher incidence of rabies than most industrial nations.  Additionally, most people do not expect to be bitten by a dog or animal; this is what makes it an accident. 

If you're bitten, your expensive trip is basically over, right there.  That person needs to evacuate to a large city with proper medical care, although The post-exposure prophylaxis is generally indicated and may be difficult to find. Most rural and developing nation hospitals may not use the safer rabies vaccines instead using older types with risk to the traveler, such as severe allergic reaction. 

Pre-exposure shots would have helped prevent this, although they are also hard to come by currently. 

I try to discuss pros and cons with people but am a big fan of this vaccine, just because of the seriousness of the illness.  I would DEMAND my mother or wife got this vaccine prior to trekking in a remote area and consequently offer the same advice to my patients.  At the end of the day, the choice belongs to the patient/traveler.

2. Avoid mozzie bites
Use DEET and permethrin, long sleeves and pants and bed nets to prevent insect bites.

3. Consider Japanese Encephalitis vaccine
JE is spread through the bites of infected mosquitoes making it very difficult to prevent -  and treatment once acquired, is only supportive.  This means that once you actually get the illness, there is not a lot that can be done about it.  However, a new (and safer) vaccine against JE has been developed and is worth considering if you are travelling in SE Asia.  Find out more here


Of course always check with your doctor, but here is a handy list of what shots are recommended by country from The Travel Doctor  as well as a link to the Center for Disease Control’s Traveler’s Health page.

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Tags: adventure, asia, immunizations, travel-health, travel-safety, vaccinations

5 Comments

  • Michael Kirsch, M.D. said

    Sound advice from the 2 experts above. I want to reinforce that the decision on which vaccines to accept belongs with the traveler. There is no rigid vaccine 'recipe' for travlers headed abroad. There are many gray areas and travelers may have different tolerances of risk. Those who are particularly safety conscious may opt for more protection than a more 'adventurous' traveler. The travel doctor's obligation is to make sure that the traveler has all of the necessary information to make an informed choice.

  • Jennifer said

    I am traveling to Liberia for work in September. I have to get numerous vaccinations, including yellow fever, meningitis, hepatitis, etc. My question is--should I space these out to minimize secondary (side) effects? Isn't it better for the immune system to do some of this in stages rather than all at once?

  • James said

    My son got sick once, had diarrhea even with bottled water. I remember the doctor told us that it is probably from bathing, so the tip there about getting your mouth closed while showering is pretty sound practice. Well, my child was pretty young then I could not keep his mouth closed so bathed him with purified water. Friends also advised the rabies vaccine prior to travel in developing nations. Dogs with rabies are seriously dangerous, knew people who actually died due to dog bites with rabies.

  • Alicia said

    Hello,<br>I'm currently in Istanbul. Yesterday afternoon i went to get a pre-exposure rabies vaccine, as I'm travelling to South America soon. The doctor said the treatment was 4 shots, and gave the the first two on the spot - one in each arm. The doctor's english was limited, so it was a litttle confusing. I am thinking she actually gave me the post-exposure shots - does this matter?<br>Now I have a high fever, chills, aches and super sensitive skin... Will I have the same reaction when I receive my 2nd and 3rd shots?

  • Safety Hub said

    Hi Alicia,<br><br>We need to say straight up front that the Safety Team at World Nomads aren't doctors - you'll need to either reconsult your physician in Istanbul if you are unsure, or consult a different doctor to clarify.<br><br>But from what we understand, the pre-exposure vaccination for rabies is not a blanket coverage against the disease - you still need to get post-exposure treatment if the situation arises.<br><br>According to the CDC Yellow Book, the pre-exposure vaccine "...simplifies management (of exposure to rabies) by eliminating the need for rabies immune globulin and decreasing the number of doses of vaccine needed"<br><br>http://www.cdc.gov/rabies/specific_groups/travelers/pre-exposure_vaccinations.html<br><br>Also, from our research, the symptoms you have listed seem to match those associated with the kind you get from having the pre-exposure vaccine (fever, chills, headaches and tiredness).<br><br>But again, we are not doctors. Check with a qualified physician (and one who can speak a little better english), if you are worried.<br><br>Thanks,<br><br>The World Nomads Safety Team

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