When it comes to vaccination and immunization for traveling Southeast-Asia, there is a neverending debate. Most travelers get confused by all those contradictory recommendations on what is really needed in Southeast-Asia. In this article, we recommend 4 basic shots (incl. prices and doses), that will secure healthy travels and may save your life.
recommended vaccinations for southeast-asia
Should you get Hepatitis A, Typhoid or Cholera vaccines? What are the exact differences between pre-, and post-exposure rabies vaccination? And what the heck is Japanese Encephalitis? This issue is a pain in the neck not least because of shots are a rather expensive part of preparation. Read all about pathogens, the number of shots,and how much they are going to cost you.
The following recommendations aren't intended for 10-days trips, mainly taking place in save hotel areas or beaches. They are meant for backpackers, who travel besides the tourist trail for several weeks up to months. Having said that, short-term visitors should get some shots too - ask your local physician for recommended vaccines.
1. Tetanus / Diphtheria / Polio booster
Tetanus, also known as lockjaw, is an often fatal disease, which is present in Southeast-Asia like in most areas worldwide. It's caused by the bacterium Clostridium tetani, that is commonly found in soil and dust. This nasty bacterium enters through a break in the skin such as a cut or wound by a contaminated object. After an incubation period averaging two weeks up to several months, Tetanus begins with fever followed by localized muscular contractions and spasms often leading to death from heart and lung failure. About 50% of people who contract tetanus die - a good reason to get vaccinated, isn't it?
Diphtheria is an upper respiratory infection caused by the bacterium Corynebacterium diphtheriae. The pathogen is usually spread between people by direct contact or droplet infection. Among Southeast-Asian countries, it's still present in the Philippines, Indonesia, and India. Once contracted, affected persons face symptoms like fever, sore throat, myocarditis, inflammation of nerves, and circulatory collapse.
Poliomyelitis is a highly infectious disease, also known as infantile paralysis. The virus is spread from person to person via the fecal-oral and the oral-oral routes. After an incubation period of 6 weeks, it leads to temporary muscle weakness resulting in an inability to move and in a small percentage of infected people, it causes nonparalytic aseptic meningitis. Since 2014, Southeast-Asia has been declared as polio-free by the WHO. But nevertheless, this shot belongs to basic vaccination even in western countries.
- The good news is they come all in one shot and it lasts for ten years. Ask for "Revaxis®" or "Repevax®" (includes in addition Pertussis). Most people just need one shot as a booster dose. Only people with an unknown vaccination status will need a second shot.
- Most health insurances will cover this shot. Otherwise, it's ~$15 for "Revaxis®" and ~$30 € for "Repevax®"
2. Hepatitis A / B vaccine
Hepatitis A is an infectious disease of the liver caused by a virus of the same name. More than 50% of infections occur away on travels especially in warm, tropical regions with poor hygienic conditions. Symptoms may include nausea, loss of appetite, vomiting, diarrhea, jaundice, fever, and abdominal pain. The virus is mainly spread via contaminated food or water.
Hepatitis B is likewise a viral caused inflammation of the liver. But this one can evoke both - acute and chronic infections. It's one of the most common infectious diseases worldwide. Some people have no symptoms at all, but some get a rapid onset of sickness with fatigue, nausea, vomiting, jaundice and abdominal discomfort. Around 10% develop chronic hepatitis B with an increased risk of liver cirrhosis and cancer.
- There's a combined vaccine for hepatitis A and B called "Twinrix®". The standard dosing schedule consists of 3 shots over the course of 6 months. The second and third doses are administered at one month and six months following the first dose respectively. Its protection lasts about ten years.
- In western Europe it's per shot $59, so ~$180 altogether for adequate protection against hepatitis A and B. In the U.S. it's a bit cheaper - all 3 shots are about $140.
3. Cholera / ETEC Combo Vaccine
Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholera. Worldwide, it affects 3-5 million people and is resposible for more than 100,000 deaths each year worldwide. The infection is often mild or without symptoms, but one out of ten people develop a more severe course, that is characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without any treatment, death may occur within short time.
ETEC is the abbreviation for enterotoxigenic Escherichia coli, one of the leading bacterial causes of severe diarrhea in lower income countries, especially among children. Moreover, it's the most common cause of travelers' diarrhea.
- Two shots of "Dukoral®" provide protective efficacy against cholera up to 85%, while protection against the toxin of ETEC reaches 67%.
- Both shots together are priced at ~ $50-60 . We are convinced that it's worth the money - we tested the vaccines during an eight months trip through Southeast-Asia, resulting in the incredible outcome, that we've been spared of travelers' diarrhea with just one exception. We spoke to other unvaccinated longterm travelers, who got infected 8-12 times and consequently spending quite a few days mainly in their bathroom.
4. Typhoid vaccine
Typhoid is a bacterial infection due to Salmonella enterica Serotype Typhi or Paratyphi A, B und C. Annual cases of infection are estimated at 22 million, causing 200.000 deaths. Typhoid outbreaks are frequently reported from countries in Southeast-Asia, due to poor hygiene habits and public sanitation conditions.
The bacteria is spread by contaminated food or water and sometimes also by flying insects feeding on feces. Untreated typhoid fever causes symptoms like a headache and cough, followed by high fever, delirium, and a lowered heartbeat rate. At least complications like dehydration due to diarrhea, encephalitis and intestinal perforation may lead to death.
- One shot gives a 60-80% protection up to three years. Due to higher response rate, the intramuscular injection should be preferred to oral vaccination. Combined with the rule of thumb "Cook it, boil it, peel it or forget", you'll come close to a 100% protection.
- One shot of "Typherix®" is $25, for "THYPiM Vi®" you'll pay $16,50.
Optional travel vaccines for southeast-asia
Do you love hiking and trekking? We too. But in Southeast-Asia, this and many more outdoor activities involve a higher risk getting severe diseases like rabies or Japanese encephalitis. This is also true for volunteer work (especially including animal contact), homestay tourism in rural areas or travels far off the beaten tourist path. If you're going to be days from proper medical assistance - it pays off to be prepared. In this case, you certainly should consider optional vaccinations.
Did you know that rabies kills 99,99% of contracted people? Rabies is caused by a number of lyssavirus causing headache, fever, inflammation of the brain, then progressing to delirium and coma. Death occurs within 15 to 90 days. Even with the administration of proper and intensive care, survival is rare.
In Southeast-Asia, the biggest risk factor contracting rabies is to get bitten by stray dogs or a monkey. But nevertheless, only saliva is a potent vector as well. Unfortunately, cute puppies rank among the vast majority of infected animals. A puppy licking your hand can trigger rabies because the virus may find its way into your blood system through mucous membranes, eyes or wounds. Since 2010, bats, cows and pigs are considered as vectors too.
Note that post-exposure prophylaxis is generally indicated, whenever you got bitten or scratched, even if vaccinated. But fully pre-exposure vaccinated travelers will need only two active boosters at day 1 and 3 and no immune globuli.
Unvaccinated travelers will require immediate post-exposure vaccination of five doses at day 0, 3, 7, 14 and 28 and more important an immune globulin placed at severe bitewounds - unfortunately, this globulis are superexpensive and hard to find. In this case, your trip is basically over. Additionally, most rural and developing nation hospitals may not use the modern rabies vaccines instead using older and cheaper types with risk to the traveler, such as severe allergic reaction.
If you are still undecided - think about the following questions:
- Are you planning to travel for more than 2-3 weeks or even months?
- Would you like to do some outdoor activities such as camping, hiking, biking, adventure travel, and caving that put you at higher risk for animal bites?
- Are you going to work with or around animals as a volunteer, veterinarian, wildlife professional or researcher?
If there is just one yes, you certainly should consider getting vaccinated against rabies.
The virus is still endemic in countries like Thailand, Laos, Cambodia, Myanmar, the Philippines, Indonesia (Bali 183 cases since 2008) and India.
Available in Europe:
- HDC® - 4 Injektions at day 0, 7, 21 or 28 and after 1 year. Additionally, a booster after 5 years is recommended.
- Rabipur® - 3 Shots at day 0, 7, 21 and a booster after 2 years or anti body titer control.
Available in the U.S.:
- Imovax rabies® - 3 doses given intramuscularly on each of days 0, 7 and 21. Booster after 2 years.
- RabAvert® - 3 injections on each of days 0, 7, and 21 (or 28). Booster after 2 years.
- HDC® - $45 / ~ €42 per dose = $180 / €168 for all 4 shots
- Rabipur® - $47,50 / ~ €44,44 per dose = $142,50 / €133,32 for all 3 shots
- Imovax rabies® - $195 for 3 doses
- RabAvert® - $195 for 3 doses
Japanese encephalitis is a disease caused by the mosquito-borne Japanese encephalitis virus. It's a virus from the family Flaviviridae and domestic pigs, and wild birds are common reservoirs of this virus. Mosquitoes are among the most important vectors and travelers show first symptoms 2 to 15 days after the initial mosquito bite. Fever, headache, and general malaise may occur, but the vast majority of infections are asymptomatic. Nevertheless, 1 in 250 infections develops into severe complications like encephalitis leading to cachexia, hemiparesis, and mental retardation.
For most backpackers, the risk is extremely low but depends on where in Southeast-Asia you are going, the time of year, your planned activities, and the length of the trip. You are at higher risk if you are traveling to rural areas, will be doing a lot of outdoor activities, or will be traveling for a long period of time. In general, the risk for an infection is given in southern tropical and subtropical areas, all year long and higher in rainy season.
At least it's a question of your personal risk appetite and your style of traveling. If you plan to trek and hike a lot through jungles or rural areas - getting vaccinates is good option to minimize a known risk, besides preventing mosquito bites at all.
- Ixiaro® - 2 shots are needed at days 0 and 28
- $96 for both shots in Europe. Prices in the U.S. vary from $250 up to 350 for each dose.
- Read the fine print of your health insurance contract or ask them via phone hotline if they refund all or at least some of your travel vaccination costs. Most of them will refund a decent amount (50-80%) of your expenses because it makes economic sense. Preventing a severe illness is in many cases cheaper than its treatment.
- There are recent reports of adult tourists beeing infected with measles during their stay in Thailand and Bali. Measles may cause severe complication in adults like inflammation of lungs and the brain. It's a general rule of thumb that teething troubles like mumps, measles, and rubella are dangerous for adults. Hence, we recommend checking your vaccination status on three diseases too.
All health and health-related information provided by the maarifa-travelguide.com website is intended to be general in nature and not to replace medical advice by certified professional. Your own healthcare professional is the best source of information regarding your health. The recommendations on this website are intended to offer only a general basis for individual travelers to discuss this topic with their physician.
- What's your destination and which vaccinations are you planning to get?
- How much did you pay and where did you get your shots?
- Have you decided to get rabies shots or not?
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