Health risks and the quality of medical facilities

Travellers tend to worry about contracting exotic infectious diseases when visiting the tropics, but these are far less common than problems with pre-existing medical conditions, such as heart disease, and accidental injury (especially as a result of traffic accidents).

Other common illnesses are respiratory infections, diarrhoea and dengue fever. Fortunately most common illnesses can be prevented or are easily treated.

Our advice is a general guide and does not replace the advice of a doctor trained in travel medicine.

Before You Go

Pack medications in clearly labelled original containers and obtain a signed and dated letter from your physician describing your medical conditions, medications and syringes or needles. If you have a heart condition, bring a copy of your electrocardiogram (ECG) taken just prior to travelling.

If you take any regular medication bring double your needs in case of loss or theft. In Thailand you can buy many medications over the counter without a doctor’s prescription, but it can be difficult to find the exact medication you are taking.

Contact your home country’s Department of Foreign Affairs or the equivalent and register your trip; this is a helpful precaution in the event of a natural disaster.

Insurance

Even if you’re fit and healthy, don’t travel without health insurance – accidents dohappen. You may require extra cover for adventure activities such as rock climbing or diving, as well as scooter/motorcycle riding. If your health insurance doesn’t cover you for medical expenses abroad, ensure you get specific travel insurance. Most hospitals require an upfront guarantee of payment (from yourself or your insurer) prior to admission. Enquire before your trip about payment of medical charges and retain all documentation (medical reports, invoices etc) for claim purposes.

Medical Checklist

Recommended items for a personal medical kit include the following, most of which are available in Thailand.

antifungal cream, eg Clotrimazole
antibacterial cream, eg Muciprocin
antibiotic for skin infections, eg Amoxicillin/Clavulanate or Cephalexin
antibiotics for diarrhoea include Norfloxacin, Ciprofloxacin or Azithromycin for bacterial diarrhoea; for giardiasis or amoebic dysentery take Tinidazole
antihistamine – there are many options, eg Cetrizine for daytime and Promethazine for night-time
antiseptic, eg Betadine
antispasmodic for stomach cramps, eg Buscopan
contraceptives
decongestant
DEET-based insect repellent
oral rehydration solution for diarrhoea (eg Gastrolyte), diarrhoea ‘stopper’ (eg Loperamide) and antinausea medication
first-aid items such as scissors, Elastoplasts, bandages, gauze, thermometer (but not one with mercury), sterile needles and syringes (with a doctor’s letter), safety pins and tweezers
hand gel (alcohol based) or alcohol-based hand wipes
ibuprofen or another anti-inflammatory
indigestion medication, eg Quick-Eze or Mylanta
laxative, eg Coloxyl
migraine medicine – for migraine sufferers
paracetamol
permethrin to impregnate clothing and mosquito nets if at high risk
steroid cream for allergic/itchy rashes, eg 1% to 2% hydrocortisone
sunscreen, sunglasses and hat
throat lozenges
thrush (vaginal yeast infection) treatment, eg Clotrimazole pessaries or Diflucan tablet
Ural or equivalent if prone to urine infections

Vaccinations

You should arrange your vaccines six to eight weeks prior to departure through a specialised travel-medicine clinic.

The Centers for Disease Control and Prevention (www.cdc.gov) has a traveller’s health section that contains recommendations for vaccinations. The only vaccine required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within the six days prior to entering Thailand. If you are travelling to Thailand fromAfrica or South America you should check to see if you require proof of vaccination.

Mosquito Avoidance Tips

Travellers are advised to prevent mosquito bites by taking these steps:

use a DEET-containing insect repellent on exposed skin
sleep under a mosquito net, ideally impregnated with permethrin
choose accommodation with screens and fans
impregnate clothing with permethrin in high-risk areas
wear long sleeves and trousers in light colours
use mosquito coils
spray your room with insect repellent before going out

In Transit

Jet Lag & Motion Sickness

Jet lag is common when crossing more than five time zones. It results in insomnia, fatigue, malaise or nausea. To avoid jet lag, drink plenty of fluids (nonalcoholic) and eat light meals. Upon arrival, seek exposure to natural sunlight and readjust your schedule. Some people find melatonin helpful.

Sedating antihistamines such as dimenhydrinate (Dramamine) or Prochlorperazine (Phenergan) are usually the first choice for treating motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger. Scopolamine patches are considered the most effective prevention.

Deep Vein Thrombosis

Deep-vein thrombosis (DVT) occurs when blood clots form in the legs during long trips such as flights, chiefly because of prolonged immobility. The longer the journey, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they can cause life-threatening complications.

The chief symptom of DVT is swelling or pain of the foot, ankle or calf, usually but not always on one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty in breathing. Travellers with any of these symptoms should immediately seek medical attention.

To prevent the development of DVT on long flights you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting) and drink plenty of fluids (nonalcoholic). Those at higher risk should speak with a doctor.

In Thailand

Infectious Diseases

Influenza

Present year-round in the tropics, influenza (flu) symptoms include high fever, muscle aches, runny nose, cough and sore throat. Flu is the most common vaccine-preventable disease contracted by travellers and everyone should consider vaccination. There is no specific treatment, just rest and paracetamol. Complications such as bronchitis or middle-ear infection may require antibiotic treatment.

Cutaneous Larva Migrans

This disease, caused by dog or cat hookworm, is particularly common on the beaches of Thailand. The rash starts as a small lump, and then slowly spreads like a winding line. It is intensely itchy, especially at night. It is easily treated with medications and should not be cut out or frozen.

Hepatitis B

The only sexually transmitted disease (STD) that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Thailand up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer, cirrhosis and death.

Rare But Be Aware

Avian InfluenzaMost of those infected have had close contact with sick or dead birds.
FilariasisA mosquito-borne disease that is common in the local population; practice mosquito-avoidance measures.
Hepatitis ETransmitted through contaminated food and water and has similar symptoms to hepatitis A. Can be a severe problem in pregnant women. Follow safe eating and drinking guidelines.
Japanese B EncephalitisViral disease transmitted by mosquitoes, typically occurring in rural areas. Vaccination is recommended for travellers spending more than one month outside cities, or for long-term expats.
MeliodosisContracted by skin contact with soil. Affects up to 30% of the local population in northeastern Thailand. The symptoms are very similar to those experienced by tuberculosis (TB) sufferers. There is no vaccine, but it can be treated with medications.
StrongyloidesA parasite transmitted by skin contact with soil; common in the local population. It is characterised by an unusual skin rash – a linear rash on the trunk that comes and goes. An overwhelming infection can follow. It can be treated with medications.
TuberculosisMedical and aid workers and long-term travellers who have significant contact with the local population should take precautions. Vaccination is recommended for children spending more than three months in Thailand. The main symptoms are fever, cough, weight loss, night sweats and tiredness. Treatment is available with long-term multidrug regimens.
TyphusMurine typhus is spread by the bite of a flea; scrub typhus is spread via a mite. Symptoms include fever, muscle pains and a rash. Following general insect-avoidance measures; Doxycycline will also prevent it.

Dengue Fever

This mosquito-borne disease is increasingly problematic in Thailand, especially in the cities. As there is no vaccine it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue is a daytime biter, so use insect-avoidance measures at all times. Symptoms include high fever, severe headache (especially behind the eyes), nausea and body aches (dengue was previously known as ‘breakbone fever’). Some people develop a rash (which can be very itchy) and experience diarrhoea. Chiang Mai and the southern islands are particularly high-risk areas. There is no specific treatment, just rest and paracetamol – do not take aspirin or ibuprofen as they increase the risk of haemorrhaging. See a doctor to be diagnosed and monitored.

Dengue can progress to the more severe and life-threatening dengue haemorrhagic fever, but this is very uncommon in tourists. The risk of this increases substantially if you have previously been infected with dengue and are then infected with a different serotype.

Hepatitis A

The risk in Bangkok is decreasing, but there is still significant risk in most of the country. This food- and waterborne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A. In rare instances it can be fatal for those over the age of 40. All travellers to Thailand should be vaccinated against hepatitis A.

Malaria

There is an enormous amount of misinformation concerning malaria. Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur – the same symptoms as many other infections. A diagnosis can only be made by taking a blood sample.

Most parts of Thailand visited by tourists, particularly city and resort areas, have minimal to no risk of malaria, and the risk of side effects from taking antimalarial tablets is likely to outweigh the risk of getting the disease itself. If you are travelling to high-risk rural areas (unlikely for most visitors), seek medical advice on the right medication and dosage for you.

Rabies

This disease, fatal if left untreated, is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having a pretravel vaccination means the postbite treatment is greatly simplified.

If an animal bites you, gently wash the wound with soap and water, and apply iodine-based antiseptic. If you are not prevaccinated you will need to receive rabies immunoglobulin as soon as possible, followed by five shots of vaccine over 28 days. If prevaccinated you need just two shots of vaccine given three days apart.

Typhoid

This serious bacterial infection is spread through food and water. It gives a high and slowly progressive fever, severe headache and may be accompanied by a dry cough and stomach pain. It is diagnosed by blood tests and treated with antibiotics. Vaccination is recommended for all travellers spending more than a week in Thailand, or travelling outside of the major cities. Be aware that vaccination is not 100% effective, so you must still be careful with what you eat and drink.

Leptospirosis

Leptospirosis is contracted from exposure to infected surface water – most commonly after river rafting or canyoning. Early symptoms are very similar to flu and include headache and fever. It can vary from a very mild ailment to a fatal disease. Diagnosis is made through blood tests and it is easily treated with Doxycycline.

Measles

This highly contagious viral infection is spread through coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash and can be complicated by pneumonia and brain disease. There is no specific treatment. Ensure you are fully vaccinated.

HIV

HIV is now one of the most common causes of death in people under the age of 50 in Thailand. Always practice safe sex, and avoid getting tattoos or using unclean syringes.

STDs

Sexually transmitted diseases most common in Thailand include herpes, warts, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia, but not warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention. If you have been sexually active during your travels, have an STD check on your return home.

Environmental Hazards

Sunburn

Even on a cloudy day, sunburn can occur rapidly. Use a strong sunscreen (at least factor 30+), making sure to reapply after a swim, and always wear a wide-brimmed hat and sunglasses outdoors. If you become sunburnt stay out of the sun until you have recovered, apply cool compresses and take painkillers for the discomfort. One-percent hydrocortisone cream applied twice daily is also helpful.

Food

Eating in restaurants is the biggest risk factor for contracting traveller’s diarrhoea. Ways to avoid it include eating only freshly cooked food and avoiding food that has been sitting around in buffets. Peel all fruit and cook vegetables. Eat in busy restaurants with a high turnover of customers.

Snakes

Though snake bites are rare for travellers, there are more than 85 species of venomous snakes in Thailand. Wear boots and long pants if walking in an area that may have snakes.

The Thai Red Cross produces antivenom for many of the poisonous snakes in Thailand.

Heat

For most people it takes at least two weeks to adapt to the hot climate. Prevent swelling of the feet and ankles as well as muscle cramps caused by excessive sweating by avoiding dehydration and excessive activity in the heat of the day.

Heat stroke requires immediate medical treatment. Symptoms come on suddenly and include weakness, nausea, a hot dry body with a body temperature of more than 41°C, dizziness, confusion, loss of coordination, fits and eventually collapse and loss of consciousness.

Insect Bites & Stings

Bedbugs live in the cracks of furniture and walls and then migrate to the bed at night to feed on humans. You can treat the itch with an antihistamine.

Ticks are contracted when walking in rural areas. They are commonly found behind the ears, on the belly and in armpits. If you’ve been bitten by a tick and a rash develops at the site of the bite or elsewhere, along with fever or muscle aches, see a doctor. Doxycycline prevents tick-borne diseases.

Leeches are found in humid rainforests. They do not transmit disease, but their bites are often itchy for weeks afterwards and can easily become infected. Apply an iodine-based antiseptic to the bite to help prevent infection.

Bee and wasp stings mainly cause problems for people who are allergic to them. Anyone with a serious allergy should carry an injection of adrenaline (eg an EpiPen) for emergencies. For others, pain is the main problem – apply ice to the sting and take painkillers.

Jellyfish Stings

Box jellyfish stings are extremely painful and can even be fatal. There are two main types of box jellyfish – multitentacled and single-tentacled.

Multitentacled box jellyfish are present in Thai waters – these are the most dangerous and a severe envenomation can kill an adult within two minutes. They are generally found along sandy beaches near river mouths and mangroves during the warmer months.

There are many types of single-tentacled box jellyfish, some of which can cause severe symptoms known as the Irukandji syndrome. The initial sting can seem minor; however severe symptoms such as back pain, nausea, vomiting, sweating, difficulty breathing and a feeling of impending doom can develop between five and 40 minutes later.

There are many other jellyfish in Thailand that cause irritating stings but no serious effects. The only way to prevent these stings is to wear protective clothing.

First Aid for Severe Stings

For severe, life-threatening envenomations, experts say the first priority is keeping the person alive. Send someone to call for medical help and start immediate CPR if they are unconscious. If the victim is conscious, douse the stung area liberally with vinegar for 30 seconds.

Vinegar can also reduce irritation from minor stings. It is best to seek medical care quickly in case any other symptoms develop over the next 40 minutes.

Australia and Thailand are now working in close collaboration to identify the species of jellyfish in Thai waters, as well as their ecology – hopefully enabling better prediction and detection of the jellyfish.

Skin Problems

Prickly heat is a common skin rash in the tropics, caused by sweat being trapped under the skin. Treat by taking cool showers and using powders.

Two fungal rashes commonly affect travellers. The first occurs in the groin, armpits and between the toes. It starts as a red patch that slowly spreads and is usually itchy. Treatment involves keeping the skin dry, avoiding chafing and using an antifungal cream such as Clotrimazole or Lamisil. The fungus Tinea versicolorcauses small and light-coloured patches, most commonly on the back, chest and shoulders. Consult a doctor.

Cuts and scratches become easily infected in humid climates. Immediately wash all wounds in clean water and apply antiseptic. If you develop signs of infection, see a doctor. Coral cuts can easily become infected.

Parasites

Numerous parasites are common in local populations in Thailand, but most of these are rare in travellers. To avoid parasitic infections, wear shoes and avoid eating raw food, especially fish, pork and vegetables.

Availability & Cost of Health Care

Bangkok is considered a centre of medical excellence in Southeast Asia. Private hospitals are more expensive than other medical facilities, but offer a superior standard of care and English-speaking staff. The cost of health care is relatively cheap in Thailand compared to most Western countries.

Traveller’s Diarrhoea

Traveller’s diarrhoea is by far the most common problem affecting travellers. In over 80% of cases, traveller’s diarrhoea is caused by a bacteria (there are numerous potential culprits) and responds promptly to treatment with antibiotics.

Here we define traveller’s diarrhoea as the passage of more than three watery bowel movements within 24 hours, plus at least one other symptom such as vomiting, fever, cramps, nausea or feeling generally unwell.

Treatment consists of staying well hydrated; rehydration solutions such as Gastrolyte are the best for this. Antibiotics such as Norfloxacin, Ciprofloxacin or Azithromycin will kill the bacteria quickly. Seek medical attention if you do not respond to an appropriate antibiotic.

Loperamide is just a ‘stopper’ that only treats the symptoms. It can be helpful, for example, if you have to go on a long bus ride. Don’t take Loperamide if you have a fever, or blood in your stools.

Giardia lambliais a parasite that is relatively common. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis. The treatment of choice is Tinidazole, with Metronidazole being a second-line option.

Amoebic dysentery is very rare in travellers, but may be misdiagnosed by poor-quality labs. Symptoms are similar to bacterial diarrhoea. You should always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: Tinidazole or Metronidazole to kill the parasite in your gut and then a second drug to kill the cysts. If left untreated complications, such as liver abscesses, can occur.

Travelling With Children

Thailand is relatively safe for children. Consult a doctor who specialises in travel medicine prior to travel to ensure your child is appropriately prepared. A medical kit designed specifically for children includes liquid medicines for children who can not swallow tables. Azithromycin is an ideal paediatric formula used to treat bacterial diarrhoea, as well as ear, chest and throat infections.

Good resources include Lonely Planet’s Travel with Childrenand, for those spending longer away, Jane Wilson-Howarth’s Your Child’s Health Abroad.

Women’s Health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester, when pregnancy-related risks are low. Avoid rural areas with poor transport and medical facilities. Ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

Malaria is a high-risk disease in pregnancy. Pregnant women should nottravel to those areas with chloroquine-resistant malaria. None of the more effective antimalarial drugs are completely safe in pregnancy.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Azithromycin is considered one of the safest anti-diarrhoea drugs in pregnancy.

In Thailand’s urban areas, supplies of sanitary products are readily available. Bring adequate supplies of your personal birth-control option. Heat, humidity and antibiotics can all contribute to thrush, which can be treated with antifungal creams and Clotrimazole. A practical alternative is one tablet of fluconazole (Diflucan). Urinary-tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics for treatment.