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Vietnam, Cambodia, Laos

These are poor countries, each with its own fascinating history, geography and culture. Common itineraries in Vietnam
include Hanoi, Ha Long Bay on a junk boat, the ethnic minorities in the mountainous north around Sapa, the coastal
towns of Hue, Hoi An, Da Neng and Nha Trang, Ho Chi Minh, the Mekong Delta floating markets and Cu Chi tunnels.
The prime attraction in Cambodia is the ancient overgrown Angkor Temple Complex near Siam Reab. Visitors to Laos
head to the old Royal capital of Luang Prabang in the north, the spectaular limestone mountains of Vang Vieng , the
Mekong for a cruise, and 4000 Islands near Pakse in the south.
We often see school groups travelling to these countries combining aid work with a remote trek or cultural experience.
The following information provides some broad and general guidelines about health risks and recommendations for
this destination.This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues
Travellers’ Diarrhoea
This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes
vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella. Careful food and drink choices,
as well as hand hygiene help in prevention. It is treated with rehydration if mild but if inconvenient, with a ‘bowel
stopper’ such as loperamide (Gastrostop or Immodium) and if more severe or persistent with an antibiotic or giardia
treatment. These are best obtained prior to travel as many medications sold over the counter are fake. We stock kits
containing all of these medications.

Dengue
This mosquito born virus causes a nasty illness with high fever, body aches, headaches and sometimes a rash.
Occasionally serious complications occur. Peak transmission is in the rainy season. It occurs mainly in urban areas. The
mosquitoes are daytime biters. Mosquito avoidance is the only prevention. There is no specific treatment but full
recovery usually occurs.

Accidents
Most accidents overseas occur as a result of people doing things they wouldn't normally do, in an environment they may
not be entirely familiar with. Examples include motorbike accidents (wear a helmet) and injuries related to recreational
activities or intoxication. Be sensible, make sure your friends look after you if you are drinking, pack a first aid kit, make
sure you take out travel insurance and keep an eye on travel alerts. Landmines are still a problem in Cambodia.

STD's
Many travellers - young and old, male and female - put themselves at risk, particularly with sex workers in the well-known
bar districts of major centres. Pack condoms and use them. Unprotected encounters carry a high risk of STD's, including

HIV, Chlamydia, Gonorrhoea and Syphilis and even using condoms doesn’t always prevent Herpes or genital warts. See a
doctor on return if you have put yourself at risk and abstain until you are given the all clear.

Animal Bites
Dog bites carry the highest risk for rabies, although any mammal wound that breaks the skin should be considered a risk monkeys included. Immediate and thorough irrigation and cleaning of animal wounds is essential, followed by a course of
shots, which may require evacuation to a country that carries safe immunoglobulin if not pre-vaccinated for rabies (see
seeking medical help below). A tetanus booster may be necessary if not up to date. Animal wounds are also prone to
becoming infected and appropriate antibiotics should be used at the first sign of spreading infection.

Malaria
Risk for most travellers is low, as the cities and most popular tourist destinations are malaria free. There is no
transmission around Angkor Wat. Those travelling deep into some rural forested areas may be at risk where malaria are
more common especially in the wet season. The mosquitoes bite from dusk onwards, so mosquito avoidance (DEET
repellent, sleeping nets) at this time in these areas is important. Seek advice from a travel health doctor as to whether
malaria preventative medication is necessary or advisable.

Japanese Encephalitis
This rare but serious mosquito born virus occurs mainly in rural areas around rice paddies in these countries, especially in
the wet season (May to October). Vaccination is often recommended for longer trips or those visiting an area with
particularly high risk for shorter trips.

Bird Flu
Sporadic cases occur, nearly always in locals who have direct contact with sick poultry. As a precaution, avoid live bird
markets and farms and ensure bird products are well cooked (including eggs). Flu vaccine does not protect against this
form of flu.

Security Safety Issues
Keep an eye on the Australian Government’s Smart Traveller website for the latest advice. Watch your valuables. Keep a
copy of all travel documentation in a separate place from the originals

Travel Insurance
Essential. Make sure it provides appropriate cover for your trip and activities.

Seeking Medical Help
The medical system in these countries is basic. Although the main cities have clinics catering for western tourists,
complicated or serious medical issues are often best dealt with by evacuation to Singapore, Bangkok or back to Australia.
Blood or blood products such as rabies immunoglobulin) may not be safe.

Vaccinations
Routine Vaccinations for all travellers
All international travellers should be up to date or immune to the following as these are transmissable diseases which
may have serious complications:


Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions

In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in these countries in the event of a tetanus prone wound.

Recommended Vaccinations for most travellers to Vietnam, Cambodia and Laos
Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated

Other vaccinations to consider
Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic
animals; in particular dogs, cats, monkeys and bats. For travel to these countries, vaccination against rabies is often
recommended for those at particularly high risk, for example working with animals or touring/biking through rural areas
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Resistance to
common antibiotics is also widespread so treatment has become more difficult.
Japanese Encephalitis, spread by the Culex mosquito, is a rare but very dangerous brain infection encountered in South
and South East Asia, extending as far north as Japan and Russia. There are now 2 very effective vaccines available. Risk is
mainly in rural areas, particularly in the wet season and near rice paddies. Vaccination should be considered for extended
travel, or short term travel to an area where there is a current outbreak.
Cholera - although this disease is very rare, because the vaccine provides some cross protection against common E Coli
diarrhoea, vaccination may be recommended for certain individuals.