Travel health in Thailand

Although Thailand’s climate, wildlife and cuisine present Western visitors with fewer health worries than in many Asian destinations, it’s as well to know in advance what the risks might be, and what preventive or curative measures you should take.

For a start, there’s no need to bring huge supplies of non-prescription medicines with you, as Thai pharmacies (raan khai yaa; typically, open daily 8.30am–8pm) are well stocked with local and international branded medicaments, and they are generally much less expensive than at home. Nearly all pharmacies are run by trained English-speaking pharmacists, who are usually the best people to talk to if your symptoms aren’t acute enough to warrant seeing a doctor. The British pharmacy chain, Boots, now has branches in many big cities. These are the best place to stock up on some Western products such as tampons (which Thai women do not use).

Hospital (rong phayabaan) cleanliness and efficiency vary, but generally hygiene and healthcare standards are good and the ratio of medical staff to patients is considerably higher than in most parts of the West. As with head pharmacists, doctors speak English. Several Bangkok hospitals are highly regarded , and all provincial capitals have at least one hospital: if you need to get to one, ask at your accommodation for advice on, and possibly transport to, the nearest or most suitable. In the event of a major health crisis, get someone to contact your embassy and insurance company – it may be best to get yourself transported to Bangkok or even home.

Inoculations

There are no compulsory inoculation requirements for people traveling to Thailand from the West, but you should consult a doctor or other health professional, preferably at least four weeks in advance of your trip, for the latest information on recommended immunizations. In addition to making sure that your recommended immunizations for life in your home country are up to date, most doctors strongly advise vaccinations or boosters against tetanus, diphtheria, hepatitis A and, in many cases, typhoid, and in some cases, they might also recommend protecting yourself against Japanese encephalitis, rabies and hepatitis B. There is currently no vaccine against malaria. If you forget to have all your inoculations before leaving home, or don’t leave yourself sufficient time, you can get them in Bangkok at, for example, the Thai Red Cross Society’s Queen Saovabha Institute or Global Doctor .

Mosquito-borne diseases

Mosquitoes in Thailand can spread not only malaria, but also diseases such as dengue fever and the very similar chikungunya fever, especially during the rainy season. There is also a risk of Zika virus transmission, a mild infection which may be more serious to pregnant women as it can cause birth defects. The main message, therefore, is to avoid being bitten by mosquitoes. You should smother yourself and your clothes in mosquito repellent containing the chemical compound DEET, reapplying regularly (shops, guesthouses and department stores all over Thailand stock it, but if you want the highest-strength repellent, or convenient roll-ons or sprays, do your shopping before you leave home, or at a branch of Boots in Thailand). DEET is strong stuff, and if you have sensitive skin, a natural alternative is citronella (available in the UK as Mosi-guard), made from a blend of eucalyptus oils; the Thai version is made with lemon grass.

At night you should sleep either under a mosquito net sprayed with DEET or in a bedroom with mosquito screens across the windows (or in an enclosed room with a/c). Accommodation in tourist spots nearly always provides screens or a net (check both for holes), but if you’re planning to go way off the beaten track or want the security of having your own mosquito net just in case, wait until you get to Bangkok to buy one, where department stores sell them for much less than you’d pay in the West. Plug-in insecticide vaporizers, insect room sprays and mosquito coils – also widely available in Thailand – help keep the insects at bay; electronic ‘buzzers’ are useless. If you are bitten, applying locally made yellow oil is effective at reducing the itch.

Malaria

Thailand is malarial, with the disease being carried by mosquitoes that bite from dusk to dawn, but the risks involved vary across the country.

There is a significant risk of malaria, mainly in rural and forested areas, in a narrow strip along the borders with Cambodia (excluding Ko Chang), Laos and Myanmar (the highest-risk area, including the countryside around Mae Hong Son, but excluding, for example, Chiang Mai, Chiang Rai and Kanchanaburi towns, and resorts and road and rail routes along the Gulf coast). Discuss with your travel health adviser which anti-malarial drugs are currently likely to be effective in these areas, as prophylaxis advice can change from year to year.

Elsewhere in Thailand the risk of malaria is considered to be so low that anti-malarial tablets are not advised.

The signs of malaria are often similar to flu, but are very variable. The incubation period for malignant malaria, which can be fatal, is usually 7 to 28 days, but it can take up to a year for symptoms of the benign form to occur. The most important symptom is a raised temperature of at least 38°C beginning a week or more after the first potential exposure to malaria: if you suspect anything, go to a hospital or clinic immediately.

Dengue fever

Dengue fever, a debilitating and occasionally fatal viral disease that is particularly prevalent during and just after the rainy season, is on the increase throughout tropical Asia, and is endemic to many areas of Thailand, with around two hundred thousand reported cases a year. Unlike malaria, dengue fever is spread by mosquitoes that can bite during daylight hours, so you should also use mosquito repellent during the day. Symptoms may include fever, headaches, fierce joint and muscle pain (‘breakbone fever’ is another name for dengue), and possibly a rash (usually develops between five and eight days after being bitten).

If you think you may have contracted the disease, you should see a doctor: the treatment is lots of rest, liquids and paracetamol (or any other acetaminophen painkiller, not aspirin or ibuprofen), and more serious cases may require hospitalization.

Rabies

Rabies is widespread in Thailand, mainly carried by dogs (between 4 and 7 percent of stray dogs in Bangkok are reported to be rabid), but also cats and monkeys. It is transmitted by bites, scratches or even occasionally licks (transmission can occur if saliva comes into direct contact with skin wounds or your eyes or mouth). Dogs are everywhere in Thailand, and even if kept as pets they’re often not very well cared for; hopefully their mangy appearance will discourage the urge to pat them, as you should steer well clear of them. If you are bitten, licked or scratched by an animal, thoroughly wash the wound with soap and water immediately and disinfect it, preferably with something containing iodine, and seek medical advice regarding treatment right away (even if you have been vaccinated for rabies). Once clinical signs appear, rabies is nearly always fatal.

Other bites and stings

Thailand’s seas are home to a few dangerous creatures that you should look out for, notably jellyfish, which tend to be washed towards the beach by rough seas during the monsoon season but can appear at any time of year. All manner of stinging and non-stinging jellyfish can be found in Thailand – as a general rule, those with the longest tentacles tend to have the worst stings – but reports of serious incidents are uncommon; ask around at your resort or at a local dive shop to see if there have been any sightings of venomous varieties. You also need to be wary of venomous sea snakes, sea urchins and a couple of less conspicuous species, such as stingrays, which often lie buried in the sand, and stonefish, whose potentially lethal venomous spikes are easily stepped on because the fish look like stones and lie motionless on the sea bed.

If stung or bitten, you should always seek medical advice as soon as possible, but there are a few ways of alleviating the pain or administering your own first aid in the meantime. If you’re stung by a jellyfish, wash the affected area with salt water (not fresh water) and, if possible, with vinegar (failing that, ammonia, citrus fruit juice or even urine may do the trick), and try to remove the fragments of tentacles from the skin with a gloved hand, forceps, thick cloth or credit card. The best way to minimize the risk of stepping on the toxic spines of sea urchins, stingrays and stonefish is to wear thick-soled shoes, though these cannot provide total protection; sea urchin spikes should be removed after softening the skin with ointment, though some people recommend applying urine to help dissolve the spines; for stingray and stonefish stings, alleviate the pain by immersing the wound in hot water while awaiting help.

In the case of a venomous snake bite, don’t try sucking out the venom or applying a tourniquet, instead, wrap up and immobilize the bitten limb and try to stay still and calm until medical help arrives; all provincial hospitals in Thailand carry supplies of antivenins.

Some of Thailand’s beaches are plagued by sandflies, tiny, barely visible midges whose bites can trigger an allergic response, leaving big red weals and an unbearable itch, and possible infection if scratched too vigorously. Many islanders say that slathering yourself in (widely available) coconut oil is the best deterrent as sandflies apparently don’t like the smell. Applying locally made camphor-based yellow oil quells the itch, but you may need to resort to antihistamines for the inflammation. Leeches aren’t dangerous but can be a bother when walking in forested areas, especially during and just after the rainy season. The most effective way to get leeches off your skin is to burn them with a lighted cigarette, or douse them in salt; oily suntan lotion or insect repellent sometimes makes them lose their grip and fall off.

Worms and flukes

Worms can be picked up through the soles of your feet, so avoid going barefoot. They can also be ingested by eating undercooked meat, and liver flukes by eating raw or undercooked freshwater fish. Worms which cause schistosomiasis (bilharziasis) by attaching themselves to your bladder or intestines can be found in freshwater rivers and lakes. The risk of contracting this disease is low, but you should avoid swimming in the southern reaches of the Mekong River and in most freshwater lakes.

Digestive problems

By far the most common travelers’ complaint in Thailand, digestive troubles are often caused by contaminated food and water, or sometimes just by an overdose of unfamiliar foodstuffs .

Stomach trouble usually manifests itself as simple diarrhoea, which should clear up without medical treatment within three to seven days and is best combated by drinking lots of fluids. If this doesn’t work, you’re in danger of getting dehydrated and should take some kind of rehydration solution, either a commercial sachet of ORS (oral rehydration solution), sold in all Thai pharmacies, or a do-it-yourself version, which can be made by adding a handful of sugar and a pinch of salt to every litre of boiled or bottled water (soft drinks are not a viable alternative). If you can eat, avoid fatty foods.

Anti-diarrhoeal agents such as Imodium are useful for blocking you up on long bus journeys, but only attack the symptoms and may prolong infections; an antibiotic such as ciprofloxacin, however, can often reduce a typical attack of traveler’s diarrhoea to one day. If the diarrhoea persists for a week or more, or if you have blood or mucus in your stools, or an accompanying fever, go to a doctor or hospital.

HIV and AIDS

HIV infection is widespread in Thailand, primarily because of the sex trade . Condoms (meechai) are sold in pharmacies, convenience stores, department stores, hairdressers and even street markets. Due to rigorous screening methods, Thailand’s medical blood supply is now considered safe from HIV/AIDS infection.