Vaccinations for Traveling Through SEA
There are a few things that can turn an adventurous tour through Southeast Asia into an unpleasant visit in a hospital. Accidents would be an obvious one, but one should not underestimate the power of mosquito bites and tainted food/water.
Malaria:
There is no effective vaccine against malaria. There are several types of anti-malarial pills you can take. They all have different side effects and the price varies greatly. The choice of drug depends on the duration of your journey through the high-risk areas.
However, the most effective prevention remains simple and cheap – don’t get biten by mosquitos. Measures include applying insect repellent (DEET), wearing long-sleeve shirts and pants, using mosquito nets, or anything you can do to keep the mosquitos from biting you. These measures will also prevent other mosquito-borne diseases, such as dengue fever and Japanese encephalitis.
| Drug | Dosage | Side Effects | Price |
| Chloroquine | 1 week prior+ daily during the journey + 4 weeks following | Nausea, headache, dizzinessRare: skin eruption, blurred vision, pruritus, impaired hearing, convulsion, blood disorder | HKD 50 |
| Proguanil | 1 day prior + daily during the journey + 4 weeks following | Nausea, diarrhea, mouth ulcersRare: haematuria, hair loss | HKD 150 |
| Mefloquine* | 1 week prior + weekly during the journey + 4 weeks following | Nausea, dizziness, headache, syncope, insomnia, extrasystoles, diarrheaRare: severe neuropsychiatric syndrome | HKD 275 |
| Doxycycline | 1 day prior + daily during the journey + 4 weeks following | Nausea, diarrhea, candida vaginitisRare: skin photosensitivity | HKD 100 |
| Atouaqune & Proguail | 1 day prior + daily during the journey + 7 days following | Abdominal pain, nausea, vomiting, headache, diarrhoea, mouth ulcersRare: hair loss, haematuria | HKD 1070 |
* FDA issued a warning for Mefloquine due to its severe side effects shown in recent studies: “mefloquine is neurotoxic and can cause lasting injury to the brainstem and emotional centers in the limbic system.”
Good information regarding anti-malarial drugs choices can be found here.
Our pick: Atouaqune & Proguail
The last thing you want during a cycling tour is illness, including the symptoms caused by the side effects of drugs. Though expensive, Atouaqune & Proguail have been proven to be very safe with minimum side effects. The doctor at the Hong Kong Travel Health Service told us that he had never received any reports of negative effects for Atouaqune & Proguail during the last decade.
The high risk countries that we will be traveling through are Vietnam, Laos, Thailand, Malaysia, Indonesia and East Timor. There will be months of traveling and we will need a lot of pills to begin with. If we had chosen Doxycycline, we would’ve had to carry a lot more pills, given the fact that you will need to continue taking the pills for 4 weeks after exiting the high risk countries. Chopper, always the first one to get a sunburn, wanted to avoid the increased risk of sun sensitivity.
Japanese Encephalitits:
Another mosquito-borne disease, Japanese Encephalitis occurs mainly in the rural and agricultural areas of Asia and Western Pacific. Though only 50,000 cases are reported annually from Asia, approximately 1 in 200 infections results in severe disease characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and death. The case fatality rate can be as high as 60% among those with disease symptoms; 30% of those who survive suffer lasting damage to the central nervous system.
| Vaccine | Vaccination schedule | Price |
| Inactivated vaccine, manufactured in EU | One primary vaccination followed by two boosters. | HKD 695 |
| Live-attenuated vaccine, manufactured in China | One shot. | HKD 85 |
Our pick: live-attenuated vaccine, manufactured in China
Only 1 shot and almost 1/10 of the price, and the Chinese vaccine has shown effectiveness throughout China. However, this inexpensive and quick vaccine is only available in China/Hong Kong region.
Poliomyelitis:
Price: HKD 60
Cher has fond childhood memories of getting polio sugar pills. However, we are advised to take a booster even we have been fully immunized from our childhood immunization routine. A good way to prevent poliomyelitis is avoiding unclean food.
Tetanus:
Price: HKD 60
Punctured wounds introduce the risk of Tetanus infection. Always good to make sure your Tetanus vaccine is up to date before travel.
Hepatitis A & B:
Price: Hepatitis A – HKD 185, Hepatitis B – HKD 60
Hepatitis A can be transmitted through uncooked/undercooked food, contaminated beverages, or pre-cut fruit, while Hepatitis B can be transmitted by direct contact with blood and body fluid.
Hepatitis A vaccine is administered in two doses six months apart. Protection against hepatitis A begins four weeks after the first dose. It is safe and does not cause serious side effects. Current evidence suggests that the protection of hepatitis A vaccination lasts for at least 10 years. Hepatitis B vaccine (total 3 doses, given initially and 1-2 and 6-18 months later) provides good protection against HBV.
Typhoid:
Typhoid fever is common in the developing countries, where it affects about 21.5 million persons each year. There is vaccine against typhoid fever. After vaccination, it will take 1 to 2 weeks for the vaccine to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.
Watching what you eat and drink when you travel is as important as being vaccinated against typhoid fever. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.
There was a typhoid vaccine recall in 2012 in Hong Kong, due to “concerns about the effectiveness of the vaccine“. This may be the reason why we couldn’t find any health service providers in Hong Kong that had typhoid vaccine in stock. Just as suggested by CDC website, “boil it, cook it, peel it, or forget it“!