Health Concerns to Consider Before You Visit Vietnam
Health Concerns to Consider Before You Visit Vietnam
Before coming to Vietnam, I had really only been to Western and Central Europe, Australia, and a couple other places. In short, I had never really had any health concerns in relation to traveling before. As I’ve lived in the US for all of my life, I was fortunate enough to not have to worry about exposure to certain diseases that are prevalent within South East Asia and other parts of the world. After speaking with my doctor about my plans to live in Vietnam, we came up with a schedule of vaccinations (as recommended by the US Center for Disease Control [CDC]) to prepare me to live a healthy life during my time in Vietnam. We also discussed some health and safety precautions to abide by during my time here to make my travels as stress free as possible. Depending on where you’ve traveled before, this may sound a little intimidating but I think that it’s completely worth the trouble to ensure that you have a positive and safe experience here.
Hepatitis A and B Vaccines
These vaccines are actually pretty standard for going to many parts of the world outside of Southeast Asia (i.e. parts of Eastern Europe and other regions within Asia to name a couple). Consider it an “investment purchase,” as it will likely come in handy if you plan to travel to other parts of the world. Per the CDC website, the Hepatitis A vaccine can last “for at least 20 years in adults administered inactivated vaccine as children with the three-dose schedule, and anti-HAV persistence of at least 20 years also was demonstrated among persons vaccinated with a two-dose schedule as adults” (source: https://www.cdc.gov/hepatitis/hav/havfaq.htm). This disease generally occurs from “Person-to-person transmission through the fecal-oral route” (wonderful…) and through exposure to contaminated water and food (this information is also from the aforementioned source). Per the same source, the Hepatitis B vaccine can last “for at least 30 years among healthy vaccinated individuals who initiated hepatitis B vaccination >6 months of age” (source: https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm). This disease occurs through contact with contaminated bodily fluids (dried or “liquid” blood, semen, and saliva). In general, it is associated with the use of needles and with unprotected sex (same source). The vaccines are generally administered in a combined shot (yay, fewer needles!), and the schedule is as follows:
- Hepatitis A: 2 doses approximately 6 months apart
- Hepatitis B: usually 3 doses at 0, 1 and 6 months
Depending on where you’ve traveled before, this vaccine may be a no-brainer for you. Stray animals are common in Vietnam and in surrounding countries. Getting your animals fixed is uncommon here (I’ve actually never seen a fixed male dog in all of my time spent here) so there are going to be a lot of unwanted animals wherever you go. Even animals that have owners seldom go to the vet so if you are bitten by an animal here, there’s a higher probability of infection than other parts of the world. I have, admittedly, been an idiot about interacting with stray animals in Southeast Asia because I think they’re so cute and I sometimes feed them some meat I save after meals. Please don’t follow my example, it’ll probs come back to bite me in the ass (hopefully not literally but that could be a thing, I guess).
Even if you do get these shots, you’re really not in the clear if you get bitten. It’s honestly just a way for you to buy more time before you get the bite looked at. You will absolutely need to seek medical attention if you get a bite that breaks the skin (I would even be more cautious and go to the doctor if it doesn’t break the skin but that’s just me). As death can occur within days of exhibiting symptoms of the disease, you really can’t procrastinate on this.
The vaccine schedule for your rabies shots is as follows:
- Rabies (preexposure shots only): 3 doses; day 0, day 7 and day 21 or 28 (I did the latter route, I’m not really sure why you can do either schedule but that’s what the CDC states…) (Source: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.html)
- Rabies (postexposure shots with no past preexposure shots): 4 doses; “Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.” (Source: https://www.cdc.gov/rabies/medical_care/index.html)
- Rabies (postexposure shots with postexposure shots having never been previously administered): 4 doses; “Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.” Note that this is the same schedule as the 2nd bullet point. (Source: https://www.cdc.gov/rabies/medical_care/index.html)
- Rabies (postexposure shots with postexposure shots having been previously administered): 2 doses; “If a person has previously received postexposure vaccinations or received preexposure vaccinations, only two doses of vaccine (on the day of exposure and then 3 days later) are needed. Human rabies immune globulin is not required.” (Source: https://www.cdc.gov/rabies/medical_care/index.html)
Japanese Encephalitis Vaccine
Depending on where you’re from in the world, you may have never heard of this vaccine before- I certainly hadn’t. This is a mosquito-borne illness so depending on where you’re going in Vietnam, you should definitely consider getting this. A word of caution: if you’re receiving your vaccines in the US, you should expect to pay as much as $350 for the full regimen and it’s quite likely that your insurance won’t cover this (yeah, it sucks). As my doctor described it, mosquitos are less of an issue if you’re near the coastline in Vietnam. However, if you’re going farther inland, you will definitely want to consider this preventative measure. I personally didn’t want to leave it to chance so I bit the bullet and just got the shots but the decision is really up to you.
The dosing schedule for this vaccine is as follows:
- Japanese Encephalitis: 2 doses at days 0 and 28 (source: https://www.cdc.gov/japaneseencephalitis/vaccine/index.html)
Depending on where you’re from, you probably haven’t had to worry about this until now. As an American, the world “typhoid” brings back fond memories of playing The Oregon Trail during computer class (literally no one outside the US will understand that reference but whatever, shout out to all my fellow ‘Murikans!). However, this disease is alive and well in other parts of the world and it’s rather unpleasant so please consider getting this vaccine. Also, it’s only one dose (!) which is a walk in the park compared to the rabies administration schedule so I think you can handle one more needle. If you hate needles, the vaccine comes in pill form but you need to follow the administration instructions exactly for this method to work or you risk contracting the disease. The disease is caused by exposure to bacteria called Salmonella Typhi and the administration is generally through the consumption of contaminated food or water (Source: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html)
- Typhoid vaccine: initially 1 dose only (sweet!). A booster shot is needed every two years if you remain exposured to the disease (Source: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html)
- Typhoid pills: 4 doses; one capsule every other day for a week (day 1, day 3, day 5, and day 7). The last dose should be given at least 1 week before travel to allow the vaccine time to work. Do not chew the capsule as it will be rendered ineffective otherwise. A booster dose is needed every 5 years if you remained exposed to the disease. Make sure to refrigerate your capsules, as you risk killing the cultures inside them and again rendering the treatment ineffective if you don’t do so (Source: same as above)
I’ve heard conflicting reviews of the need for malaria pills during my travels in Southeast Asia. I’ve met people traveling for two weeks who carry them and people traveling for 11 months who skipped this step entirely. Keep this precaution in mind but know that many people don’t consider it essential. I think there is value to having the pills on hand if you’re traveling to lesser known cities- especially when you’re away from the coastline- as the mosquitos will generally be more prevalent there. Per the CDC website, there are “rare cases in the Mekong and Red River Deltas. None in the cities of Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), Nha Trang, and Qui Nhon.” (Source: https://www.cdc.gov/malaria/travelers/country_table/v.html). Per the same source, Chloroquine and Mefloquine are the recommended treatment options (note that the type of medicine you should take is different depending on which part of the world you’re traveling to. If you’re heading to parts of Africa, you wouldn’t necessarily take the same medicines with you so keep that in mind).
From what little I knew about malaria pills before writing this article (I’m one of the travelers who ignored this step), I had heard about very vivid nightmares as being the worst side effect of taking the medication. The Chloroquine actually has different side effects (among which are nausea, headaches, temporary hair loss [ugh], blurred vision, etc.). The Mefloquine, however, can cause “dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances” (Source: https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/mefloquine.pdf).
Per the CDC’s explanation, “No antimalarial drug is 100% protective and must be combined with the use of personal protective measures, (i.e., insect repellent, long sleeves, long pants, sleeping in a mosquito-free setting or using an insecticide-treated bednet.” Ironically, the symptoms of malaria may closely resemble the side effects of the pills that you might be taking (i.e. “fever, chills, sweats, headaches, nausea and vomiting, body aches, general malaise”) so that’s… pretty sucky? Yeah modern medicine is great and all but seriously, that’s pretty counterintuitive? Below is the dosing schedule for using these antimalarials:
- Chloroquine medication: “Both adults and children should take one dose of chloroquine per week starting at least 1 week before traveling to the area where malaria transmission occurs. They should take one dose per week while there, and for 4 consecutive weeks after leaving.” (Source: https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/Chloroquine.pdf)
- Mefloquine medication: “Both adults and children should take one dose of mefloquine per week starting at least 2 weeks before traveling to the area where malaria transmission occurs. They should take one dose per week while there, and for 4 consecutive weeks after leaving.” (Source: https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/mefloquine.pdf)
For me, using hand sanitizer around here is pretty central to my daily routine (although I’m not as intense about it as when I first got here). It’s an easy precaution you can take to protect yourself from illness. It’s cheap, accessible, and a small step you can take to stay out of the hospital here (which I HIGHLY recommend based on personal experiences. No disrespect intended towards the healthcare professionals of Vietnam but it’s… different out here than what I’m used to). Most Vietnamese bathrooms have soap but if you head into neighboring countries (i.e. Cambodia) you’re absolutely going to regret not being more prepared. Soap is essentially a luxury item out there so consider yourself warned.
Additionally, the pharmacies in Vietnam and in some of the surrounding countries work quite differently than what I’m used to in the US. As most medicines (i.e. antibiotics) can be obtained without a doctor’s visit or a prescription, drug resistant disease has become a real concern in much of Southeast Asia. This might sound irresponsible of the locals but consider it from their perspective: it can be expensive to go to the doctor, it takes time out of their day which could otherwise be spent working and earning money, and most medicines are readily available without a doctor’s approval. Also, public hospitals here don’t seem to follow a strict protocol for sanitation so there’s a good chance you can actually get sick from seeking medical attention. After going to the emergency room myself, I better understand the notion of not wanting to schedule an appointment if it can be avoided. A lack of public awareness of drug resistant illnesses may also contribute to this trend, but of course it depends on the individual. In short, do yourself a favor and keep a small bottle on you at all times, as you’ll never know when it’ll come in handy!
When my doctor heard I was moving to Vietnam, she gave me a lecture on which medications I should take with me to assist with food poisoning/general indigestion. As horrible as it may sound, you should assume that you will get sick from food or water out here at least once. Naturally there’s a spectrum for the severity of your symptoms but don’t waltz in here and expect to be healthy the whole time. That’s just not a thing. For the first line of defense, I brought a bottle of Pepto Bismol pills. This usually solves the problem but if it doesn’t, bring a box of Imodium, as well. If that doesn’t work (i.e. you have symptoms for more than 3 or 4 days), you should have traveler’s diarrhea pills at the ready. A full round of treatment should consist of 3 positively gigantic pills and should be prescribed to you through your doctor. If that doesn’t work, just bite the bullet and go to the damn hospital. The private practices around here are popular among tourists, as there tends to be more order and better sanitation there than in public hospitals. Just recognize that this is absolutely a luxury experience- the locals often can’t afford treatment in these facilities so consider yourself nothing short of very fortunate for at least having the option.
Travelers usually get sick through a few methods of transmission. The first (and perhaps the most obvious) is through drinking the local water. While it might seem incredibly wasteful, get used to drinking bottled water only. I even use it for brushing my teeth but many travelers will tell you this is not necessary (it really depends on how sensitive your stomach is, I guess?). For many of you, it will be frustrating to use so much plastic. If you’re concerned, you can buy the 1.5 liter bottles of water as opposed to smaller sizes. “Ecofriendly tourism” is becoming more of a thing out here so this is permeating the ranks of many hostels in Vietnam. There will often be an area to refill your water bottle so you can get a few more uses out of it than just throwing it away after one use. You may see a recycling bin or two in a major city, but get used to the idea of throwing the plastic away with all of your other garbage, as conventional recycling is not common out here.
It’s not as bad as you might think, however. Even though there’s no official system in place to sort through trash, an unofficial system led by locals takes the place of that, at least in part. They will sometimes sort through trash piles to extract out the plastic bottles and other reusable items. They, in turn, sell these back companies for a small profit. In many other countries, you can generally rely on a formal recycling system to do this but ultimately someone at the top of the corporate food chain is making a large profit off of using this method. Foreigners may have the luxury of participating in their local recycling system with minimal effort. Here, the recycling comes from within the local community at a grassroots level. I honestly think this is a really amazing concept and while it might not be the most efficient way of getting things done, the system really does work itself out to a degree.
While I’m on this subject, please keep in mind that it was really the west that introduced plastic packaging to this region. For generations the locals have relied on biodegradable packaging made of paper, which could be thrown on the ground and would eventually disintegrate over time. Now that plastic packaging is king, the locals sometimes still dispose of the waste in the same way (especially if you’re outside of a major city) but it’s really not their fault. A lack of education about waste management, an intergenerational system of dealing with the problem that has since become obsolete, and a potential lack of access to an official waste management system (depending on how rural the area is) is really to blame. Had the west never pushed the idea of plastic packaging on this region, the system that worked for generations would still be relevant so you can hardly demonize the locals for the trash situation here. You can find more information about this issue here: https://www.vietnamonline.com/living/garbage-and-recycling.html, it’s pretty interesting, actually.
Sorry for that very long tangent but it’s important for me to express this stuff so you can be a bit more informed about the region. The other obvious method of getting sick is through the consumption of unwashed (or washed) raw vegetables, fruits without peels, and undercooked/old food. Be wary of the first two- even if things are washed, it may be done with local tap water which is not safe for many foreigners to consume. As a result, I tend to limit my consumption of raw vegetables and I only eat fruits like bananas out here. Regarding the undercooked or neglected food, this is an issue at some (but not all) food stalls. As the food tends to be made in batches, it could very well be that your soup has been sitting in a pot for a while. Before you buy, try to sneak a peek to make sure the soup is boiling to avoid this issue and walk away from a situation where it feels like this isn’t being done.
Often, foreigners wonder if the ice served in beverages at restaurants is safe to consume. The short answer is yes, most of the time, but not always. One way you can determine this is by observing where the locals go to eat. If you see a lot of Vietnamese people in a restaurant, there’s a good chance that the drinks aren’t making everyone sick. Take it on a case-by-case basis, however, and don’t make sweeping generalizations about all the restaurants in Vietnam. Much of the time bottled water is used to make the ice but don’t be overly trusting with this, as you may regret the consequences later on. You are the judge of what goes in your body and you are capable enough of reading the situation to make an informed decision.
This one is a no-brainer if you’ve read about the mosquito-borne illnesses above. As previously stated, your malaria pills may not be 100% effective so consider carrying some of this around with you. My doctor recommended a formula with minimum 50% DEET but I’ve gotten away with a spray that contains 20% picaridin. There’s actually stuff on the market that contains over 90% DEET but I wouldn’t touch that stuff with a 10-foot (3.048 meters lol) pole to be honest. So which of these ingredients is the lesser of two evils? Well per a google search I found that “the toxicity of DEET is unclear and is still under investigation” (convenient for those companies that use DEET in their products, eh?). “It is known that DEET is absorbed by the skin and excreted by the kidneys” which sort of terrifies me? Apparently it can “melt plastics” (WTF) and has a strong odor. It can also make your skin very oily (Source: http://healthcenter.indiana.edu/answers/insect-precautions.shtml). Picaridin, on the other hand, has none of these issues so I’m all about that. (same source as above). There’s also more “natural” formulas out there but I don’t really have much experience with these. Ask your closest hippie friend if you want more information on that (or just google it yourself, ya lazy fool!).
So it’s going to be a wild ride with medical precautions for this region, there’s no way around it. It will probably be expensive (my out-of-pocket costs in the US would be about $1,000 for the vaccinations alone and I’ve yet to see if my health insurance will actually cover any of it at all… Best of luck to me!). However, it’s very worth it to see this amazing part of the world and be safe at the same time. Make an effort (and open your wallet) and I guarantee that you won’t regret taking these precautions. Safe travels!
About the author:
I’m an American backpacker who has been traveling in South East Asia for the past 2.5 months. I left a job in finance to see more of the world and to teach English abroad. I’ve loved my experience in HCMC and beyond and I hope to share some of my experiences with prospective and fellow travelers.