Vaccinations For Southeast Asia – What Do I Need?

Getting vaccinations for Southeast Asia is something you should do at least a month, perhaps even several months before setting off on your travels as it will take time for the vaccine to kick in and for your body to be fully protected.

With some vaccines, you will need several doses over a period of a few months, so without a doubt, this should be one of the first things that you think about when preparing for your travels to Southeast Asia.

Visit a Travel Medical Clinic

Disclaimer: It’s very important to visit a travel medical clinic in your home country before you fly to Southeast Asia. Below, you will find some guidelines for the essential and recommended vaccinations for Southeast Asia. These are collated from online resources and personal experience. However, I am not a doctor (only a panicky traveller who does a lot of research on these sort of things!). We strongly advise you to consult with a health professional before travelling.

Most medical clinics have a special ‘travel department’ (complete with world maps on the wall!) that will be able to advise you on what vaccinations you will need, based on the countries that you are travelling to, and in some cases, the types of activities that you will be doing. (Certain activities, such as jungle trekking, for example, may pose a higher risk of some diseases.)

Opinions tend to vary from country to country and even from medical centre to medical centre. I’ve prepared for long-haul travel to Asia in the UK, Spain and France and have been advised differently in all three countries.

So what do you do in this case? I simply go with what the medical centre says. 99% of the time, I find that the medical clinic is overly cautious in what they recommend and so at the very worst, I’ll end up inoculated against something that there is little risk of in the country that I’m travelling, however, what’s the harm in that. It’s better to be safe than sorry!

That said, it is important to do your own research online to make sure that you are not being advised to get a vaccine that is simply not necessary for your travel itinerary. Vaccinations for travel can be expensive and so if your local travel clinic gives you an extra long list, don’t be afraid to question the health professionals. Look online and get a second opinion at another travel medical clinic if you’re just not sure.

The first time I went travelling I spent far too much money on daily malaria tablets that I was recommended to take, but just didn’t need – but that’s another story!

Anyway, the below is a guideline of which vaccinations are essential for Southeast Asia and which ones are recommended. It’s up to you to do your own research after this, chat with health professionals and weigh up the pros and cons (and your wallet!) of getting each vaccination.

(Oh, and please don’t panic too much, I’ve never heard of any traveller actually getting any of the diseases below.)

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Essential Vaccines for Southeast Asia

From our experience, you don’t need to go through Southeast Asia country by country looking what vaccinations that you will need, as the requirements are the same for the whole region. Plus, if you’re travelling for an extended period of time, you never know if your travel plans will change and you end up going to a country that you didn’t plan on going. It’s better to be prepared!

Nobody should travel to Asia without the following essential vaccines… 

Hepatitis A

Hepatitis A is a very infectious disease which affects more than 400,000 people in Southeast Asia. The virus is spread through contaminated food and water and is, therefore, more prevalent in countries with low levels of sanitation and hygiene.

The Hepatitis A vaccine is highly recommended for travellers to Southeast Asia and is given as a single injection, with a booster (optional) 6-12 months, after the initial injection, that will then protect you for at least 20 years.

How long before you travel should you have the Hepatitis A Jab?

Ideally, you should have the Hepatitis A vaccination at least 2 weeks before you set off on your travels. However, if you forget, you should still get it done regardless of how many days it is until your departure, even if it’s the day before! (Note: If you’re from the UK, the Hepatitis A vaccine is free on the NHS.)

Read more about the Hepatitis A vaccine here.

Hepatitis B

Hepatitis B is a serious viral infection of the liver. 250+ million people all over the world are estimated to be living with the virus. It is transmitted via bodily fluids, exposure to infected blood, unclean needle usage, unprotected sex and from mother to baby. If you get a tattoo or piercing whilst abroad, need stitches in a local hospital or get a new sexual partner, you could be at risk.

You will need three injections of the Hepatitis B vaccine over a period of six months. Once this schedule is complete, you will be inoculated for life. The vaccine has an excellent record of effectiveness.

How long before you travel should you have the Hepatitis B Jab?

It is recommended that the vaccine course runs over six months, therefore six months before you travel would be ideal. However, if you are going to set off on your travels much sooner than that, don’t panic, the course can be shortened to as little as 3 weeks.

Read more about the Hepatitis B vaccine here.

Hepatitis A + B Vaccine Combined?

It is possible to have a combined vaccination against both Hepatitis A and B. The combination vaccine is known as Twinrix. The vaccine is given as a serious of two shots, with a second booster shot being given 1-6 months after the initial injection. Your schedule may be different depending on the risk. Check with your own medical clinic to see if this combined vaccine is available.

Typhoid

Typhoid is a serious bacterial infection that is caused by the bacteria known as Salmonella typhi. It can lead to high fever, vomiting, diarrhoea and even death. It is passed on through contaminated food and water and is, therefore, more common in places with poor hygiene and where handwashing is not the norm. (India is one of the places that you are at most risk.)

Globally around 20 million people each year are affected by typhoid or typhoid fever as it is sometimes called. If treated early on, antibiotics are usually successful in eradicating typhoid. However, if left untreated it can be fatal.

It is recommended for travellers to Southeast Asia to be vaccinated against typhoid, particularly those who are doing homestays, workaways or are staying in places with low levels of sanitation.

The typhoid vaccine can be given in two ways:

1. A single injection. Booster injections are recommended every three years if you continue to travel to areas with risk of infection.
2. Capsules taken orally. 4 tablets taken every other day, the last taken just one week before travel.

It’s also possible to have a combined Hepatitis A and Typhoid vaccination.

How long before you travel should you have the Typhoid Jab?

You should have the typhoid vaccination injection at least one month before you travel. However, it can be given closer to the travel date in an emergency. It’s always better to have it than not at all.

Read more about the Typhoid Vaccination here.

Tetanus, Diphtheria, Polio (Combined)

It is recommended that all travellers to Southeast Asia are up to date with the following three:

Tetanus – caused by the bacteria Clostridium tetani, found in soil, saliva, dust and animal poo. The disease is also known as lockjaw, due to the stiffness of the neck and muscle spasms that are common with this disease.

Diphtheria – an infection of the mucous membranes of the throat and nose. It is very contagious and can be spread through sneezing, sharing bottles of cups or touching a used tissue. It is recommended that travellers heading to destinations where the vaccine is not as commonly given are vaccinated themselves.

Polio – also known as Poliomyelitis is a viral disease most common amongst children. It is a highly infectious disease spread through bodily fluids that causes paralysis in its victims. We are lucky today to have a vaccine against this terrible illness.

The Combined Tetanus, Diptheria, Polio Vaccine

Many children are given this combined vaccination when they are at school. In the UK, this is given in year 9 and then a further booster is given at age 14 (the 3-in-1 teenage booster) as part of the national immunisation program.

If you had this vaccine over 10 years ago, it is likely that you will need to get a booster.

How long before you travel should you have the Tetanus, Diphtheria, Polio Jab?

You should get your tetanus, diphtheria, polio vaccine at least two weeks before you travel.

MMR (Measles, Mumps, Rubella)

The MMR vaccine is routinely given to children across the Western world. The first is given when they are one year old, and the second is given at age 4-5 before the child started school. Once vaccinated you are protected for at least 20 years. It was introduced to the UK in 1988 and since then cases of the three diseases have fallen dramatically.

It is wise to check that you have had both the first and second MMR vaccine before travelling to areas which may be affected by these viruses. If you have only had the first vaccine, you will likely need to have a booster before you travel. Enquire with your local medical clinic, check back through your health records or ask your Mum!

If you had it already when you were a child and you do have it again, the NHS in the UK advises that it is safe to do so.

Recommended Southeast Asia Vaccines

While not essential, it is often recommended that travellers get the following vaccines:

Rabies

Visions of snarling dogs with foaming mouths and red crazed eyes come to mind as soon as someone utters the word ‘rabies’. It’s a disease of nightmares, that causes seizures, hallucinations, paralysis and a full-on attack of the nervous system, that almost certainly leads to death in its victims.

Is this vaccination necessary for Southeast Asia?

Some considerations…

Cost: The rabies jab typically involves three separate doses over the course of 28 days. (Therefore you would need to start treatment one month before travel.) In the UK, for example, each dose costs 40-60 GBP, so an entire course can be 120-180 GBP. In the US, it is estimated that the cost of a rabies vaccine can range between $197 – $957 USD depending on your health insurance, location and your doctor. For a traveller on a budget, this cost isn’t to be sniffed at.

Side effects: Definitely the vaccine that gives you the sorest arm.

Doesn’t offer full protection: Many travellers actually decide against having the rabies jab for the simple fact that the vaccine doesn’t offer full protection against rabies. What does this mean? Well, in the event of an animal bite, even those travellers who have had a vaccine would still need to get a further booster vaccine, they just have more time to get treated. If you have already had the jab, the time period extends from 24 hours to 72 hours to get yourself treated.

If you haven’t had the jab and you are bitten by a suspect animal whilst in Asia, you would need to find two things within 24 hours: 1) Rabies Vaccine. 2) Rabies Immune Globulin. While 24 hours may seem like a long time to get hospital care in the West, do you really want to take that risk whilst travelling? How can you be sure that you will always be within 24 hours of the correct medicine, regardless of weather, transport failures, sickness, natural disasters etc?

Animal bites are not uncommon in Southeast Asia: Stray dogs are all over the place in Southeast Asia and while rabies has been eradicated in some places (well done Koh Phangan!), in many mainland areas it has not. Travelling Southeast Asia over the past 10 years and although I’ve never been bitten, I’ve been chased and gnarled at by many a suspicious looking dog. Cats, bats, racoons, monkeys, foxes and even cattle can be prone to rabies.

Here is a list of countries worldwide where rabies exists among local animals.

Rabies can be transmitted through a lick: Rabies is transferred in fluids, you don’t have to be bitten to be at risk. If you have broken skin and are licked by an infected animal, you should get treatment. Rabies is easier to catch than you think.

Animals don’t always show symptoms: Animals don’t always show the stereotypical symptoms that we think of with rabies. It takes 2-8 weeks for the disease to incubate and within this time the animal may have no symptoms, but can still be a carrier for the disease.

Our humble non-medical opinion?

Definitely worth getting (we did).

Especially if you are planning to travel long-term, are not sure about which countries you will travel, or are thinking of travelling to remote regions. (As backpackers, we never know when our plans will change.) If you are thinking of doing long treks in Nepal or India and places where you may be more than 24 hours away from sufficient healthcare I would say it is an absolute must to get vaccinated.

There’s some excellent advice by this Australian Travel Doctor on the Rabies vaccine here.

Tips for Rabies prevention:

• Even though they may look cute, don’t stroke or pet stray dogs and cats in Southeast Asia and avoid looking angry dogs in the eye or provoking them in any way.
• If a dog goes for you, one tip we’ve learnt is to bend down as though you are picking up a stone to throw at them. You don’t actually have to throw a stone, but this simple action has been known to scare the dog away on many an occasion. (Probably because the locals have thrown stones at them in the past and they have learnt to run.)
• Whether you get the vaccination or decide not to if you are bitten by an animal on your trip be sure to get it checked out as soon as possible.

Japanese Encephalitis

No, not just needed for travellers to Japan! Japanese Encephalitis (JEV) is a horrid disease that is found in pigs and birds and is spread through mosquitos, mostly in rural areas. It causes vomiting, fever, coma and in some cases, death in its victims. It is common through many parts of Asia and is recommended to travellers who are staying at least a month in a country where the condition is common. However, cases of travellers contracting JE are very rare.

The vaccine is given in two doses, the second dose administered 28 days after the first. In the UK, the vaccine isn’t free on the NHS and will typically cost you around 90 GBP in a travel clinic.

Is this vaccination necessary for Southeast Asia?

If you are travelling to rural areas: Doctors advise this vaccination if you’re planning on spending a lot of time in rural or agricultural areas, volunteering, doing conservation work, farm work, camping or planning a long hike. Especially during the rainy season. Your risk is very low if you are planning to travel to urban areas.

The disease is very rare amongst travellers: According to statistics, there have been only 62 cases of travellers getting JE in the past 40 years. However, 30,000-50,000 people living in rural areas with pig-farming and rice-growing contract it each year. While the stats are low, as this travel website says: ‘rare doesn’t mean never’.

Side effects of the vaccine: Before having the vaccine, your doctor will inform you about the potential side effects. Up to 40% of people experience mild side effects, while more serious side effects are rare.

Our humble non-medical opinion?

I didn’t have this vaccine the first time that I travelled to Southeast Asia and looking back, I’m not really sure why I was advised not to. It seems that ‘better safe than sorry’ is the key here. However, speak with health professionals at your travel clinic and do your own research, we really can’t advise.

Tips for JE prevention:

• Stay protected against mosquitos as much as you can. Buy a strong mosquito repellant and wear it during sunrise and sunset when the mosquitos are most prevalent. We recommend Jungle Formula, which contains DEET as an active ingredient. Much as we’d like to use a natural repellant, we haven’t yet found one that works well enough.
• Of course, protecting yourself against mosquitos is also important to lessen the risk of malaria and dengue fever.
• In some areas, taking a mosquito net with you may be necessary. We’ve found Coghlan’s Travellers Mosquito Net to be the easiest to erect and it’s a decent price.

Cholera

The cholera vaccine is not normally recommended for your average traveller. However, if you are planning to find a job as an aid worker, volunteer or travel to remote areas with limited access to medical services, then your doctor may advise you to get this vaccine.

Cholera is often contracted through drinking unclean water or eating food that has been washed in dirty water. While Africa gets the worst of it, in Asia, cholera is most common in India, Bangladesh and Pakistan where there is increased poverty, inadequate sewage systems and a greater risk of contaminated water sources. Read more here.

Drink the vaccine: Unlike other vaccines, the cholera vaccine is given as a drink in two doses. The second dose is given six weeks after the first dose. You should have the last dose at least one week before you board that plane. If you’ve already been vaccinated and you are travelling to an infected area again, then a booster dose may be necessary.

Tips for Cholera prevention:

• Always wash your hands before eating, and if there is no soap available, use hand sanitiser.
• Never drink tap water. If you’re not sure where your clean water sources will come from (and you want to save plastic!) investing in a filtered water bottle for your travels is a good idea.
• Brush your teeth using bottled or boiled water.

What about Yellow Fever?

Yellow Fever is only advised for travellers going to Africa, South and Central America and the Caribbean. It is not usually advised for travellers to Asia, however as I’ve mentioned already, backpackers plans change and you never know when you might hop on a plane to follow that dream guy/girl to Argentina…

Here is a map of countries where yellow fever is found.

The jab costs 60-80 GBP in the UK and should be given at least 10 days before travelling. Once you’ve had it you’re safe for 10 years until you need another booster. So, while you’re getting all your other injections done, you may as well get the yellow fever jab too and be free to go anywhere the wind takes you!

Read more about yellow fever here.

Immunisation Resources:

You can get more in-depth advice about each country on the following websites:

• Travel Health Pro
• Fit For Travel
• NHS Travel Vaccinations