CHINA - CAMBODIA - JAPAN - KOREA - LAOS - MONGOLIA - VIETNAM
	PREVENTION OF MALARIA  |   DIARRHOEA  |   VACCINATIONS
	FAR EAST CHINA: There is no risk of malaria in the main towns and above 1500 m. In the tourist areas, the risk of malaria is extremely low to non-existent. In China the risk of malaria has drastically diminished the last years. Generally speaking, no antimalaria measures are necessary for tourists or hikers along the silk route or those taking a cruise on the Yangtze River. In rural areas to the south of latitude 33° north protective measures against mosquito bites in the evenings and at night are certainly adequate. Precautions for those taking an adventure holiday: - There is no malaria risk at all in the northern provinces: Heilongjiang, Jilin, Nei Monggol, Beijing, Shanxi, Ningxia, Qinghai, nor in the Western provinces Gansu, Xinjiang (except in the valley along the Yili river), and Xizang (except for one area in the extreme South-east in the valley of the Zangbo river, towards the border with Myanmar). Protective measures against mosquito bites are sufficient. -       In some southern regions in the Yunnan province (in the extreme south of China, in the border area with Laos-Vietnam-Myanmar (Burma)) and in some southern regions of the island of Hainan there is a malaria risk the whole year, but only in areas below 1500 m and away from the towns.  When on an adventure trip in rural areas, the measures for the prevention of malaria discussed in NOTE 2 apply. -      There is also a variable but limited malaria risk in the remaining part of South-east China, but only in remote areas below 1500 metres, away from the towns, outside the densely populated plain areas and tourist routes (areas in some central and southern provinces, e.a. Anhui, Henan, Hubei, Ghuizhou and Jiangsu). It only concerns P. vivax malaria. ·   Above latitude 33° north: malaria risk from July to November ·   Between latitude 33° and 25° north: malaria risk only from May to December ·   Below latitude 25° north, namely in the Guanxi province, there is a risk of malaria the whole year.       The recommendations for the prevention of malaria discussed in NOTE 1 apply in these areas for persons spending the night in primitive conditions        in rural areas. CAMBODIA: There is a malaria risk in the whole country, except for the following areas where there is as good as no risk:     -      the capital Phnom Pehn and surrounding area;     -      downstream from Phnom Pehn along the Mekong river and its large tributary the Tonle Bassac (down to the border with Vietnam)     -      upstream from Phnom Pehn along the Tonle Sap river to the Tonle Sap Lake and surrounding area -     in Siem Riepville itself: the risk is low or non-existent, also in Angkor Wat the malaria risk is negligible -    in most of the provincial capitals (with the exception of Prey Vihar, Rattanakiri, Mondolkiri, where there is a risk) -       There is a low risk on the coast; also at night and in the evening on beaches such as Kep and Sihanoukville and the coastal islands (Ko Kong - Ko Rung - Ko Rung Sanloem). For well organized tours with overnight stays in luxury hotels, precautions against mosquito bites are sufficient and there is no need to take malaria tablets. In case of fever, malaria should always be considered. In other cases, measures described in NOTE 2 apply. In Cambodia’s Western provinces, bordering on Thailand, there is a Lariam resistant form of malaria (and a tolerance of (or diminished effectiveness) of Artemisinine): for protective measures see NOTE 3. http://www.cambodia.net/malaria -> malaria area map JAPAN: there is no malaria. KOREA: there is only a very limited risk of P. vivax malaria in a few remote localities in the north of South Korea (Republic of Korea) (northwest of the Imjin River on the Northern border provinces Kyonggi-do and Gangwon-do) and in the adjacent areas in the south of North Korea (Democratic People's Republic of Korea): no chemoprophylaxis needs to be taken, mosquito repellent if necessary. http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm ® Korea LAOS: there is no malaria risk in the capital Vientiane and a low risk in the city of Luang Prabang. For most organized tours with overnight stay in luxury hotels, no intake of malaria tablets is necessary and precautions against mosquito bites are sufficient. In case of fever, malaria should always be considered. However, there is a malaria risk throughout the rest of the country. The recommendations discussed in NOTE 2 apply here. MONGOLIA: there is no malaria. VIETNAM: - There is a risk of malaria throughout the whole country, but not in large towns such as Hanoi, Danang, Nha Trang, Ho Chi Minh, etc. nor in the delta of the Red River. (There is a very low risk in the Mekong delta and on the islands Dao Phu Quoc & Dao Tho Chu). -       There is no risk in the coastal plains of central Vietnam north of Nha Trang. -       There is a high risk:   (1) inland, south of 18° north latitude on the plateaus and on the wooded hill slopes below 1500 metres, mainly in the 4 central highland provinces: Dak Lak, Dak Nong, Gia Lai and Kon Tum   (2) in the Binh Phuoc province   (3) in the western parts of the coastal provinces Quang Tri, Quang Nam, Ninh Thuan and Khanh Hoa.         No tablets are necessary for well-organised journeys from city to city, protective measures against mosquito bites in the evenings and at night  should be sufficient (in case of fever, malaria should always be considered). The recommendations for prevention of malaria discussed in NOTE 2 apply for other travellers. There is important Lariam^® resistance in the central part of Vietnam (between 15° and 11° north latitude) until the border with Cambodia; in this region the intake of Malarone^® or Doxycycline is recommended (CDC 2010 - http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx).
	PREVENTION OF MALARIA Precautions against mosquito bites in the evenings and at night are always essential to protect against possible malaria. Tourists visiting a malaria area during the daytime and staying in good hotels in the evenings and at night run no risk, and do not need to take any antimalaria tablets. However, everybody should always have a mosquito-repellent product (for application to the skin) with them, in case they cannot get back to the hotel in time in the evening, e.g. due to problems such as illness, car breakdown, etc. You should also apply the mosquito-repellent generously to the skin when on a trip or a safari in the early morning, in the evening or at night. Tourists on adventure-type trips in rural areas who stay overnight in primitive conditions are also advised to impregnate the mosquito nets with permethrine or deltamethrine, a chemical substance that provides an extra mosquito-repellent and mosquitocidal effect; taking antimalaria tablets is also necessary: P.N. In many Asian regions (http://www.dtg.org/21.0.html) one can dispense with the chemoprophylaxis (even for adventurous travellers) after having an extensive talk with a specialized doctor who will evaluate the malaria risk depending on the type of lodgings and only when strict measures are taken against mosquito bites from dusk till dawn and malaria emergency treatment is available (Malarone^®) with complete instructions. NOTE 1 NIVAQUINE^® 3 tablets per week, taken in one dose, starting from 1 week before departure, and continuing until 4 weeks after returning home. NOTE 2 MALARONE^® (1 tablet daily from 1 day before departure until 7 days after returning home) OR DOXYCYCLINE (1 tablet daily from 1 day before departure until 4 weeks after returning home; in some cases a tolerance test during a few days is necessary) OR LARIAM^® (1 tablet once a week, starting 2-3 weeks before departure until 4 weeks after returning home) are the first choice of medication. In order to have an effective level of LARIAM^®in your blood upon arrival in the malaria area, it is recommended to start taking this drug 2 to 3 weeks before departure. People who have never taken this medicine before should start taking it at least 2 to 3 weeks beforehand to deal with possible side effects (dizziness, insomnia, nightmares, agitation, inexplicable anxiety, cardiac palpitations). Lariam will not be prescribed if the doctor thinks there are contraindications (pregnancy wish, epilepsy, depression, or cardiac rhythm disorders for which medications such as beta-blockers, calcium antagonists of digitalis are being taken), or if you did not tolerate this medication on an earlier occasion. You should continue to take the medication until 4 weeks after returning home. If Lariam^® is well tolerated; it can if necessary be taken for many months or even years. For a short trip MALARONE^®is an excellent choice and is usually well-tolerated. MALARONE can be taken for several months, but it is in that case an expensive alternative. DOXYCYCLINE: 100 mg daily, to be taken the day before departure and continuing until 4 weeks after returning home. Doxycycline should be taken sitting down with plenty of liquid or during a meal. Doxycycline can sometimes give rise to phototoxicity and fungal infections of the mouth and genitals. Doxycycline can be taken for several months. A lot of places in Vietnam have the facilities to diagnose and treat malaria quickly and efficiently. All this should be individually discussed with your doctor or with the doctor at the travel advice centre. NOTE 3 MALARONE^®: 1 tablet daily from 1 day before departure until 7 days after returning home OR DOXYCYCLINE: 100 mg daily, to be taken the day before departure and continuing until 4 weeks after returning home. Doxycycline should be taken sitting down with plenty of liquid or during a meal. Doxycycline can sometimes give rise to phototoxicity and fungal infections of the mouth and genitals. Doxycycline can be taken for several months. All this should be individually discussed with your doctor or with the doctor at the travel advice center.
	DIARRHOEA DIARRHOEA is a frequent travel problem. Even when travelling in good conditions, it is not always possible to avoid it. Some advice and the correct medication from the travel pharmacy are very useful. Always consult the section on traveller’s diarrhoea where the measures for prevention and correct treatment of diarrhoea are discussed.
	DENGUE In Asia dengue fever may occur. Prevention = apply protective measures against mosquito bites during the day. Consult the text on dengue - www.travelhealth.be & consult the world card on www.who.int/ith ® " disease distribution maps".
	VACCINATIONS No vaccinations are actually required. YELLOW FEVER vaccination is NOT required if you are departing from Belgium since there is no yellow fever here. If you are travelling from another country, where yellow fever can occur (Africa, South America, see http://www.who.int/ith/en/index.html ® disease distribution maps), you should certainly be vaccinated from the age of 1 year for China, Cambodia, Laos, North Korea and Vietnam. Going on a trip is also an ideal opportunity to bring TETANUS-, DIPHTHERIA-, PERTUSSIS-, MEASLES- and POLIO VACCINATIONS up to date. Anyone travelling to Asia, regardless of the duration and conditions of the trip, should be vaccinated against HEPATITIS A. Vaccination against TYPHOID is in any case recommended for people who are travelling in poor hygienic conditions, go abroad frequently or for long periods (for example longer than 2 - 3 weeks), even in good hygienic conditions. In a lot of cases, vaccination against HEPATITIS B should also be considered. For further details, please consult the text about "VACCINATIONS" People on adventure trips through the countryside lasting more than 4 weeks or people who will be staying there for a long time should consider vaccination against JAPANESE ENCEPHALITIS (not for Mongolia) and RABIES.              All this should be individually discussed with your doctor or with the doctor at the travel advice centre.