Southeast Asia
Travel To Southeast Asia
* Brunei * Burma (Myanmar) * Cambodia * East Timor * Indonesia * Laos * Malaysia * Philippines * Singapore * Thailand * Vietnam
More common infections in travellers to the area include dengue fever, respiratory infections, and diarrhoeal infections. Chronic and latent infections in immigrants (and long-term residents) include tuberculosis, late complications of hepatitis B infection, intestinal helminth infections (including strongyloidiasis), and other helminth infections, such as paragonimiasis, opisthorchiasis, and clonorchiasis.
Vector-borne infections: Dengue fever is hyperendemic in the region, and epidemics are common; cases occur in travellers to the region. Malaria is found in focal areas (primarily rural) in all these countries (except Brunei and Singapore), especially in rural areas. Japanese encephalitis is widely distributed in the region and is hyperendemic in some areas; risk is seasonal in some countries. Scrub typhus is a common cause of fever in the region. Other vector-borne infections include murine typhus, Chikungunya virus, and relapsing fever. Foci of transmission of lymphatic filariasis are found throughout the area, with the exception of some of the Indonesian islands.
Food- and water-borne infections: Risk of hepatitis A is widespread in the region. Risk of diarrhoea caused by bacteria, viruses, and parasites is high in parts of the area. Campylobacter infections are especially common in Thailand and are often resistant to fluoroquinolones. Amebic liver abscesses, typhoid fever, and brucellosis occur. Isolates of Salmonella causing typhoid fever may be resistant to multiple drugs, including the fluoroquinolones. Cholera epidemics have been common in the past. Outbreaks of hepatitis E have been reported from the region (Indonesia and Burma). Cysticercosis is especially common in Indonesia. Gnathostomiasis is endemic in region and especially common in Thailand. Intestinal helminth infections are common in some rural areas; risk to the usual traveller is low. Opisthorchiasis, clonorchiasis, fasciolopsiasis, and paragonimiasis are endemic in parts of the region (especially Laos and Burma).
Airborne and person-to-person transmission: The annual incidence rate of tuberculosis per 100,000 population is estimated to be >300 in Cambodia and 100-300 in the rest of the region. Measles transmission persists in region, although vaccination coverage is improving in some countries. SARS outbreaks occurred in the region (especially in Singapore and Vietnam) in 2003. Influenza infections can occur throughout the year in tropical areas.
Sexually transmitted and blood-borne infections: The prevalence of HIV is 1%-5% in Thailand and Cambodia in adults and <1% in the rest of the region. Higher prevalence may be found in specific populations. The prevalence of hepatitis B chronic carriage exceeds 8% in many parts of region. The prevalence of chronic hepatitis C is 1%-2.4%. Chancroid is a common cause of genital ulcer disease.
Zoonotic infections: Rabies is common in the region, and travellers are at risk for exposure to rabid animals, especially dogs. Outbreaks of avian influenza occurred in 2003-2004 in Thailand, Vietnam, Indonesia, Malaysia, and Cambodia. Human cases (with high mortality rates) occurred in Vietnam and Thailand. Anthrax* is hyperendemic in Burma; sporadic cases occur in much of the rest of the region. An outbreak of Nipah virus, with a probable reservoir fruit bats and documented transmission to humans from pigs, occurred in Malaysia (1998-1999) and in Singapore (after contact with pigs imported from Malaysia). Cases of human plague* have been reported since 1990 from Indonesia, Laos, Burma, and Vietnam.
Soil- and water-associated infections: Schistosomiasis caused by S. japonicum is found in the Philippines and Indonesia (Sulawesi [Celebes]); caused by S. mekongi in Cambodia and Laos; and caused by S. malayensis in peninsular Malaysia. Leptospirosis* is common in tropical areas and has been reported in travellers to the area. Melioidosis is a common cause of community-acquired sepsis, especially in rural areas of Thailand; it is also common in Cambodia, Laos, and Vietnam. Cases have increased in 2004 in Singapore. Infection in travellers is rare. Penicilliosis marneffei is found in southeast Asia and is a common opportunistic infection in HIV-infected patients, especially in Thailand. Rare cases have been reported in travellers to the region. Cutaneous larva migrans is common on warm coastal areas.
Other risks for travellers include snake bites and motor vehicle accidents. Screening of blood before transfusion is inadequate in many hospitals.
