Immunisation shots, what do I need?

[neil1280]

Iv'e read a few conflicting things about which shots to get, I crapped myself when my doctor told me that all the shots needed came to nearly £400 which would seriously mess up my budget!! Ive read some saying they haven't took any at all, some saying you need Malaria and Rabies... its endless

So my plan is to spend around 4 weeks in Thailand in the usual beach destinations and Bangkok and Chiang mai, we will also go to Cambodia and Laos one or the other but maybe not both. We will Jungle trek so there is a risk of animals and insects.

Also a friend suggested that it would be handy to have them done in Bangkok when I arrive there as my first stop.

I'd appreciate your thoughts on this guys.. £400 is just waaay to steep for me

[Sheryl]

There is no vaccine for malaria and anyway you will not be in any endemic areas. Forget that issue.

Rabies vaccine is highly recommended. It is a series of 3 injections, 2nd one a week after the first and 3rd one 3 weeks later that.

So is Hepatitis A + B if you haven't already had them. There is a good chance you have had at least the Hep A vaccine as this is now part of the standard immunization schedule in many countries, so check your medical records. In some countries Hepatitis B vaccine is also routinely given in childhood. The Hep B is a series of 3 injections, the second one a month after the first then ther third 4-6 months later.

The other possible need is Japanese B encephalitis. You will be at risk only if you spend time in rural areas where pigs are raised, asp pigs are the reservoir. This does not sound like it will be true in Thailand but not sure sure about Laos and Cambodia. Probably wisest to get it. This too is a series of 3 injections, the second one a week after the first and the third 3 weeks after that.

Depending on how soon you plan to travel, a reasonable option would be to start these 3 series in the UK and complete them in Thailand, i.e. get the 1st two of the rabies & Jap B vaccines and (if needed) the 1st Hepatitis jab there then the rest in Thailand. It would not be wise to defer everything until arrival in Bangkok as you will then have no immunity for most of the time you are here, which is rather the point.

Beyond these 3, all the other vaccines are the same as those required back in the UK which you have undoubtedly had already. If it has been a while since your last tetanus shot, a booster but that's easily done in Thailand.

If you come during or right after the rainy season dengue fever is a risk but there is no vaccine for it, just use mosquito repellent and try to avoid/minimize bites.

People always focus on the "exotic" threats, but by far the biggest health risk you run in Thailand, Cambodia and Laos is traffic accidents. Seat belts, helmet when on motorcycle, more than usual caution when crossing the street (they do not tend to brake for pedestrians here!).

And - very important -- take out travel insurance. Foreigners are not entitled to free health care here and more than a few tourists have wound up (usually courtesy of a traffic accident) with catastrophic hospital bills they couldn't pay.

[FBN]

Good advice from Sheryl and I want to emphasise Japanese B encephalitis shots (jungle trekking; rainy season) as well as Rabies.

Dengue also a risk but there is no vaccine for it so mosquito repellants are important.

[phuketrichard]

last shots i had was back when i was in africa in the peace corps in 1981

Never had any since i have lived here

A second to the accidents for injuries is Dengue fever and nothing u can do to prevent getting it except cover up all the time and use mosquito replient.

[JAS21]

I've been wondering about getting rabies injection ... where I go in Thailand the risk is small but one never knows. My friend got bitten by a stray dog and then had to rush off to get injections and it cost quite a lot.

My wife says not to bother but on this occasion I'm not so sure of her advice. Also if away 'say on holiday' ... maybe in Koh Chang for example ...and you got bitten by even a small animal having to decide whether to try and find somewhere to get treated. I understand that you need a certain injection within the first 24Hrs.

What would be the cost of the 'no rush' anti rabies injections and where would be a good place to have them ... I live in the Pakret area. Also are there any side effects?

[JAS21]

I've been wondering about getting rabies injection ... where I go in Thailand the risk is small but one never knows. My friend got bitten by a stray dog and then had to rush off to get injections and it cost quite a lot.

My wife says not to bother but on this occasion I'm not so sure of her advice. Also if away 'say on holiday' ... maybe in Koh Chang for example ...and you got bitten by even a small animal having to decide whether to try and find somewhere to get treated. I understand that you need a certain injection within the first 24Hrs.

What would be the cost of the 'no rush' anti rabies injections and where would be a good place to have them ... I live in the Pakret area. Also are there any side effects? Thanks

Edited June 20, 2013 by JAS21

[AyG]

If it has been a while since your last tetanus shot, a booster but that's easily done in Thailand.

I believe current medical thinking is that if you've had 5 previous tetanus shots that's enough for life.

[neil1280]

Hi I forgot about this post, My friend has been living in Thailand for 5 years, worked 2 weeks at a time in the jungle all summer doing tours, he has only had the free nhs shot and suggests just to run the risk but always know that you are not more than a couple of hours from a hospital. I've never had any shot in my life whatsoever so anything I have is completely new and i leave in three weeks so maybe i dont even have time for them all

I'm not so sure about that anyway knowing my luck, so il go this week to have my free shot and see what i can have done before i go

could someone also tell me where i could have any of these injections in bangkok close to sukhumvit or khao san road?

and even how much these could cost?

[lopburi3]

If it has been a while since your last tetanus shot, a booster but that's easily done in Thailand.

I believe current medical thinking is that if you've had 5 previous tetanus shots that's enough for life.

Every 10 years still seems to be the recommendation I find and had another last year myself. The initial children (DTaP) vaccine series is five shots before you even start to get the boosters (at not more than ten years). Suspect some will have many more if given for injury or live a long life.

[Sheryl]

Hi I forgot about this post, My friend has been living in Thailand for 5 years, worked 2 weeks at a time in the jungle all summer doing tours, he has only had the free nhs shot and suggests just to run the risk but always know that you are not more than a couple of hours from a hospital. I've never had any shot in my life whatsoever so anything I have is completely new and i leave in three weeks so maybe i dont even have time for them all

I'm not so sure about that anyway knowing my luck, so il go this week to have my free shot and see what i can have done before i go

could someone also tell me where i could have any of these injections in bangkok close to sukhumvit or khao san road?

and even how much these could cost?

Not far from Khao San:

http://www.mission-hospital.org/index.php/en/medical-services/intl-travel-wellness.html

I don't know the cost of these vaccines but you can email and ask them.

[Forethat]

Hi I forgot about this post, My friend has been living in Thailand for 5 years, worked 2 weeks at a time in the jungle all summer doing tours, he has only had the free nhs shot and suggests just to run the risk but always know that you are not more than a couple of hours from a hospital. I've never had any shot in my life whatsoever so anything I have is completely new and i leave in three weeks so maybe i dont even have time for them all

I'm not so sure about that anyway knowing my luck, so il go this week to have my free shot and see what i can have done before i go

could someone also tell me where i could have any of these injections in bangkok close to sukhumvit or khao san road?

and even how much these could cost?

I cant help myself......NHS is a sack of <deleted>. Dont ever trust anything that originates from NHS. Seriously.

[wellred]

Do you think I might need malaria tablets if I'm going to koh lipe? It's pretty close to Malaysia so wasn't sure.

Also on rabies my GP said not to bother as even if you get it and still get bitten you would still need a jab. All that does is buy you a little extra time.

[jrtmedic]

wellred

Sorry to tell you that your GP has failed to provide you with complete and accurate information.

Got here for the full story!

http://www.immunizationinfo.org/vaccines/rabies

For previously vaccinated people post exposure (after being bitten) treatment is much easier (just two ) injections.

Here is the protocol of treatment provided for unprotected individuals

"Previously unvaccinated people should receive the vaccine intramuscularly at 0, 3, 7, and 14 days. For adults the vaccine is given in the deltoid area; for children, it may be given in the anterolateral aspect of the thigh. In addition to rabies vaccine, these people should also receive rabies immune globulin (HRIG) at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works."

Please check the link provided and make a fully informed decision about Rabies vaccination.

[Sheryl]

You do not need malaraia prophylaxis for Koh Lipe, nor anywhere else you'd be likely to go.

[kriswillems]

wellred

Sorry to tell you that your GP has failed to provide you with complete and accurate information.

Got here for the full story!

http://www.immunizationinfo.org/vaccines/rabies

For previously vaccinated people post exposure (after being bitten) treatment is much easier (just two ) injections.

Here is the protocol of treatment provided for unprotected individuals

"Previously unvaccinated people should receive the vaccine intramuscularly at 0, 3, 7, and 14 days. For adults the vaccine is given in the deltoid area; for children, it may be given in the anterolateral aspect of the thigh. In addition to rabies vaccine, these people should also receive rabies immune globulin (HRIG) at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works."

Please check the link provided and make a fully informed decision about Rabies vaccination.

The number of injections they give you for post-exposure treatment (if you never had pre-exposure treatment) has decreased but you still need immune globulin.

Immune globulin is very expensive if you buy the stuff we use in Europe (HRIG). In Thailand you will usually get ERIG which is much cheaper (but it still costs up to 5000B depending on your body weight). They will do a skintest and only if you're allergic for ERIG (which is unlikely) you'll get HRIG (which can cost up to 20000B).

I think the red cross clinic in BKK is the best place to get the latest info about rabies in Thailand (they do research on rabies and helped decreasing the number of necessary injections).

Because of new statistics the number of necessary injections for pre- and post expose treatment decreased the last years.

You've to think about how much the rabies injections cost in Europe. If the total cost is more than 5000B, it's probably better to do nothing, because post-exposure treatment is available in all big hospitals and the price is around 5000B (and it's also very effective).

PS. I got post-expose treatment in Thailand after being bitten by a stray-dog.

Edited June 26, 2013 by kriswillems

[jrtmedic]

FACT ---------"immune globulin" is not required in the case of a fully vaccinated individual if they are exposed to a rabies risk !

Private (and Government) hospitals may attempt to sell to someone who is scared and vulnerable.

The link I gave is good ! ------ and represents a "gold standard" approach to treating rabies exposed people.

Pre exposure vaccination is always preferable to post exposure treatment which may be delayed with fatal consequence.

Edited June 26, 2013 by jrtmedic

[kriswillems]

If you live in Thailand you would be stupid not to get rabies vaccinations. But the thread starter doesn't live in Thailand.

I was stupid or unknowing until I got bitten by a dog while riding bicycle. The vaccinations are very cheap here (200B per shot) and you can even get them for free because Thai government vaccinates people for free several times per year at some temples or police boxes.

If you live in Europe the price of the rabies vaccinations might be very high.

In case the price is too high for you, you should not forget you've to get the full treatment (with immune globulin) within 48 and even better 24 hours after being bitten by any mammal (dog, monkey, cat, bat, ....). Forgetting to go to the hospital might result in a terrible death. You also need the post-exposure vaccinations. The total price in this case is around 5000B. I think this approach is valid and it's also the option the doctors in my (Western European) country advice to travelers to Thailand.

Edited June 27, 2013 by kriswillems

[jrtmedic]

Kris -----I am sure your expert knowledge on this subject will be appreciated by a few.

However I would urge anyone seeking genuine authoritative information to consult the American NNii site ( I give the link again below)

http://www.immunizationinfo.org/vaccines/rabies

This site provides authoritative advise which is adopted and used everywhere in the World including Europe.

I have lived in Thailand for many years but have no knowledge of people being vaccinated against Rabies at temples or police boxes !

Rabies vaccination may indeed be available free but but that would only be for Thai Nationals.

There is NO "free" healthcare for foreigners in Thailand

Edited June 27, 2013 by jrtmedic

[kriswillems]

Thanks again for the link to that American world leading website. You urged us to read it, so I did.

This is what I got from this website about who should get the pre-exposure vaccinations:

Travelers who will spend more than one month in countries with a high rate of rabies infection, if they are likely to come in contact with rabid animals and immediate access to appropriate medical care is limited.

The thread starter

- stays only 4 weeks (so, not more than 1 month)

- has easy access to hospitals (there are enough hospitals in Thailand).

So, he's not in this group. Easy access to medical care is not limited here when it comes to rabies. The number of hospital having ERIG or HRIG is huge (much higher than in Europe).

--------

The advertisement for free vaccinations is in Thai and I see it often at several locations in my city (at police boxes and in te temples). I can read Thai.

Your place might be different. I work near the temple and I saw people getting the free vaccinations.

In my city some people can also can get free flu vaccinations. The advertisement for this can be found at exactly the same places. The doctors go to the temples and police boxes because many people are scared to go to a hospital (At least, I think that's the reason)

I don't think I said non-Thai nationals can use these services. I don't know. I'll ask them, if you want.

Same for free surgery for cataract. Once per 2 years the hospital organizes free surgery. Advertisement is again at exactly the same place. At that moment our family buys sleeping mats and we donate them to the hospital so the patients can sleep on the floor because there are not enough beds. It's our way of helping the doctors that have to do hundreds of operations in a few days.

Edited June 27, 2013 by kriswillems

[poanoi]

I didnt take a single shot before i moved here 11 years or so ago.

In hindsight i wish i had taken vaccine against gonorrhea & diarrhea,

had those existed.

[neil1280]

ok guys, i got my shots today, i got hep A and B, , thphoid, malaria and tetanus I gave the rabies and Jap encepahilits a miss I just done think i will be spending enough time in the particluar areas for rabies and the risk is therefore very low for me. besides ive never been attacked or cut or scratched from any animal touch wood, the japanese one again statistically one in 1,000,000 are affected and 250 to 1 are serious, i like them odds lol

Thanks for all your help guys, much appreciated!!

Edited June 27, 2013 by neil1280

[Sheryl]

You didn't get a shot for malaria as there is no such thing.

IMO the 2 things you "skipped" are second in importance only the Hep A &B.

Rabies is endemic everywhere in Thailand and there are stray dogs all over the place. Odds of getting bitten are far from low no matter where you go.

Jap B - odds of getting it may be low but consequences (permanent brain damage or death) are catastrophic. It is particulalry widespread in Cambodia and Laos where even in towns people raise pigs.

[jrtmedic]

Sheryl

Absolutely agree !

[kriswillems]

From the NNii website:

"In general, JE-VC vaccine is recommended for travelers 17 years of age and older who plan to spend a month or longer in areas where JE virus infection of pigs occurs during the time of year when they will be travelling. Because the risk of JE varies based on destination, duration of visit, season of the year, and planned activities, travelers and their healthcare providers will need to weigh the overall risk for travel-associated JE, the high morbidity and mortality when JE occurs, and the low probability of vaccine-associated adverse effects."

You stay less than a month.

I personally went to get the JE vaccinations in Europe before coming to Thailand. They are expensive in Europe and different from the ones you get in Thailand (in Thailand they use a cheaper Chinese live attenuated SA 14-14-2 vaccine). The cheap Chinese JE vaccinations have just as effective, but when you'll arrive it will be too late to get them.

If you forget or choose not to take the rabies vaccine you can still get post-exposure treatment and you'll not be at risk. But if you forget to take JE vaccinations there's not much more you can do. That's why I took them.