Vaccinations for Thailand and Asia: What is Mandatory? (Interview with a Doctor)

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What vaccinations should you get before traveling to Asia? What to pack in your first aid kit? What do you need to know before traveling to tropical countries to stay safe? Especially if we are going there with a child? – The most important thing is to be aware of the threats and prepare for them properly – a conversation with Milena Dorosz, a specialist in infectious diseases, maritime medicine, and tropical diseases.

In short – what you need to know:

Mandatory vaccinations: None (unless you are arriving from a country at risk of yellow fever).
Recommended vaccinations: Hepatitis A and B, tetanus, diphtheria, typhoid fever.
First aid kit: Remember probiotics, painkillers, and repellents with DEET.

Medical preparations are the first step. If you are looking for inspiration on where to use this health, check out our subjective guide to Koh Lanta.

Travel medicine doctor – a mandatory visit before traveling to tropical countries

I will emphasize this right at the beginning. And twice. Before every trip to tropical countries, whether it’s 2 weeks, 3 months, or a year, we should seek professional medical help. We won’t get reliable information from Dr. Google or random internists about vaccinations or the potential risks that accompany us in the tropics.

Therefore, a visit to a doctor specializing in tropical diseases, who also regularly travels to such regions, is simply essential in our opinion.

Let me give you an example.

When we set off on our first long journey with Marianka to South America two years ago, we decided to visit a so-called travel medicine doctor. We signed up at one of the largest Polish private medical clinics. The only recommendation we received then was a total ban on leaving Poland before our daughter turned two. We also learned that we shouldn’t go to the mountains (even the Polish ones, because you never know how a child will react) and that the best way to expand a diet is with jars. Not to mention the leaflets with dietary supplements that we got in the package.

We have received a lot of similar stories from you over the last few years.

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Before trip to Thailand look for an expert on tropical diseases

That is why, before our first trip to Southeast Asia, we decided to look for a doctor for whom the chosen specialization is not just a job, but a true passion. That’s how we found Milena Dorosz, a specialist in infectious diseases, maritime and tropical medicine, co-organizer of the Medellan Travel Medicine Clinic, a globetrotter (check out Milena’s profile on Instagram), and a participant in medical missions in South Asia.

We used her help both 6 years ago and now, before moving to Koh Lanta, the Thai island where we will live for the coming months.

Safety is important not only in the doctor’s office but also on the trail. We always take care of prevention, regardless of whether we live on an island or travel through Thailand with kids.

What does a visit to a travel medicine doctor look like?

Our visit (we are a family of 5) lasted about 3 hours. During this time, the doctor conducted a very detailed interview with each of us regarding our medical history and medications taken. We also had to bring our current vaccination documentation (Mario and I pulled out documents from our clinics where we were registered as children; for our three kids, we brought health booklets with a list of vaccinations).

We also talked in detail about where we would be living, how we would be moving around, whether we planned trips to other countries, etc. Only on this basis were the appropriate vaccinations selected for us. We also got prescriptions for antibiotics and medicines that we should take with us. And a whole list of guidelines on what to watch out for, how to behave, and what to do in case of an emergency.

After the consultation, the doctor performed the vaccinations she ordered for us – it was cool that we didn’t have to go anywhere else. Everything took place in one spot. The cost of the visit and vaccinations for 5 people: approx. 2500 PLN for the basic package (the extended one costs about twice as much). On the one hand, it’s a lot, because if you add the cost of insurance for the whole year (approx. 10-12,000 PLN), it really adds up to a nice sum. However, if we compare this with the costs of potentially using medical care on-site, it turns out that it is absolutely worth it.

Example: Just after arriving in Thailand, Mario got a high fever that we couldn’t bring down in any way. It turned out he got an ear infection packaged with acute angina. He spent 2 days in the hospital. The hospital bill amounted to over 4000 PLN. The insurance covered it cashless (we didn’t have to pay from our own money). A few days later, our son got sick. Also an ear infection. The bill for consultations and medicines: another few hundred zlotys.

However, if we had a more serious problem involving surgical intervention or more detailed tests resulting from diseases we could have avoided by getting vaccinated against them, the costs would rise to several hundred thousand zlotys. Rather not cool to cover this out of your own pocket, right?

That is why, together with our proven travel medicine doctor, we have prepared a mini-guide for you regarding trips to tropical countries, such as Thailand.

I believe that the more we know before doing something for the first time, the greater the probability that nothing bad will happen to us. Because even if we go somewhere for the fifth, tenth, or fifteenth time and nothing has happened so far, we never have a guarantee that the next time will also be problem-free.

Below you will find a long, substantive interview with Dr. Milena Dorosz – there are guidelines not only on how to prepare for a stay in tropical countries but also what to put in a first aid kit, how to survive a flight with a child, or what to avoid while being there.
To start with, however, I invite you to listen to a short conversation with our doctor, which I recorded on… a Thai beach. It turned out that 3 weeks after our arrival on Koh Lanta, Milena also visited this island :). So I couldn’t miss such an opportunity and asked her about Her Thai experiences (she has been to Thailand 6 times already!). So listen to our conversation, and then be sure to read the very detailed interview with Doctor Dorosz.

Listen to the podcast with Dr. Milena Dorosz

How to prepare for a trip to tropical countries?

More and more people travel the world with children, visiting countries they would have been afraid to go to before. However, for many parents, taking children to another continent is still unthinkable.

lek. Milena Dorosz: ou can travel, you just have to prepare well for these trips and be aware of potential threats. Basically, every minor or major trip carries some risk. Knowing what might happen to us, we should always try to organize the trip so that it is as safe as possible for children and for ourselves. We must realize that some vaccinations have limited application, for example, due to the child’s age. But if someone comes to our clinic with a few-month-old baby and is going on a trip to tropical countries, e.g., to India, and does not intend to change plans to another, safer direction, then our task is to prepare the parents so that the trip in a given situation is as safe as possible for their child.

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Vaccinations before traveling to Thailand and other tropical countries

Southeast Asia, i.e., Thailand, Vietnam, or Cambodia, but also other tropical countries, i.e., Dominican Republic, Zanzibar, Kenya, or Mexico are becoming increasingly popular among families with small children. We are the best example of this ourselves. How should we prepare for such a trip? Are there any special vaccinations required there?

The countries you mentioned are not covered by the list of mandatory vaccinations upon departure from Poland. World guidelines recommend only selected vaccinations. However, the fact that there are no mandatory vaccinations for a given country does not mean that there is no risk of contracting a given disease. The vaccination obligation mainly concerns vaccination against yellow fever. There are countries that require vaccination against yellow fever from everyone, regardless of where we come from. But there are also those, such as the mentioned Tanzania or Kenya, where vaccination is required only depending on the place and length of transfer time in the previously visited country (we also take into account even the transfer at the airport itself).

Most tropical countries, however, have recommended vaccinations, which are equally important and, above all, we should perform them for our own, individual protection (even though no one will check us for having them at the border). We simply do them for ourselves, for our own health. Everything, however, within reason. I am not a supporter of vaccinating everyone against everything.

We select vaccinations not only for the destination of our trip itself but also for its character, intensity, or duration, as well as for the health condition, age of the given patient, or history of previous vaccinations.

If we have any doubts, let’s use the advice of an experienced doctor of travel medicine, infectious diseases, or tropical medicine. 

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During travel around Asia, we are most often exposed to various types of infections via the digestive tract, primarily traveler’s diarrhea, viral hepatitis type A, or typhoid fever.

Importantly, in this case, it does not matter much whether the trip is two weeks or six months long, whether we will live in a hotel or go on our own. The fact is that with longer trips, the number of different events carrying the risk of acquiring a given disease increases adequately. We can get infected in the simplest, everyday situations: by consuming contaminated water and food. Therefore, vaccinations against viral hepatitis or typhoid fever are very often recommended.

In some adults, it is also worth remembering about a booster vaccination against diphtheria, tetanus, pertussis, or poliomyelitis.

Tetanus is common all over the world; infection occurs most often through injuries, most often contaminated with soil, metal objects.

I would also recommend vaccination against viral hepatitis type B.

Currently, in children, this vaccination is part of the mandatory preventive vaccination calendar. The first dose of the vaccine is already administered on the first day of life. This vaccination is recommended in adults previously unvaccinated regardless of travel. In the case of this vaccination, it actually does not matter whether the patient sets off to the other end of the world or plans to limit their travels exclusively to European countries in the near future.

It is also worth mentioning here that

ome childhood vaccinations “stop working” after some time

(like the mentioned tetanus) and we should take single booster doses from time to time. A visit to the Travel Medicine Clinic therefore also gives the opportunity to verify and check the validity of our current vaccinations..

Tattoos, cosmetic procedures, casual sex

In many everyday situations, we may have contact with infected blood. Any procedures are also a risk factor; this applies to both surgical and dental procedures as well as cosmetic ones. While traveling, we most often encounter manicures, tattoos, acupuncture, providing help to an injured person during a street accident, or engaging in risky sexual behaviors. In tropical countries, it is enough to end up at the nearest hairdressing, cosmetic, or medical point. One should be aware that in low-developed countries, we do not always deal with exemplary sterilization of various tools.

Of course, there are other vaccinations that should be considered for other trips, including against yellow fever, meningococcal disease, cholera, rabies, or Japanese encephalitis. Especially these last two vaccinations for longer, often several-month trips to Southeast Asia..

It is important that the selection of vaccinations is an individual matter for the given person, direction, character, and length of the trip.

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Antimalarial drugs for children before trip to Thailand

And what about traveling with children to places where there is a threat of malaria? Can we give children antimalarial drugs?

If we decide to go to a region with a high malaria risk, such as part of Cambodia, Burma (Myanmar), and Laos, or even the recently very popular Zanzibar – with children or without – we should strictly take antimalarial drugs. Currently, the most recommended and most widely used drug is atovaquone+proguanil.

So far, malaria parasites have not developed resistance to it in any region of the world (it is effective everywhere) and most importantly, according to global guidelines, it can be used in an appropriately calculated dose per body weight even in children weighing from 5 kg.

Of course, as with any drug, side effects may occur during use: headaches, nausea, vomiting, abdominal pain. In my medical practice, I had patients who had side effects, but they were in the vast minority. I myself have also taken antimalarial drugs several times and felt no side effects. Of course, this is also an individual matter.

I am also unable to say whether it was a placebo effect (these people expected to feel worse after taking the drug, according to what can be read on the internet) or a real deterioration of well-being due to taking the drug. However, what is a slight deterioration in the quality of life compared to safety and ensuring protection against a serious, often even fatal, disease such as malaria. Unfortunately, the disadvantage of this drug is still the relatively high price.

There are a few other antimalarial drugs, e.g., doxycycline, which we can use in adults or in children over 13 years of age (or according to other sources from 8 years of age). Ultimately, the selection of an antimalarial drug should be considered individually. Its choice depends on the region of the world, the length of stay in the malaria zone, the burden of a given patient, or their financial possibilities.

How is atovaquone+proguanil (Malarone/Falcimar) taken?

Malarone should be started 1-2 days before staying in the malaria zone. If we leave for such a region directly from Poland, then the drug should be taken while still at home, before reaching the given country. There are countries in the world, such as Sub-Saharan Africa or Oceania, whose entire area belongs to the high-malaria zone.

But there are also countries such as Thailand or Vietnam (we keep sticking to Southeast Asia), whose risk of malaria threat depends on the specific region. So it may happen that we start taking the antimalarial drug only on one of the subsequent days of our trip just before reaching the high malaria risk area. We take the drug daily during the stay in the malaria zone, and also for 7 days from the moment of leaving such a zone (regardless of the length of stay in the above-mentioned region)..

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Mosquitoes in Thailand

Since we are on the subject of malaria, the question arises by itself: how to protect yourself against mosquitoes?

First of all, use so-called repellents, i.e., insect repellents to be applied to the skin. Not all available on the market are suitable for taking on a trip to tropical countries. Currently, agents containing diethyltoluamide, so-called DEET, are most widely recommended. They can be bought in stationary or online travel shops, sometimes in some pharmacies. For adults with a minimum of 20% DEET content (optimally 30%, max. 50%). In children, such agents can be used only above 2 months of age with a maximum DEET content of 30%.

Although according to the latest reports, repellents based on another agent: icaridin, seem to be safer for children and at the same time comparably effective to the previous ones. The use of these repellents is also recommended for adults.

However, remember not to apply repellents to the face and hands of the youngest ones.

We smear only exposed body parts, such as arms, legs. It is also not recommended to use such agents on clothes made of very thin, delicate materials or mosquito nets. In addition to repellents, we should also use other protective measures against mosquitoes, such as sleeping in air-conditioned rooms or under mosquito nets, using special insect-sealing nets in windows, wearing appropriate clothes, etc.

First aid kit on a trip to Asia

What, apart from repellents, should our travel first aid kit contain? What to take with you and what to buy on-site?

• Besides repellents, the first aid kit should primarily contain the previously mentioned drugs used in antimalarial prophylaxis (if recommended for a given trip).
• In addition, we always take a set of medicines for the first days of illness (e.g., for the time of a typical viral respiratory infection) happening, especially in children, immediately after arriving in a given country with a different climate zone. Sometimes it is worth taking an antibiotic for bacterial respiratory infections. While traveling, we do not always have the opportunity to contact a doctor immediately.
• Let’s also always remember about appropriate sunscreen creams, dressings (plasters, bandages, a pair of disposable gloves), wound disinfectants, and hand disinfectants (many times during the trip we do not have the opportunity to wash our hands).
• It is also necessary to take antipyretic and analgesic medicines with you. Antiallergic drugs (tablets, ointments) are also very often useful in case of allergic reactions after insect bites.
• We also always take an appropriate supply of chronically taken medicines on a trip.
• It is certainly also worth taking an antibiotic for one of the most common ailments, i.e., traveler’s diarrhea, called depending on the region of the world, among others, “galloping gringo”, “Pharaoh’s curse”, or “Montezuma’s revenge”. Many of us have experienced this unpleasant ailment that can be a major hindrance to travel. This specific type of diarrhea should be treated with an antibiotic. The selection of the appropriate antibiotic depends largely on the region of the world (in some regions resistance to some antibiotics has developed) and the age of the patient. The antibiotic of first choice during a specific trip is not always the same in children as in adults.
• We should also not use only popular constipation medicines available without a prescription. At most, they can be combined with an antibiotic. In small children, if it is not necessary, I do not recommend using constipation medicines.
• During diarrhea, let’s also remember about proper hydration of the body. In such situations, we add appropriate sachets with electrolytes to the water.

The selection of a travel first aid kit should always be treated individually.

Slightly different medicines should be collected if we are going on a monthly trek in the Himalayas (we remember about altitude sickness medicines) or we are going on a touring trip around Europe or we are leaving for a week to stay on a paradise beach..

An experienced travel medicine doctor will present us with a list of medicines that we should take with us, depending on where and for how long we are going and what the nature of our trip will be. As a rule, during the visit, we sit down with the patient and discuss step by step exactly in what situations and how to use a given drug.

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Child on a plane to Thailand

After many preparations, we finally set off. We get on the plane where we will spend a few or a dozen hours. How can our little ones react?

The first thing is the change in pressure in the plane, and thus in the ears. Not all children, just like not all adults, will feel discomfort due to this. However, it is worth preventing potential dissatisfaction and giving the child something tasty to eat or drink at the very take-off and during the further flight (e.g., candy, water bottle, chewing gum), thanks to which they will swallow, and thus equalize the pressure difference. Infants can be breastfed or drink milk from a bottle at this time.

Jetlag – what is it?

The second thing is the so-called jetlag, i.e., sudden time zone change syndrome. Small children won’t say that their head hurts and that they feel tired. They may simply be more irritable, tearful, and have difficulty getting used to a different sleeping rhythm. However, this is not dangerous to their health, in most cases.

Food on a trip to Asia

And the last thing: food on the trip. Is there anything children shouldn’t eat?

We do not recommend consuming freshly squeezed juices and drinks containing ice cubes. Boiled or bottled, factory-sealed water is the safest. It is also better to avoid cakes with creams and undercooked, raw meat. It is better to buy vegetables and fruits yourself at the market than to buy pre-cut ones sold on trays on the beach or street.

The general rule is: “wash, scald, peel, cook, or forget”.

Before every meal, let’s wash our hands or disinfect them with a special antibacterial gel. It is certainly safer to consume what is prepared from fresh products and heat-treated.

Eating “on the street”, i.e., popular street-food in Thailand

As a rule, the best recommendation is a place where “locals” eat. And street food has the plus that it is usually freshly prepared. Although often the sanitary conditions in which meals are prepared leave much to be desired. But on the other hand, contrary to appearances, we can also get “poisoned” by consuming so-called “hotel food”, where sometimes the kitchen facilities in hotels can look worse than many a street food stall.

So let’s not go crazy. It’s not about limiting yourself to eating only rice during the trip, for example. Getting to know other countries, other cultures, it is also worth taking advantage of tasting local cuisine. One must also realize that even if we follow all safety rules, always wash our hands and consume only cooked meals, even the smallest trip can carry the risk of food infections. That is why it is important that we are properly prepared and familiar with how to proceed in such or other situations during travel.

Thank you very much for the conversation! All information is really super useful.

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