Vaccines for China

A shorter "most travelers" list than its neighbors

On the CDC page for China, only hepatitis A and hepatitis B carry the "most travelers" label. Hepatitis B covers unvaccinated travelers of all ages, as in Vietnam. The difference with Thailand, Vietnam or India is typhoid, which CDC moves to the consider group for China, with three situations named: travel to areas with poor sanitation and unsafe water, rural areas included; a long stay, such as a month or more; and visits to friends or relatives. A business week in Shanghai or a guided tour of Beijing, Xi'an and Guilin does not match those descriptions as written; a semester in a provincial city or a family visit in a village in Fujian may, and the decision is made with a clinician.

Both hepatitis A doses and the two dose adult hepatitis B series, with visit fees, cost $460 to $810 at the US county health departments that publish prices, median $550. Adding the typhoid shot, when it applies, brings $174 more at the median.

Japanese encephalitis outside the big cities

CDC lists Japanese encephalitis for some travelers to China. It is recommended for people moving to an affected area, spending a month or more there, or traveling there often. For shorter stays, CDC says to consider it when the trip includes rural visits, hiking or camping, rooms without air conditioning, screens or bed nets, or when activities and length are uncertain. Short trips to urban areas are outside the recommendation. A cycling trip through the rice terraces of Yunnan or Guangxi is the kind of itinerary that raises the question; a conference in Shenzhen is not.

The vaccine is two doses: 7 days apart for adults of 18 to 65, so the series starts 14 days before departure; 28 days apart for other ages, starting 35 days before. At $375 a dose on the US lists ($325 to $420), it is the most expensive line of a China list.

Rabies and tick-borne encephalitis

Dogs infected with rabies are commonly found in China, CDC writes, and rabies is also present in some terrestrial wildlife species. Rabies vaccines are typically available throughout most of the country after an exposure. Pre-exposure vaccination is a consider line, weighed on activities with animals and on access to prompt care; two doses cost $838 at the median.

Tick-borne encephalitis is missing from the CDC pages for Thailand, Vietnam or India, but it is on the pages for China, Japan, Mongolia and South Korea. CDC recommends the TBE vaccine for people with extensive tick exposure based on their outdoor plans and itinerary in endemic areas, and says it may be considered for those who might spend time outdoors where ticks are likely. Only 3 of the US health departments followed here publish a TBE price, $324 to $330 a dose.

No malaria section on the China page

The CDC destination page for China, as last reviewed, has no malaria entry and no chemoprophylaxis advice, which is why the checker shows no tablets for China. That is a reading of the current page, not a statement about every province. Travelers who combine China with Myanmar, Laos or Vietnam get the malaria advice of those countries when they add them to the route above. Mosquito bite prevention still applies, since CDC notes that chikungunya vaccination is generally not recommended for China and asks all travelers to avoid bites.

Yellow fever, Hong Kong and Macao

CDC does not recommend the yellow fever vaccine for China. Mainland China requires a certificate from travelers 9 months or older who arrive from a country with yellow fever risk, an airport transit or layover of more than 12 hours included. Two special cases are written into the rule: travelers whose itinerary is limited to the Hong Kong or Macao Special Administrative Regions are exempt. A flight from Los Angeles, London, Toronto or Sydney triggers nothing. A project trip from Nigeria or Angola to Guangzhou does: the shot, $269 at the median, must be given at least 10 days before arrival. The yellow fever certificate list covers every country with such a rule.