Vaccines for Southeast Asia

The table

For each country, CDC's level for hepatitis A and typhoid, its yellow fever advice and border rule, and whether it advises malaria tablets somewhere in the country. The country pages on this site quote CDC's full text, which is where the malaria areas are named.

Japanese encephalitis: the regional question

Japanese encephalitis is the vaccine that most separates one Southeast Asia trip from another. CDC's wording is identical on every country page: recommended for people moving to the region, staying a month or more in affected areas or traveling there often; to consider for shorter trips with rural visits, hiking, camping, or nights without air conditioning, screens or bed nets; not recommended for short trips limited to cities. A two week island and city holiday in Thailand falls in the last group; three months of backpacking through rural Laos and Vietnam in the rainy season falls in the first. The two doses must be finished a week before travel, so the series starts at least 14 days ahead for an adult of 18 to 65. The Japanese encephalitis page covers the schedule and price.

Malaria: mostly at the edges

Unlike sub-Saharan Africa, malaria in Southeast Asia is concentrated in forested, rural and border areas. CDC's page for Thailand places it primarily in provinces bordering Burma, Cambodia and Malaysia, with rare cases in Bangkok, Chiang Mai and Phuket. In Indonesia, CDC lists all of eastern Indonesia, Labuan Bajo and the Komodo Islands included, and rural areas of Kalimantan, Lombok, Sulawesi and Sumatra; Bali is not among the areas named. In the Philippines, risk is limited to Palawan and the Mindanao island group, with none in Manila or other urban areas. In Vietnam, CDC names rural areas only, and no transmission in Hanoi, Ho Chi Minh City, Da Nang or Nha Trang. In Cambodia, it is isolated to pockets of rural and forested areas, with no or negligible transmission in Phnom Penh and Siem Reap, the town of the Angkor temples. Burma is the exception, with all areas listed. Resistance to chloroquine is general, and in Burma, Cambodia, Laos, Thailand and Vietnam CDC also reports mefloquine resistance, which narrows the drugs to atovaquone-proguanil, doxycycline and tafenoquine in the areas concerned. Many travelers on the classic routes need no tablets; a prescriber decides from the exact itinerary.

Rabies, dengue and the rest

Dogs are the main rabies risk across the region, and monkeys at temples and tourist sites bite visitors often enough for CDC to mention them. Pre-exposure rabies vaccine is a matter for a clinician, weighing long stays, remote trips, cycling and children; the rabies page explains what it changes after a bite. Dengue is widespread, in cities as much as in the countryside, and has no vaccine for travelers; chikungunya vaccine may be considered for long stays in most of the region. Cholera appears as a vaccine to consider in Burma and the Philippines, where CDC lists areas of active transmission.

Singapore, Brunei and the cities

The shortest lists in the region belong to Singapore and Brunei, where CDC lists typhoid only as a vaccine to consider and advises no malaria tablets. Large cities elsewhere, Bangkok, Kuala Lumpur, Hanoi, Manila or Jakarta, carry the national list for hepatitis A and typhoid, since food and water are the route, but not the rural risks: Japanese encephalitis is not recommended for short city stays, and malaria is absent from most of them. A traveler whose trip is a week in Bangkok and Singapore therefore has a short list, while one heading upriver in Borneo or to the outer islands of Indonesia has a long one, though both are going to Southeast Asia.

Yellow fever transits

No Southeast Asian country recommends the yellow fever vaccine for a visit, but most ask for the certificate from travelers who come from a country with risk. A traveler who flies from Nairobi, Addis Ababa, Lagos or São Paulo with a long transit there, or who visited one of those countries first, may need it on arrival in Thailand, the Philippines, Malaysia or Indonesia. The certificate page gives every rule, and the checker above applies them in order.

The Thailand, Vietnam, Indonesia, Philippines and Cambodia pages go into each country in detail.