Official Immunization and Health Advice

Kids, if ya come to China, PLEASE take immunizations and health seriously. The diseases they immunize you for are so nasty and dangerous that they simply aren't worth the risk. We can't sell ya drinks We'll miss your delightful company if you're dead or in an isolation ward somewhere.

The info below is from the US Centers for Disease Control (CDC). The full story can be found at http://www.cdc.gov/travel/eastasia.htm  Please note that this info is for travelers. As expats, the rules are a little different....you aren't going to spend a year or more here without eating at a street vendor's, but the increased time will increase your exposure to diseases that are just exotic rarities for short-term travelers!

Please note that Polio seems to have been dropped from the list of concerns in China by both the CDC and the WHO. Case in point for us long-term expats: this info does change over time and we should be sure and update ourselves periodically!

Also note that these immunizations are on top of the standard protections you should have anyway.  You should especially be sure that your Tetanus protection is up to date!

If our dear friends who happen to be swarthy, foreign, less-sanitation-intensive Commonwealth types stubbornly insist on using your own pathetic, derivative health care info sources you can find them here:

Canada- http://www.voyage.gc.ca/dest/index.asp

UK- http://www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en

Australia- http://www.smartraveller.gov.au/zw-cgi/view/Advice/China

Now for some real information...
The CDC recommends the following vaccines (as appropriate for age):

See your doctor at least 4?6 weeks before your trip to allow time for shots to take effect.

    * Hepatitis A or immune globulin (IG), except travelers to Japan.
    * Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment.
    * Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis.
    * Rabies, if you might be exposed to wild or domestic animals through your work or recreation.
    * Typhoid, particularly if you are visiting developing countries in this region.
    * As needed, booster doses for tetanus-diphtheria and measles. Hepatitis B vaccine is now recommended for all infants and for children ages 11?12 years who did not receive the series as infants.

All travelers should take the following precautions, no matter the destination:

    * Wash hands often with soap and water.
    * Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts.
    * Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases.
    * Don?t eat or drink dairy products unless you know they have been pasteurized.
    * Don?t share needles with anyone.
    * Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it.
    * Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems.

Travelers visiting undeveloped areas should take the following precautions:

To stay healthy, do...

    * Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an ?absolute 1-micron or less? filter AND adding iodine tablets to the filtered water. ?Absolute 1-micron filters? are found in camping/outdoor supply stores.
    * If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.)
    * Protect yourself from mosquito bites:
          o Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active.
          o Wear long-sleeved shirts, long pants, and hats.
          o Use insect repellents that contain DEET (diethylmethyltoluamide).
          o Read and follow the directions and precautions on the product label.
          o Apply insect repellent to exposed skin.
          o Do not put repellent on wounds or broken skin.
          o Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
          o Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net.
          o DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
          o Children under 10 years old should not apply insect repellent themselves. Do not apply to young children?s hands or around eyes and mouth.
          o For details on how to protect yourself from insects and how to use repellents, see Protection against Mosquitoes and Other Arthropods.
    * To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.

Current Range of Japanese Encephalitis


From the US Centers for Disease Control (CDC). Note that it says an effective cheaper vaccine is available in China. Also note that it's spreading and is expected in northern Oz soon... MORE INFO at http://www.cdc.gov/ncidod/dvbid/jencephalitis/

Japanese Encephalitis Fact Sheet

CLINICAL FEATURES

    * Acute encephalitis; can progress to paralysis, seizures, coma and death
    * The majority of infections are subclinical

ETIOLOGIC AGENT

    * Japanese encephalitis (JE) virus: flavivirus antigenically related to St. Louis encephalitis virus

INCIDENCE

    * Leading cause of viral encephalitis in Asia with 30-50,000 cases reported annually
    * Fewer than 1 case/year in U.S. civilians and military personnel traveling to and living in Asia
    * Rare outbreaks in U.S. territories in Western Pacific

SEQUELAE

    * Case-fatality ratio: 30%
    * Serious neurologic sequela: 30%

COST

    * Domestic: < $1 million/year - largely cost of immunizing travelers and military personnel
    * International: no data, probably tens of millions of dollars

TRANSMISSION

    * Mosquito-borne Culex tritaeniorhynchus group

RISK GROUPS

    * Residents of rural areas in endemic locations
    * Active duty military deployed to endemic areas
    * Expatriates in rural areas
    * Disease risk extremely low in travelers

SURVEILLANCE

    * Passive system based on domestic imported cases referred to CDC and other reference laboratories
    * Laboratory-based passive surveillance in endemic areas

TRENDS

    * Expanding range of JE viral transmission to northern Australia
    * Inactivated JE vaccine

CHALLENGES

    * Currently available killed vaccine expensive and occasionally reactogenic

OPPORTUNITIES

    * Alternative cheaper, effective attenuated vaccine used in China, but not available elsewhere
    * Post marketing surveillance of adverse reactions to killed vaccine
    * Electronically available information for travelers and care providers

RESEARCH PRIORITIES

    * Facilitate implementation of attenuated vaccine in unvaccinated populations in endemic areas
    * Develop improved vaccines
    * Identify risk factors for progression to symptomatic encephalitis and viral persistence
    * Describe clinical features of JE in AIDS and determine its potential as an opportunistic infection

Another, more readable and useful, fact sheet on JE from some nameless American health nobbling council to be found at http://www.astdhpphe.org/infect/jpenceph.html

Japanese Encephalitis

* Japanese encephalitis is a potentially severe viral disease that is spread by infected mosquitoes in the agricultural regions of Asia.
* It is one of several mosquito-borne virus diseases that can affect the central nervous system and cause severe complications and death.
* Japanese encephalitis can be a risk to travelers to rural areas where the disease is common.
* There is no specific treatment for Japanese encephalitis.
* A vaccine is licensed for use in travelers whose itineraries might put them at risk for Japanese encephalitis. All travelers should take precautions to avoid mosquito bites to prevent Japanese encephalitis and other mosquito-borne diseases.


What is Japanese encephalitis?

Japanese encephalitis is a disease that is spread to humans by infected mosquitoes in Asia. It is one of a group of mosquito-borne virus diseases that can affect the central nervous system and cause severe complications and even death.


What is the infectious agent that causes Japanese encephalitis?

Japanese encephalitis is caused by the Japanese encephalitis virus, an arbovirus. Arbovirus is short for arthropod-borne virus. Arboviruses are a large group of viruses that are spread by certain invertebrate animals (arthropods), most commonly blood-sucking insects. Like most arboviruses, Japanese encephalitis is spread by infected mosquitoes.


Where is Japanese encephalitis found?

Japanese encephalitis is found throughout rural areas in Asia. Transmission can also occur near urban areas in some developing Asian countries.

Japanese encephalitis is a seasonal disease that usually occurs in the summer and fall in the temperate regions of China, Japan, and Korea. In other places, disease patterns vary with rainy seasons and irrigation practices.


How do people get Japanese encephalitis?

The Japanese encephalitis virus has a complex life cycle involving domestic pigs and a specific type of mosquito, Culex tritaeniorhynchus, that lives in rural rice-growing and pig-farming regions. The mosquito breeds in flooded rice fields, marshes, and standing water around planted fields. The virus can infect humans, most domestic animals, birds, bats, snakes, and frogs. After infection, the virus invades the central nervous system, including the brain and spinal cord.


What are the signs and symptoms of Japanese encephalitis?

Most infected persons develop mild symptoms or no symptoms at all. In people who develop a more severe disease, Japanese encephalitis usually starts as a flu-like illness, with fever, chills, tiredness, headache, nausea, and vomiting. Confusion and agitation can also occur in the early stage. The illness can progress to a serious infection of the brain (encephalitis) and can be fatal in 30% of cases. Among the survivors, another 30% will have serous brain damage, including paralysis.


How soon after exposure do symptoms appear?

Symptoms usually appear 6-8 days after the bite of an infected mosquito.


How is Japanese encephalitis diagnosed?

Diagnosis is based on tests of blood or spinal fluid.


How common is Japanese encephalitis?

Japanese encephalitis is the leading cause of viral encephalitis in Asia, where 30,000 to 50,000 cases are reported each year. The disease is very rare, however, in U.S. travelers to Asia.

The chance that a traveler to Asia will get Japanese encephalitis is very small: 1) only certain mosquito species can spread Japanese encephalitis; 2) in areas infested with mosquitoes, only a small portion of the mosquitoes are usually infected with Japanese encephalitis virus; 3) among persons who are infected by a mosquito bite, only 1 in 50 to 1 in 1,000 will develop an illness. As a result, fewer than 1 case per year is reported in U.S. civilians and military personnel traveling to and living in Asia. Only 5 cases among Americans traveling or working in Asia have been reported since 1981.


Who is at risk for Japanese encephalitis?

Anyone can get Japanese encephalitis, but some people are at an increased risk:

* People living in rural areas where the disease is common
* Active-duty military deployed to areas where the disease is common
* Travelers to rural areas where the disease is common (very small increased risk)


What is the treatment for Japanese encephalitis?

There is no specific treatment for Japanese encephalitis. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Care of patients centers on treatment of symptoms and complications.


How can Japanese encephalitis be prevented?

A vaccine is licensed for use in U.S. travelers to rural areas where the disease is common. The vaccine is recommended only for persons who plan to travel in these areas for 4 weeks or more, except in special circumstances such as an ongoing outbreak of disease.

Because of the potential for other mosquito-borne diseases in Asia, all travelers should take steps to avoid mosquito bites. The mosquitoes that transmit Japanese encephalitis feed mainly outside during the cooler hours at dusk and dawn. Travelers should minimize outdoor activities at these times, use mosquito repellent on exposed skin, and stay in air-conditioned or well-screened rooms. Travelers to rural areas should use a bednet and aerosol room insecticides.

Note that only the far southern fringes of China- down near the borders with Myanmar, Thailand, Laos, and Vietnam- are in the malaria zone. The vast majority of us will not need anti-malarials in China unless we travel into this region.

Ladies and gentlemen, I stand corrected. It seems that RURAL dwellers in a number of areas, especially the Yangzi River Valley should also take malaria precautions. Please read the following:

Malaria: Prophylaxis is recommended only for rural areas in the following provinces: Hainan, Yunnan, Fuijan, Guangdong, Guangxi, Guizhou, Sichuan, T (Xizang) (in the Zangbo River valley only), Anhui, Hubei, Hunan, Jiangsu, Jiangxi, Shandong, Shanghai, and Zhejiang. In provinces with risk, transmission occurs only during warm weather: north of latitude 33? N, July-November; between latitude 25? N and 33? N, May-December; south of latitude 25? N, transmission occurs year-round. For the provinces of Hainin and Yunnan, prophylaxis with Lariam, Malarone, or doxycycline is recommended. For all other risk areas, chloroquine is the drug of choice.

This comes from a great resource at http://www.mdtravelhealth.com/destinations/asia/china.html. Goes to show ya...those of us who live here, especially those living outside the cities, really need to stay on top of this stuff. We really ain't in Kansas anymore.

OK, got the check over from my doctor today. He gave me an information sheet and I figured it would be worthwhile putting the highlights up here. The dates given below are for arrival on 31/1/2009.



All travellers should carry an International Certificate of Vaccination or Prophylaxis in which their immunisations are recorded.

Hepatitis A, Typhoid
Vaccination recommended for protection against disease

Hepatitis B
Optional

Japanese Encephalitis
Is seasonal

Malaria
Chloroquine resistant malaria.
Short stay prophylaxis – Doxycycline 100mg daily OR Mefloquine (LLariam) 250mg weekly OR Malarone 1 table daily.
Sheet gives areas that are at risk. No risk in urban areas, risk predominantly in southern and central provinces including Anhui, Henan, Hubei and Jiangsu. All year transmission south of latitude 25N. Malaria mostly P.vivax but for multi-resistant P.falciparum present in rural Yunnan and Hainan so use mefloquine or doxycycline.

Yellow Fever
A valid Yellow Fever vaccination certificate is required form all travellers over 9 months of age coming from infected areas.

Notes:
Diptheria Vaccination in adults is best given with multivalent vaccine like Boostrix (or Adacel) or BoostIPV (or AdacelPolio).

Tetanus vaccination in adults is best given with multivalent vaccine like Boostrix (or Adacel) or BoostIPV (or AdacelPolio).



Schedule
ADT or ADACEL or BOOSTRIX vaccine today, if required.
Oral SABIN or IPOL or BOOSTRIX-IPV or ADACEL POLIO vaccine today, if required.
Yellow fever vaccine before 27/12/2008 – if required
HAVRIX 1440 vaccine before 27/12/2008
      OR
VAQTA vaccine before 27/12/2008
      OR
AVAXIM vaccine before 27/12/2008

1st oral typh vax capsule on 3/1/2009, 2nd oral typh vax capsule on 5/1/2009, 3rd oral typh vax capsule on 7/1/2009
       OR
Typhim Vi vaccination before 27/12/2008
       OR
Typherix vaccine before 27/12/2008

If Mefloquine prescribed:
1st dose of Mefloquine tablets on 17/1/2009. Mefloquine should be taken weekly until 4 weeks after returning.

If Doxycycline prescribed:
1st does of Doxycycline on 29/1/2009. Because Doxycycline is a suppressive chemoprophylactic agent, it should be continued for 28 days after leaving malaria endemic areas.

It is acceptable to have vaccinations 1or 2 days either side of the given dates.
Oral medications should be taken on the nominated days.
This information does not apply to children under 12 years old or pregnant or breastfeeding women.

For the most up to date advice from the Foreign and Commonwealth Office refer to MASTA subscription service at www.masta.edu.au or email masta at masta.edu.au

See, we don't get these requirements in Russia or coming from Russia. The only requirement I ever had to fulfill is getting Yellow Fever vaccination when going to Africa.