China
Good dental care is available in the larger cities. Avoid dental treatment elsewhere in china as the standard of care cannot be guaranteed
Only purchase medication from the larger pharmacies in the cities, which stock internationally produced drugs. Avoid provincial pharmacies which may sell locally made products.
There is a shortage of blood products in China and what supplies there are may not be adequately screened, therefore blood supplies should be considered as unsafe.
The quality of medical care in China varies. Competent, trained doctors and nurses are available in major metropolitan centers, but many do not speak English. Hospital accommodations are spartan, and medical technology is not up-to-date. Doctors and hospitals often expect immediate cash payment for health services and may not accept checks or credit cards.
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.
Drink only bottled beverages (including water) or beverages made with boiled water. Do not use ice cubes or eat raw seafood, rare meat or dairy products. Eat well-cooked foods while they are still hot and fruits that can be peeled without contamination. Avoid roadside stands and street vendors.
Swim only in well-maintained, chlorinated pools or ocean water known to be free from pollution; avoid freshwater lakes, streams and rivers. Wear clothing which reduces exposed skin and apply repellents containing DEET to remaining areas. Sleep in well-screened accommodations. Carry anti-diarrheal medication. Reduce problems related to sun exposure by using sunglasses, wide-brimmed hats, sunscreen lotions and lip protection.
A new strain of cholera (Bengal cholera) has appeared in western China. Disease caused by this new strain is characterized by extremely rapid onset of severe symptoms. The current cholera vaccine affords no protection against this new strain; therefore, particular caution should be taken with food, beverages and personal hygiene. Persons becoming ill should seek immediate medical care and rehydration therapy.
AIDS occurs. Blood supply may not be adequately screened and/or single-use, disposable needles and syringes may be unavailable. When possible, travelers should defer medical treatment until reaching a facility where safety can be assured. (According to press reports, a long-term AIDS prevention program, including blood screening and public education, has been launched to combat the spread of the disease. The significant increase in cases is being blamed on growing prostitution and drug use, as well as poor hygiene practices by some health providers, who now may face criminal prosecution if HIV is found in the blood supply.)
The blood type of the general Asian populace is Rh positive; Rh negative blood may be difficult to obtain.
Because of the prevailing dust, and the burning of soft coal during the winter, Beijing has a high rate of pollution, and thus causes many bronchial/sinus ailments.
Rabid dogs present a problem throughout China. Reports indicate that as many as one million people are bitten by rabid dogs each year and that 5,000 of those victims die (the high mortality rate is attributed to a scarcity of rabies vaccine in rural areas where bite victims cannot be treated in time). Measures taken to control the number of dogs have not met with substantial results. While pet canines are banned in China's crowded cities without police permission, the rules are often unenforced, and the canine population is now estimated at 100 million. Travelers should remain well clear of roaming dogs and to seek immediate medical attention if injured by a dog.
Persons electing to see China via riverboat should choose modern ships for sanitary reasons since many older boats use untreated river water for washing dishes and in bathrooms - thus increasing the risk of illnesses such as traveler's diarrhea and schistosomiasis.
Sunlight is intense at Tibet's high elevations, and travelers there should bring sun screen. Also intense is the dust level in Lhasa, and a face mask is suggested. Respiratory problems are common; thus, antihistamines and cough syrup are recommended items. Other practical items include tissues, toilet tissue, and wet wipes.
Virtually all of the Tibetan Autonomous Region, much of Qinghai and Xinjiang, and parts of Sichuan, Yannan, and Gansu are above 13,000 feet (4,000 meters) in altitude. Some main roads in Tibet, Qinghai, and Xinjiang go above 17,000 feet (5,200 meters), where available oxygen is only half that available at sea level. Conditions in Tibet are primitive and travel there can be particularly arduous. Medical facilities are practically nonexistent. Many otherwise healthy visitors to these high altitude areas of Tibet may suffer severe headaches, nausea, dizziness, shortness of breath, or a dry cough. These symtoms usually disappear after a few days of acclimatization. However, if they do not, sufferers should descend to a lower altitude, or seek medical assistance. Visitors with respiratory or cardiac problems should avoid such high altitudes and consult a physician before making the trip.
No Western brand-name drugs or non-prescription medicines are available locally, although some Chinese equivalents are found at modest prices.
Cholera: Although limited in effectiveness, vaccination may be appropriate for persons living and/or working in less than sanitary conditions for more than 3 months where medical facilities are unavailable. Vaccination may also be appropriate for travelers with impaired gastric defenses who are planning an extended visit or being exposed to unsanitary conditions. Vaccination is not advised for pregnant women, infants younger than 6 months old, or persons with a history of severe reaction to the vaccine.
Hepatitis A: Consider active immunization with hepatitis A vaccine or passive immunization with immune globulin (IG) for all susceptible travelers. Especially consider choosing active immunization for persons planning to reside for a long period or for persons who take frequent short-term trips to risk areas. The importance of protection against hepatitis A increases as length of stay increases. It is particularly important for persons who will be living in or visiting rural areas, eating or drinking in settings of poor or uncertain sanitation, or who will have close contact with local persons (especially young children) in settings with poor sanitary conditions.
Hepatitis B: Vaccination is advised for health care workers, persons anticipating direct contact with blood from or sexual contact with inhabitants, and persons planning extended stays of 6 months or greater (especially those who anticipate using local health care facilities, staying in rural areas, or having intimate contact with the local population).
Japanese Encephalitis: Vaccination is not routinely recommended for travelers visiting urban areas only. However, consider vaccination if staying a month or more during transmission season (May to September in north; April to October in south) if travel includes rural areas. Also consider if staying less than 30 days during these periods and at high risk (in case of epidemic outbreak or extensive outdoor exposure in rural areas). No cases have been reported in Xizang (Tibet), Xinjiang and Qinghai provinces. Southern risk area consists of Yunnan, Guangxi and Guangdong provinces, plus the southern portions of Sichuan, Guizhou, Hunan, Jiangxi and Fujian provinces.
Polio: A one-time booster dose is recommended for travelers who have previously completed a standard course of polio immunization. Refer to CDC guidelines for vaccinating unimmunized or incompletely immunized persons. Pregnancy is a relative contraindication to vaccination; however, if protection is needed, either IPV or OPV may be used, depending on preference and time available.
Rabies: Preexposure vaccination should be considered for persons staying longer than 30 days who are expected to be at risk to bites from domestic and/or wild animals (particularly dogs), or for persons engaged in high risk activities such as spelunking or animal handling. Need for vaccination is more important if potential exposure is in rural areas and if adequate postexposure care is not readily available.
Typhoid: Vaccination should be considered for persons staying longer than 3 weeks, adventurous eaters, and those who will venture off the usual tourist routes into small cities, villages and rural areas. Importance of vaccination increases as access to reasonable medical care becomes limited. Contraindications depend on vaccine type.
Note: All routine vaccines (such as DTP or Td, Hib, MMR, polio, varicella, influenza and pneumococcal) should be kept up-to-date as a matter of good health practice unrelated to travel.
Insect-borne illness:
Dengue fever - occurs
Dengue hemorrhagic fever - occurs
Encephalitis (Japanese type) - common (hyperendemic in southern areas, endemic with periodic epidemics in northern areas)
Encephalitis (tick-borne) - occurs
Filariasis (Bancroftian type) - occurs
Filariasis (Malayan type) - occurs
Hemorrhagic fever (with renal syndrome) - occurs
Leishmaniasis (visceral) - occurs
Malaria - occurs
Plague - occurs
Typhus (mite-borne) - occurs in southern areas
Food-borne and water-borne illness: diseases such as the diarrheal diseases and hepatitis are common.
Brucellosis - occurs
Cholera - occurs
Clonorchiasis (oriental liver fluke) - occurs
Fasciolopsiasis (giant intestinal fluke) - occurs
Leptospirosis - occurs
Paragonimiasis (oriental lung fluke) - occurs
Schistosomiasis - occurs in many watercourses of southeastern and eastern China along the Changjiang (Yangtze) Valley and its tributaries (also known as the "lake country")
Typhoid - occurs
Other hazards:
Diseases such as measles and diphtheria are commonly reported, and cases of polio still occur regularly.
Influenza risk extends from November to April.
Trachoma - occurs
Tuberculosis - common (incidence is 55 times the rate in the United States)
AIDS: According to the Department of State, testing is required for those staying more than 6 months. Foreign test results are accepted under certain conditions. Contact China's embassy for details.
Yellow fever: A yellow fever vaccination certificate is required from travelers coming from infected areas.
