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Malaysia
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionAir pollutionGeneral advice
Ambulance and Emergency ServicesMedical facilitiesPharmacies
Traveling with childrenTravel and pregnancyMaps
Embassy/Consulate LocationSafety information

 

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Summary of recommendations:

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

Malaria: Prophylaxis with Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline is recommended for rural areas of Malaysian Borneo (Sabah and Sarawak Provinces) and peninsular Malaysia, particularly the forested, hilly, and underdeveloped interior areas.
Vaccinations:

Hepatitis A

Recommended for all travelers

Typhoid

For travelers who may eat or drink outside major restaurants and hotels

Yellow fever

Required for all travelers greater than one year of age arriving from a yellow-fever-infected area in Africa or the Americas and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission. Not recommended otherwise.

Japanese encephalitis

For travelers who may spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors in rural areas, especially after dusk

Hepatitis B

Recommended for all travelers

Rabies

For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats

Measles, mumps, rubella (MMR)

Two doses recommended for all travelers born after 1956, if not previously given

Tetanus-diphtheria

Revaccination recommended every 10 years

Medications

Travelers' diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.

Most cases of travelers' diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Malaysia: prophylaxis is recommended for rural areas of Malaysian Borneo (Sabah and Sarawak Provinces) and peninsular Malaysia, particularly the forested, hilly, and underdeveloped interior areas. There is no risk in urban or coastal areas. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics.

Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.

Insect protection measures are essential.

Malaria prophylaxis is not necessary for the urban or coastal areas (outside Sabah) visited by most travelers.

Further information concerning malaria in Malaysia is available from the World Health Organization - Western Pacific Region and the Department of Public Health.

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Immunizations

The following are the recommended vaccinations for Malaysia:

Hepatitis A vaccine is recommended for all travelers over one year of age. In Malaysia, most cases of hepatitis are reported from Sabah, Kedah, Terengganu and Kelantan. Hepatitis A vaccine should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.

Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Due to improved sanitation, the number of cases of typhoid fever has been decreasing, especially in endemic states like Kelantan.

Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening. Japanese encephalitis occurs sporadically in all states with most cases reported from Penang, Parak, Salangor, Johore, and Sarawak. The disease is transmitted by mosquito bites and occurs year-round.

The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. In Malaysia, the greatest risk is from dog bites. Sabah and Sarawak are rabies-free. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.

Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not generally recommended, even though cholera is sometimes reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. In October 2000, the World Health Organization certified that polio had been eradicated from the Western Pacific region, including Malaysia.

Yellow fever vaccine is required for all travelers over one year of age arriving from a yellow-fever-infected country in Africa or the Americas and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

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Recent outbreaks

A case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection was reported in April 2014 in a traveler who had returned from Saudi Arabia, where a MERS outbreak was in progress (see ProMED-mail). There was no evidence of secondary spread. There is no risk for travelers to Malaysia.

An outbreak of an acute illness resembling sarcocystosis was reported in October 2011 among travelers who had visited Tioman Island off the east coast of peninsular Malaysia between June and August 2011, causing 35 cases. Most but not all of the travelers had also visited Perhentiau Island. All had fever, muscle aches, and marked increase in eosinophils (a type of white blood cell). Some had diarrhea and cardiac conduction disorders. An additional 65 cases were identified among travelers to Tioman Island in the summer of 2012. In May 2014, six cases were reported in Germany after travel to Tioman Island. Sarcocystosis is generally acquired by consumption of undercooked pork or beef products. Travelers to Malaysia should make sure that all pork and beef products are fully cooked before they are eaten. For further information, go to Eurosurveillance, ProMED-mail (October 31, 2011) and the Centers for Disease Control.

An outbreak of hepatitis A, thought to be related to contaminated river water, was reported in November 2011 from three villages in Hulu Terengganu district, Terengganu state. Hundred of people were affected. Hepatitis A vaccine is recommended for all travelers to Malaysia.

A series of cases of leptospirosis, some of them fatal, were reported from Malaysia in July and August, 2010. The number of cases of leptospirosis has been increasing in Malaysia in recent years, rising from 263 cases and 20 deaths in 2004 to 1400 cases and 62 deaths in 2009. Leptospirosis is a bacterial infection transmitted to humans by exposure to water contaminated by the urine of infected animals. Symptoms may include fever, chills, headache, muscle aches, conjunctivitis (pink eye), photophobia (light sensitivity), and rash. Most cases resolve uneventfully, but a small number may be complicated by meningitis, kidney failure, liver failure, or hemorrhage. Travelers to Malaysia should avoid exposure lakes, rivers. and other bodies of fresh water. Those engaging in high-risk activities may consider taking a prophylactic 200 mg dose of doxycycline, either once weekly or as a one-time dose.

An outbreak of leptospirosis was reported among participants in the Eco-Challenge Sabah 2000 Expedition Race held in Borneo from August 20 to September 3, 2000. Illness was associated with exposure to water from the Segama River. Symptoms included fever, chills, headache, muscle aches, joint pains, and conjunctivitis. No deaths were reported. See MMWR and Emerging Infectious Diseases for further details.

Outbreaks of dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, occur annually in Malaysia. More than 45,000 cases and 134 deaths were reported in 2010, compared to 41,000 cases and 87 deaths the year before. In December 2009, a dengue outbreak was reported from Sarawak, particularly affecting Miri City. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. The number of cases has been rising in recent years, particularly in the states of Federal Territory Kuala Lumpur, Selangor, Johor, Pahang, and Penang. No vaccine is available at this time. Insect protection measures are advised, as below. See the World Health Organization for further information.

A major dengue outbreak was reported from Malaysia in January 2009, causing more than 38,000 cases and 79 deaths by December. Selangor state, which includes the capital city of Kuala Lumpur, was particularly affected, followed by the states of Putrajaya, Johor, Penang and Kedah. For the year 2008, almost 45,000 cases and 98 deaths were reported nationwide. In the first eight months of 2007, more than 30,000 dengue cases were reported nationwide, almost 50% more than during the same period in 2006. The states with the highest number of dengue cases were Selangor, Kelantan, Johor and Kuala Lumpur (see ProMED-mail, May 21, June 12, and August 16, 2007, and September 1 and December 23, 2008). For the year 2006, more than 34,000 suspected cases were reported for the country as a whole, including more than 11,000 cases in Selangor.

An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, was reported from Malaysia in early 2009, causing more than 5000 cases as of December, compared to 4271 cases for all of 2008. The most affected areas were the northern provinces of Kedah, followed by Kelantan, Selangor, Perak, and Sarawak. A number of cases have been reported in travelers: in December 2008, two cases in Australian travelers who had visited Sibu Island off the east coast of Malaysia; in February 2009, one case in a Japanese resident who had visited Kuala Lumpur; in March 2009, one case in German resident who had visited Malaysia and Viet Nam. In September 2009, an outbreak was reported from the town of Sibu in Sarawak.

Chikungunya fever is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites. See NATHNAC, Emerging Infectious Diseases, and ProMED-mail (April 2, 2006, January 21, 2007, and April 28, September 4, and December 20, 2008) for further information. An outbreak was reported from Johor state in April 2008 and had spread to the states of Melaka, Perak, Negeri Sembilan, and Selangor by August. In March and December 2006, chikungunya outbreaks were reported from an isolated coastal town in Perak, in the northwestern part of the country.

A malaria outbreak caused by Plasmodium vivax was reported in June 2010 from Ulu Baram, Sarawak. In August 2008, a Plasmodium vivax outbreak occurred among the Penan community in the Bario highlands in northern Sarawak. In July 2005, a malaria outbreak was reported from Penang (see ProMED-mail, July 27, 2005, August 6 and 11, 2008, and July 5, 2010).

A cholera outbreak was reported from Limbang (Sarawak) in April 2011, causing over 100 cases. In November 2009, a cholera outbreak occurred in the states of Sabah and Terengganu. In April 2007, an outbreak occurred in three northern Sabah districts. A cholera outbreak was also reported from Sabah in May 2006 (see ProMED-mail; May 12, 2006; April 6, 2007; and November 25, 2009). Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.

An outbreak of hand, foot, and mouth disease caused by enterovirus 71 was reported in March 2006 from Sarawak state on the island of Borneo, affecting more than 13,000 children and causing 13 deaths as of August (see ProMED-mail, June 6, June 28, July 17, July 30, and August 21, 2006). Outbreaks of enterovirus 71 infections occur every 3 years in Sarawak (previous outbreaks occurred in 1997, 2000, and 2003). An outbreak in 2011 caused more than 2000 cases in Sarawak and more than 3000 cases nationwide. An outbreak in the first few months of 2012 caused more than 17,000 cases, most of them mild.

Transmission of hand, foot, and mouth disease usually peaks between March and May, though cases may occur through the summer. Most cases occur in infants and young children, though adults may also be affected. The illness is characterized by fever, oral blisters, and a rash or blisters on the palms and soles. Most cases resolve uneventfully, but a small percentage are complicated by encephalitis (inflammation of the brain), myocarditis (inflammation of the heart muscle), or pulmonary edema (fluid in the lungs). Outbreaks of hand, foot, and mouth disease caused by other enteroviruses, which are clinically milder and rarely fatal, were reported in 2001, 2002, and 2008 (see ProMED-mail, April 3, 2002, May 2, 2008, and May 19, 2012, and The Lancet Infectious Diseases, May 2003). Enteroviruses are transmitted by exposure to fecal material from infected individuals. There is no vaccine. The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and before handling food.

An outbreak of H5N1 avian influenza ("bird flu") was reported in August 2004 from a poultry farm in northern Malaysia. The outbreak appeared to have been controlled, but fresh poultry cases were reported in February-March 2006 and again in June 2007. No human cases have been reported from Malaysia.

Most travelers are at extremely low risk for avian influenza, since almost all human cases in other countries have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control does not advise against travel to Malaysia, but recommends that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Malaysia should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.

A typhoid outbreak was reported in April 2005 from Kelantan state in the northeastern part of the country. See ProMED-mail for details. Typhoid vaccine is recommended for most travelers to Malaysia, as above.

An outbreak of encephalitis caused by Nipah virus, a newly discovered paramyxovirus, was reported between September 1998 and June 1999 in the states of Perak and Negri Sembilan. A total of 265 people were infected, leading to 105 deaths. Infection appeared to be related to exposure to infected pigs and was limited to those closely associated with pig farms. There was no evidence of human-to-human transmission and no evidence of any risk associated with eating cooked pork. The outbreak was controlled by mass slaughter of pigs and personal protective measures. A small number of additional cases were reported in July 2000. For further information, go to the World Health Organization.

An outbreak of viral myocarditis with severe neurologic complications was reported among children in Sarawak in the spring of 1997, resulting in at least 34 deaths. There is evidence that two different viruses, enterovirus 71 (which causes hand, foot, and mouth disease) and an unusual strain of adenovirus, may have played a role in this outbreak.

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Other infections

Other infections and toxic risks include

  • Scrub typhus (deforested areas; transmitted by chigger bites)
  • Hepatitis E (transmitted by contaminated food or water)
  • Leptospirosis (animal reservoir includes rats, cattle, buffalo, and pigs)
  • Gnathostomiasis (acquired by eating undercooked freshwater fish; see Emerging Infectious Diseases)
  • Melioidosis (caused by bacteria found in contaminated soil and water, especially in agricultural fields during the rainy season; causes wound infections or pneumonia, which may progress rapidly and be life-threatening; forty cases, one of them fatal, reported nationwide for the year 2012, down from 121 cases and 11 deaths in 2011)
  • Legionnaires' disease (recently reported in three Scottish travelers; see ProMED-mail, Oct. 28, 2006)
  • Brucellosis (low incidence)
  • Lymphatic filariasis (chiefly caused by Brugia malayi)
  • Chikungunya fever
  • Kunjin virus infections (reported from Sarawak)
  • Lung fluke (paragonimiasis)
  • Giant intestinal fluke (fasciolopsiasis)
  • Sea snakes (may be highly venomous, well-camouflaged, and highly aggressive; found in coastal waters, lakes and rivers; anti-venom may not be readily available)

HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

For further details regarding many infectious diseases in Malaysia, including malaria, dengue fever, typhoid fever, and hepatitis, go to the Department of Public Health. For an overview of health care in Malaysia, go to the World Health Organization - Western Pacific Region.

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Food and water precautions

Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.

All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if accompanied by nausea, vomiting, cramps, fever or blood in the stool. Antibiotics which have been shown to be effective include ciprofloxacin (Cipro), levofloxacin (Levaquin), rifaximin (Xifaxan), or azithromycin (Zithromax). Either loperamide (Imodium) or diphenoxylate (Lomotil) should be taken in addition to the antibiotic to reduce diarrhea and prevent dehydration.

If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.

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Insect and Tick Protection

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accommodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night. In rural or forested areas, perform a thorough tick check at the end of each day with the assistance of a friend or a full-length mirror. Ticks should be removed with tweezers, grasping the tick by the head. Many tick-borne illnesses can be prevented by prompt tick removal.

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Air pollution

Air pollution is a significant health problem in Malaysia. Air quality is especially poor from March through June and during September and October, when burning of vegetation occurs in Malaysia and nearby countries. Pollution is also caused by vehicle and industrial emissions. Pollutants of greatest concern include benzene, sulfur dioxide, nitrogen oxides, ozone, and particulate matter. At times, Kuala Lumpur has had the worst air quality in Asia, including benzene levels as high as 37 ppm. Benzene is a known carcinogen. Short-term exposure to high concentrations may cause depression of the central nervous system, whereas long-term exposure to lower levels may affect the bone marrow and the reproductive system.

Travelers with respiratory or cardiac conditions and those who are elderly or extremely young are at greatest risk for complications from air pollution, which may include cough, difficulty breathing, wheezing, or chest pain. The risk may be minimized by staying indoors, avoiding outdoor exercise, and drinking plenty of fluids.

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General advice

Bring adequate supplies of all medications in their original containers, clearly labeled. Carry a signed, dated letter from the primary physician describing all medical conditions and listing all medications, including generic names. If carrying syringes or needles, be sure to carry a physician's letter documenting their medical necessity.Pack all medications in hand luggage. Carry a duplicate supply in the checked luggage. If you wear glasses or contacts, bring an extra pair. If you have significant allergies or chronic medical problems, wear a medical alert bracelet.

Make sure your health insurance covers you for medical expenses abroad. If not, supplemental insurance for overseas coverage, including possible evacuation, should be seriously considered. If illness occurs while abroad, medical expenses including evacuation may run to tens of thousands of dollars. For a list of travel insurance and air ambulance companies, go to Medical Information for Americans Traveling Abroad on the U.S. State Department website. Bring your insurance card, claim forms, and any other relevant insurance documents. Before departure, determine whether your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures. The Medicare and Medicaid programs do not pay for medical services outside the United States.

Pack a personal medical kit, customized for your trip (see description). Take appropriate measures to prevent motion sickness and jet lag, discussed elsewhere. On long flights, be sure to walk around the cabin, contract your leg muscles periodically, and drink plenty of fluids to prevent blood clots in the legs. For those at high risk for blood clots, consider wearing compression stockings.

Avoid contact with stray dogs and other animals. If an animal bites or scratches you, clean the wound with large amounts of soap and water and contact local health authorities immediately. Wear sun block regularly when needed. Use condoms for all sexual encounters. Ride only in motor vehicles with seat belts. Do not ride on motorcycles.

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Ambulance and Emergency Services

For a public ambulance in Malaysia, call 999, but the ambulance staff may not be fully trained and the patient will be sent to a hospital chosen by the dispatcher, not the patient. Long-term visitors should locate private ambulance services in their area. In Kuala Lumpur, call 603-7956-9999 for an ambulance to Gleneagles Intan Medical Centre.

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Medical facilities

Adequate medical care is available for basic problems in the larger cities, but may be difficult to locate in rural areas. In the Kuala Lumpur and Selangor area, many expatriates go to one of the following facilities:

  • Gleneagles Intan Medical Centre (includes 24-hour emergency room; 282 Jalan Ampang; 50450 Kuala Lumpur; tel. 603-4257﷓-1300, emergency tel. 603-4255-2880; web site: http://www.gimc.com.my)
  • Subang Jaya Medical Center (1 Jalan SS 12/1A; 47500 Subang Jaya (12 kilometers from K.L.); tel. 5634-1515; member of the international networks of the Massachusetts General Hospital and the New York-Presbyterian Hospital, two leading U.S. hospitals)
  • Ampan Puteri Specialist Hospital (No. 1 Jalan Mamanda 9; Taman Dato' Ahmad Razali, 68000 Ampang; tel. 4270﷓-2500; web site: http://www.apsh.kpj.com.my)

For a directory of other hospitals in Malaysia, go to the Malaysian Medical Association website. Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. Serious medical problems will require air evacuation to a country with state-of-the-art medical facilities.

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Pharmacies

Most pharmacies are well-supplied. Many travelers go to Guardian, which operates a chain of pharmacies throughout Malaysia (go to their website at http://www.guardian.com.my/aboutUs.cfm?auPage=4 for locations and hours). The Guardian pharmacists are all fully trained.

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Traveling with children

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed.

All children should be up-to-date on routine childhood immunizations, as recommended by the American Academy of Pediatrics. Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days, before international travel. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. Children less than one year of age may also need to receive other immunizations ahead of schedule (see the accelerated immunization schedule).

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; and (2) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever, which are transmitted by contaminated food and water, are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

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Travel and pregnancy

International travel should be avoided by pregnant women with underlying medical conditions, such as diabetes or high blood pressure, or a history of complications during previous pregnancies, such as miscarriage or premature labor. For pregnant women in good health, the second trimester (18–24 weeks) is probably the safest time to go abroad and the third trimester the least safe, since it's far better not to have to deliver in a foreign country.

Before departure, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency obstetric care if necessary. In general, pregnant women should avoid traveling to countries which do not have modern facilities for the management of premature labor and other complications of pregnancy.

As a rule, pregnant women should avoid visiting areas where malaria occurs. Malaria may cause life-threatening illness in both the mother and the unborn child. None of the currently available prophylactic medications is 100% effective. Mefloquine (Lariam) is the drug of choice for malaria prophylaxis during pregnancy, but should not be given if possible in the first trimester. If travel to malarious areas is unavoidable, insect protection measures must be strictly followed at all times. The recommendations for DEET-containing insect repellents are the same for pregnant women as for other adults.

Strict attention to food and water precautions is especially important for the pregnant traveler because some infections, such as listeriosis, have grave consequences for the developing fetus. Additionally, many of the medications used to treat travelers' diarrhea may not be given during pregnancy. Quinolone antibiotics, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin), should not be given because of concern they might interfere with fetal joint development. Data are limited concerning trimethoprim-sulfamethoxazole, but the drug should probably be avoided during pregnancy, especially the first trimester. Options for treating travelers' diarrhea in pregnant women include azithromycin and third-generation cephalosporins. For symptomatic relief, the combination of kaolin and pectin (Kaopectate; Donnagel) appears to be safe, but loperamide (Imodium) should be used only when necessary. Adequate fluid intake is essential.

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Maps

Helpful maps are available in the University of Texas Perry-Castaneda Map Collection and the United Nations map library. If you have the name of the town or city you'll be visiting and need to know which state or province it's in, you might find your answer in the Getty Thesaurus of Geographic Names.

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Embassy/Consulate Location

(reproduced from the U.S. State Dept. Consular Information Sheet)

American citizens living in or visiting Malaysia are encouraged to register at the U.S. embassy in Kuala Lumpur either online, or in person at the consular section, and to obtain updated information on travel and security within the country. The U.S. embassy is located at 376 Jalan Tun Razak 50400, Kuala Lumpur. The local mailing address is P.O. Box No. 10035, 50700 Kuala Lumpur. The U.S. embassy telephone (60-3) 2168-5000, is available 24 hours per day for emergencies such as arrests, serious illness/injury, or death of Americans, (after business hours, please press 1 at the recording). The American Citizen Services telephone number is (60-3) 2168-4997/4979, and the Consular section fax number is (60-3) 2148-5801. The general fax number for the U.S. Embassy is (60-3) 2142-2207. The U.S. Embassy's web site is http://malaysia.usembassy.gov/; and the Consular section's e-mail is: klconsular@state.gov.

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Safety information

For information on safety and security, go to the U.S. Department of State, United Kingdom Foreign and Commonwealth Office, Foreign Affairs Canada, and the Australian Department of Foreign Affairs and Trade.

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