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Vietnam
Summary of recommendationsMedicationsImmunizations
Recent outbreaksOther infectionsFood and water precautions
Insect and Tick ProtectionSwimming and bathing precautionsGeneral 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 is recommended for all rural areas, except for the Red River delta, the coastal plain north of the Nha Trang, and the Mekong Delta. Either Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline may be given, except for the southern provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh, where mefloquine should not be used because of the risk of mefloquine-resistant malaria.
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. 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 Viet Nam: prophylaxis is recommended for all rural areas except for the Red River delta, the coastal plains north of Nha Trang, and the Mekong Delta. The highest risk exists in the two southernmost provinces, Ca Mau and Bac Lieu, and the highland areas below 1500 m south of 18 degrees N. Either mefloquine (Lariam), atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given, except for the southern provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh, where mefloquine should not be used because of the risk of mefloquine-resistant malaria. 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. Insect protection measures are essential.

Rare malaria cases are reported from the Mekong Delta. Insect protection measures are advised, but malaria medications are not generally recommended.

There is no malaria risk in Hanoi, Ho Chi Minh City (Saigon), Hue, Can Tho, Da Nang, Nha Trang, Qui Nhon, and Haiphong.

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.

For further information concerning malaria in Viet Nam, go to the World Health Organization - Western Pacific Region and the World Health Organization.

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Immunizations

The following are the recommended vaccinations for Viet Nam:

Hepatitis A vaccine is recommended for all travelers over one year of age. It 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. 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.

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 is highly prevalent throughout Viet Nam, with highest incidence in the northern part of the country, especially in and near Hanoi. Transmission is greatest from May through October. A total of 120 cases were reported in the first half of 2010.

For those age 17 or older, 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 17. For the vaccination options for those under age 17, go to the Japanese encephalitis section. In addition to vaccination, strict attention to insect protection measures is essential for anyone at risk.

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 Viet Nam, most cases are related to dog bites, though bites from monkeys and other wildlife may also be responsible. 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 occurs in Viet Nam, 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 Viet Nam.

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, 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

Outbreaks of hand, foot, and mouth disease occur regularly in Viet Nam. More than 100,000 cases, including 42 deaths, were reported in the first nine months of 2012. Slightly more than half the cases and more than 90 percent of the deaths occurred in the southern region. Most of the cases and all of the fatalities were caused by enterovirus 71, which produces an especially severe form of the illness. An outbreak in the year 2011 caused more than 110,000 cases and 169 deaths, mostly in children, by the end of the year.

Enteroviruses are transmitted by exposure to fecal material from infected individuals. 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). The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and changing diapers and before handling food.

In May 2008, an outbreak of hand, foot and mouth disease was reported from the southern part of Viet Nam, causing hundreds of cases and several fatalities in young children. In September 2007, an outbreak was reported from Ho Chi Minh City (see ProMED-mail; September 26, 2007, May 4, 2008, and April 9, 2011). A previous outbreak was reported from the southern part of the country in September 2006.

The number of deaths caused by rabies appears to be rising: there were 64 deaths from rabies for the year 2009, down fromm previous years, but 34 deaths in the first six months of 2010. The increase appeared to be related to a failure to vaccinate dogs and cats, as well as a Vietnamese custom of eating dogs, especially puppies, who are too young to be vaccinated. A rabies outbreak related to bites from rabid dogs was reported from northern Lai Chau Province in July 2009, killing four people. The outbreak appeared to have been caused by importation of dogs from other provinces, due to the high demand for dog meat (see ProMED-mail). As above, rabies vaccine is recommended for travelers to Viet Nam who will be 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.

A measles outbreak was reported from Viet Nam in January 2014, causing almost a thousand cases by February, chiefly in the northern mountainous provinces, Hanoi and Ho Chi Minh City. A measles outbreak also occurred in early 2009, affecting the city of Hanoi and other areas. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Viet Nam.

Five cases of Angiostrongylus meningitis were reported among children in the Hanoi area in the year 2008 (see ProMED-mail; November 13, 2008). Angiostrongylus cantonensis is a parasitic roundworm which humans acquire by eating raw or undercooked snails, slugs, freshwater prawns, crabs, or frogs which have been infected. The most common symptoms are headache, neck stiffness, numbness and tingling, visual disturbances, photophobia (sensitivity to light), and fatigue. There is no treatment except symptomatic relief. Food and water precautions, as discussed below, are advised to prevent this and other parasitic infections.

A cholera outbreak was reported from Viet Nam in May 2010, affecting five northern provinces, including Hanoi, Ha Nam, Hai Duong, Hai Phong and Bac Ninh, and three southern provinces, including An Giang, Tay Ninh and Ho Chi Minh City. In October 2008, a cholera outbreak was reported from Quynh Luu district in the central Nghe An Province, probably related to contamination of the Mai Giang River, which runs through the district. A major cholera outbreak was reported in March 2008, chiefly affecting Hanoi. As of August, more than 700 cases had been confirmed (see the World Health Organization and ProMED-mail). A smaller cholera outbreak was reported from the northern part of the country in October 2007. Many cases in the northern outbreaks appeared to have been caused by consumption of raw shrimp paste, seafood salad, blood pudding, and raw vegetables (see ProMED-mail; November 2, 9, and 26, 2007; April 1, 9, and 15, 2008).

The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. 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.

A total of 127 human cases of H5N1 avian influenza ("bird flu") have been reported from Viet Nam, of which 64 have been fatal. Most of the cases occurred in the year 2003. Since then, there have been only sporadic cases of human H5N1 infection. The most recent were reported in January 2014 from Tan Long village, Thanh Binh district, Dong Thap province, and from southern Binh Phuc province. Avian influenza is continuing to occur on poultry farms throughout the country. The latest wave of poultry outbreaks began in October 2013 and was ongoing as of February 2014.

Most travelers are at extremely low risk for avian influenza, since almost all human cases 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 Viet Nam, 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 Viet Nam 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.

Dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, is one of the leading causes of hospitalization and death in Viet Nam, especially in the southern part of the country. The number of cases has been rising in recent years. A total of 42,181 cases and 44 deaths were reported nationwide for the first ten months of 2011. A total of 80,000 cases and 59 deaths were reported nationwide for the first nine months of 2010. For the year 2009, a total of 105,370 cases and 87 deaths were reported; more than usual occurred in Hanoi and other areas in the northern part of the country. In the year 2008, more than 78,500 cases and 79 deaths were recorded nationwide, including almost 14,000 cases in Ho Chi Minh City. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. Transmission usually peaks from May through November each year, though the disease occurs year-round. The most intense transmission occurs in the Mekong delta. No vaccine is available at this time. The cornerstone of prevention is insect protection measures, as outlined below.

More than 50,000 cases, including 49 deaths, were reported in the first eight months of 2007, an increase of more than 40% compared to the same period in 2006 (see ProMED-mail, June 8, July 10, August 6, and September 8, 2007). For the year 2006, more than 77,800 cases were reported nationwide, including 68 fatalities, compared to 49,400 cases and 51 deaths for the year 2005. An epidemic of dengue hemorrhagic fever resulting in more than 200,000 cases occurred in southern Viet Nam in 1998, possibly related to climatic changes due to El Nino. See Emerging Infectious Diseases for further information. For further information on dengue in Viet Nam, go to the World Health Organization - Western Pacific Region.

An outbreak of Streptococcus suis infections was reported in July 2007, resulting in 42 cases (22 in the north and 20 in the south), including two fatalities. Sporadic human cases have been reported since then, including 11 cases in the first five months of 2011. An increased number of cases was reported from the northern part of the country in June 2012. One fatal case was reported from Hanoi's Tay Ho district in September 2012, and two more fatal cases were reported from Hanoi in February 2013. Three cases were reported from Da Nang in January 2013. An isolated fatal case was reported in February 2014 from Thai Binh province, in a man who had eaten blood pudding made from uncooked pig blood, a known source of infection.

Most human cases of Streptococcus suis infections occur in adult male farmers or butchers who have had direct contact with diseased or dead pigs. The infection may also be acquired by eating contaminated pork or pork products. In general, the disease is not transmitted from person-to-person. Symptoms include high fever, malaise, nausea, and vomiting, followed in severe cases by meningitis, subcutaneous hemorrhage, toxic shock, and coma. Travelers should avoid visiting pig farms and should make sure all pork products are thoroughly cooked before consumption. For further information, go to ProMED-mail (July 22 and 26, 2007; May 19, 2011; June 26, 2012; and February 10, 2014).

An outbreak of severe acute respiratory syndrome (SARS) was reported in March 2003, resulting in 63 cases and five deaths. The outbreak was terminated by an aggressive program of contact identification and quarantine. No travel restrictions are recommended for Viet Nam at this time.

The outbreak was apparently triggered by a single person who became ill after arriving from Shanghai and Hong Kong. Almost all cases occurred in health care workers or in family members or other close contacts of those with the disease.

The disease appears to be caused by a previously unknown virus belonging to the coronavirus family. The incubation period usually ranges from two-to-seven days, but may be as long as ten days. The first symptom is usually fever, often accompanied by chills, headache, body aches, and malaise. This is typically followed by dry cough and difficulty breathing, at times severe enough to require intubation and mechanical ventilation.

For further information, go to the World Health Organization, Health Canada, and the Centers for Disease Control.

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Other infections

Plague remains prevalent in Viet Nam, chiefly in Daklak, Gialai, and Binh Dinh provinces. The plague is usually transmitted by the bite of rodent fleas. Less commonly, the disease is acquired by inhalation of infected droplets, which may be coughed into the air by a person with plague pneumonia, or by direct exposure to infected blood or tissues. Most travelers are at low risk. Those who may have contact with rodents or their fleas should bring along a bottle of doxycycline, to be taken prophylactically if exposure occurs. Those less than eight years of age or allergic to doxycycline may take trimethoprim-sulfamethoxazole instead. To minimize risk, travelers should avoid areas containing rodent burrows or nests, never handle sick or dead animals, and follow insect protection measures, as described below.

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.

Other infections and toxic exposures include

  • Anthrax (outbreaks reported in July and August 2011 from the northern mountainous provinces of Lai Chau, Dien Bien, and Ha Giang; see ProMED-mail, July 24 and August 12, 2011)
  • Scrub typhus (deforested areas; transmitted by chigger bites)
  • Murine typhus
  • Leptospirosis (animal reservoir includes pigs, dogs, rats, and cattle)
  • Hepatitis E (transmitted by contaminated food or water)
  • Chikungunya fever
  • Melioidosis (caused by bacteria known as Burkholderia pseudomallei 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)
  • Liver fluke (fascioliasis) (increased number of cases reported from the central and central highlands regions in 2009; see ProMED-mail, September 13, 2009)
  • Lung fluke (paragonimiasis)
  • Giant intestinal fluke (fasciolopsiasis)
  • Oriental liver fluke (clonorchiasis)
  • Schistosomiasis (Mekong delta; caused by Schistosoma japonicum; swimming and bathing precautions are advised, as below)
  • Strongyloides
  • Venomous snakes (cobras, vipers)

For an overview of health care in Viet Nam, 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 accomodation 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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Swimming and bathing precautions

Avoid swimming, wading, or rafting in bodies of fresh water, such as lakes, ponds, streams, or rivers. Do not use fresh water for bathing or showering unless it has been heated to 150 degrees F for at least five minutes or held in a storage tank for at least three days. Toweling oneself dry after unavoidable or accidental exposure to contaminated water may reduce the likelihood of schistosomiasis, but does not reliably prevent the disease and is no substitute for the precautions above. Chlorinated swimming pools are considered safe.

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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 an ambulance in Viet Nam, call 115, but response times may be slow and staffing and equipment may be substandard. For a private ambulance, call Family Medical Practice in Hanoi (tel. 844-843-0748), Danang (tel. 84 511 582-699/700), or Ho Chi Minh City (tel. 848-822-7848).

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Medical facilities

Medical care in Viet Nam is extremely limited. Medicines and supplies are often lacking and medical staff may speak little or no English. Many expatriates go to the Family Medical Practice (website http://www.vietnammedicalpractice.com/), which has clinics in Hanoi (tel. 844-843-0748), Danang (tel. 84 511 582-699/700), and Ho Chi Minh City (tel. 848-822-7848) (see website for locations). In Hanoi, another option for travelers is International SOS (31 Hai Ba Trung; tel,. 844-934-0555; Dr. Bruce Miller, Dr. Oliviers Bernard). For a list of other physicians and hospitals in Viet Nam, go to the U.S. Embassy website. Medical care is acceptable for minor illnesses and injuries, but serious medical problems will require air evacuation to a country with state-of-the-art medical facilities, usually Thailand or Singapore. Most doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance.

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Pharmacies

Many common Western medications may be unavailable in Viet Nam. Most pharmaceuticals are imported from France, India, and China. Counterfeit pharmaceuticals remain a problem throughout Southeast Asia. Medications should only be purchased through a reputable pharmacy with a physician's prescription.

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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 (see the U.S. Embassy website).

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 (see the U.S. Embassy website). 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)

U.S. citizens traveling to or residing in Vietnam are encouraged to register online at https://travelregistration.state.gov/ibrs. This free internet-based registration service allows U.S. citizens to record information about themselves, their emergency contacts, and their travel itinerary. The U.S. Embassy and Consulate General can use this information to assist travelers in case of an emergency.

The Consular Section of the U.S. Embassy in Hanoi is located at 6 Ngoc Khanh, Ba Dinh District, Hanoi, Socialist Republic of Vietnam, telephone: (84-4) 831-4590; after hours emergency telephone number: (84-4) 772-1500; fax: (84-4) 831-4578, Internet home page: http://hanoi.usembassy.gov

The Consular section's business hours are 8:00 am to 5:00 pm. The Consular Section provides the full range of services for U.S. citizens (passport services, consular reports of birth abroad, notarial services) and non-immigrant visa services (except K-1 fiancée visas).

The U.S. Consulate General in Ho Chi Minh City is located at 4 Le Duan, District 1, Ho Chi Minh City, Socialist Republic of Vietnam, telephone: (84-8) 822-9433; fax: (84-8) 822-9434; web site, http://hochiminh.usconsulate.gov. The Consulate General's business hours are 8:00 am to 5:00 pm. The Consulate General provides the full range of consular services for U.S. citizens (passport services, consular reports of birth abroad, notarial services) and the full range of immigrant and non-immigrant visa services. All immigrant visa processing in Vietnam, including visas for adopted children and fiancé/e visas, is conducted solely at the Consulate General in Ho Chi Minh City. It is advisable to check the Consulate's web page to see which services require an appointment, and for a list of holiday closings and public hours, at http://hochiminh.usconsulate.gov/wwwhcits.html

Callers from the U.S. should note that Vietnam is 12 hours ahead of Eastern Standard Time and 11 hours ahead of Eastern Daylight Time.

A copy of the U.S. citizen registration form is on the Embassy website and may be downloaded and faxed to the Embassy's Consular Section or to the Consulate General, along with a copy of the traveler's U.S. passport biographic page.

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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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