Vietnam: Culture, Social Change, and Development TABLE OF CONTENTS GENERAL INFORMATION ............................................. 2 PREVENTION OF INSECT-BORNE ILLNESSES ................. 2 PREVENTION OF FOOD- AND WATER-BORNE ILLNESSES ..................................................................... 3 OTHER DISEASES .......................................................... 5 IMMUNIZATIONS ......................................................... 6 IMMUNIZATION SCHEDULE ......................................... 7 SIT Study Abroad programs may venture off the usual tourist track. Pay careful attention to health and safety guidelines. GENERAL INFORMATION To protect your health in Vietnam, you need certain pre-departure immunizations followed by reasonable PREVENTION OF INSECT-BORNE health precautions while in the country. The following ILLNESSES health guidelines and requirements are based on years of Insect precautions are recommended for this experience and the current recommendations from the program. Malaria is not a problem in Ho Chi Minh City US Centers for Disease Control and Prevention. It is (the program base); and the scheduled destinations of designed to inform you of health concerns that may be the program including the cities of Hanoi and the present in Vietnam especially as you venture to smaller Mekong Delta. It does occur however, in certain rural cities off the usual tourist track, or spend time in small locations. Insect precautions are usually sufficient for this villages and rural areas for extended periods. Although program. However, if you plan on doing your no information sheet can address every conceivable Independent Study Project (ISP) or Internship in a contingency, the following health guidelines and malarious area or plan on visiting one after the program requirements are an attempt to provide you with a ends; you should bring the appropriate amount of standard, which if followed, should optimize good health malaria prophylaxis with you. For full protection, you during your stay abroad. should take your first pill before any travel to these areas. The CDC guidelines suggest that prevention of You may find that local customs and practice, as well as malaria is possible if you follow personal protective varying US physicians’ approaches, at times conflict with measures carefully as described below and take one of these guidelines. It is essential that you review these the following antimalarial drugs (listed alphabetically) as health guidelines and requirements with your physician, directed by your health care provider: to discuss individual issues such as pre-existing medical Atovaquone/proguanil (Malarone), doxycycline, or problems and allergies to specific drugs. Any further tafenoquine (Arakoda). The selection should be questions or concerns should be directed to the US discussed with your physician or health care Centers for Disease Control and Prevention (CDC) in provider. If, in spite of adherence to these preventive Atlanta (Web site: http://www.cdc.gov/travel) or your measures, you develop symptoms of malaria, prompt own physician. medical attention lessens the severity of the illness. The following insect precautions should be followed, especially after dark, to prevent mosquito bites that may transmit malaria: • Wear long-sleeved shirts and long pants. • Use mosquito netting over bedding. • Use insect repellents on bedding and netting. (e.g. permethrin – commonly known as Permanone). 2 Vietnam 2020 • Use insect repellents on skin and clothing. DEET- should be vigilant in using insect precautions and containing products, e.g., Off, Off Deep Woods, personal protection measures against day-biting Jungle Juice, Muskol. These products may be used on mosquitoes (see insect precautions section above). CDC skin in concentration up to 30–40% and on clothing recommends that pregnant women consider postponing in higher concentration. Permethrin (Permanone) travel to countries where the Zika virus is prevalent. may also be used on clothing. Dengue SIT Study Abroad suggests that if you have further Dengue is a viral disease and is transmitted by questions, do not hesitate to contact the Malarial mosquitoes which bite primarily in the daytime. It occurs Division of CDC at 888-232-3228 for recorded in urban as well as rural areas. The disease causes information or visit the CDC website: considerable discomfort (fever, body aching), but is self- http://www.cdc.gov/malaria/travelers/index.html limited in adults. Risk is greatest in the Mekong delta region and is extremely high in Ho Chi Minh City Japanese Encephalitis Japanese Encephalitis is a viral infection affecting the especially during the peak of the rainy season (June brain, which occurs in rural tropical areas, primarily through September). There is no licensed vaccine against during the rainy season (April-November in the north it, but personal protective measures against mosquito and year round in the south), and is passed by bites are effective in prevention (see insect precautions mosquitoes mainly during the evening hours. The highest section). incidence occurs in the area around Hanoi and in the Mekong and Red River deltas. A vaccine, which is helpful Rickettsial Infections: Typhus in prevention, is currently licensed in the United States. Murine typhus is a bacterial disease that is transmitted to Vaccinations should be considered if you are planning to people by the bite of infected fleas, mites (chiggers), lice, do your Independent Study Project (ISP) in a rural area or ticks usually harbored by rats and other small during the rainy season, or if you plan to travel to a rural mammals (cats, dogs et al.). Symptoms may vary and its or agricultural area for a significant time before or after severity but are typically headache, fever, chills, and rash. the program. In addition all travelers should follow Low risk exists in Vietnam including Hanoi and Ho Chi personal protective measures to avoid mosquito bites Minh City. There is currently no vaccine to prevent (see under malaria section). typhus. Travelers should avoid rodents and their fleas. Insect precautions are recommended. Travelers who are asymptomatic should seek immediate medical attention Chikungunya Chikungunya is an arboviral infection that is transmitted and are treated with antibiotics. by day-biting Aedes mosquitoes. It is prevalent in tropical Africa and Asia, parts of Central and South America, and the Caribbean. Symptoms are typically fever and joint pain. There is no licensed vaccine against it, but insect precautions and personal protective measures (especially during peak times (early morning and late afternoon) are the main prevention strategy. Zika Zika is a viral infection that is also transmitted by the bite of the Aedes mosquitoes. Risk exists and is limited to the southern and central areas of the country especially PREVENTION OF FOOD- AND WATER- in Ho Chi Minh City. Symptoms include mild fever, rash, BORNE ILLNESSES conjunctivitis (red eyes), joint or muscle pain and Diarrhea-producing infections headache. The disease causes considerable discomfort, “Traveler’s diarrhea” is the most common form of but is mild and self-limited, lasting for several days to a diarrhea in Vietnam. This is a self-limited diarrhea lasting week. There are no vaccines or medications available to from a few to several days, characterized by watery, prevent or treat Zika infections therefore students 3 Vietnam 2020 non-bloody bowel movements. Traveler’s diarrhea usually requires no treatment other than fluid DO EAT replacement including ORS (World Health • Cooked vegetables, fruits with thick covering (citrus, Organization’s Oral Rehydration Solution which comes bananas, and melons); and well-washed raw fruits in package form) or other home-made solutions such as: and vegetables. 1 teaspoon salt, 1/2 teaspoon baking soda, and 2–3 • Meat or fish that is thoroughly cooked (pork and tablespoons sugar or honey in 1 liter of clean water; lamb should be very well done). another option is carbonated soda diluted by one half. • Pasteurized dairy products from large commercial Antidiarrheals such as Imodium or Lomotil may be used dairies. short-term in some circumstances. Pepto Bismol in large amounts and certain antibiotics (doxycycline, sulfa-TMP, DON’T EAT ciprofloxacin) can prevent or attenuate the infection. • Unwashed or unpeeled raw fruits and vegetables. Antibiotics are indicated for more severe cases of • Fruits that do not have a thick, disposable outside traveler’s diarrhea. covering. • Rare or raw meat or fish or shellfish. Therefore, the best way to avoid such infections is to • Dairy products from small, independent vendors respect certain do’s and don’ts: without pasteurizing facilities, including food of any kind that has been left out in the sun, especially DO WASH your hands scrupulously with non- custards, creams, and mayonnaise. contaminated water and soap before eating and snacking. • Raw (unpasteurized) milk or milk products. DO DRINK There may be times when refusing an offer of food or • Bottled or canned beverages (water, soda, soft beverage, even a drink with ice or avoiding a salad will be drinks) from a trusted source (ensure caps are considered rude. You must decide for yourself, but sealed). polite refusals, thought out in advance, are often handy. • Hot beverages (coffee, tea). Discuss these alternatives with your Academic • Water that has reached a rolling boil for at least one Director(s). minute at sea level (longer at higher altitudes). • Carbonated mineral