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China is a reasonably healthy country to travel in, but some health issues should be noted. Pre-existing medical conditions and accidental injury (especially traffic accidents) account for most life-threatening problems, but becoming ill in some way is not unusual. Outside of the major cities, medical care is often inadequate, and food and waterborne diseases are common. Malaria is still present in some parts of the country, and altitude sickness can be a problem, particularly in Tibet.

In case of accident or illness, it’s best just to get a taxi and go to hospital directly.

The following advice is a general guide only and does not replace the advice of a doctor trained in travel medicine.

Before You Go

  • Pack medications in their original, clearly labelled containers.
  • If you take any regular medication, bring double your needs in case of loss or theft.
  • Take a signed and dated letter from your physician describing your medical conditions and medications (using generic names).
  • If carrying syringes or needles, ensure you have a physician’s letter documenting their medical necessity.
  • If you have a heart condition, bring a copy of your ECG taken just prior to travelling.
  • Get your teeth checked before you travel.
  • If you wear glasses, take a spare pair and your prescription.

In China you can buy some medications over the counter without a doctor’s prescription, but not all, and in general it is not advisable to buy medications locally without a doctor’s advice. Fake medications and poorly stored or out-of-date drugs are also common, so try to take your own.

Insurance

  • Even if you are fit and healthy, don’t travel without health insurance – accidents happen.
  • Declare any existing medical conditions you have (the insurance company will check if your problem is pre-existing and will not cover you if it is undeclared).
  • You may require extra cover for adventure activities such as rock climbing or skiing.
  • If you’re uninsured, emergency evacuation is expensive; bills of more than US$100,000 are not uncommon.
  • Ensure you keep all documentation related to any medical expenses you incur.

Vaccinations

Specialised travel-medicine clinics stock all available vaccines and can give specific recommendations for your trip. The doctors will consider your vaccination history, the length of your trip, activities you may undertake and underlying medical conditions, such as pregnancy.

  • Visit a doctor six to eight weeks before departure, as most vaccines don’t produce immunity until at least two weeks after they’re given.
  • Ask your doctor for an International Certificate of Vaccination (otherwise known as the ‘yellow booklet’), listing all vaccinations received.
  • The only vaccine required by international regulations is yellow fever.

Proof of vaccination against yellow fever is only required if you have visited a country in the yellow-fever zone within the six days prior to entering China. If you are travelling to China directly from South America or Africa, check with a travel clinic as to whether you need a yellow-fever vaccination.

Recommended Vaccinations

The World Health Organization (WHO) recommends the following vaccinations for travellers to China:

Adult diphtheria and tetanus (ADT) Single booster recommended if you’ve not received one in the previous 10 years. Side effects include a sore arm and fever. An ADT vaccine that immunises against pertussis (whooping cough) is also available and may be recommended by your doctor.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as a headache and sore arm occur in 5% to 10% of people.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months; a rapid schedule is also available. There is also a combined vaccination with hepatitis A. Side effects are mild and uncommon, usually a headache and sore arm. Lifetime protection results in 95% of people.

Measles, mumps and rubella (MMR) Two doses of MMR is recommended unless you have had the diseases. Occasionally a rash and a flulike illness can develop a week after receiving the vaccine. Many adults under 40 require a booster.

Typhoid Recommended unless your trip is less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single shot. Tablets are also available; however, the injection is usually recommended as it has fewer side effects. A sore arm and fever may occur. A vaccine combining hepatitis A and typhoid in a single shot is now available.

Varicella If you haven’t had chickenpox, discuss this vaccination with your doctor.

The following immunisations are recommended for travellers spending more than one month in the country or those at special risk:

Influenza A single shot lasts one year and is recommended for those over 65 years of age or with underlying medical conditions such as heart or lung disease.

Japanese B encephalitis A series of three injections with a booster after two years. Recommended if spending more than one month in rural areas in the summer months, or more than three months in the country.

Pneumonia A single injection with a booster after five years is recommended for all travellers over 65 years of age or with underlying medical conditions that compromise immunity, such as heart or lung disease, cancer or HIV.

Rabies Three injections in all. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally a headache and sore arm.

Tuberculosis A complex issue. High-risk adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than vaccination. Only one vaccine is given in a lifetime. Children under five spending more than three months in China should be vaccinated.

Pregnant women and children should receive advice from a doctor who specialises in travel medicine.

Medical Checklist

Recommended items for a personal medical kit:

  • Antibacterial cream, eg mucipirocin
  • Antibiotics for diarrhoea, including norfloxacin, ciprofloxacin or azithromycin for bacterial diarrhoea; or tinidazole for giardia or amoebic dysentery
  • Antibiotics for skin infections, eg amoxicillin/clavulanate or cephalexin
  • Antifungal cream, eg clotrimazole
  • Antihistamine, eg cetrizine for daytime and promethazine for night-time
  • Anti-inflammatory, eg ibuprofen
  • Antiseptic, eg Betadine
  • Antispasmodic for stomach cramps, eg Buscopan
  • Decongestant, eg pseudoephedrine
  • Diamox if going to high altitudes
  • Elastoplasts, bandages, gauze, thermometer (but not mercury), sterile needles and syringes, safety pins and tweezers
  • Indigestion tablets, such as Quick-Eze or Mylanta
  • Insect repellent containing DEET
  • Iodine tablets to purify water (unless you’re pregnant or have a thyroid problem)
  • Laxative, eg coloxyl
  • Oral-rehydration solution (eg Gastrolyte) for diarrhoea, diarrhoea ‘stopper’ (eg loperamide) and antinausea medication (eg prochlorperazine)
  • Paracetamol
  • Permethrin to impregnate clothing and mosquito nets
  • Steroid cream for rashes, eg 1% to 2% hydrocortisone
  • Sunscreen
  • Thrush (vaginal yeast infection) treatment, eg clotrimazole pessaries or Diflucan tablet
  • Urinary infection treatment, eg Ural

Further Reading

Healthy Travel – Asia & India (Lonely Planet) Handy pocket size, packed with useful information.

Traveller’s Health by Dr Richard Dawood.

Travelling Well (www.travellingwell.com.au) by Dr Deborah Mills.

Websites

Health Advisories

It’s usually a good idea to consult your government’s travel-health website before departure, if one is available.

Australia

Canada

New Zealand

UK Search for travel in the site index.

USA

In China

Infectious Diseases

Typhoid

Typhoid is a serious bacterial infection spread via food and water. Symptoms include headaches, a high and slowly progressive fever, perhaps accompanied by a dry cough and stomach pain. Vaccination is not 100% effective, so still be careful what you eat and drink. All travellers spending more than a week in China should be vaccinated.

Dengue

This mosquito-borne disease occurs in some parts of southern China. There is no vaccine so avoid mosquito bites. The dengue-carrying mosquito bites day and night, so use insect-avoidance measures at all times. Symptoms include high fever, severe headache and body ache. Some people develop a rash and diarrhoea. There is no specific treatment – just rest and paracetamol. Do not take aspirin.

Japanese B Encephalitis

A rare disease in travellers; however, vaccination is recommended if you’re in rural areas for more than a month during summer months, or if spending more than three months in the country. No treatment available; one-third of infected people die, another third suffer permanent brain damage.

Drinking Water

Follow these tips to avoid becoming ill.

  • Never drink tap water.
  • Bottled water is generally safe – check the seal is intact at purchase.
  • Avoid ice.
  • Avoid fresh juices – they may have been watered down.
  • Boiling water is the most efficient method of purifying it.
  • The best chemical purifier is iodine. It should not be used by pregnant women or those with thyroid problems.
  • Water filters should also filter out viruses. Ensure your filter has a chemical barrier such as iodine and a pore size of less than 4 microns.

Malaria

Malaria has been nearly eradicated in China; it is not generally a risk for visitors to the cities and most tourist areas. It is found mainly in rural areas in the southwestern region bordering Myanmar, Laos and Vietnam, principally Hǎinán, Yúnnán and Guǎngxī. More limited risk exists in the remote rural areas of Fújiàn, Guǎngdōng, Guìzhōu and Sìchuān. Generally, medication is only advised if you are visiting rural Hǎinán, Yúnnán or Guǎngxī.

To prevent malaria:

  • Avoid mosquitoes and take antimalarial medications (most people who catch malaria are taking inadequate or no antimalarial medication).
  • Use an insect repellent containing DEET on exposed skin (natural repellents such as citronella can be effective, but require more frequent application than products containing DEET).
  • Sleep under a mosquito net impregnated with permethrin.
  • Choose accommodation with screens and fans (if it’s not air-conditioned).
  • Impregnate clothing with permethrin in high-risk areas.
  • Wear long sleeves and trousers in light colours.
  • Use mosquito coils.
  • Spray your room with insect repellent before going out for your evening meal.

Rabies

An increasingly common problem in China, this fatal disease is spread by the bite or lick of an infected animal, most commonly a dog. Seek medical advice immediately after any animal bite and commence postexposure treatment. The pretravel vaccination means the post-bite treatment is greatly simplified.

If an animal bites you:

  • Gently wash the wound with soap and water, and apply an iodine-based antiseptic.
  • If you are not prevaccinated, you will need to receive rabies immunoglobulin as soon as possible, followed by a series of five vaccines over the next month. Those who have been prevaccinated require only two shots of vaccine after a bite.
  • Contact your insurance company to locate the nearest clinic stocking rabies immunoglobulin and vaccine. Immunoglobulin is often unavailable outside of major centres, but it’s crucial that you get to a clinic that has immunoglobulin as soon as possible if you have had a bite that has broken the skin.

Schistosomiasis (Bilharzia)

This disease occurs in the central Yangzi River (Cháng Jiāng) basin, carried in water by minute worms that infect certain varieties of freshwater snail found in rivers, streams, lakes and, particularly, behind dams. The infection often causes no symptoms until the disease is well established (several months to years after exposure); any resulting damage to internal organs is irreversible. Effective treatment is available.

  • Avoid swimming or bathing in fresh water where bilharzia is present.
  • A blood test is the most reliable way to diagnose the disease, but the test will not show positive until weeks after exposure.

Hepatitis A

A problem throughout China, this food-and-waterborne virus infects the liver, causing jaundice (yellow skin and eyes), nausea and lethargy. There is no specific treatment for hepatitis A; you just need to allow time for the liver to heal. All travellers to China should be vaccinated.

Hepatitis B

The only sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by contact with infected body fluids. The long-term consequences can include liver cancer and cirrhosis. All travellers to China should be vaccinated.

Environmental Hazards

Air Pollution

Air pollution is a significant and worsening problem in many Chinese cities. People with underlying respiratory conditions should seek advice from their doctor prior to travel to ensure they have adequate medications in case their condition worsens. Take treatments such as throat lozenges, and cough and cold tablets.

Hypothermia

Be particularly aware of the dangers of trekking at high altitudes or simply taking a long bus trip over mountains. In Tibet it can go from being mildly warm to blisteringly cold in minutes – blizzards can appear from nowhere.

Progress from very cold to dangerously cold can be rapid due to a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing. Dress in layers; silk, wool and some artificial fibres are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer (and a space blanket for emergencies) is essential. Carry basic supplies, including food containing simple sugars, and fluid to drink.

Symptoms of hypothermia are exhaustion, numb skin (particularly the toes and fingers), shivering, slurred speech, irrational or violent behaviour, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy.

To treat mild hypothermia, first get the person out of the wind and/or rain, remove their clothing if it’s wet, and replace it with dry, warm clothing. Give them hot liquids – not alcohol – and high-calorie, easily digestible food. Early recognition and treatment of mild hypothermia is the only way to prevent severe hypothermia, a critical condition that requires medical attention.

Heat Exhaustion

Dehydration or salt deficiency can cause heat exhaustion. Take time to acclimatise to high temperatures, drink sufficient liquids and avoid physically demanding activity.

Salt deficiency is characterised by fatigue, lethargy, headaches, giddiness and muscle cramps; salt tablets may help, adding extra salt to your food is better.

Insect Bites & Stings

Bedbugs don’t carry disease but their bites are very itchy. Treat the itch with an antihistamine.

Lice inhabit various parts of the human body, most commonly the head and pubic areas. Transmission is via close contact with an affected person. Lice can be difficult to treat, but electric lice combs/detectors can be effective (pick one up before travelling); otherwise you may need numerous applications of an antilice shampoo such as permethrin. Pubic lice (crab lice) are usually contracted from sexual contact.

Ticks are contracted by walking in rural areas, and are commonly found behind the ears, on the belly and in armpits. If you have had a tick bite and experience symptoms such as a rash, fever or muscle aches, see a doctor. Doxycycline prevents some tick-borne diseases.

Altitude Sickness

There are bus journeys in Tibet, Qīnghǎi and Xīnjiāng where the road goes above 5000m. Acclimatising to such extreme elevations takes several weeks at least, but most travellers come up from sea level very fast – a bad move! Acute mountain sickness (AMS) results from a rapid ascent to altitudes above 2700m. It usually commences within 24 to 48 hours of arriving at altitude, and symptoms include headache, nausea, fatigue and loss of appetite (feeling much like a hangover).

If you have altitude sickness, the cardinal rule is that you must not go higher as you are sure to get sicker and could develop one of the more severe and potentially deadly forms of the disease: high-altitude pulmonary oedema (HAPE) and high-altitude cerebral oedema (HACE). Both are medical emergencies and, as there are no rescue facilities similar to those in the Nepal Himalaya, prevention is the best policy.

AMS can be prevented by ‘graded ascent’; it is recommended that once you are above 3000m you ascend a maximum of 300m daily with an extra rest day every 1000m. You can also use a medication called Diamox as a prevention or treatment for AMS, but you should discuss this first with a doctor experienced in altitude medicine. Diamox should not be taken by people with a sulphur drug allergy.

If you have altitude sickness, rest where you are for a day or two until your symptoms resolve. You can then carry on, but ensure you follow the graded-ascent guidelines. If symptoms get worse, descend immediately before you are faced with a life-threatening situation. There is no way of predicting who will suffer from AMS, but certain factors predispose you to it: rapid ascent, carrying a heavy load, and having a seemingly minor illness such as a chest infection or diarrhoea. Make sure you drink at least 3L of noncaffeinated drinks daily to stay well hydrated.

Traveller’s Diarrhoea

Between 30% and 50% of visitors will suffer from traveller’s diarrhoea within two weeks of starting their trip. In most cases, the ailment is caused by bacteria and responds promptly to treatment with antibiotics.

Treatment consists of staying hydrated; rehydration solutions such as Gastrolyte are best. Antibiotics such as norfloxacin, ciprofloxacin or azithromycin will kill the bacteria quickly. Loperamide is just a ‘stopper’ and doesn’t cure the problem; it can be helpful, however, for long bus rides. Don’t take loperamide if you have a fever, or blood in your stools. Seek medical attention if you do not respond to an appropriate antibiotic.

  • Eat only at busy restaurants with a high turnover of customers.
  • Eat only freshly cooked food.
  • Avoid food that has been sitting around in buffets.
  • Peel all fruit, cook vegetables and soak salads in iodine water for at least 20 minutes.
  • Drink only bottled mineral water.

Amoebic Dysentery

Amoebic dysentery is actually rare in travellers and is over-diagnosed. Symptoms are similar to bacterial diarrhoea – fever, bloody diarrhoea and generally feeling unwell. Always seek reliable medical care if you have blood in your diarrhoea. Treatment involves two drugs: tinidazole or metronidazole to kill the parasite in your gut, and then a second drug to kill the cysts. If amoebic dysentery is left untreated, complications such as liver or gut abscesses can occur.

Giardiasis

Giardiasis is a parasite relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardia, but are not specific to the parasite. Giardiasis will eventually go away if left untreated, but this can take months. The treatment of choice is tinidazole, with metronidazole a second option.

Intestinal Worms

These parasites are most common in rural, tropical areas. Some may be ingested in food such as undercooked meat (eg tapeworms) and some enter through your skin (eg hookworms). Consider having a stool test when you return home.

Women’s Health

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 14 and 28 weeks), when the risk of pregnancy-related problems is at its lowest and pregnant women generally feel at their best. During the first trimester, miscarriage is a risk; in the third trimester, complications such as premature labour and high blood pressure are possible. Travel with a companion and carry a list of quality medical facilities for your destination, ensuring you continue your standard antenatal care at these facilities. Avoid rural areas with poor transport and medical facilities. Above all, ensure travel insurance covers all pregnancy-related possibilities, including premature labour.

Malaria is a high-risk disease in pregnancy. The World Health Organization recommends that pregnant women do not travel to areas with chloroquine-resistant malaria.

Traveller’s diarrhoea can quickly lead to dehydration and result in inadequate blood flow to the placenta. Many drugs used to treat various diarrhoea bugs are not recommended in pregnancy. Azithromycin is considered safe.

Heat, humidity and antibiotics can all contribute to thrush. Treatment is with antifungal creams and pessaries such as clotrimazole. A practical alternative is a single tablet of fluconazole (Diflucan). Urinary tract infections can be precipitated by dehydration or long bus journeys without toilet stops; bring suitable antibiotics.

Supplies of sanitary products may not be readily available in rural areas. Birth-control options may be limited, so bring adequate supplies of your own form of contraception.

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) views the human body as an energy system in which the basic substances of (气; vital energy), jīng (精; essence), xuè (血; blood) and tǐyè (体液; body fluids, blood and other organic fluids) function. The concept of yīn (阴) and yáng (阳) is fundamental to the system. Disharmony between yīn and yáng or within the basic substances may be a result of internal causes (emotions), external causes (climatic conditions) or miscellaneous causes (work, exercise, stress etc). Treatment includes acupuncture, massage, herbs, diet and qì gōng (气功), which seeks to bring these elements back into balance. Treatments can be particularly useful for treating chronic diseases and ailments such as fatigue, arthritis, irritable bowel syndrome and some chronic skin conditions.

Be aware that ‘natural’ does not always mean ‘safe’; there can be drug interactions between herbal medicines and Western medicines. If using both systems, ensure you inform both practitioners what the other has prescribed.

Availability of Health Care

Good clinics catering to travellers can be found in major cities. They are more expensive than local facilities but you may feel more comfortable dealing with a Western-trained doctor who speaks your language. These clinics usually have a good understanding of the best local hospital facilities and close contacts with insurance companies should you need evacuation.

If you think you may have a serious disease, especially malaria, do not waste time – get to the nearest quality facility. To find the nearest reliable medical facility, contact your insurance company or your embassy. Hospitals are listed in the Information sections in cities and towns throughout the guide.