1

I don't know enough about JE. YOu should do more research on the disease itself in order to weigh up the risks. That's what i do.

I haven't spent much time in south east asia. I think most travellers to south east asia don't get rabies vaccinaitions. I don't think it would be normally recommended for what you are doing by the sounds of it.

If you are not going to do it, make sure you understand what the after bite treatment is all about in detail!!. Ie wash the wound thoroughly first. A very important step however small the wound. Then get the shots as soon as you can. get the IG shot, consider going home or leaving the country. do whatever you have to do to get that IG shot. If you don't know what i am talking about then read up on the WHO AND CDC and other websites. Learn about the IG shot. Its rare.

Its not a daft question. Being ignorant about the risk and how to minimise them s is daft. Make sure you know what to do if a dog or other animal bites you.

If you get bitten and are not sure what to do, jump on here and we will help if we can.

2

Japanese encephalitis is primarily a disease of pigs and some birds. It is spread by mosquitoes that breed around rice fields and hang out in pig sties. It tends to occur seasonally, in outbreaks. You can read up on individual countries here

Immunization is usually recommended for people who will be spending a lot of time in farming areas during the transmission season. The US CDC says that people who will stay for more than a month in JE areas during the transmission season, as well as

3

Rabies is always a tough call--you have to weigh the risk of exposure, the availability of treatment at your destination, and the cost of the immunizations.

If SEA includes Bali, you should be aware that there is a current outbreak of rabies there, and people have reported that they had to go to Bangkok or Singapore to find immune globulin. The situation is improving, but it's something to think about.

I'm going to copy a previous post of mine, with a few changes:

Preventive rabies vaccination is called "pre-exposure vaccination." It is a series of three shots given over a month. Rabies vaccination does not make you truly immune--not like, say, measles shots. What it does do, is buy you a little time to get treatment and reduce the treatment regime.

If you have not been previously vaccinated, and are bitten by a potentially rabid animal, treatment is one shot of rabies immune globulin (RIG--ready-made antibodies against rabies), as soon as possible, plus a series of rabies vaccine shots over the course of a month (may be fewer shots over the course of a couple of weeks, depending on the vaccine used.) One serious problem is that in many countries, RIG may be hard to find and will probably be very expensive. I've seen reports of US$1,000. I'd be rather concerned about Mongolia, both for risk and for availability of treatment.

If you get the pre-exposure vaccination, then you do not need the RIG. The after-bite treatment is two shots of vaccine, three days apart.

Pre-exposure vaccination is almost always very expensive and not covered by national health or private insurance programs.

Generally, pre-exposure immunization is not recommended for people on safari. One factor is--are you doing anything that might put you at more serious risk of exposure, such as working with animals or cycling?

For a trip like yours, you should be investing in really good travel medical insurance on general principles. This would get you evacuated to a place where you can be treated. Some people feel that putting the money they would have spent on rabies immunization into insurance is a better investment.

4

Thanks both for your support with this. We are going to have the rabies pre-exposure vaccination, especially as we are 2.5 weeks in Mongolia and at this stage not sure whereabout we will go within the country. We won't be working with animals or cycling in Mongolia but will be cycling in parts of China. We won't be going to Bali, just concentrating on Vietnam, Cambodia and Malaysia. I believe we have invested in good travel medical insurance and peace of mind far outweigh the cost, so actually feel better for having made the decision and have the first appointment this weekend. Hopefully all will be OK and will report back if any issues!

Thanks again for the info and advice.

Heather

5

Is there a lot of rabies in mongolia and china?

6

It may not just be about the risk of rabies there, but availability of treatment and risk of a bite. There are not many people who are bitten that decide not to seek treatment based on the fact the risk is low. How much human immune globulin you require is based on body weight and is really expensive (as Nutrax says an average size european male would cost close to $1000). In countries /regions where people are poor it is not going to be stocked and in the case of a bad bite you don't have long to find a source.