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Health

Health issues (and the quality of medical facilities) vary enormously depending on where you are in Vietnam. The major cities are generally not high risk and have good facilities, though rural areas are another matter.

Travellers tend to worry about contracting infectious diseases in Vietnam, but serious illnesses are rare. Accidental injury (especially traffic accidents) account for most life-threatening problems. That said, a bout of sickness is a relatively common thing. The following advice is a general guide only.

Before You Go

  • Pack any medications in clearly labelled containers.
  • Bring a letter from your doctor describing your medical conditions and medications.
  • If carrying syringes or needles, have a physician’s letter documenting their medical necessity.
  • If you have a heart condition, bring a copy of a recent ECG.
  • Bring extra supplies of any regular medication (in case of loss or theft).

Health Insurance

Even if you are fit and healthy, don’t travel without health insurance – accidents do happen. If your health insurance doesn’t cover you for medical expenses abroad, get extra insurance – check our website (www.lonelyplanet.com) for more information. Emergency evacuation is expensive – bills of US$100,000 are not unknown – so make sure your policy covers this.

Recommended Vaccinations

The only vaccination required by international regulations is yellow fever. Proof of vaccination will only be required if you have visited a country in the yellow-fever zone within six days of entering Vietnam.

Most vaccines don’t produce immunity until at least two weeks after they’re given, so visit a doctor four to eight weeks before departure.

Required & Recommended Vaccinations

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

Adult diphtheria and tetanus Single booster recommended if you’ve had none in the previous 10 years.

Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection.

Hepatitis B Now considered routine for most travellers. Given as three shots over six months. A rapid schedule is also available, as is a combined vaccination with Hepatitis A. Lifetime protection occurs in 95% of people.

Measles, mumps and rubella Two doses of MMR are required unless you have had the diseases. Many young adults require a booster.

Typhoid Recommended unless your trip is less than a week and only to developed cities. The vaccine offers around 70% protection and lasts for two or three years.

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

Long-term Travellers

These vaccinations are recommended for people travelling for more than one month, or those at special risk:

Japanese B encephalitis Three injections in all. A booster is recommended after two years. A sore arm and headache are the most common side effects reported.

Meningitis Single injection.

Rabies Three injections in all. A booster after one year will provide 10 years of protection.

Tuberculosis Adults should have a TB skin test before and after travel, rather than the vaccination.

Medical Checklist

Recommended, but not exhaustive, items for a personal medical kit:

  • antibacterial cream, eg mupirocin
  • antihistamines for allergies, eg cetirizine for daytime and promethazine for night
  • antiseptic for cuts and scrapes, eg iodine solution such as Betadine
  • DEET-based insect repellent
  • diarrhoea ‘stopper’, eg loperamide
  • first-aid items, such as scissors, plasters (such as Band-Aids), bandages, gauze, safety pins and tweezers
  • paracetamol or ibuprofen for pain
  • steroid cream for allergic/itchy rashes, eg 1% hydrocortisone
  • sunscreen
  • antifungal treatments for thrush and tinea, eg clotrimazole or fluconazole

Websites

There’s a wealth of travel-health advice on the internet.

In Vietnam

Infectious Diseases

Malaria

For such a serious and potentially deadly disease, there is an enormous amount of misinformation concerning malaria. You must get expert advice as to whether your trip actually puts you at risk. Many parts of Vietnam, particularly city and resort areas, have minimal to no risk of malaria, including Danang, Hanoi, Ho Chi Minh City and Nha Trang. For most rural areas, however, the risk of contracting the disease far outweighs the risk of any tablet side effects. Travellers to isolated areas in high-risk regions such as Ca Mau and Bac Lieu provinces, and the rural south, may like to carry a treatment dose of medication for use if symptoms occur. Remember that malaria can be fatal. Before you travel, seek medical advice on the right medication and dosage for you.

Malaria is caused by a parasite transmitted by the bite of an infected mosquito. The most important symptom of malaria is fever, but general symptoms such as headache, diarrhoea, cough or chills may also occur. Diagnosis can only be made by taking a blood sample.

Two strategies should be combined to prevent malaria – mosquito avoidance and antimalarial medications.

Malaria Prevention

  • Choose accommodation with screens and fans (if not air-conditioned).
  • Impregnate clothing with permethrin in high-risk areas.
  • Sleep under a mosquito net.
  • Spray your room with insect repellent before going out for your evening meal.
  • Use a DEET-containing insect repellent on all exposed skin, particularly the ankle area. Natural repellents such as citronella can be effective but must be applied frequently.
  • Use mosquito coils.
  • Wear long sleeves and trousers in light colours.

Malaria Medication

There are various medications available.

Chloroquine & Paludrine The effectiveness of this combination is now limited in Vietnam. Generally not recommended.

Doxycycline A broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis, tick-borne disease, typhus and melioidosis. Potential side effects include a tendency to sunburn, thrush in women, indigestion and interference with the contraceptive pill. It must be taken for four weeks after leaving the risk area.

Lariam (mefloquine) Receives a lot of bad press, some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and seizures. It’s around 90% effective in Vietnam.

Malarone Side effects are uncommon and mild, most commonly nausea and headaches. It is the best tablet for scuba-divers and for those on short trips to high-risk areas.

A final option is to take no preventive medication but to have a supply of emergency medication (Malarone is usually recommended: four tablets once daily for three days) should you develop the symptoms of malaria. This is less than ideal, and you’ll still need to get to a good medical facility within 24 hours of developing a fever.

Typhoid

This serious bacterial infection is spread via food and water. It gives a high, slowly progressive fever and headache. Vaccination is recommended for all travellers spending more than a week in Vietnam, or travelling outside of the major cities. Be aware that vaccination is not 100% effective so you must still be careful with what you eat and drink.

Hepatitis A

A problem throughout the region, this food- and water-borne 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 Vietnam should be vaccinated against hepatitis A.

Tuberculosis

Tuberculosis (TB) is very rare in short-term travellers. Medical and aid workers, and long-term travellers who have significant contact with the local population should take precautions. Vaccination is usually only given to children under the age of five, but it is recommended that at-risk adults have pre- and post-travel TB testing. The main symptoms are fever, cough, weight loss, night sweats and tiredness.

Hepatitis B

The only serious sexually transmitted disease that can be prevented by vaccination, hepatitis B is spread by body fluids, including sexual contact. In some parts of Southeast Asia up to 20% of the population are carriers of hepatitis B, and usually are unaware of this. The long-term consequences can include liver cancer and cirrhosis.

Measles

Measles remains a problem in Vietnam, including the Hanoi area. Many people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash but can be complicated by pneumonia and brain disease. There is no specific treatment.

STDs

Condoms, widely available throughout Vietnam, are effective in preventing the spread of most sexually transmitted diseases. However they may not guard against genital warts or herpes. If after a sexual encounter you develop any rash, lumps, discharge or pain when passing urine, seek immediate medical attention.

Rabies

This uniformly fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. Seek medical advice immediately after any animal bite and start post-exposure treatment. Having a pre-travel 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 vaccinated you will need to receive rabies immunoglobulin as soon as possible.

Schistosomiasis

Schistosomiasis (also called bilharzia) is a tiny parasite that enters your skin after you’ve been swimming in contaminated water. If you are concerned, you can be tested three months after exposure. Symptoms are coughing and fever. Schistosomiasis is easily treated with medications.

Japanese B Encephalitis

This viral disease is transmitted by mosquitoes. It’s very rarely caught by travellers but vaccination is recommended for those spending extended time in rural areas. There is no treatment; a third of infected people will die while another third will suffer permanent brain damage.

Bird Flu

The bird flu virus rears its head from time to time in Vietnam. It occurs in clusters, usually among poultry workers. It's rarely fatal for humans. When outbreaks do occur, eggs and poultry are banished from the menu in many hotels and restaurants.

Dengue

This mosquito-borne disease is becoming increasingly problematic in Southeast Asia. Several hundred thousand people are hospitalised with dengue haemorrhagic fever in Vietnam every year, but the fatality rate is less than 0.3%. As there is no vaccine available, it can only be prevented by avoiding mosquito bites. The mosquito that carries dengue bites throughout the day and night, so use insect-avoidance measures at all times. Symptoms include a high fever, a severe headache and body aches (dengue was once known as ‘breakbone fever’). Some people develop a rash and experience diarrhoea. There is no specific treatment, just rest and paracetamol – do not take aspirin as it increases the likelihood of haemorrhaging. See a doctor to be diagnosed and monitored.

HIV

The official figures on the number of people with HIV/AIDS in Vietnam are vague, but they are on the rise. Health-education messages relating to HIV/AIDS are visible all over the countryside, but the official line is that infection is largely limited to sex workers and drug users. Condoms are widely available throughout Vietnam.

Typhus

Murine typhus is spread by the fleas of rodents whereas scrub typhus is spread via a mite. These diseases are rare in travellers. Symptoms include fever, muscle pains and a rash. You can avoid these diseases by following general insect-avoidance measures. Doxycycline will also help prevent them.

Travellers’ Diarrhoea

Travellers’ diarrhoea is by far the most common problem affecting travellers – between 30% and 50% of people will suffer from it within two weeks of starting their trip. In over 80% of cases, travellers’ diarrhoea is caused by a bacteria, and therefore responds promptly to treatment with antibiotics. It can also be provoked by a change of diet, and your stomach may settle down again after a few days.

Treatment consists of staying hydrated, or you could take rehydration solutions.

Loperamide is just a ‘stopper’ and doesn’t get to the cause of the problem. It is helpful if you have to go on a long bus ride, but don’t take loperamide if you have a fever or blood in your stools.

Amoebic Dysentery

Amoebic dysentery is very rare in travellers. Symptoms are similar to bacterial diarrhoea (eg fever, bloody diarrhoea and generally feeling unwell). Treatment involves two drugs: tinidazole or metronidazole to kill the parasite and a second to kill the cysts.

Giardiasis

Giardia lamblia is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis, but they are not specific to this infection. The treatment of choice is tinidazole.

Environmental Hazards

Heat

Many parts of Vietnam are hot and humid throughout the year. Take it easy when you first arrive. Avoid dehydration and excessive activity in the heat. Drink rehydration solution and eat salty food.

Heat exhaustion Symptoms include feeling weak, headaches, irritability, nausea or vomiting, sweaty skin and a fast, weak pulse. Cool down in a room with air-conditioning and rehydrate with water containing a quarter of a teaspoon of salt per litre.

Heatstroke This is a serious medical emergency. Symptoms come on suddenly and include weakness, nausea, a temperature of over 41°C, dizziness, confusion and eventually collapse and loss of consciousness. Seek medical help and start cooling by following cooling treatment.

Prickly heat A common skin rash in the tropics. Stay in an air-conditioned area for a few hours and take cool showers.

Bites & Stings

Bedbugs These don’t carry disease but their bites are very itchy. Move hotel, and treat the itch with an antihistamine.

Jellyfish In Vietnamese waters most are not dangerous, just irritating. Pour vinegar (or urine) onto the affected area. Take painkillers, and seek medical advice if you feel ill in any way. Take local advice if there are dangerous jellyfish around and keep out of the water.

Leeches Found in humid forest areas. They do not transmit any disease but their bites can be intensely itchy. Apply an iodine-based antiseptic to any leech bite to help prevent infection.

Snakes Both poisonous and harmless snakes are common in Vietnam, though very few travellers are ever bothered by them. Wear boots and avoid poking around dead logs and wood when hiking. First aid in the event of a snakebite involves pressure immobilisation via an elastic bandage firmly wrapped around the affected limb, starting at the bite site and working up towards the chest. The bandage should not be so tight that the circulation is cut off, and the fingers or toes should be kept free so the circulation can be checked. Immobilise the limb with a splint and carry the victim to medical attention. Do not use tourniquets or try to suck the venom out. Antivenom is available only in major cities.

Ticks Contracted during walks in rural areas. If you have had a tick bite and experience symptoms such as a rash (at the site of the bite or elsewhere), fever or muscle aches, you should see a doctor. Doxycycline prevents tick-borne diseases.

Air Pollution

Air pollution, particularly vehicle pollution, is severe in Vietnam’s major cities. If you have severe respiratory problems consult your doctor before travelling.

Food

Eating in restaurants is the biggest risk factor for contracting travellers’ diarrhoea. Ways to avoid it include eating only freshly cooked food, and avoiding shellfish and buffets. Peel all fruit and try to stick to cooked vegetables. Eat in busy restaurants with a high turnover of customers.

Sunburn

  • Even on a cloudy day, sunburn can occur rapidly.
  • Always use a strong sunscreen (at least factor 30).
  • Reapply sunscreen after swimming.
  • Wear a hat.
  • Avoid the sun between 10am and 2pm.

Skin Problems

Fungal rashes Common in humid climates. Moist areas that get less air, such as the groin, armpits and between the toes, are often affected. Treatment involves using an antifungal cream such as clotrimazole. Consult a doctor.

Cuts and scratches Minor cuts and scratches can become infected easily in humid climates and may fail to heal because of the humidity. Take meticulous care of any wounds: immediately wash in clean water and apply antiseptic.

Availability & Cost of Health Care

The significant improvement in Vietnam’s economy has brought with it some major advances in public health. However, in remote parts, local clinics will only have basic supplies – if you become seriously ill in rural Vietnam, get to HCMC, Danang or Hanoi as quickly as you can. For surgery or other extensive treatment, don’t hesitate to fly to Bangkok, Singapore or Hong Kong.

Private Clinics

These should be your first port of call. They are familiar with local resources and can organise evacuations if necessary. The best medical facilities – in Hanoi, HCMC and Danang – have health facility standards that come close to those in developed countries.

State Hospitals

Most are overcrowded and basic. In order to treat foreigners, a facility needs to obtain a special licence and so far only a few have been provided.

Self-Treatment

If your problem is minor (eg travellers’ diarrhoea) this is an option. If you think you may have a serious disease, especially malaria, do not waste time – travel to the nearest quality facility to receive attention.

Buying medication over the counter is not recommended, as fake medications and poorly stored or out-of-date drugs are common. Check expiry dates on all medicines.

Tap Water

Be very careful of what you drink. Tap water is heavily chlorinated in urban areas, but you should still avoid it. Stick to bottled water, which is available everywhere. Ice is generally safe in the cities and resorts, and is often added to drinks and coffee.

Women’s Health

Supplies of sanitary products are readily available in urban areas. Birth control options may be limited, so bring adequate stocks.

Pregnant women should receive specialised advice before travelling. The ideal time to travel is in the second trimester (between 16 and 28 weeks), during which the risk of pregnancy-related problems is at its lowest. Some advice:

Rural areas Avoid remote areas with poor transportation and medical facilities.

Travel insurance Ensure you’re covered for pregnancy-related possibilities, including premature labour.

Malaria None of the more effective antimalarial drugs are completely safe in pregnancy.

Travellers’ diarrhoea Many diarrhoea treatments are not recommended during pregnancy. Azithromycin is considered safe.