I have just met with my nurse who said that she personally doesn't advise either japanese encephalitis or cholera for our trip. Everywhere else online seems to suggest it.
We are going to Indonesia (Flores, Bali, Java) for about 4 weeks, Malaysian borneo (Sabah) for 2 weeks, Lankawi for 1 week and Thailand for about 6 weeks and Vietnam for two.
I'd prefer not to have them if I don't need them but I want to make sure by not having them we aren't at risk.
I would go with your nurse. Rather than someone on a travel forum. What does the FCO advise on it?
With Japanese Encephalitis there is about 2 cases per 100,000 population a year and about a quarter of them die. You are not going to the parts of Asia with particularly high rates and it is an expensive vaccine so I would agree with the nurse you consulted. Cholera used to have an international vaccination certificate (like yellow fever and smallpox) but it was done away with, the vaccine is not 100% effective, the risk particularly for an adult is not huge and treatment is effective so I would also agree with the nurse you consulted.
Japanese Encephalitis is primarily a disease of pigs and birds. It is spread by mosquitoes that breed in rice fields & hang out in pig sties. If you will not be spending a lot of time in farming areas, you may not need this. It does tend to occur in outbreaks. Immunization is usually recommended for people who will be spending more than a month in high risk areas or doing high risk activities. Here is how the US CDC describes those activities:
Examples of higher-risk activities or itineraries include 1) spending substantial time outdoors in rural or agricultural areas, especially during the evening or night; 2) participating in extensive outdoor activities (such as camping, hiking, trekking, biking, fishing, hunting, or farming); and 3) staying in accommodations without air conditioning, screens, or bed nets.
Immunization is also recommended for people going to areas with an active outbreak. I did not find reports of a current outbreak in any of the areas you will be visiting.
Sabah is not considered a high risk area. In Indonesia, Bali might be the highest risk area, but only if you spend a lot of time outside of resort areas. In Thailand, the highest risk is in the north, May-October. In Vietnam, the highest risk is north of Hanoi and in areas bordering China.
Unless you are going to be spending a lot of time outdoors or are researching mosquitoes or something, I think your nurse made a good call. Preventing mosquito bites is important, and since you will be in some prime malaria areas (especially Sabah) and places with dengue, you'll want to do that anyway.
For most travelers, risk of cholera is very low. Immunization (which is indeed not fully effective) is usually recommended for those at special risk--people working in refugee camps, disaster relief, or doing aid work in areas of very poor sanitation.
#1, she did consult a travel clinic but I guess wants anecdotal confirmation from other travellers that she won't be at risk.
If mosquitoes are out and about, make sure you cover up and use a low percentage DEET spray. That is also the only thing to guard against Dengue fever.
Immunization against cholera is not very useful.
"My" travel clinic don't use it since a long time...
Michel
Thank you very much. I have seen my nurse and I am booked in on Tuesday to go to Boots for a consultation.
I am surprised as my GP says they have no typhoid, hep a or cholera. Therefore I have found Boots seems to be the cheapest place to be vaccinated and the above plus Rabies and Japanese Encephalitus will cost me £512 which is astronomical!
Regarding the price, I will not be helpful at all.
I'm from Belgium and the price is not the same at all.
Michel
Some people choose to use the money they would have spent on rabies to buy really good travel health insurance, including medical evacuation. That could be used to get you to Bangkok, Singapore, Hong Kong or even Australia if necessary for treatment should you be bitten. You should also be able to get good rabies treatment in Hanoi, Saigon, and certainly Singapore (and, I now know, Phnom Penh). There is an excellent rabies clinic in Bangkok.
This is my standard rabies post, a bit modified:
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 time to get treatment and reduce the treatment regime. If you get the pre-exposure vaccination, then the after-bite treatment is two shots of vaccine, three days apart. You also have a latitude of a few more days to get to treatment.
There is no fixed amount of time you have to get treatment after being bitten. It depends on the location & the severity of the bite. A mauling to the head is a big emergency; a nip on the ankle is urgent but not an emergency. Obviously, though, sooner is better; you should never delay getting treatment as soon as you can.
If you were not previously vaccinated, then you need a shot of rabies immune globulin (RIG) and a series of five shots of vaccine given over the course of a month. The vaccine may be hard to find in remote areas.
RIG can be hard to find (there is a worldwide shortage) and can be expensive. I've seen reports of US$1000 or more for human RIG. You may be offered immunoglobulin derived from horse serum (ERIG) as an alternative. The main problem with ERIG is that it can cause serious allergic reactions. You can be given immune globulin up to 7days after you start getting the vaccine, so you can get the vaccine at some rural location (if you can find it) and then head to a big city for the rest.
