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Japanese encephalitis dilema

Posted by sunlvr on 10/9/2015 at 09:42

Trying not to be a hypochondriac after meeting with the travel doctor! My question is.... my doc does not recommend the Japanese encephalitis vaccine, but my travel companions doctors do. So, 2 out 3 recommend it. Whats your opinion on this matter?? We will be traveling the well traveled path of Phnom Penh to Siem Reap, fly to Luang Prabang bus to Vientianne, train to Bangkok. This will be from mid October to mid November. Not a lot of rural areas except that which we can reach with bicycles.

#1 sunlvr has been a member since 7/8/2014. Posts: 37

Posted by antoniamitchell on 12/9/2015 at 02:03

Hi Sunlvr,

The CDC's website recommends the vaccine for anyone planning on spending more than a month is endemic (rural) area during transmission season, and says it CAN be considered for those with shorter terms in the endemic area during transmission season IF their activities are likely to put them at greater risk (ie camping), and isn't necessary at all for those spending all their time in urban, rather than rural areas, or who are visiting outside of JE transmission season. Quite a lot of tourists will fit into the middle group, so the doctor has to use their judgement.

The other thing with the JE vaccine is that is carries it's own very small risks (as do all vaccines, truthfully, but the risks for JE are very slightly higher than for many of the others). As those risks vary from person to person, doctors have to use their judgement about whether to recommend it for a patient or not (for example, those with pre-existing allergic conditions are more likely to have a reaction, which is the reason I elected not to have it when travelling in the region, coupled with the fact that my activities weren't going to be high risk, ie., camping in a swamp).

Finally, there can be some economic issues to be considered. If you go to your GP, who admittedly isn't an expert travel doctor, they'll tend to recommend less. If you go to a private travel doctor, they sometimes recommend you have a lot more shots. Are they being ultra-cautious because they fully understand the risks, or are they taking more of a "might as well" approach and recommending more of the can-be-considered treatments because they make a profit on every one?

Hopefully that's given you some food for thought, and each person has to make their own decisions, in consultation with their medical provider. But as you say you're not planning on doing high risk activities, I'd see no reason for you not to listen to your doctor.

Have a good trip!

#2 antoniamitchell has been a member since 13/5/2012. Posts: 569

Posted by sunlvr on 16/9/2015 at 17:56

Thanks so much for replying Antonia! As always you are very well informed. :)
Think I'll be skipping that vaccine I agree with my doc and with the CDC's info dont feel it's all that necessary for this trip. I just got a little nervous with the others saying it was recommended to them.
What's your thoughts on anti-malarials? I'm torn on it.

#3 sunlvr has been a member since 7/8/2014. Posts: 37

Posted by exacto on 16/9/2015 at 18:28

I've lived, worked, and travelled in southeast Asia for about 7 years total and never took anti-malarials. It is a personal choice of course. For me, I fear that the side effect risks of the drugs outweigh the risks of catching malaria, and so far that has worked out well. Someone who caught malaria would likely see it very differently.

With malaria or the JE you mentioned above, an important part of keeping healthy is to protect yourself against mozzie bites, which you do by covering up, particularly at dusk and dawn, wearing a good repellent (I usually wait and buy a local brand on arrival, as they seem to work better than what I've brought from home), eating healthy, getting enough rest, and all those other things.

If I were going into particularly rural or otherwise high-risk areas, I might re-consider, but my travel usually isn't in rural or high-risk areas.

I'll be interested to hear Antonia's follow-up response, and with any luck Tilapia will reply too, as he is also very knowledgeable on health-related issues. Regards.

#4 exacto has been a member since 12/2/2006. Location: United States. Posts: 2,840

Posted by antoniamitchell on 17/9/2015 at 00:47

Hi again,

TBH, I pretty much follow the CDC advice on malarials as well.

I spent 3.5 months travelling around Thailand, Malaysia and Vietnam a few winters ago and didn't take any malarials (all the areas I was visiting were classified as low risk overall, or low risk in the months I was there). I also went to Burma for 3 weeks last summer, and did take malarials for the period when I was up country (as the CDC lists the rural areas as moderate risk, and I was there at the start of the wet season so I was expecting lots of mosquitoes - although to be honest I saw fewer than I expected).

Exacto's right about the bite avoidance measures, and I should have remembered to mention them. They are, by far, the most important thing you should do to protect yourself. Dengue is more common than JE or malaria in the region, and has no prophylaxis.

#5 antoniamitchell has been a member since 13/5/2012. Posts: 569

Posted by sunlvr on 7/10/2015 at 09:26

Thanks exacto and antonia for your well informed replies. I ended up not doing JE, but do have the anti-malarials and probably will take them since it is the rainy season. Will definitely be using mozzie repellent as the little buggers seem to love me. :)

#6 sunlvr has been a member since 7/8/2014. Posts: 37

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