Guidelines
It's advisable to get vaccinations for hepatitis A (and possibly B), polio, rabies, typhoid and tuberculosis, but those for cholera are reputedly ineffective, even counter-productive. If you do decide to have several injections, plan your course at least four weeks in advance. Arrivals from Africa or Latin America must be vaccinated for yellow fever. All travelers should have had tetanus and diphtheria boosters, and checked their measles, mumps and rubella immunization is complete. High AIDS awareness means needles aren't reused, so no need to bring a syringe pack unless it's for insulin etc. Some vaccinations require shots weeks apart, so enquire at least six weeks before departure. Avoid wading in floodwater, which may be infectious from rat urine or drain overflow.

Thanks to eradication programmes, malaria is only an issue on the Burma, Laos or Cambodia borders and in remoter forested parts of Thailand. Thai tropical medicine experts often caution against malaria prophylaxis due to resistant strains of the disease and sometimes severe side effects (particularly front Larium)-if you plan to go trekking or visit border areas, consult a specialist. Not getting bitten is the best protection, so wear white and use insect repelling lotions Qaico is reliable), sprays, coils and electric tabs. Most rooms have screens or nets.

That's also the only defence against hemorrhagic dengue fever (kai leuad ok), which has increased throughout the tropics, notably in cities during rainy season. Passed on by the daytime, striped legged Aedes mosquito, dengue has similar symptoms to malaria, but no prophylaxis or cure. It is most serious in children, the elderly and repeat sufferers. Seek early diagnosis (before the rash starts).

1: A yellow fever vaccination certificate is required from travelers over one year of age arriving from infected areas. Countries and areas included in endemic zones are considered to be infected areas.

2: Following WHO guidelines issued in 1973, a cholera vaccination certificate is not a condition of entry to Thailand. However, cholera is a serious risk in this country and precautions are essential. Up-to-date advice should be sought before deciding whether these precautions should include vaccination, as medical opinion is divided over its effectiveness.

3: Malaria risk exists throughout the year in rural areas throughout the country, especially in forested and hilly areas and around the international borders. There is no risk in cities and the main tourist resorts, e.g. Bangkok, Chiang Mai, Pattaya, Phuket and Samui. The malignant falciparum form is present and is reported to be highly resistant to chloroquine and resistant to sulfadoxine-pyrimethamine. Resistance to mefloquine and to quinine has been reported from areas near the borders with Burma and Cambodia.

4: Food and water-borne diseases are common. Use only bottled or otherwise sterilised (eg boiled) water for drinking, brushing teeth or making ice. Unpasteurised milk should also be boiled, although pasteurised or homogenised milk is available from some dairies. Tinned or powdered milk is safe as long as it is reconstituted with sterile water. Beware of dairy products that may have been made with un-boiled milk. Stick to meat and fish that have been well cooked, preferably served hot, but not reheated. Avoid raw vegetables and unpeeled fruit.

5 :Japanese encephalitis may occur, particularly in rural areas. A vaccine is available, and travelers are advised to consult their doctor prior to departure. Precautions should be taken to guard against mosquito bites due to the risk of this disease and dengue fever.

6: Amoebic and bacillary dysentery and hepatitis A and E may occur. Hepatitis B is highly endemic and trachoma is also reported. Rabies is present. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay.

7: Health Care: Health insurance is recommended. Medical facilities are good in main centers. All major hotels have doctors on call.
In the UK and Ireland, the least costly way of getting immunized is to head first to your local health centre (in the UK some immunizations are free under the NHS while other vaccines must be paid for on prescription, but all are administered at no cost by your doctor or health-centre nurse). Though most general practitioners can give advice on inoculation requirements, its a good idea to come for your appointment armed with a "Health Brief", written information tailored to your journey, provided by return of post by MASTA . However, your local health clinic may not administer some of the less common immunizations and you may have to go to a specialist travel clinic: these work out to be expensive but have the advantage of being staffed by tropical-disease specialists, some of whom are listed below on this website.
North Americans will have to pay full whack for their inoculations, available at an immunization centre - there's one in every city of any size - or most local clinics. In the US, the doctor's consultation fee is generally $75, and the inoculations cost $75-175 each.

Australians and New Zealanders can have their jabs administered by their GP for around A$35/NZ$30 per visit plus the cost of the serums. In Australia, sixty percent of the consultation fee is refundable via Medicare, though you still pay for the serums, while Healthcare card-holders are excused the consultation fee and pay only A$2.50 for medicines. In New Zealand, nothing is refundable without medical insurance. In both countries, those who have to pay will find vaccination centres less expensive than doctors' surgeries.

If you forget to have all your inoculations before leaving home, or don't leave yourself sufficient time, you can get them in Bangkok at the Australian-run Travmin Bangkok Medical Centre (see p.163 for details), though this is unlikely to work out cheaper than doing it at home. Travmin also advises on and dispenses malaria prophylactics.

USA and Canada

International Association for Medical Assistance to Travellers; 417 Center St, Lewiston t 716/754-4883; and 40 Regal Rd, Guelph, Ontario 519/836-0102. A non-profit organization supported by donations, which can provide leaflets on various diseases and inoculations. Travelers Medical Center, 31 Washington Square, New York (T) 212/982-1600. Offers a consultation service on immunizations and treatment of diseases for people travelling to developing countries.

Australia and New Zealand

Travellers' Medical and Vaccination Centres Australia: 2/393 Little Bourke St, Melbourne 03/9602 5788; 7/428 George St, Sydney (T )02/9221 7133 and branches in many other cities. New Zealand: 1/170 Queen St, Auckland (t)09/373 3531; 147 Armagh St, Christchurch 03/379 4000; Shop 15, Grand Arcade, 14-16 Willis St, Wellington 04/473 0991. Travel medicine and vaccination services.

UK and Ireland

British Airways Travel Clinics No appointments necessary at 156 Regent St, London (Mon-Fri 9.30am-5.15pm, Sat 10am-4pm; (020/7439 9584). BA also operates other appointment-only clinics in the capital and throughout the country (call 01276/685040). Hospital for Tropical Diseases Travel Clinic, 2nd Floor, Mortmer Market Centre, off Capper Street, London (Mon-Fri 9am-5pm by appointment only; (T) 020/7388 9600; £15 consultation fee is waived if you have your injections here). Their recorded Heath Line 09061/337733, 50p per min) gives hints on hygiene and illness prevention as well as listing appropriate immunizations.

MASTA (Medical Advisory Service for Travellers Abroad). Call their prerecorded 24hr Travellers' Health Line (in the UK , 0906/822 4100, 60p per min; in Ireland 1560/147000min) to request printed health information; in ~ UK they also provide up-to-date information on malaria on t 0891/600350 (24hr recorded image, 40p per minute).

Nomad pharmacy, 40 Bernard St, London, opposite Russell Square tube station; and 3-4 Turnpike Lane, London (Mon-Fri 9.30am-6pm, 1020/7833 4114 to book appointment; their telephone helpline is , 09068/633414, costing 60p a minute).

Trailfinders, 194 Kensington High St, London (on-Fri 9am-5pm, Thurs to 6pm, Sat 9.30am-4pm; , 020/7938 3999). This branch of the travel agency has a no-appointments-necessary immunization clinic.

Travel Health Centre, Dept of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Mercers Medical Centre, Stephen's St Lower, Dublin ,O1402 2337. Expert pre-trip advice and inoculations.

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