Vietnam Staying Healthy

Common sense is the simplest prescription for good health while you travel. Drink lots of water to prevent dehydration and constipation, and wear sturdy, broken-in shoes and clean socks. Avoid tap water and ice throughout Vietnam, and use bottled water to brush your teeth.

Environmental Hazards

High Altitude: Allow your body a few days to adjust to lower oxygen levels before exerting yourself. Alcohol is more potent and UV rays are stronger at high elevations.
Heat exhaustion and dehydration: Vietnam can be oppressively hot between March and October; the southern half of the country is susceptible to extremely hot days at any time of year. Heat exhaustion leads to nausea, excessive thirst, headaches, and dizziness. Avoid it by drinking plenty of fluids, eating salty foods (e.g., crackers), abstaining from dehydrating beverages (e.g., alcohol and caffeinated beverages), and wearing sunscreen. Continuous heat stress can eventually lead to heatstroke, characterized by a rising temperature, severe headache, delirium, and cessation of sweating. Victims should be cooled off with wet towels and taken to a doctor. Rehydration powders (like Gatorade®) that have sodium and carbohydrates in the solution are good to have, especially if the water you’ll be drinking from doesn’t taste so good.
Hypothermia and frostbite: A rapid drop in body temperature is the clearest sign of overexposure to cold. Victims may also shiver, feel exhausted, have poor coordination or slurred speech, hallucinate, or suffer amnesia. Do not let hypothermia victims fall asleep. To avoid hypothermia, keep dry, wear layers, and stay out of the wind. When the temperature is below freezing, watch out for frostbite. If skin turns white or blue, waxy, and cold, do not rub the area. Drink warm beverages, stay dry, and slowly warm the area with dry fabric or steady body contact until a doctor can be found.
Sunburn: Always wear sunscreen (SPF 30 or higher) when spending excessive amounts of time outdoors. If you get sunburned, drink more fluids than usual and apply an aloe-based lotion once the burn has cooled. Severe sunburns can lead to sun poisoning, a condition that can cause fever, chills, nausea, and vomiting. Sun poisoning should always be treated by a doctor.

Insect-Borne Diseases

Many diseases are transmitted by insects—mainly mosquitoes, fleas, ticks, and lice. Be aware of insects in wet or forested areas, especially while hiking and camping; wear long pants and long sleeves, tuck your pants into your socks, and use a mosquito net. Use insect repellents with DEET and soak or spray your gear with permethrin (licensed in the US only for use on clothing). Mosquitoes—responsible for malaria, dengue fever, yellow fever, and Japanese encephalitis, among others—can be particularly dangerous in wet, swampy, or wooded areas, which characterize the majority of rural Vietnam.

Dengue fever: An “urban viral infection” transmitted by Aedes mosquitoes, which bite during the day rather than at night. The incubation period can be as long as 14 days, but it’s usually 4-7. Early symptoms include a high fever, severe headaches, swollen lymph nodes, and muscle aches. Many patients also suffer from nausea, vomiting, and a pink rash. If you experience these symptoms, see a doctor immediately, drink plenty of water, and take fever-reducing medication such as acetaminophen (Tylenol®). Never take aspirin to treat dengue fever. There is no vaccine available for dengue fever.
Japanese Encephalitis: Another mosquito-borne disease, most prevalent during the rainy season in rural, agricultural areas near rice fields and livestock pens. Aside from delirium, most symptoms are flu-like: chills, headache, fever, vomiting, muscle fatigue. As the disease has a high mortality rate, it’s vital to go to a hospital as soon as any symptoms appear. While the JE-VAX vaccine, usually given in 3 shots over a 30-day period, is effective for a year, it has been associated with serious side effects. According to the CDC, there is little chance of being infected if proper precautions are taken, such as using mosquito repellents containing DEET and sleeping under mosquito nets.
Lymphatic filariasis: A roundworm infestation transmitted by mosquitoes. Infection causes enlargement of extremities and has no vaccine.
Malaria: Transmitted by Anopheles mosquitoes that bite at night. The incubation period varies anywhere between 10 days and 4 weeks. Early symptoms include fever, chills, aches, and fatigue, followed by high fever, sweating, and sometimes vomiting and diarrhea. See a doctor for any flu-like sickness that occurs after travel in a risk area. To reduce the risk of contracting malaria, use mosquito repellent, particularly in the evenings and when visiting forests. Make sure you see a doctor at least 4-6 weeks before a trip to a high-risk area to get up-to-date malaria prescriptions and recommendations. A doctor may prescribe oral prophylactics such as mefloquine or doxycycline. Mefloquine can have serious side effects, including paranoia, psychotic behavior, and nightmares.

Food- And Water-Borne Diseases

Prevention is the best cure: be sure that your food is properly cooked and your drinking water is clean. Peel fruits and vegetables before eating them and avoid tap water (including ice cubes and anything washed in tap water, like salad). Watch out for food from markets or street vendors that may have been cooked in unhygienic conditions. Other culprits are raw shellfish, unpasteurized milk, and sauces containing raw eggs. Buy bottled water (cheap and ubiquitous in Vietnam), or purify your own water by bringing it to a rolling boil or treating it with iodine tablets; note, however, that some parasites such as giardia have exteriors that resist iodine treatment, so boiling is more reliable. Always wash your hands before eating or bring a quick-drying purifying liquid hand cleaner. Street food in general should be safe, but use your common sense. Many travelers find that food poisoning is most common in Western dishes served at tourist-oriented restaurants rather than in recipes more familiar to Vietnamese cooks.

Cholera: An intestinal disease caused by bacteria in contaminated food. Symptoms include diarrhea, dehydration, vomiting, and muscle cramps. See a doctor immediately; if left untreated, cholera can be lethal within hours. Antibiotics are available, but the most important treatment is rehydration. No vaccine is available in the US.
Dysentery: Results from an intestinal infection caused by bacteria in contaminated food or water. Common symptoms include bloody diarrhea, fever, and abdominal pain and tenderness. The most common type of dysentery lasts for only a week, but it is highly contagious. Seek medical help immediately. Dysentery can be treated with the drugs norfloxacin or ciprofloxacin (commonly known as Cipro). If you are traveling in especially rural regions, consider obtaining a prescription before you leave home.
Giardia: Transmitted through parasites and acquired by drinking untreated water from streams or lakes. Symptoms include diarrhea, cramps, bloating, fatigue, weight loss, and nausea. If untreated it can lead to severe dehydration. Giardiasis occurs worldwide.
Hepatitis A: A viral infection of the liver acquired through contaminated water or shellfish. Symptoms include fatigue, fever, loss of appetite, nausea, dark urine, jaundice, vomiting, aches and pains, and light stools. The risk is highest in rural areas and the countryside, but it is also present in urban areas. Ask your doctor about the Hepatitis A vaccine or an injection of immune globulin (IG).
Leptospirosis: A bacterial disease caused by exposure to fresh water or soil contaminated by the urine of infected animals. Able to enter the human body through cut skin, mucus membranes, and by ingestion, it is most common in tropical climates, including some tropical areas in Vietnam. Symptoms include a high fever, chills, nausea, and vomiting. If left untreated, it can lead to liver failure and meningitis. There is no vaccine; consult a doctor for treatment.
Traveler’s diarrhea: Results from drinking fecally-contaminated water or eating uncooked and contaminated foods. Symptoms include nausea, bloating, and urgency. Try quick-energy, non-sugary foods with protein and carbohydrates to keep your strength up. Over-the-counter anti-diarrheals (e.g., Imodium®) may counteract the problem. The most dangerous side effect is dehydration; drink 8 oz. of water with tsp. of sugar or honey and a pinch of salt, try decaffeinated soft drinks, or eat salted crackers. If you develop a fever or your symptoms don’t go away after 4-5 days, consult a doctor. Consult a doctor immediately for treatment of diarrhea in children.
Typhoid fever: Caused by the salmonella bacteria; common in villages and rural areas in Vietnam. While mostly transmitted through contaminated food and water, it may also be acquired by direct contact with another person. Early symptoms include high fever, headaches, fatigue, appetite loss, constipation, and a rash on the abdomen or chest. Antibiotics can treat typhoid, but a vaccination (70-90% effective) is recommended.

Other Infectious Diseases

The following diseases exist in every part of the world. Travelers should know how to recognize them and what to do if they suspect they have been infected.

AIDS and HIV: Acquired Immune Deficiency Syndrome (AIDS), caused by Human Immunodeficiency Virus (HIV), attacks and eventually disables the immune system, making common colds and diseases fatal for virus carriers. AIDS has been on the rise throughout Asia in recent years. For information on AIDS/HIV in Vietnam, call the US Center for Disease Control’s 24hr. hotline at ☎800-342-2437. Also see The AIDS Crisis.
Avian Influenza (Bird flu): A virulent strain of flu largely restricted to birds; cases of bird-to-human transmission in Vietnam and Thailand in early 2004 led to international fears that a SARS-like outbreak was imminent, which fortunately was not the case (though 36 people have died in Vietnam since). There have been no recorded cases of human-to-human transmission, and travelers who avoid large-scale contact with poultry and their feces shouldn’t be at any risk. See The Bird Flu Outbreak, for more info.
Hepatitis B: A viral infection of the liver transmitted via blood or other bodily fluids. Symptoms, which may not surface until years after infection, include jaundice, appetite loss, fever, and joint pain. It is transmitted through unprotected sex and unclean needles. A 3-shot vaccination sequence begun 6 months before traveling is recommended for sexually active travelers and anyone planning to seek medical treatment abroad.
Rabies: Transmitted through the saliva of infected animals; fatal if untreated. By the time symptoms (thirst and muscle spasms) appear, the disease is in its terminal stage. If you are bitten, wash the wound, seek immediate medical care, and try to have the animal located. A rabies vaccine, which consists of 3 shots given over a 21-day period, is available and recommended for developing world travel, but is only semi-effective.
Sexually transmitted infections (STIs): Gonorrhea, chlamydia, genital warts, syphilis, herpes, and other STIs are easier to catch than HIV and can be just as serious. Though condoms may protect you from some STIs, oral or even tactile contact can lead to transmission. If you think you may have contracted an STD, see a doctor immediately.

Other Health Concerns

Medical Care On The Road

The radical disparity between Vietnam’s haves and have-nots characterizes the country’s hospitals, as with so many other things. Most hospitals are state-run and are in mediocre condition; their facilities don’t have the kind of absolute hygiene to which Westerners seeking medical care might be accustomed (be wary of blood hygiene—this is yet another reason to make sure you get vaccinated for Hepatitis A and B). Their general state of disrepair can be disconcerting. Privately run hospitals are a different story; patients are treated with state-of-the-art technology and in completely sterile conditions. A single consultation at one will cost over US$50. Private hospitals primarily serve expats and tourists and can only be found in Vietnam’s biggest and most popular cities, like Hà Nÿi, HCMC, and Nha Trang.

If you are concerned about obtaining medical assistance while traveling, you may wish to employ special support services. The MedPass from GlobalCare, Inc., 6875 Shiloh Rd. East, Alpharetta, GA 30005, USA (☎800-860-1111; www.globalcare.net), provides 24hr. international medical assistance, support, and medical evacuation resources. The International Association for Medical Assistance to Travelers (IAMAT; Canada ☎519-836-0102, US 716-754-4883; www.iamat.org) has free membership, lists English-speaking doctors worldwide, and offers detailed info on immunization requirements and sanitation. If your regular insurance policy does not cover travel abroad, you may wish to purchase additional coverage .

Those with medical conditions (such as diabetes, allergies to antibiotics, epilepsy, or heart conditions) may want to obtain a MedicAlert membership (first year US$35, annually thereafter US$20), which includes among other things a stainless steel ID tag and a 24hr. collect-call number. Contact the MedicAlert Foundation, 2323 Colorado Ave., Turlock, CA 95382, USA (US ☎888-633-4298, elsewhere 209-668-3333; www.medicalert.org).

Women’S Health

Women traveling in unsanitary conditions are vulnerable to urinary tract (including bladder and kidney) infections (UTIs). Over-the-counter medicines can sometimes alleviate symptoms, but if they persist, see a doctor. Vaginal yeast infections may flare up in hot and humid climates. Wearing loosely fitting trousers or a skirt and cotton underwear will help, as will over-the-counter remedies like Monistat® or Gynelotrimin. Bring supplies from home if you are prone to infection, as they may be difficult to find on the road. Tampons, pads, and contraceptive devices are widely available in Vietnam, but your favorite brand probably won’t be stocked—bring extras of anything you can’t live without. Abortion is legal in Vietnam; contact the Vietnam Family Planning Association (VINAPFPA; vinafpa@hn.vnn.vn).