Country Specific Advice for Travel to Areas Affected by the Earthquake and Tsunamis of 26 December 2004
updated 1 April 2005
- Almost the whole length of the west coast of Thailand
- Phang Nga province, including the resorts of Phuket, Khao Lak and Krabi.
- Many of the islands in the Andaman Sea
- Services and facilities in most areas of Thailand affected by the tsunami are now operating normally. However, on the coast of Khao Lak and on Phi Phi Island , houses, shops, hotels and tourist accommodation have been destroyed and infrastructure and services remain disrupted in these areas.
- Travellers intending to visit affected areas should regularly consult the FCO website for the latest information about safety and the advisability of travelling.
- Travellers should check with tour operators to see if their intended tour is still available and that their resort is operating normally.
- Travellers should be aware that medical and emergency services are overextended and medical facilities may not be available to treat new arrivals that subsequently become ill.
- British citizens caught up in the disaster, needing assistance should contact the Embassy or the Phuket office. The British Embassy in Bangkok is on telephone number (++66) (0)2 305 8333; the office in Phuket can be contacted on (++66) (0)76 264 473/4.
- An emergency hotline has been set up for foreign nationals affected by the tsunami. This is manned 24 hours on (++66) (0)2 643 5256. Casualty information can be found on the following websites: www.disaster.go.th and http://www.narenthorn.or.th
- All travellers to Thailand should ensure they have appropriate health insurance (and should ensure that their insurance is valid, particularly if visiting areas affected by the tsunami).
Infectious disease risks
The World Health Organization has reported cases of diarrhoea in countries affected by the tsunami; they are being tested for cholera and typhoid. The risk of cholera outbreaks is of concern. Lack of adequate clean drinking water and sanitation facilities, psychosocial trauma, and overcrowding in camps contributes to heighten the risks of disease outbreaks. Updated disease information can be accessed at: http://www.who.int/hac/crises/international/asia_tsunami/tha/en/
Food and water advice
- Flooding, stagnant water and contamination of the water supply are conducive to development of diseases such as salmonellosis, campylobacteriosis, shigellosis and cholera, hepatitis A and E, and intestinal parasites including Giardia , Cryptosporidium and amoeba.
- Cases of acute diarrhoea are currently being reported by the World Health Organization
- Careful food and water hygiene precautions should be employed by travellers to the area
- Reliable sources of bottled water may not be available and it may be necessary to use water sterilisation methods. Bringing water to a boil is the most reliable method, but this may not always be practical. Using iodine or chlorine preparations to purify water are usually effective but protozoan parasites such as Cryptosporidium and Giardia are not always killed by these agents. In these cases combining iodine or chlorine treatment with filtration of water using a portable water filter that has a filter size of 0.2 µm to 1.0 µm should be performed.
- Those with gastrointestinal symptoms should exercise strict personal hygiene to prevent spread of the disease to those in close contact
- Travellers are advised to carry a medical kit. Suggested items to include are: oral rehydration therapy, loperamide, and a treatment course of ciprofloxacin (500 mg twice daily for up to three days) for diarrhoea . Additional items which may be included in a medical kit can be found at the following address: http://www.cdc.gov/travel/other/travelers-health-kit.htm
Vaccination Advice for Those Travelling to Tsunami-Affected Areas.
- All travellers should be up to date with routine immunisations for living in the UK. This includes MMR as the risk of exposure to measles could be high, and BCG , particularly for work in refugee settings and for longer-term stay.
- Tetanus/diphtheria : Tetanus is transmitted via wound contamination with the bacterium Clostridium tetani ; diphtheria can be transmitted by the respiratory route or following skin infection with Corynebacterium diphtheriae . A booster is recommended if not taken within the past 10 years
- Polio : transmitted by the faecal-oral route. A booster dose is recommended if not taken within the past 10 years
- Hepatitis A : transmitted by the faecal-oral route.
- Typhoid : transmitted by the faecal-oral route. If travellers are not going to affected areas and are on a business trip or short holiday stay in hotels, vaccine may not be necessary.
- Hepatitis B : transmitted by contact with blood or body fluids. Vaccine is recommended for those involved in health care, relief work, or who may be exposed to blood and body fluids. Sexual transmission is also a risk.
- Cholera : transmitted via the faecal-oral route. For the majority of travellers advice on food and water hygiene precautions is adequate protection. However, given the potential for cholera to occur in refugee settings in tsunami-affected areas, vaccination of aid workers is recommended.
Vaccination against cholera consists of two doses administered 1 - 6 weeks apart. The limited data available suggests that there is little protection after only one dose. If time before travel is short a second dose can be carried with the traveller and taken at the destination. However, this dose should be kept at 2 - 8ºC during transport and at the destination until it is taken. The vaccine must not be frozen, and if carried by the traveller, should be kept in hand luggage and not in the luggage hold.
The manufacturer cannot guarantee the effectiveness of the product if it is not stored at 2 - 8ºC. It is unlikely, however, that the efficacy of the vaccine will be affected for short periods at room temperature.
- Influenza : transmitted via the respiratory route. Vaccine is recommended for those working in refugee or relief settings who may be at particular risk due to exposure in overcrowded conditions.
- Japanese encephalitis : Transmitted via mosquitoes. The transmission season is usually May - October. Given this transmission season, it is unlikely that Japanese encephalitis will be a problem in affected areas.
- Rabies : Most rabies in resource-poor regions of the world is transmitted by the bite of an infected dog. Avoidance of all dogs is important. Rabies vaccine should be considered as adequate post-exposure treatment with rabies immune globulin and vaccine may not be available.
Malaria and Other Vector - Borne Diseases
Malaria advice has been developed in conjunction with the Health Protection Agency, Advisory Committee on Malaria Prevention (ACMP). The malaria situation may become unstable in countries affected by the tsunami due to flooding, population migration and disruption of control measures. For this reason advice may change as more information becomes available.
- The risk of malaria is generally low in Thailand.
- On the affected west coast of Thailand, including Phuket and Phi Phi island, mosquito avoidance is recommended
- Dengue fever may occur at increased frequency in the setting of poor environmental conditions with flooding and stagnant water.
- Mosquito bite avoidance is essential as these measures will also help to prevent other vector-borne diseases such as dengue and Japanese encephalitis. Malaria and Japanese encephalitis mosquitoes tend to bite in the hours from dusk to dawn. Those that transmit dengue fever are daytime bitters.
- Leptospirosis is a zoonosis which infects a variety of wild and domesticated animals and is excreted in their urine.
- The disease is transmitted to humans if they are exposed to fresh or brackish water or moist soil contaminated by the urine of infected animals.
- Leptospira, the organism which causes the disease , usually enters the body through cut or abraded skin, mucous membranes, and conjunctivae. Ingestion of contaminated water can also lead to infection.
- Risk of acquiring the disease is greatest for those exposed to fresh water. Travellers should be advised to avoid exposure to potentially contaminated water. Flooding as a result of the tsunami may increase the risk of leptospirosis.
- Pre-exposure chemoprophylaxis of doxycycline 200 mg weekly, commencing 1 to 2 days prior to exposure, can be offered to those who may be unavoidably exposed to potentially contaminated water.
- Protective clothing should be worn by those who may be in direct contact with rodents, sewage or contaminated water. Cuts and grazes should be covered.
Other Disease Risks
Other possible infections that travellers may encounter directly after a flood are those transmitted through direct contact with polluted waters, such as wound and skin infections, eye infections such as conjunctivitis, and ear, nose and throat infections. Vibrio vulnificus infection of wounds can occur when salt or brackish water contaminates them. Crowding can lead to the risk of respiratory infections such as influenza and tuberculosis.
- Advice for health professionals caring for travellers returning from affected areas is available on the Health Protection Agency website.
- The Health Protection Agency website also has advice for travellers returning from affected areas.
- Returning travellers who are unwell with fever, gastro-intestinal symptoms, or have wounds that are failing to heal should consult their GP promptly for treatment.
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