Chapter 4Select DestinationsAsia
Vietnam has a population of approximately 90 million people, of whom about 70% live in rural areas. The total size of Vietnam is 127,243 mi2 (331,114 km2), making it the 66th largest country in the world, comparable to Finland and Malaysia, or the combined size of Ohio, Kentucky, and Tennessee. It is located in Southeast Asia and borders China, Laos, and Cambodia. Vietnam is divided into 63 provinces. The terrain and climate vary, particularly between the north and the south and the mountainous and coastal areas.
Vietnam is an increasingly popular travel destination for business and tourism. Travelers often try to get a flavor for the entire country with at least a 10-day trip, or combine their Vietnam travels with other nearby Southeast Asia destinations such as Angkor Wat in Cambodia and Luang Prabang in Laos. There is no shortage of attractions in Vietnam, regardless of whether a traveler is interested in touring historical sites, shopping in ethnic markets or traditional trade villages, trekking or biking in hills or valleys, seeing native wildlife, cruising on the Mekong River, scuba diving in the sea, relaxing at a spa resort, visiting art galleries, or taking cooking lessons to understand the regional variations of Vietnam’s cuisine.
A typical itinerary might start in the north and include visiting the capital, Hanoi; touring the UNESCO World Heritage site, Ha Long Bay, aboard a junk; and experiencing the rice fields and ethnic minorities in Sapa or Mai Chau. In the coastal region travelers often go to Hue, Hoi An, Danang, Dalat, and Nha Trang, each with their own charms and unique personalities. In the South travelers often choose to see Vietnam’s largest, busiest, and most modern city, Ho Chi Minh City. From there, Phu Quoc Island, the Cu Chi tunnels, and floating markets of the Mekong Delta are easy trips.
Travelers to Vietnam should be up-to-date on routine vaccines, such as measles-mumps-rubella, diphtheria-pertussis-tetanus, and influenza. Travelers should also protect themselves by getting vaccinated against typhoid and hepatitis A. Hepatitis B protection is advised, especially for long-term travelers and expatriates, given the high prevalence of chronic HBV infection in the population.
Japanese Encephalitis Vaccine
Because Japanese encephalitis (JE) is endemic throughout Vietnam, JE vaccination is recommended for all travelers who spend ≥1 month or more in the country during the transmission season and should be considered for short-term travelers who plan on spending time outside urban areas and may be involved in activities that expose them to the mosquitoes that transmit JE virus. Such activities may include camping, hiking, biking or other outdoor activities, or straying in accommodations without air conditioning, screens, or bed nets (see Chapter 3, Japanese Encephalitis). JE has seasonal peaks from May through October, especially in the northern part of the country, where the highest rates of JE disease occur in the northern provinces around Hanoi and the northwestern and northeastern provinces bordering China. Personalized advice during a thorough pre-travel consultation is important.
Travelers should receive preexposure immunizations against rabies if they will be spending a lot of time outdoors, have direct contact with wildlife, or will be in Vietnam for a prolonged period of time. Most dogs are not routinely vaccinated in Vietnam and are numerous even in urban areas. Special consideration should be given to vaccinating children. Care should also be taken to avoid contact with nonhuman primates, as several tourist destinations (for example, islands in Ha Long Bay and off Nha Trang) have macaques that are not afraid of humans and may be infected with herpes B virus as well as rabies. Human rabies immune globulin is usually available in larger cities, such as Hanoi and Ho Chi Minh City. Travelers should be encouraged to purchase travel health insurance that includes medical evacuation insurance in the event postexposure prophylaxis is unavailable.
Most tourist itineraries do not include malarious areas of Vietnam. Malaria is primarily a concern in rural areas and is mostly caused by Plasmodium falciparum. There are rare cases in the Mekong Delta and none in the Red River Delta, the coast north of Nha Trang, or in larger cities such as Da Nang, Haiphong, Hanoi, Ho Chi Minh City, Nha Tran, and Qui Nhon. Travelers to the Mekong Delta should avoid exposure to mosquitos but do not need to take antimalarial drugs. Travelers to other parts of Vietnam where malaria is known to be circulating should take chemoprophylaxis appropriate to the specific places they will be visiting. Mefloquine resistance has been reported in some areas, so travel health clinicians may feel more comfortable recommending atovaquone-proguanil or doxycycline to travelers (see Chapter 3, Malaria).
Dengue is endemic in Vietnam and although peak transmission occurs during the summer rainy season, dengue virus transmission occurs year-round. Travelers to Vietnam should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Insects & Arthropods).
Vietnam continues to report sporadic cases of human infection with avian influenza A (H5N1) or “bird flu,” as it is commonly known. Most people who have become infected had direct contact or close exposure to sick or dead poultry by visiting live bird or poultry markets or preparing or eating uncooked or undercooked bird products (such as meat, eggs, or blood). In extremely rare situations, a few people were infected as a result of close, prolonged contact with another person who was sick with avian influenza.
To avoid infection, travelers to an area affected by avian influenza should avoid direct contact with birds, including poultry (such as chickens and ducks) and wild birds; avoid touching surfaces that have bird droppings (feces) or other bird fluids on them; and avoid places where live birds are raised or kept.
In general, travelers should eat only bird meat or products that have been thoroughly cooked. Any dishes that contain uncooked (raw) or undercooked bird meat or products such as eggs and poultry blood should be avoided. For example, egg yolks should not be runny or liquid. Travelers should also practice healthy habits to help stop the spread of germs by washing hands often with soap and clean water or using an alcohol-based hand sanitizer (containing at least 60% alcohol) when soap and clean water are not available and hands are not visibly dirty.
Other Health and Safety Risks
Drinking tap water should be avoided, as should beverages with ice. Travelers should avoid eating food or drinking beverages from street vendors and should avoid eating raw or undercooked meat, seafood, uncooked vegetables, and raw fruits that cannot be peeled by the traveler.
Travelers with seafood allergies should be particularly cautious in Vietnam, given the common use of fish and other seafood sauces in many dishes.
Skin rashes may result from the combination of heat and humidity or fungal infections. Efforts should be made to keep clothes, shoes, and linens clean and dry.
Noise and Air Pollution
Construction sounds and frequent honking of motorbike and car horns can be an annoyance. Travelers with allergies or asthma may find their conditions are exacerbated because of high levels of particulate matter and indoor air pollution.
To avoid motor vehicle–related injuries, travelers should fasten seat belts when riding in cars and wear a helmet when riding bicycles and motorbikes. Pedestrians may find road conditions in Vietnam to be challenging. Travelers are advised to walk facing traffic and, when crossing the street, to proceed at a consistent pace (not stopping or suddenly turning back). Pedestrians will observe that motorbikes and cars will go around them much like a school of fish will part and then regroup when it encounters an object.
Medical Care in Vietnam
Several private medical practices, clinics, and hospitals that serve foreigners are available in Hanoi and Ho Chi Minh City. However, blood transfusion services, inpatient care, and specialty services are generally not of high quality. Thus travelers should ensure that they have adequate medical evacuation insurance in case they need to be evacuated to Singapore or Bangkok where high-quality specialty services are provided (see Chapter 2, Travel Insurance, Travel Health Insurance, & Medical Evacuation Insurance). To ensure the quality of any needed medications, travelers may want to consider purchasing them through an expatriate or international travel clinic, even if the price is higher.
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