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Chapter 4 Select Destinations Asia

Cambodia

Michael C. Thigpen, Dora Warren, Grant Ludwig

DESTINATION OVERVIEW

Every year, >4 million tourists travel to Cambodia, many to visit Angkor Wat, a collection of approximately 100 ancient temples and other structures covering 400 km2 (150 square miles) in the northwestern Cambodia jungle (Map 4-09). The Angkor Temple Complex is considered one of the architectural wonders of the world and, in 1992, was designated a World Heritage site. The temples were built between the 9th and 14th centuries AD, at the height of the Khmer Empire. These historical structures are decorated with intricately carved Khmer artwork depicting Hindu and Buddhist themes, providing an archaeological portrayal of the empire that ruled much of Southeast Asia for 5 centuries. After the decline of the Khmer Empire, the site was largely abandoned to the surrounding jungle and remained virtually untouched until descriptions of the “lost temples of Cambodia” were published late in the 19th century. Restorations began as international visitors arrived, but the emergence of the Khmer Rouge and the ensuing decades of civil war halted most tourist travel to the site until the late 1990s. As Cambodia has emerged from >20 years of political and economic turmoil, the Angkor temples have become one of the most popular tourist destinations in Southeast Asia. Increasingly, tourists are also visiting other areas of Cambodia, including beaches along the coast and islands in the Gulf of Thailand. Adventure tourism through the rural and forested areas bordering Vietnam and Laos has also become popular.

Cambodia is one of the poorest countries in Southeast Asia but is rapidly developing. As a result, business-related travel is increasing. Visitors can fly directly to Phnom Penh or Siem Reap from a number of Asian cities, including Bangkok, Singapore, Kuala Lumpur, Seoul, Hong Kong, Vientiane, and Ho Chi Minh City. Overland travel is also possible via direct bus service from Bangkok and Ho Chi Minh City.

Map 4-09. Cambodia destination map

Map 4-09. Cambodia destination map

PDF Version (printable)

HEALTH ISSUES

Immunizations

All travelers to Cambodia should be up-to-date with their routine immunizations, including seasonal influenza, and should be protected against hepatitis A and B and typhoid fever.

Japanese encephalitis (JE) is considered endemic throughout Cambodia; transmission occurs year-round but peaks during the May to October rainy season. The vaccine is recommended for travelers who plan to spend ≥1 month in rural areas and should be considered for short-term travelers who may be at increased risk for JE virus exposure, such as those who will spend substantial time outdoors in rural or agricultural areas, especially during the rainy season. Travelers on a typical 2- to 4-day visit to the close-in Angkor temples, staying in air-conditioned hotels in Siem Reap, are at minimal risk, but mosquito prevention measures should be employed.

Rabies is endemic throughout Cambodia. For most travelers on a short tour of the Angkor Wat temples, the risk is minimal. However, travelers planning more extensive travel in Cambodia should consider rabies immunization before arrival. The chief risk is from dog bites. The Pasteur Institute in Phnom Penh and some private clinics can provide rabies vaccine and consultation; rabies immunoglobulin is available to the public at the Pasteur Institute.

Although yellow fever is not a disease risk in Cambodia, the government requires travelers arriving from countries with a risk of yellow fever virus transmission to present proof of yellow fever vaccination.

Other Health and Safety Risks

Travelers’ Diarrhea

Diarrhea and foodborne infections in travelers are common in Cambodia. Avoid water that is not bottled, ice, and food from street vendors. Safe, bottled water is readily available. Travelers should practice safe food and water precautions (see Chapter 2, Food & Water Precautions) and carry an antibiotic for self-treatment. Because fluoroquinolone resistance is widespread in Cambodia and other areas of Southeast Asia, azithromycin may be preferred (see Chapter 2, Travelers’ Diarrhea for self-treatment recommendations).

Dengue

Dengue is endemic throughout Cambodia, and large epidemics occur every several years. Peak transmission occurs during the rainy season, although cases occur year-round even in nonepidemic years. Travelers to Cambodia should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Arthropods).

Malaria

The highest risk of malaria infection for the traveler in Cambodia is in forested areas. There is little transmission of malaria around Angkor Wat, Tonle Sap Lake, Siem Reap city, and Phnom Penh. On a typical 2- to 4-day visit that involves exploring the close-in temples of Angkor Wat during the day and staying in an air-conditioned hotel in Siem Reap at night, malaria risk is minimal. However, mosquito protection measures should still be employed. Travelers planning to visit the more remote Angkor temples deeper in the forest, or who travel outside the main tourist sites in Phnom Penh, especially to forested areas, should consider malaria chemoprophylaxis. The recommended chemoprophylaxis regimen for Banteay Meanchey, Battambang, Kampot, Koh Kong, Odder Meanchey, Pailin, Preah Vihear, Pursat, and Siem Reap is atovaquone-proguanil or doxycycline. Mefloquine is an additional option in all other areas (see Chapter 3, Malaria, for more information).

Chikungunya

Chikungunya was reintroduced into Cambodia in 2011, and a large outbreak occurred in southeastern Cambodia in March 2012. Risk of chikungunya infection exists throughout the day, as the primary vector, Aedes aegypti, aggressively bites during the daytime. Travelers can protect themselves by preventing mosquito bites (see Chapter 3, Chikungunya for additional details).

Schistosomiasis

Liver flukes such as Schistosoma mekongi are found in the Mekong Basin from the border of Laos to Kratie Province in Cambodia, where the freshwater dolphins attract tourists. Swimming in natural freshwater settings such as lakes, rivers, and ponds should be avoided. (see Chapter 3, Schistosomiasis).

Snakebites

At least 17 known venomous snake species are found in Cambodia; therefore travelers should use precautions to avoid snakebites. Effective antivenom is available in some international hospitals, including the Royal Angkor International Hospital in Siem Reap and the Calmette Hospital in Phnom Penh (see Chapter 2, Animal-Associated Hazards).

Transportation

Motor vehicle crashes are a rapidly rising cause of injury and death to passengers and pedestrians. Most road users are on motorcycles and are required to wear helmets as drivers but not as passengers. Avoid riding on motorcycle taxis. In addition to the ever-growing number of cars and motorcycles, there is lax enforcement of traffic laws and scant understanding of rules of the road. Travelers should carefully look in every direction before crossing the street. In cities and at Angkor Wat, most travelers use tuk-tuks (usually 3-wheeled), which are readily available, or hire cars with a driver guide. The fare should be negotiated at the outset. For those who, in spite of the risk, end up riding on the back of a motorcycle, wearing a helmet is essential. Five national highways link Cambodia’s capital city, Phnom Penh, to other cities and beach resorts. During the rainy season road conditions deteriorate rapidly, and travel after dark on the highways is discouraged.

Safety

Travelers should be alert at all times and use common-sense measures such as not walking or traveling alone at night. Travelers are also advised to only carry what they are willing to lose. The most common type of theft is “snatch and grab” robbery. Travelers should keep belongings out of sight if traveling via tuk-tuk and carry items and bags away from the street side while walking.

Land Mines

Although the areas around the Angkor Wat temples and major towns have been cleared, land mines and unexploded ordnance from the decades of conflict are still found in rural areas in Cambodia, including Battambang, Banteay Meanchey, Pursat, Siem Reap, and Kampong Thom Provinces. Travelers to those areas should exercise caution, especially when venturing out to the more remote temples and forest, by staying on roads and paths and using a guide with knowledge of local hazards. Travelers should not touch anything resembling a mine or unexploded ordnance. If these items are observed, the Cambodia Mine Action Center should be notified.

Counterfeit Drugs

Local pharmacies provide a limited number of prescription and over-the-counter medications, but because the quality of locally obtained medications can vary greatly, travelers should bring an adequate supply of medications. Counterfeit drugs are commonly found and are often indiscernible from authentic medication (see Chapter 2, Perspectives: Pharmaceutical Quality & Counterfeit Drugs). If needed, medications should only be purchased from licensed pharmacies, which can easily be recognized by a green cup and snake sign.

Climate

Cambodia has a tropical climate and is generally hot throughout the year. The hottest months are March through May, and heat precautions should be taken when exploring the temples or visiting other tourist areas. Many travelers explore the temples in the early mornings and late afternoon, taking a midday break in the comfort of an air-conditioned restaurant. Rainy season is from late April or early May through October or November. During this time, risk of vectorborne disease transmission increases.

Medical Care

Medical facilities and services in Cambodia do not generally meet international standards. A few internationally run clinics and hospitals in Siem Reap and Phnom Penh can provide basic medical care and stabilization. Some information on health facilities and pharmacies in Cambodia can be found on the website for the US embassy in Phnom Penh. For anything other than basic care and stabilization, most travelers should seek medical care in Bangkok or Singapore. For this reason, travel health insurance that includes medical evacuation insurance should be strongly considered.

BIBLIOGRAPHY

  1. CDC. Chikungunya outbreak—Cambodia, February–March 2012. MMWR Morb Mortal Wkly Rep. 2012 Sep 21;61:737–40.
  2. Embassy of the United States, Phnom Penh, Cambodia [Internet]. Medical services in Cambodia. Phnom Penh: US Department of State; 2014 [cited 2014 Jun 25]. Available from: http://cambodia.usembassy.gov/medical_information.html.
  3. Ledgerwood J. Landmines in Cambodia. DeKalb, IL: Northern Illinois University [cited 2014 Jun 25]. Available from: http://www.seasite.niu.edu/khmer/Ledgerwood/Landmines.htm.
  4. Ly S, Buchy P, Heng NY, Ong S, Chhor N, Bourhy H, et al. Rabies situation in Cambodia. PLoS Negl Trop Dis. 2009;3(9):e511.
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  7. Touch S, Hills S, Sokhal B, Samnang C, Sovann L, Khieu V, et al. Epidemiology and burden of disease from Japanese encephalitis in Cambodia: results from two years of sentinel surveillance. Trop Med Int Health. 2009 Nov;14(11):1365–73.
  8. US Department of State. Cambodia country specific information. Washington, DC: US Department of State; 2013 [cited 2014 Sep 22]. Available from: http://travel.state.gov/content/passports/english/country/cambodia.html.
  9. Vong S, Goyet S, Ly S, Ngan C, Huy R, Duong V, et al. Under-recognition and reporting of dengue in Cambodia: a capture-recapture analysis of the National Dengue Surveillance System. Epidemiol Infect. 2012 Mar;140(3):491–9.
  10. World Health Organization. Cambodia. In: World Malaria Report, 2013. Geneva: World Health Organization; 2013 [cited 2014 Sep 22]. Available from: http://www.who.int/malaria/publications/country-profiles/profile_khm_en.pdf.
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