Chapter 4 Select Destinations Asia
Thailand, known as “the Land of Smiles,” is a popular travel destination because of its warm and welcoming reception of tourists and expatriates, beautiful beaches, delicious cuisine, excellent shopping, fabulous golf courses, exciting nightlife, and exotic adventure opportunities. Many travelers also visit Thailand for business, and the country is quickly becoming a regional business hub. In 2011, >19 million visitors spent more than 1 night in Thailand, and the number of visitors continues to grow. Thai is a melodic, tonal language that can be difficult to learn. Luckily, most popular destinations in Thailand feature Thai people who speak English and road signs, maps, and tourist guides that provide information in English and Thai.
With close to 67 million people, divided into 76 political provinces, Thailand is a geographically diverse country a little smaller than the state of Texas (Map 4-13). Thailand’s geography includes the following:
- Sandy beaches and rocky shores along its 2,000-mile coastline and >1,400 islands
- Central plains made up of extensive rice fields along the Chao Phraya River
- Mountainous areas in northern, western, and eastern Thailand
- The dry Khorat Plateau in northeastern Thailand.
Because Thailand is close to the equator, the climate is tropical and often hot and humid. Flooding is always a possibility in Thailand, and various regions are prone to flash floods. Monsoon rains fall from May through July and can last until cooler, drier weather comes in November, making November through February a popular time of year to visit Thailand. Thailand’s central location and major international airport in Bangkok make it an easy access point for other destinations in Asia.
More than 9 million people live in the capital city of Bangkok, a major metropolis and center of commerce. Bangkok is a mix of old and new—skyscrapers and waterways, bustling city streets full of people, vendors, dogs, uneven sidewalks, and lots of traffic, in contrast to the fast, quiet, and cool modern monorail and subway systems. Tourists visit historic sites of glittering grandeur such as the Grand Palace to catch a glimpse of the Emerald Buddha or one of Bangkok’s 400 Buddhist temples. The main artery of Bangkok is the Chao Phraya River and its canals, which provide access to tourist sites, boat tours, the floating market, and restaurants. Bangkok is a paradise of culinary delights, from local fare at a sidewalk noodle stand to a fancy 4-star meal in a restaurant. Rounding off a visit to Bangkok, many tourists will enjoy the pleasures of Thai nightlife, which includes a variety of bars and pubs, dance clubs, drag shows, and the famous red light districts of Soi Cowboy, Nana, and Patpong.
Visitors to Thailand will also likely visit Chiang Mai, in northern Thailand. The city, surrounded by a moat and defensive wall, has >300 temples, a popular night bazaar for great shopping, and easy access to the handicraft villages, elephant nature parks, and outdoor adventures that are popular in the region.
A popular reason to visit Thailand is for rest and relaxation on sandy beaches along the coast or on one of the many islands. Beach destinations include plenty of opportunities for snorkeling, scuba diving, windsurfing, sailing, swimming, and dining on fresh seafood. A growing number of tourists seek out such relaxation opportunities as part of their recovery from medical or dental procedures.
Over the years, medical tourism to Thailand has increased, as the costs for treatment are much lower and the quality of care is generally good. Thailand is frequently listed as one of the top medical tourist destinations worldwide; 27 Thai hospitals were accredited by the Joint Commission International in 2014. For example, Thailand’s Bumrungrad Hospital has a special section of their website for medical tourists in addition to an office, with translators, to facilitate services for foreigners seeking treatment and care at their facility.
Thailand has a large expatriate community and has also become a popular destination for retirees from around the world. The warm climate and low cost of living make Thailand an attractive place to live.
Map 4-13. Thailand destination map
All travelers should be up-to-date on their routine vaccinations. In addition, travelers to Thailand should also be vaccinated against hepatitis A and hepatitis B. Typhoid and Japanese encephalitis vaccines should be considered based on potential risk.
Government-sponsored mass vaccination campaigns for dogs and cats have reduced the prevalence of rabies in Thailand, but rabies is still a risk, particularly in Bangkok, where dogs roam the streets. Preexposure vaccination is only recommended for travelers who have an occupation that puts them at risk for exposure (such as veterinarians) or will be traveling for long periods of time. Hospitals and clinics in Bangkok cater to the expatriate community and medical tourists, and rabies vaccine is readily available for preexposure and postexposure prophylaxis, although not all hospitals in Thailand carry human rabies immune globulin.
Japanese Encephalitis vaccine
Japanese encephalitis (JE) is endemic throughout Thailand (see Chapter 3, Japanese Encephalitis). Transmission occurs year-round, with seasonal epidemics from May through October in the northern provinces. JE vaccine is recommended for travelers who plan to visit Thailand for ≥1 month and should be considered for those visiting for a shorter period but who have an increased risk of JE virus exposure due to their itineraries or activities. The highest rates of human disease have been reported from the Chiang Mai Valley. Several cases have been reported among travelers who visited resort or coastal areas of southern Thailand.
Malaria is endemic in specific areas of Thailand, particularly the rural, forested areas that border Burma (Myanmar), Cambodia, and Laos, as well as the rural, forested areas of Phang Nga and Phuket. Prophylaxis is recommended for travelers visiting any of these areas (see Chapter 3, Malaria). Transmission in Thailand occurs year-round, and most cases are due to Plasmodium falciparum, with the rest due to P. vivax or mixed infection. Atovaquone-proguanil or doxycycline are the recommended antimalarial drugs for travelers in Thailand.
Dengue is endemic throughout Thailand (see Chapter 3, Dengue) with large epidemics that occur every several years. Peak transmission occurs during the rainy season, although cases occur year-round even in non-epidemic years. Travelers to Thailand should take measures to protect themselves from daytime mosquito bites to prevent dengue (see Chapter 2, Protection against Mosquitoes, Ticks, & Other Arthropods).
Although the Thai government and several nongovernmental organizations are leading projects to provide clean water across Thailand, and some hotels use their own filtration systems, water and food may still contain harmful bacteria and other contaminants. Travelers should practice food and water precautions and bring an antibiotic for self-treatment. Because fluoroquinolone resistance is widespread in Thailand and other areas of Southeast Asia, azithromycin may be preferred (see Chapter 2, Travelers’ Diarrhea).
Water and Soil Diseases
Melioidosis is highly endemic in northeast Thailand, and the highest number of leptospirosis cases can be found in the southern and northeastern regions of the country. For both diseases, most cases occur during the rainy season. Travelers who visit endemic areas should avoid contact with soil and water that could be contaminated and ensure that any open wounds are covered to prevent exposure. When contact cannot be avoided, travelers should wear protective clothing and footwear to reduce the risk of exposure. Skin lacerations, abrasions, or burns that have been contaminated with soil or surface water should be immediately and thoroughly cleaned.
Other Health and Safety Risks
As one of the top destinations for medical travel, travelers who plan to seek medical care in Thailand should be advised to research facilities and develop a plan before departure, learn about health insurance coverage, and evaluate their health before making the trip (see Chapter 2, Medical Tourism).
Sexually Transmitted Diseases and HIV/AIDS
Thailand is a popular destination for sex tourism (see Chapter 3, Perspectives: Sex & Tourism), and although illegal, sex work is practiced openly across the country. A 100% condom program with sex workers helped slow the spread of HIV and other sexually transmitted diseases; however, approximately 450,000 people are living with HIV/AIDS in Thailand. Although the number of new HIV infections has been decreasing, HIV remains concentrated in key populations. Travelers should be aware of these risks and always use condoms during sex with partners whose HIV status is unknown.
Safety and Security
Approximately 13,000 people are killed on the roads in Thailand each year, and a substantial proportion (74% in 2010) are killed in motorcycle accidents. Motorcycles are a cheap, easy, and popular mode of transportation, but they are also the most vulnerable vehicles on the road. Travelers should avoid riding motorcycles. If they must ride, they should wear a helmet.
Since 2006, Thailand has experienced intermittent periods of political unrest. Travelers should be aware of the possibility of demonstrations, pay attention to the local news, and monitor the US embassy website (bangkok.usembassy.gov) and social media outlets to find out if and where protests and demonstrations may occur. Travelers should avoid these locations, since no one can predict whether protests will stay peaceful or turn violent.
- Bumrungrad International Hospital [Internet]. Plan your visit-overview. Bangkok, Thailand: Bumrungrad International Hospital; 2014 [cited 2014 Sep 18]. Available from: http://www.bumrungrad.com/en/plan-your-visit/overview.
- Bureau of Epidemiology, Ministry of Public Health, Thailand. National disease surveillance (report 506): Leptospirosis. Bangkok: Ministry of Public Health Thailand; 2014 [cited 2014 Sep 22]. Available from: http://www.boe.moph.go.th/boedb/surdata/506wk/y57/en/d43_0957_en.pdf.
- Chanlett-Avery E, Dolven B. Thailand: background and US relations. Washington, DC: Congressional Research Service; 2014 [cited 2014 Sep 22]. Available from: http://fas.org/sgp/crs/row/RL32593.pdf.
- Gongal G, Wright AE. Human rabies in the WHO Southeast Asia Region: forward steps for elimination. Adv Prev Med. 2011;Article ID 383870:1–5.
- Joint Commission International (JCI) [Internet]. JCI-accredited organizations. Oak Brook, IL: JCI; 2014 [cited 2014 Sep 18]. Available from: www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/.
- Joint United Nations Programme on HIV/AIDS (UNAIDS). HIV in Asia and the Pacific: UNAIDS report 2013. Geneva: UNAIDS; 2013 [cited 2014 Sep 22]. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2013/2013_HIV-Asia-Pacific_en.pdf.
- Wiwanitkit V. Rate of malarial infection among foreigners in a tertiary hospital of Thailand: change of epidemiology and importance of travel medicine (1996–2005). J Vector Borne Dis. 2007 Sep;44(3):219–22.
- World Bank [Internet]. International tourism, number of arrivals. Washington, DC: The World Bank Group; 2014 [cited 2014 Sep 22]. Available from: http://data.worldbank.org/data-catalog/world-development-indicators.
- World Health Organization. WHO global status report on road safety 2013: supporting a decade of action Geneva: World Health Organization; 2013 [cited 2014 Sep 19]. Available from: http://www.who.int/violence_injury_prevention/road_safety_status/2013/en/.
- Page created: July 10, 2015
- Page last updated: July 10, 2015
- Page last reviewed: July 10, 2015
- Content source: