Chapter 10 Popular Itineraries Asia
Known as “the Land of Smiles,” Thailand is a popular destination for tourists, offering beautiful beaches, delicious cuisine, excellent shopping, fabulous golf courses, exciting nightlife, cultural diversity, and adventure opportunities. Thailand is also a regional business hub. In 2017, >35 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; however, English is commonly spoken at most popular destinations in Thailand. Road signs, maps, and tourist guides provide information in English and Thai.
Thailand is a geographically diverse country a little smaller than the state of Texas (Map 10-15). Because it is close to the equator, the climate is tropical and often hot and humid. Flooding is always a possibility, and various regions are prone to flash floods. Monsoon rains fall from July through October and can last until cooler, drier weather comes in November, making November through February a popular time of year to visit. Thailand’s central location and major international airports in Bangkok make it an easy access point for other destinations in Asia.
Out of a total population of nearly 70 million people, more than 10 million live in the capital city of Bangkok, a major metropolis and center of commerce. Tourists here visit historic sites of glittering grandeur such as the many Buddhist temples and the Grand Palace (to catch a glimpse of the Emerald Buddha). The main arteries of Bangkok are the Chao Phraya River and its canals, which provide access to tourist sites, the floating market, and restaurants. Bangkok is a paradise of culinary delights, from sidewalk noodle stands to exquisite 3-star restaurant meals.
Many visitors to Thailand also visit Chiang Mai in the north. The old city is surrounded by a moat and defensive wall; beyond the wall are >300 temples, a popular night bazaar for shopping, and easy access to the handicraft villages, elephant nature parks, and popular outdoor adventures.
Over the years, medical tourism to Thailand has increased. Compared with the United States, the cost of medical or surgical treatment is much less, and the quality of care is generally good. In addition, the country has become a popular destination for retirees from around the world, including a large American expatriate community. The warm climate and low cost of living make Thailand an attractive place to live.
Map 10-15. Thailand destination map
All travelers should be up-to-date on their routine vaccinations, including seasonal influenza. In addition, vaccination against hepatitis A and hepatitis B is strongly recommended. 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 a small risk persists. Preexposure vaccination is recommended only for travelers whose occupation puts them at risk for exposure (such as veterinarians) or for those who will be traveling in areas where it will be difficult to get immediate access to care, including biologics (see Chapter 4, Rabies). Rabies vaccine for preexposure and postexposure prophylaxis and human rabies immune globulin are readily available in all provincial and most district hospitals throughout Thailand.
Outside the capital, Japanese encephalitis (JE) is endemic to many parts of Thailand (see Chapter 4, Japanese Encephalitis). Transmission occurs year-round, with seasonal epidemics occurring in the northern provinces from May through October. Although the Chiang Mai Valley reports the highest rates of human disease, several cases have occurred in travelers who visited resort or coastal areas of southern Thailand. 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 who have an increased risk of JE virus exposure due to their itineraries or activities.
Malaria is endemic to specific areas in Thailand, particularly the rural, forested areas bordering Burma (Myanmar), Cambodia, and Laos and the provinces of the far south along the border with Malaysia. Transmission is year-round, peaking during the rainy season, with a second, smaller peak in December. More than 70% of cases are due to Plasmodium vivax, and the rest are due to P. falciparum or mixed infection. CDC recommends protection against mosquito bites and antimalarial prophylaxis for travelers visiting any of the endemic areas (see Chapter 2, Mosquitoes, Ticks & Other Arthropods and Chapter 4, Malaria). Atovaquone-proguanil, tafenoquine, or doxycycline are the recommended prophylactic antimalarial drugs for travelers going to Thailand.
Dengue is endemic throughout Thailand, and large epidemics occur every several years (see Chapter 4, Dengue). Peak transmission is during the rainy season, although cases are reported year-round even in non-epidemic years. Travelers to Thailand should take measures to protect themselves from mosquito bites to prevent dengue (see Chapter 2, Mosquitoes, Ticks & Other Arthropods).
Zika is a risk in Thailand. Because of the risk of birth defects in infants born to women infected with Zika during pregnancy, women who are pregnant or trying to become pregnant should research the most recent recommendations at www.cdc.gov/zika.
Thailand’s street food is convenient, inexpensive, and delicious. Unfortunately, it can also be a source of “Bangkok belly,” as the lack of running water at outdoor eateries precludes good hand and food preparation hygiene. Travelers can still enjoy the experience of street food, however, by following some basic food and water safety precautions: frequent only those restaurants or food stalls that cook food to order, avoid raw or undercooked food, and drink beverages only from sealed containers (see Chapter 2, Food & Water Precautions).
Although visitors can easily access hospitals, clinics, and laboratories in most cities, carrying antibiotics for self-treatment of moderate to severe diarrhea is prudent. Fluoroquinolone resistance is widespread in Thailand and other areas of Southeast Asia; therefore, azithromycin may be preferred (see Chapter 2, Travelers’ Diarrhea).
Active cholera transmission has been reported from Thailand in recent years. Check the destination page at www.cdc.gov/travel for current recommendations.
Water and Soil Diseases
Melioidosis is highly endemic in northeast Thailand, and most leptospirosis cases can be found in the southern and northeastern regions of the country. For both diseases, most cases occur during the rainy season from July through October. Because their activities expose them to soil and water, adventure travelers may be at increased risk for these diseases. Travelers visiting endemic areas should avoid contact with soil and water 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. Travelers should immediately and thoroughly clean skin lacerations, abrasions, or burns contaminated with soil or surface water.
OTHER HEALTH AND SAFETY RISKS
Thailand is among the top medical tourism destinations worldwide. Travelers intending to obtain medical care abroad should plan ahead by first researching the facilities at their destination, learning about health insurance coverage, and consulting with a travel medicine specialist in advance of their trip (see Chapter 9, Medical Tourism).
Sexually Transmitted Infections and HIV/AIDS
Thailand is a destination for tourists seeking sex (see Chapter 9, Sex & Travel) and, although illegal, commercial sex work is practiced across the country. Visitors to Thailand’s red-light district should be aware that these areas have been associated with human trafficking.
A 100% condom program with sex workers has helped slow the spread of HIV and other sexually transmitted diseases; however, approximately 450,000 people were living with HIV/AIDS in Thailand in 2014. Although the number of new HIV infections is decreasing, HIV remains concentrated in key populations. In Bangkok, for example, more than 28% of men who have sex with men are infected. Travelers should be aware of these risks, always use condoms during sex, and avoid injecting drugs or sharing needles. Travelers whose practices put them at high risk for HIV infection should discuss preexposure prophylaxis with their primary care and travel medicine providers.
SAFETY AND SECURITY
Approximately 14,000 motor vehicle deaths occur in Thailand each year, with a substantial proportion (73% in 2012) due to motorcycle crashes. A cheap and popular mode of travel, motorcycles are among the most vulnerable vehicles on the road. Travelers should avoid riding motorcycles, including motorcycle taxis. If they must ride, they should wear a helmet. Travelers should also fasten seat belts when riding in cars (see Chapter 8, Road & Traffic Safety).
Thailand has experienced political unrest throughout the country and ethno-nationalist violence in the southern provinces. In 2014, a caretaker military government was established to maintain peace, develop a constitution, and facilitate democratic elections. However, the country remains politically divided. Travelers should be aware of the possibility of demonstrations, pay attention to the local news, and monitor the US embassy website (http://bangkok.usembassy.gov) and social media outlets to find out if, when, and where protests and demonstrations may occur. It may be prudent to avoid these locations, since no one can predict whether protests will stay peaceful or turn violent (see Chapter 3, Safety & Security Overseas).
- Central Intelligence Agency. The World Fact Book 2018; East and Southeast Asia: Thailand. Washington, DC: CIA; 2018 [updated 2018 Sep; cited 2018 Oct 3]. Available from: www.cia.gov/library/publications/the-world-factbook/geos/th.html.
- Finch, S. Thailand top destination for medical tourists. CMAJ. 2014 Jan 7;186(1):E1–2.
- National AIDS Committee, Royal Thai Government. Thailand ending AIDS: Thailand AIDS response progress report 2015. Geneva: UNAIDS, 2015 Apr 2. [cited 2018 Oct 3]. Available from: www.aidsdatahub.org/thailand-global-aids-response-progress-report-2015-national-aids-committee-2015.
- Thailand Ministry of Public Health, Bureau of General Communicable Diseases. Rabies situation in Thailand. [cited 2018 Oct 2]. Available from: http://thaigcd.ddc.moph.go.th/en/health_issues/2.
- World Health Organization. Global status report on road safety 2015. Geneva: 2015. 2016 Apr 9. Report No. 978 92 4 156506 6. [cited 2018 Oct 3]. Available from: www.who.int/violence_injury_prevention/road_safety_status/2015/en/