Author(s): Wai Yan Aung

Destination Overview

Burma (also called Myanmar) offers travelers a mix of traditional and modern culture. Nearly all visitors to this country come to see the classic golden temples of Rangoon (Yangon), Burma’s former capital and its largest city. Visitors also enjoy strolling colonial-era parks and shopping at Bogyoke Aung San Market. The city includes British, Chinese, and Indian influences. Travelers wanting a glimpse of rural life can do so with a short ferry ride across the Yangon River to Dala, or by riding the circle train that makes a loop just north of the city.

Many travelers take advantage of the improving domestic air and bus service to explore other parts of the country. International flights to Mandalay are available from neighboring China, Singapore, and Thailand. Burma’s varied geography includes highlands, plains, beaches, and >800 islands. Several climate zones are found along its river basins and mountain ranges.

The people of Burma are diverse—the country has 135 officially recognized ethnic groups speaking >100 different languages. Of the country’s >56 million people, about two-thirds can speak or understand Burmese. English is widely spoken in popular visitor destinations, where travelers often remark on the hospitality and generosity of their hosts.

Religious sites and ancient cities, with their temples and festivals, attract many visitors to Burma. Unique architecture and heritage combine at places like Bagan, Bago, Kyaiktiyo Pagoda, and Mrauk U. Travelers can easily arrange outdoor activities (e.g., boating, cycling, trekking) around Inle Lake, Hsipaw, or Kalaw in hilly Shan State, home to a thrilling train ride across the Goteik viaduct. River cruises along the Ayeyarwady begin or end in Mandalay (Map 10-11). Meditation retreats are also widely available.

Infectious Disease Risks

Travelers to Burma should be up to date on routine vaccines, including diphtheria-tetanus- pertussis, hepatitis A, measles-mumps-rubella (MMR), polio, and varicella (chickenpox). Influenza exhibits a seasonal pattern that peaks during June–September, overlapping with the typical rainy season; influenza vaccine is recommended for travelers.

Bloodborne Pathogens

The prevalence of hepatitis B infection in Burma has been estimated as low to intermediate. Hepatitis B vaccination is especially crucial for anyone engaging in activities that increase their chances of exposure to blood or body fluids (e.g., people who might use injection drugs, those traveling to provide or receive medical care, and people who plan to get a tattoo or engage in condomless sexual contact). For more details, see Sec. 5, Part 2, Ch. 8, Hepatitis B.

Enteric Infections & Diseases

Local dishes such as mohinga (rice noodles in fish soup), curries, and salads appeal to many visitors. Travelers should observe safe food and water precautions, however, especially in secondary towns and in rural areas, where cleanliness during food preparation, utensil washing, and safe waste disposal might be lacking or not practiced. See Sec. 2, Ch. 6, Travelers’ Diarrhea, and Sec. 2, Ch. 8, Food & Water Precautions, for additional recommendations. Tap water in Burma is considered not safe for drinking.

Cholera

Burma last reported cholera data to the World Health Organization (WHO) for 2016. Nonetheless, WHO believes Burma to be a country that remains at risk for the disease. For a list of countries reporting active cholera transmission, see the Centers for Disease Control and Prevention (CDC) Travelers’ Health website. For recommendations regarding use of cholera vaccine in international travelers, see Sec. 5, Part 1, Ch. 5, Cholera.

Hepatitis A

As in much of Asia, hepatitis A virus is endemic to Burma (Sec. 5, Part 2, Ch. 7, Hepatitis A). Travelers can reduce their risk for hepatitis A infection by following safe food and water precautions (see Sec. 2, Ch. 8, Food & Water Precautions) and by getting vaccinated before travel.

Opisthorchiasis

Opisthorchiasis—caused by Opisthorchis viverrini— has long been endemic in the Greater Mekong subregion in Southeast Asia. Although information on human liver fluke infection in Burma has not been published until very recently, data now show that O. viverrini human infection is prevalent in 3 southern regions of the country, Bago, Mon, and Yangon. Risk to most travelers is likely low but is increased among people who eat raw or undercooked freshwater fish (see Sec. 5, Part 3, Ch. 10, Liver Flukes).

Travelers’ Diarrhea

Travelers’ diarrhea is common among visitors to Burma. Instruct travelers to follow safe food and water precautions by eating food that is thoroughly cooked and served hot, avoiding raw or undercooked foods, and drinking only boiled or bottled water. Oral rehydration solution is helpful in cases of moderate to severe diarrhea and is usually available in pharmacies. Although visitors can receive treatment from clinics or hospitals in major cities, consider prescribing antibiotics for travelers to carry for self-treatment of moderate to severe diarrhea (see Sec. 2, Ch. 6, Travelers’ Diarrhea).

Typhoid Fever

Typhoid fever is common in Burma. Although only limited data are available on the prevalence of drug-resistant typhoid infections in Burma, studies conducted in Rangoon demonstrate a high prevalence of first-line antimicrobial drug resistance in other bacterial infections, suggesting the same could be true for typhoid. Typhoid vaccine is recommended for travel to Burma (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever).

Respiratory Infections & Diseases

Avian Influenza

Live bird markets, common in Burma, can be a source of avian influenza virus (see Sec. 5, Part 2, Ch. 12, Influenza). Travelers should avoid visiting bird markets and poultry farms, and other places where live birds are raised, kept, or sold, and avoid preparing or eating raw or undercooked poultry products.

Coronavirus Disease 2019

All travelers going to Burma should be up to date with their COVID-19 vaccines.

Tuberculosis

In 2019, WHO ranked Burma among the 20 countries with the highest tuberculosis (TB) burdens in the world, with a total of 181,000 cases (range 119,000–256,000) and an incidence of 338 TB cases per 100,000 population. Both multidrug-resistant and extensively drug–resistant TB have been reported in Burma. Overall, however, risk to travelers is low.

Sexually Transmitted Infections & HIV

The prevalence of HIV among people ≥15 years old living in Burma is 0.6%. According to the most recent official estimates [PDF], ≈220,000 people in Burma were living with HIV in 2017; ≈66% were receiving antiretroviral therapy (ART). More recent (unpublished) estimates are that as of late 2020, ≈240,000 people were living with HIV, almost 83% of whom were receiving ART. Advise travelers on correct and consistent use of external or internal latex condoms to reduce the risk for HIV infection and other sexually transmitted infections with any new sex partners (see Sec. 9, Ch. 12, Sex & Travel, and Sec. 11, Ch. 10, Sexually Transmitted Infections). Good quality condoms are widely available for purchase in Burma, both at local pharmacies and at grocery stores.

Soil- & Waterborne Infections

Leptospirosis

Leptospirosis (see Sec. 5, Part 1, Ch. 10, Leptospirosis) is common in Burma and most often occurs during the rainy season. Risk for contracting leptospirosis is associated with participating in outdoor activities (e.g., kayaking, rafting, swimming, wading) that bring people in contact with contaminated freshwater sources.

Schistosomiasis

A low risk for schistosomiasis exists in Bago Region, and in Rakhine and Shan states (including Inle Lake). Widespread distribution is presumed in the Ayeyarwady Delta, and travelers should avoid bathing, swimming, wading, or other contact with freshwater in this region (see Sec. 5, Part 3, Ch. 20, Schistosomiasis).

Vectorborne Diseases

Chikungunya, Dengue & Zika

Vectorborne diseases endemic to Burma include chikungunya, dengue, and Zika (see the respective disease chapters in Section 5). Risk for chikungunya and dengue exists throughout Burma; peak transmission occurs during the rainy season, May/June–October. Because of the risk for birth defects in infants born to people infected with Zika during pregnancy, people who are pregnant or trying to become pregnant should review the most recent recommendations available on the CDC Travelers’ Health website.

Japanese Encephalitis

Japanese encephalitis (JE) is presumed to be endemic throughout Burma, and travelers should take precautions to avoid mosquito bites (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods). Consider recommending JE vaccine for travelers who will be in country for >1 month or whose itineraries include higher-risk activities (e.g., spending substantial time in rural areas; participating in outdoor activities like camping, farming, or hiking; staying in accommodations without air conditioning, window or door screens, or mosquito nets). See Sec. 5, Part 2, Ch. 13, Japanese Encephalitis, for more details.

Malaria

Malaria is endemic in all areas of Burma below 1,000 m (≈3,300 ft) elevation, including the ancient capital city of Bagan. Malaria incidence in Burma exceeds that of neighboring countries in the Greater Mekong subregion and is concentrated in and around forested areas. Chloroquine- and mefloquine-resistant malaria has been and continues to be a concern, and chemoprophylaxis recommendations vary accordingly. For malaria prevention recommendations, see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country, and Sec. 5, Part 3, Ch. 16, Malaria.

Environmental Hazards & Risks

Animal Bites

Rabies

Among the >150 countries reporting cases of rabies, Burma has an increasing number of dog bites and one of the highest rates of disease. Rabies vaccination is recommended for travelers participating in outdoor activities (e.g., camping, caving) that could increase their risk of animal bites. Vaccination is also recommended for travelers working with animals (e.g., veterinarians), people taking long trips or moving to Burma, and young children, for whom it can be difficult to prevent interaction with dogs or other animals (see Sec. 5, Part 2, Ch. 18, Rabies). Rabies immune globulin is available at tertiary and international hospitals in Burma for postexposure prophylaxis.

Snakes

Snake species in Burma vary by location. Many snakes are non-venomous; others are only mildly venomous and not particularly dangerous to humans. A few snakes are highly venomous, however, and their bites are potentially lethal. Estimates of >10,000 snakebites and >1,000 snakebite deaths are reported each year in Burma, which has one of the highest rates of venomous snakebites in the world.

Burma produces antivenom specific for Russell’s viper (Daboia russelii) and cobra venom. These locally produced products are more effective than imported products not specific for Burma’s indigenous snake species. Most local hospitals in Burma are stocked with antivenoms. Advise travelers to seek medical attention immediately if bitten.

In addition, educate travelers that snakebites are preventable and avoiding snakes is key. Travelers should not aggravate or provoke snakes. When walking through brushy areas or undergrowth, travelers should wear tall boots to protect their legs; using a flashlight at night also can be helpful. Travelers should avoid sleeping on the ground; advise those who do to use a well-tucked-in mosquito net.

Climate & Sun Exposure

Climate in Burma varies depending on season and elevation. During the dry months, November–February, Rangoon and southern Burma average 80°F (27°C) during the day, but farther north, nighttime temperatures can drop to 45°F–50°F (8°C–10°C).

Hot season, March–May, and rainy season, May/June–October, are appropriately named. Average high temperatures during the hot season can exceed 95°F (35°C) in many parts of the country, including popular tourist destinations like Rangoon and central Burma (Bagan and Mandalay). Prolonged heat exposure poses a risk for various forms of heat-related illness, especially for travelers in poor physical condition, very old or very young travelers, people participating in strenuous activities, and those unaccustomed to heat (see Sec. 4, Ch. 2, Extremes of Temperature). During periods of high heat, travelers should seek shade, drink ample water, and wear lightweight, loose-fitting, light-colored clothing. Sunscreen products are widely available for purchase (see Sec. 4, Ch. 1, Sun Exposure).

Natural Disasters

Flooding is always a possibility during the rainy season in Burma, and various regions are prone to flash floods.

Safety & Security

Political Unrest

Since February 2021, after a military coup in Burma, political unrest and anti-coup protests have occurred throughout the country. Travelers to Burma should register with the Department of State’s Smart Traveler Enrollment Program (STEP).

Traffic-Related Injuries

Vehicular crashes are a leading cause of injury and death among travelers (see Sec. 8, Ch. 5, Road & Traffic Safety). Remind people visiting Burma to use only reputable taxi or public transportation companies and to always wear seat belts. Motorcycles account for a high percentage of road traffic deaths and should be avoided. Pedestrians and bicyclists are also common victims of road traffic deaths and should exercise caution; right-of-way rules and infrastructure improvements (e.g., bike lanes, crosswalks) to protect these groups are often not in place or not followed. When sidewalks are not available, travelers should walk on the side of the road facing oncoming traffic. Advise anyone who plans to ride a bicycle in Burma to bring and wear a helmet.

Availability & Quality of Medical Care

Travelers with chronic medical conditions should not rely on being able to purchase or refill medications in Burma; counterfeit and substandard medications are common (see Sec. 6, Ch. 3, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel). Hospitals providing an international standard level of care are located only in major cities like Mandalay and Rangoon; local treatment for acute severe injuries or chronic disease exacerbations can be suboptimal. Encourage travelers going to Burma to strongly consider purchasing medical evacuation insurance coverage (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance).