CDC Yellow Book 2024Popular Itineraries
Thailand, a geographically diverse country a little smaller than the state of Texas (see Map 10-14), is a popular destination for tourists, offering beaches, a wide range of cultures and cuisine, eco-adventure opportunities, nightlife, and shopping. Thailand is also a regional business hub. In 2019, ≈40 million visitors spent >1 night in Thailand—the number of visitors to Thailand increased annually during each of the 5 years before the onset of the coronavirus disease 2019 (COVID-19) pandemic. During 2020, Thailand had <7 million visitors, an 80% reduction compared with 2019, mainly due to COVID-19 travel restrictions.
Of a total population of 70 million people, >10 million live in the capital city of Bangkok, a major commercial center. Tourists to Bangkok visit historic and cultural sites including Buddhist temples, the Grand Palace, and 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 includes many culinary options, from sidewalk noodle stands to 4- and 5-star restaurants representing a variety of global cuisines. Although Thai is a tonal language that can be difficult for Americans to learn, English is commonly spoken at most popular destinations. Maps, road signs, and tourist guides frequently provide information in both English and Thai.
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 handicraft villages, elephant nature parks, and other popular outdoor adventures.
Thailand’s central location and major international airport in Bangkok make it an easy access point for other destinations in Asia. In addition, the country has become a popular retirement destination for people from around the world, including many US citizens. The warm climate and low cost of living make Thailand an attractive place to live.
Map 10-14 Thailand
Infectious Disease Risks
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. Consider Japanese encephalitis (JE) and typhoid fever vaccines based on the traveler’s potential risk during a visit to, or residence in, Thailand.
Enteric Infections & Diseases
Active cholera transmission has been infrequently reported from Thailand in recent years. For current recommendations for travelers to Thailand, see the Centers for Disease Control and Prevention (CDC) Travelers’ Health website.
Thailand’s street food is convenient, delicious, and inexpensive. Unfortunately, it also can be a source of travelers’ diarrhea (TD) because lack of clean running water in outdoor eateries precludes good hand and food preparation hygiene. For travelers determined to experience Thai street food, the risk for foodborne illness might be mitigated to some degree by following some basic food and water safety precautions. For instance, visit only restaurants or food stalls that cook food to order, avoid raw or undercooked food, eat only steaming hot food served on new disposable dishes, avoid raw garnishes, eat fruit that you peel yourself, and only drink beverages from sealed containers (see Sec. 2, Ch. 8, Food & Water Precautions). For further information about travelers’ diarrhea, see Sec. 2, Ch. 6, Travelers’ Diarrhea. Fluoroquinolone-resistant enteric pathogens are widespread in Thailand and other areas of Southeast Asia.
Typhoid fever is endemic to Thailand. Incidence has been declining, however, and was estimated to be 3 cases per 100,000 population in 2014. People planning extended stays or travel to remote parts of the country should be vaccinated against typhoid (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever).
Respiratory Infections & Diseases
Coronavirus Disease 2019
For current information on COVID-19 in Thailand, consult the US Embassy & Consulate in Thailand website. See the US government’s COVID-19 international travel requirements and recommendations. All travelers going to Thailand should be up to date with their COVID-19 vaccines.
Thailand has a high burden of tuberculosis (TB). Immunocompromised travelers who visit Thailand for extended visits could be at increased risk for TB. Travelers should avoid people known to have active TB, and refrain from consuming unpasteurized dairy products (see Sec. 5, Part 1, Ch. 22, Tuberculosis).
Sexually Transmitted Infections & HIV
Thailand is a destination for tourists seeking sex (see Sec. 9, Ch. 12, Sex & Travel). Although commercial sex work is illegal, it is practiced in many places in Thailand. Visitors to Thailand’s red-light districts should be aware that these areas have been associated with human trafficking.
In 2019, ≈470,000 people were living with HIV/AIDS in Thailand. The number of new HIV infections reported nationwide each year decreased during 2010–2019. A 100% condom program, which encourages sex workers and their customers to always use condoms, has helped slow the spread of HIV and other sexually transmitted infections (STIs). Nonetheless, HIV infection remains concentrated in many populations. In 2020, an estimated 12% of men who have sex with men, and 3% of sex workers (≈4% of male sex workers and 1.7% of female sex workers) in Thailand were living with HIV.
Travelers should be aware of the risks of acquiring HIV and other STIs in Thailand, 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 (see Sec. 5, Part 2, Ch. 11, Human Immunodeficiency Virus / HIV).
Soil- & Waterborne Infections
Leptospirosis & Melioidosis
Leptospirosis (see Sec. 5, Part 1, Ch. 10, Leptospirosis) cases occur mainly in the southern and northeastern regions of the country; melioidosis (see Sec. 5, Part 1, Ch. 12, Melioidosis) is highly endemic to northeast Thailand. For both diseases, most cases occur during the rainy season, July–October. Adventure travelers can be at increased risk for these diseases because their activities expose them to soil and surface water. Advise travelers visiting endemic areas to avoid contact with soil and water and to ensure that any open wounds are covered to prevent exposure. When contact cannot be avoided, travelers should wear protective clothing and footwear to reduce their exposure risk. Counsel travelers to immediately and thoroughly clean abrasions, burns, or lacerations contaminated with soil or surface water.
Dengue & Zika
Dengue (see Sec. 5, Part 2, Ch. 4, Dengue) is endemic throughout Thailand. Large epidemics occur every several years. 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 Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods).
Transmission of Zika virus (see Sec. 5, Part 2, Ch. 27, Zika) has occurred in Thailand, but no evidence suggests recent outbreaks. Because of the risk for birth defects in infants born to people infected with Zika during pregnancy, however, travelers who are pregnant or trying to become pregnant should review the most recent CDC recommendations.
JE is endemic to many parts of Thailand outside the capital. Transmission occurs year-round, with seasonal epidemics occurring in the northern provinces during May–October. Although most outbreaks occur in the Chiang Mai valley, cases have occurred in travelers who visited resorts or coastal areas in southern Thailand. JE vaccine is recommended for travelers who plan to visit Thailand for ≥1 month and should be considered for people visiting for a shorter period who have an increased risk for JE virus exposure due to their itineraries or activities (see Sec. 5, Part 2, Ch. 13, Japanese Encephalitis).
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. Approximately 80% of cases are due to Plasmodium vivax; <20% are due to P. falciparum. CDC recommends protection against mosquito bites and antimalarial prophylaxis for travelers visiting any of the endemic areas (see Sec. 2, Ch. 5, Yellow Fever Vaccine and Malaria Prevention Information, by Country; Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods; and Sec. 5, Part 3, Ch. 16, Malaria). Atovaquone-proguanil, doxycycline, or tafenoquine are the recommended prophylactic antimalarial drugs for travelers going to malaria-endemic areas in Thailand; mosquito avoidance only (no chemoprophylaxis) is recommended for people traveling to areas where cases of malaria transmission are rare to few (e.g., Bangkok, Chiang Mai, Phuket).
Map 2-16 Malaria prevention in Thailand
Air quality in Thailand varies by province and fluctuates throughout the year, with seasonal smog becoming an increasing health concern in some areas of the country (see Sec. 4, Ch. 3, Air Quality & Ionizing Radiation). The air quality in several provinces (Bangkok, Chiang Mai, Chiang Rai, Khon Kaen, Lampang, Lamphun, Mae Hong Son, Nan, and Samut Sakhon) has exceeded Thai and US government daily standards for fine particulate matter (PM2.5) during parts of the year. In Chiang Mai and other northern provinces, air quality is frequently poor during February–April because of agricultural burning and forest fires.
Animal Bites & Rabies
Government-sponsored mass vaccination campaigns for cats and dogs 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 (e.g., veterinarians) or people who will be traveling to areas where immediate access to care and rabies biologics will be difficult (see Sec. 5, Part 2, Ch. 18, 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.
Climate & Sun Exposure
Because Thailand is close to the equator, the climate is often hot and humid (see Sec. 4, Ch. 1, Sun Exposure, and Sec. 4, Ch. 2, Extremes of Temperature). Flooding is always a possibility, and various regions are prone to flash floods. Monsoon rains typically fall during July–October and can last until relatively cooler, drier weather begins in November, making November–February a popular time of year to visit.
Tsunamis are a risk in Thailand; the 2004 tsunami was the deadliest on record. Two other tsunamis have hit Thailand since 2004, resulting in ≈8,000 deaths.
Safety & Security
The crime rate in Thailand exceeds that of some other countries in Asia. Although most crime involves petty theft, crime related to drug use and the illegal drug trade, gambling, and human trafficking and prostitution also occur. And while more violent crime (e.g., homicide, rape) involving visitors is uncommon in Thailand, it has happened.
Thailand has experienced political unrest throughout the country and ethnonationalist violence in the southern provinces. In 2014, a caretaker military government was established to maintain peace, develop a constitution, and facilitate democratic elections. The country remains politically divided, however, and demonstrations and government protests continue. Prudent travelers should avoid these gatherings because no one can predict whether they will stay peaceful or turn violent (see Sec. 4, Ch. 11, Safety & Security Overseas).
To find out if, when, and where political protests might occur, travelers should monitor the local news, social media outlets, and the US Embassy & Consulate in Thailand website. In addition, by enrolling with the US Department of State’s Smart Traveler Enrollment Program, US citizens and nationals traveling and living in Thailand receive safety alerts from the US embassy; it also enables the US embassy to contact them in the event of an emergency.
Recent terrorism-related incidents in Thailand have been related to the South Thailand insurgency, a separatist group with roots in ethnic and religious tensions. The insurgency has been ongoing for several decades and is concentrated in 4 provinces (Narathiwat, Pattani, Songkhla, Yala) in the far south of the country, near the Malaysian border. Martial law is enforced in these provinces. Due to safety concerns, US government employees need official authorization to travel to these areas, and the US embassy in Thailand strongly discourages all other Americans from going. The Royal Thai Government has taken active measures to counter terrorism through legislation, capacity-building, and communication and collaboration with other countries in the region.
Traffic accidents are common in Thailand. According to the World Health Organization, in 2018, Thailand had one of the world’s highest traffic-related fatality rates, due in large part to reckless driving. Approximately 20,000 motor vehicle deaths occur in Thailand each year. Motorcycles, a cheap and popular mode of travel, are among the most vulnerable vehicles on the road. During 2019–2021, 85% of road accidents involved motorcycles or scooters, and a substantial proportion (73% in 2012) of motor vehicle deaths are due to motorcycle and scooter crashes. Travelers should avoid riding motorbikes, including motorbike taxis, but if they must ride, they should wear a helmet. Travelers also should fasten seat belts when riding in cars (see Sec. 8, Ch. 5, Road & Traffic Safety).
Availability & Quality of Medical Care
Health care in Thailand is generally considered to be of good quality and less costly than in many high-income countries. Approximately 20% of hospitals are private, and many accept online registration and have English-speaking staff. Most major medical centers are in larger metropolitan areas. In rural areas, availability and quality of medical care is more limited.
Medical tourism to Thailand increased during 2010–2019. The cost of medical or surgical treatment is lower, and the level of care is considered comparable to that of many places in the United States. Thailand is among the top medical tourism destinations worldwide. Travelers intending to obtain medical care abroad should research the facilities at their destination; learn about health insurance coverage, travel regulations, and requirements for visitors seeking medical care in Thailand; and consult with their primary care physician and a travel medicine specialist in advance of their trip (see Sec. 6, Ch. 4, Medical Tourism).
The following authors contributed to the previous version of this chapter: John R. MacArthur, Joshua Mott, Sopon Iamsirithaworn
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