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Vietnam Travel Information

For many years Vietnam formed part of the French colony of Indochina, along with Cambodia and Laos. In 1941, the Japanese occupied Vietnam during their WWII sweep through South East Asia. The resistance to the Japanese was led by the Indochinese Communist Party.
Communist revolutionary Ho Chi Minh established the Viet Minh during WWII in order to gain independence from France. Fighting continued until 1954 when the French surrendered to the Viet Minh at Dien Bien Phu and Hanoi became capital of North Vietnam, but Ho Chi Minh was determined to reunite the whole country.

The USA came to the support of South Vietnam and full-scale war – with the southern Communist guerrillas (known as the Viet Cong), the North Vietnam Army and the Soviet Union on one side, and the Americans and the South Vietnamese Army on the other – broke out in 1965. The Americans withdrew in 1973 and fighting continued until 1975 when Saigon fell to North Vietnamese troops. Vietnam was reunited under Communist rule the following year.

Vietnamese troops occupied Cambodia in 1978 to drive out the genocidal Khmer Rouge regime and stayed there until it withdrew its troops in 1989.
After withdrawing from Cambodia, Vietnam concentrated on rebuilding its own economy and following years of rampant inflation, poverty and repression, the government introduced economic reform or doi moi in 1986, allowing people to own their own businesses. Nonetheless, the Vietnamese economy suffered from the withdrawal of aid and subsidised goods from the former USSR and from Eastern Europe, as well as the continuing US-organised trade boycott instituted after the US withdrawal. Relations with the USA eased after full diplomatic relations were restored in 1995.
Recent reforms resulted in rapid economic growth, until the global crisis in 2008, but there has been no parallel development in the country’s political environment – the Communist Party has no intention of relaxing its hold on political power and has been criticised by human rights groups for increasingly suppressing online dissent and freedom of expression.

Geography

Vietnam lies within the tropics and is principally agricultural with a central tropical rainforest. The ‘S’-shaped country shares borders to the north with the People’s Republic of China and to the west withLaos and Cambodia. The eastern and southern shores are lapped by the South China Sea and the Pacific Ocean.
Northern Vietnam is dominated by the Red River plains that bisect Hanoi, and the Lo and Chay rivers. To the north and west of Hanoi are green hilly areas; particularly well known is the Sapa Valley. East of Hanoi, Halong Bay features a stunning natural formation of more than 3,000 limestone islands jutting sharply out of the South China Sea.
To the south, it is the Mekong River and its fertile plain that governs the geography and consequently the rice industry. Among the plains, in the middle of the thin country and to the southwest are mountainous areas, known as the highlands, where farmers grow rubber, tea and coffee.

Culture

Buddhism is major religion but there are also Taoist, Confucian, Hoa Hao, Caodaist and Christian minorities.
Handshaking and a vocal greeting is normal. Clothing should be kept simple, informal and discreet. Avoid shorts if possible as they are usually only worn by children. Footwear should be removed when entering Buddhist pagodas. Vietnamese people should not be touched on the head. It is also polite to give and receive gifts and business cards using two hands.

Health Precaution and Immunization

All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.

Malaria:Â Prophylaxis is recommended for all rural areas, except for the Red River delta, the coastal plain north of the Nha Trang, and the Mekong Delta. Either Lariam (mefloquine), Malarone (atovaquone/proguanil), or doxycycline may be given, except for the southern provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh, where mefloquine should not be used because of the risk of mefloquine-resistant malaria.

Medications
Travelers’ diarrhea is the most common travel-related ailment. The cornerstone of prevention is food and water precautions, as outlined below. All travelers should bring along an antibiotic and an antidiarrheal drug to be started promptly if significant diarrhea occurs, defined as three or more loose stools in an 8-hour period or five or more loose stools in a 24-hour period, especially if associated with nausea, vomiting, cramps, fever or blood in the stool. A quinolone antibiotic is usually prescribed: either ciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin) 500 mg once daily for a total of three days. Quinolones are generally well-tolerated, but occasionally cause sun sensitivity and should not be given to children, pregnant women, or anyone with a history of quinolone allergy. Alternative regimens include a three day course of rifaximin (Xifaxan) 200 mg three times daily or azithromycin (Zithromax) 500 mg once daily. Rifaximin should not be used by those with fever or bloody stools and is not approved for pregnant women or those under age 12. Azithromycin should be avoided in those allergic to erythromycin or related antibiotics. An antidiarrheal drug such as loperamide (Imodium) or diphenoxylate (Lomotil) should be taken as needed to slow the frequency of stools, but not enough to stop the bowel movements completely. Diphenoxylate (Lomotil) and loperamide (Imodium) should not be given to children under age two.
Most cases of travelers’ diarrhea are mild and do not require either antibiotics or antidiarrheal drugs. Adequate fluid intake is essential.
If diarrhea is severe or bloody, or if fever occurs with shaking chills, or if abdominal pain becomes marked, or if diarrhea persists for more than 72 hours, medical attention should be sought.
Though effective, antibiotics are not recommended prophylactically (i.e. to prevent diarrhea before it occurs) because of the risk of adverse effects, though this approach may be warranted in special situations, such as immunocompromised travelers.

Malaria in Viet Nam: prophylaxis is recommended for all rural areas except for the Red River delta, the coastal plains north of Nha Trang, and the Mekong Delta. The highest risk exists in the two southernmost provinces, Ca Mau and Bac Lieu, and the highland areas below 1500 m south of 18 degrees N. Either mefloquine (Lariam),atovaquone/proguanil (Malarone)(PDF), or doxycycline may be given, except for the southern provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh, where mefloquine should not be used because of the risk of mefloquine-resistant malaria. Mefloquine is taken once weekly in a dosage of 250 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Mefloquine may cause mild neuropsychiatric symptoms, including nausea, vomiting, dizziness, insomnia, and nightmares. Rarely, severe reactions occur, including depression, anxiety, psychosis, hallucinations, and seizures. Mefloquine should not be given to anyone with a history of seizures, psychiatric illness, cardiac conduction disorders, or allergy to quinine or quinidine. Those taking mefloquine (Lariam) should read the Lariam Medication Guide (PDF). Atovaquone/proguanil (Malarone) is a combination pill taken once daily with food starting two days before arrival and continuing through the trip and for seven days after departure. Side-effects, which are typically mild, may include abdominal pain, nausea, vomiting, headache, diarrhea, or dizziness. Serious adverse reactions are rare. Doxycycline is effective, but may cause an exaggerated sunburn reaction, which limits its usefulness in the tropics. Insect protection measures are essential.
Rare malaria cases are reported from the Mekong Delta. Insect protection measuresare advised, but malaria medications are not generally recommended.
There is no malaria risk in Hanoi, Ho Chi Minh City (Saigon), Hue, Can Tho, Da Nang, Nha Trang, Qui Nhon, and Haiphong.
Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours. See malaria for details. Symptoms of malaria sometimes do not occur for months or even years after exposure.
For further information concerning malaria in Viet Nam, go to the World Health Organization – Western Pacific Region and the World Health Organization.

Immunizations
The following are the recommended vaccinations for Viet Nam:

Hepatitis A vaccine is recommended for all travelers over one year of age. It should be given at least two weeks (preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) (PDF) and Havrix (GlaxoSmithKline) (PDF). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the injection site, headache, and malaise.
Older adults, immunocompromised persons, and those with chronic liver disease or other chronic medical conditions who have less than two weeks before departure should receive a single intramuscular dose of immune globulin (0.02 mL/kg) at a separate anatomic injection site in addition to the initial dose of vaccine. Travelers who are less than one year of age or allergic to a vaccine component should receive a single intramuscular dose of immune globulin (see hepatitis A for dosage) in the place of vaccine.

Typhoid vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.) (PDF), given as a single dose. Adverse reactions, which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There are no data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably preferable to the oral vaccine in pregnant and immunocompromised travelers.

Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening. Japanese encephalitis is highly prevalent throughout Viet Nam, with highest incidence in the northern part of the country, especially in and near Hanoi. Transmission is greatest from May through October. A total of 120 cases were reported in the first half of 2010.
The recommended vaccine is IXIARO , given 0.5 cc intramuscularly, followed by a second dose 28 days later. The series should be completed at least one week before travel. The most common side effects are headaches, muscle aches, and pain and tenderness at the injection site. Safety has not been established in pregnant women, nursing mothers, or children under the age of two months. In addition to vaccination, strict attention to insect protection measures is essential for anyone at risk.

Hepatitis B vaccine is recommended for all travelers if not previously vaccinated. Two vaccines are currently licensed in the United States: Recombivax HB (Merck and Co., Inc.) (PDF) and Engerix-B (GlaxoSmithKline) (PDF). A full series consists of three intramuscular doses given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.

Rabies vaccine is recommended for travelers spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats. Children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites. In Viet Nam, most cases are related to dog bites, though bites from monkeys and other wildlife may also be responsible. A complete preexposure series consists of three doses of vaccine injected into the deltoid muscle on days 0, 7, and 21 or 28. Side-effects may include pain at the injection site, headache, nausea, abdominal pain, muscle aches, dizziness, or allergic reactions.
Any animal bite or scratch should be thoroughly cleaned with large amounts of soap and water and local health authorities should be contacted immediately for possible post-exposure treatment, whether or not the person has been immunized against rabies.

Tetanus-diphtheria vaccine is recommended for all travelers who have not received a tetanus-diphtheria immunization within the last 10 years.

Measles-mumps-rubella vaccine: two doses are recommended (if not previously given) for all travelers born after 1956, unless blood tests show immunity. Many adults born after 1956 and before 1970 received only one vaccination against measles, mumps, and rubella as children and should be given a second dose before travel. MMR vaccine should not be given to pregnant or severely immunocompromised individuals.

Cholera vaccine is not generally recommended, even though cholera occurs in Viet Nam, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, andDukoral, licensed in Canada, Australia, and the European Union. These vaccines, where available, are recommended only for high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. The only cholera vaccine approved for use in the United States is no longer manufactured or sold, due to low efficacy and frequent side-effects.

Polio vaccine is not recommended for any adult traveler who completed the recommended childhood immunizations. In October 2000, the World Health Organization certified that polio had been eradicated from the Western Pacific region, including Viet Nam.

Yellow fever vaccine is required for all travelers over one year of age arriving from a yellow-fever-infected country in Africa or the Americas, but is not recommended or required otherwise. Yellow fever vaccine (YF-VAX; Aventis Pasteur Inc.) (PDF) must be administered at an approved yellow fever vaccination center, which will give each vaccinee a fully validated International Certificate of Vaccination. Yellow fever vaccine should not in general be given to those who are younger than nine months of age, pregnant, immunocompromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.

Recent outbreaks
An increased number of cases of Japanese encephalitis, a mosquito-borne viral infection which may cause permanent brain damage, was reported from Viet Nam in June 2014. As of July, a total of 325 cases and five deaths had been identified, mostly in children (see ProMED-mail, June 29 and July 11, 2014). In August 2014, a Japanese encephalitis outbreak was reported from the northern province of Son La, affecting more than 100 children and killing 13 of them. All travelers to Viet Nam should be sure to follow insect protection measures, as below. Japanese encephalitis vaccine is recommended for those who expect to spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors or engage in extensive outdoor activities in rural or agricultural areas, especially in the evening.
An increased number of cases of Angiostrongylus meningitis was reported in July 2014 from Ho Chi Minh City. Most of the cases occurred in children who had eaten or played with snails, which carry the causative organism, Angiostrongylus cantonensis, also known as rat lungworm. Five cases of Angiostrongylus meningitis were reported among children in the Hanoi area in the year 2008 (see ProMED-mail; November 13, 2008, and July 18, 2014). Angiostrongylus cantonensis is a parasitic roundworm which humans acquire by eating raw or undercooked snails, slugs, freshwater prawns, crabs, or frogs which have been infected. The most common symptoms are headache, neck stiffness, numbness and tingling, visual disturbances, photophobia (sensitivity to light), and fatigue. There is no treatment except symptomatic relief. Food and water precautions, as discussed below, are advised to prevent this and other parasitic infections.
Outbreaks of hand, foot, and mouth disease occur regularly in Viet Nam. More than 24,000 cases, three of them fatal, were reported nationwide in the first five months of 2014. More than 100,000 cases and at least 42 deaths were reported in the year 2012. Slightly more than half the cases and more than 90 percent of the deaths occurred in the southern region. Most of the cases and all of the fatalities were caused by enterovirus 71, which produces an especially severe form of the illness. An outbreak in the year 2011 caused more than 110,000 cases and 169 deaths, mostly in children, by the end of the year.
Enteroviruses are transmitted by exposure to fecal material from infected individuals. The illness is characterized by fever, oral blisters, and a rash or blisters on the palms and soles. Most cases resolve uneventfully, but a small percentage are complicated by encephalitis (inflammation of the brain), myocarditis (inflammation of the heart muscle), or pulmonary edema (fluid in the lungs). The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and changing diapers and before handling food.
In May 2008, an outbreak of hand, foot and mouth disease was reported from the southern part of Viet Nam, causing hundreds of cases and several fatalities in young children. In September 2007, an outbreak was reported from Ho Chi Minh City (seeProMED-mail; September 26, 2007, May 4, 2008, and April 9, 2011). A previous outbreak was reported from the southern part of the country in September 2006.
The number of deaths caused by rabies appears to be rising: there were 64 deaths from rabies for the year 2009, down fromm previous years, but 34 deaths in the first six months of 2010. The increase appeared to be related to a failure to vaccinate dogs and cats, as well as a Vietnamese custom of eating dogs, especially puppies, who are too young to be vaccinated. A rabies outbreak related to bites from rabid dogs was reported from northern Lai Chau Province in July 2009, killing four people. The outbreak appeared to have been caused by importation of dogs from other provinces, due to the high demand for dog meat (see ProMED-mail). As above, rabies vaccine is recommended for travelers to Viet Nam who will be spending a lot of time outdoors, for travelers at high risk for animal bites, such as veterinarians and animal handlers, for long-term travelers and expatriates, and for travelers involved in any activities that might bring them into direct contact with bats.
A measles outbreak was reported from Viet Nam in January 2014, causing almost a thousand cases by February, chiefly in the northern mountainous provinces, Hanoi and Ho Chi Minh City. A measles outbreak also occurred in early 2009, affecting the city of Hanoi and other areas. All travelers born after 1956 should make sure they have had either two documented MMR or measles immunizations or a blood test showing measles immunity. Those born before 1957 are presumed to be immune. Although measles immunization is usually begun at age 12 months, children between the ages of 6 and 11 months should be given an initial dose of measles or MMR vaccine before traveling to Viet Nam.
A cholera outbreak was reported from Viet Nam in May 2010, affecting five northern provinces, including Hanoi, Ha Nam, Hai Duong, Hai Phong and Bac Ninh, and three southern provinces, including An Giang, Tay Ninh and Ho Chi Minh City. In October 2008, a cholera outbreak was reported from Quynh Luu district in the central Nghe An Province, probably related to contamination of the Mai Giang River, which runs through the district. A major cholera outbreak was reported in March 2008, chiefly affecting Hanoi. As of August, more than 700 cases had been confirmed (see theWorld Health Organization and ProMED-mail). A smaller cholera outbreak was reported from the northern part of the country in October 2007. Many cases in the northern outbreaks appeared to have been caused by consumption of raw shrimp paste, seafood salad, blood pudding, and raw vegetables (see ProMED-mail; November 2, 9, and 26, 2007; April 1, 9, and 15, 2008).
The main symptoms of cholera are profuse watery diarrhea and vomiting, which in severe cases may lead to dehydration and death. Most travelers are at extremely low risk for infection. Cholera vaccine, where available, is recommended only for certain high-risk individuals, such as relief workers, health professionals, and those traveling to remote areas where cholera epidemics are occurring and there is limited access to medical care. All travelers should carefully observe food and water precautions, as below.
A total of 127 human cases of H5N1 avian influenza (“bird flu”) have been reported from Viet Nam, of which 64 have been fatal. Most of the cases occurred in the year 2003. Since then, there have been only sporadic cases of human H5N1 infection. The most recent were reported in January 2014 from Tan Long village, Thanh Binh district, Dong Thap province, and from southern Binh Phuc province. Avian influenza is continuing to occur on poultry farms throughout the country. The latest wave of poultry outbreaks began in October 2013 and was ongoing as of February 2014.
Most travelers are at extremely low risk for avian influenza, since almost all human cases have occurred in those who have had direct contact with live, infected poultry, or sustained, intimate contact with family members suffering from the disease. The Centers for Disease Control does not advise against travel to Viet Nam, but recommends that travelers should avoid exposure to live poultry, including visits to poultry farms and open markets with live birds; should not touch any surfaces that might be contaminated with feces from poultry or other animals; and should make sure all poultry and egg products are thoroughly cooked. A vaccine for avian influenza was recently approved by the U.S. Food and Drug Administration (FDA), but produces adequate antibody levels in fewer than half of recipients and is not commercially available. The vaccines for human influenza do not protect against avian influenza. Anyone who develops fever and flu-like symptoms after travel to Viet Nam should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, Health Canada, the Centers for Disease Control, and ProMED-mail.
Dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, is one of the leading causes of hospitalization and death in Viet Nam, especially in the southern part of the country. The number of cases has been rising in recent years. A total of 42,181 cases and 44 deaths were reported nationwide for the first ten months of 2011. A total of 80,000 cases and 59 deaths were reported nationwide for the first nine months of 2010. For the year 2009, a total of 105,370 cases and 87 deaths were reported; more than usual occurred in Hanoi and other areas in the northern part of the country. In the year 2008, more than 78,500 cases and 79 deaths were recorded nationwide, including almost 14,000 cases in Ho Chi Minh City. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. Transmission usually peaks from May through November each year, though the disease occurs year-round. The most intense transmission occurs in the Mekong delta. No vaccine is available at this time. The cornerstone of prevention isinsect protection measures, as outlined below.
More than 50,000 cases, including 49 deaths, were reported in the first eight months of 2007, an increase of more than 40% compared to the same period in 2006 (seeProMED-mail, June 8, July 10, August 6, and September 8, 2007). For the year 2006, more than 77,800 cases were reported nationwide, including 68 fatalities, compared to 49,400 cases and 51 deaths for the year 2005. An epidemic of dengue hemorrhagic fever resulting in more than 200,000 cases occurred in southern Viet Nam in 1998, possibly related to climatic changes due to El Nino. See Emerging Infectious Diseases for further information. For further information on dengue in Viet Nam, go to the World Health Organization – Western Pacific Region.
An outbreak of Streptococcus suis infections was reported in July 2007, resulting in 42 cases (22 in the north and 20 in the south), including two fatalities. Sporadic human cases have been reported since then, including 11 cases in the first five months of 2011. An increased number of cases was reported from the northern part of the country in June 2012. One fatal case was reported from Hanoi’s Tay Ho district in September 2012, and two more fatal cases were reported from Hanoi in February 2013. Three cases were reported from Da Nang in January 2013. An isolated fatal case was reported in February 2014 from Thai Binh province, in a man who had eaten blood pudding made from uncooked pig blood, a known source of infection.
Most human cases of Streptococcus suis infections occur in adult male farmers or butchers who have had direct contact with diseased or dead pigs. The infection may also be acquired by eating contaminated pork or pork products. In general, the disease is not transmitted from person-to-person. Symptoms include high fever, malaise, nausea, and vomiting, followed in severe cases by meningitis, subcutaneous hemorrhage, toxic shock, and coma. Travelers should avoid visiting pig farms and should make sure all pork products are thoroughly cooked before consumption. For further information, go to ProMED-mail (July 22 and 26, 2007; May 19, 2011; June 26, 2012; and February 10, 2014).
An outbreak of severe acute respiratory syndrome (SARS) was reported in March 2003, resulting in 63 cases and five deaths. The outbreak was terminated by an aggressive program of contact identification and quarantine. No travel restrictions are recommended for Viet Nam at this time.
The outbreak was apparently triggered by a single person who became ill after arriving from Shanghai and Hong Kong. Almost all cases occurred in health care workers or in family members or other close contacts of those with the disease.
The disease appears to be caused by a previously unknown virus belonging to the coronavirus family. The incubation period usually ranges from two-to-seven days, but may be as long as ten days. The first symptom is usually fever, often accompanied by chills, headache, body aches, and malaise. This is typically followed by dry cough and difficulty breathing, at times severe enough to require intubation and mechanical ventilation.
For further information, go to the World Health Organization, Health Canada, and the Centers for Disease Control.

Other infections
Plague remains prevalent in Viet Nam, chiefly in Daklak, Gialai, and Binh Dinh provinces. The plague is usually transmitted by the bite of rodent fleas. Less commonly, the disease is acquired by inhalation of infected droplets, which may be coughed into the air by a person with plague pneumonia, or by direct exposure to infected blood or tissues. Most travelers are at low risk. Those who may have contact with rodents or their fleas should bring along a bottle of doxycycline, to be taken prophylactically if exposure occurs. Those less than eight years of age or allergic to doxycycline may take trimethoprim-sulfamethoxazole instead. To minimize risk, travelers should avoid areas containing rodent burrows or nests, never handle sick or dead animals, and follow insect protection measures, as described below.
HIV (human immunodeficiency virus) infection is reported, but travelers are not at risk unless they have unprotected sexual contacts or receive injections or blood transfusions.

Health information is sourced from mdtravelhealth.com

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