Thailand, the only Southeast Asian nation never to have been colonized by European powers, is a constitutional monarchy whose current head of state is HM Bhumibol Adulyadej. A unified Thai kingdom has existed since the mid-14th century, and Thailand was known as Siam until 1939 when it officially became the Kingdom of Thailand.
Thailand is the 50th largest country in the world; most nearly equal in size to Spain. Located just 15 degrees north of the equator, Thailand has a tropical climate and temperatures typically range from 19 to 38 degrees C (66-100 F). Thailand’s largest peak, Doi Inthanon, is 2,565 meters (8,415 ft) tall. Thailand covers 510,890 sq km of land and 2,230 sq km of water. The coastline of Thailand is 3,219 km long. Thailand’s longest shared border is with Myanmar (Burma), stretching 1,800 km.
The population of Thailand comprises of roughly 65 million citizens, the majority of whom are ethnically Thai, though peoples of Chinese, Indian, Malay, Mon, Khmer, Burmese, and Lao origin are also represented to varying degrees. Approximately 7 million citizens live in the capital city, Bangkok, though this number varies seasonally and is otherwise difficult to accurately count.
The vast majority (roughly 80%) of Thailand’s nearly 65 million citizens are ethnically Thai. The remainder consists primarily of peoples of Chinese, Indian, Malay, Mon, Khmer, Burmese, and Lao decent. Of the 7 million citizens who live in the capital city, Bangkok, there is a greater diversity of ethnicities, including a large number of expatriate residents from across the globe. Other geographic distinctions of the population include a Muslim majority in the south near the Malaysian border, and hill tribe ethnic groups, such as the Hmong and Karen, who live in the northern mountains.
More than 92% of the population speaks Thai or one of its regional dialects. While the Thai language is the official language of Thailand, as a result of its cosmopolitan capital city and established tourism infrastructure, English is spoken and understood throughout much of Thailand.
94.6% of Thais are Buddhist, 4.6% of Thais are Muslim 0.7% of Thais are Christian
Thailand hotels are some of the finest in the world, whether they are five star luxury spa retreats or quaint family-run beachfront bungalows. There is a hotel in Thailand for every type of traveler on every budget. That said, the best prices are during Thailand’s off-peak season (May – Aug), while the most expensive prices are typically during the cool season (Dec – Feb). Whether your accommodation choice is a homestay with local villagers, a guesthouse in a backpacker district, a beach bungalow, or a five star hotel in Thailand, unless you have booked ahead, settle for nothing less than the warmest “land of smiles” hospitality.
Medical Precaution and Vaccination
All travelers should visit either their personal physician or a travel health clinic 4-8 weeks before departure.
Malaria:Â Prophylaxis with Malarone (atovaquone/proguanil) or doxycycline is recommended for rural areas bordering Cambodia, Laos, and Myanmar, including Mae Hong Son. Rare local cases have been reported from Phang Nga and Phuket; insect protection measures but not malaria pills are not recommended for these two areas.
Hepatitis A: Recommended for all travelers
Typhoid: For travelers who may eat or drink outside major restaurants and hotels
Yellow fever: Required for all travelers greater than one year of age arriving from a yellow-fever-infected area in Africa or the Americas and for travelers who have been in transit in an airport located in a country with risk of yellow fever transmission. Not recommended or required otherwise.
Japanese encephalitis: For travelers who may spend a month or more in rural areas and for short-term travelers who may spend substantial time outdoors in rural areas, especially after dusk.
Hepatitis B: Recommended for all travelers
Rabies: For travelers spending a lot of time outdoors, or at high risk for animal bites, or involved in any activities that might bring them into direct contact with bats
Measles, mumps, rubella (MMR): Two doses recommended for all travelers born after 1956, if not previously given
Tetanus-diphtheria: Revaccination recommended every 10 years
Travelers’ diarrhea is the most common travel-related infection. It may be caused by many different organisms, including bacteria such as E. coli, Salmonella, Shigella, Campylobacter, Aeromonas, Plesiomonas, and vibrios; parasites such as Giardia, Entamoeba histolytica, Cryptosporidium, and Cyclospora; and viruses. In addition to diarrhea, symptoms may include nausea, vomiting, abdominal pain, fever, sweats, chills, headache, and malaise. The chief complication is dehydration, which may become severe, especially in warmer climes.
The best means of prevention is to avoid any questionable foods or beverages. Do not drink tap water unless it has been boiled, filtered, or chemically disinfected. Do not drink unbottled beverages or drinks with ice. Do not eat fruits or vegetables unless they have been peeled or cooked. Avoid cooked foods that are no longer piping hot. Cooked foods that have been left at room temperature are particularly hazardous. Avoid unpasteurized milk and any products that might have been made from unpasteurized milk, such as ice cream. Avoid food and beverages obtained from street vendors. Do not eat raw or undercooked meat or fish, including ceviche. Some types of fish may contain poisonous biotoxins even when cooked. Barracuda in particular should never be eaten. Other fish that may contain toxins include red snapper, grouper, amberjack, sea bass, and a large number of tropical reef fish.
Although antibiotics may be taken prophylactically to prevent travelers’ diarrhea (i.e. taken on a daily basis before symptoms have a chance to occur), this isn’t generally recommended because starting antibiotics after diarrhea begins works well and because increased antibiotic use might lead to a greater incidence of side-effects and the selection of resistant organisms. Prophylactic antibiotics might be appropriate for situations in which diarrhea might prove unusually troublesome (i.e. business trip, diplomatic mission, athletic event) or for travelers who are immunocompromised or who have a history of intestinal disorders, such as those with inflammatory bowel disease.
Appropriate regimens include ciprofloxacin (Cipro)(PDF) or levofloxacin (Levaquin)(PDF) 500 mg once daily or (less effectively) trimethoprim-sulfamethoxazole (Bactrim; Septra) one double-strength tablet daily. Bismuth subsalicylate (Pepto-Bismol) (two tablets or two ounces four times daily) will reduce the likelihood of travelers’ diarrhea, but few take this because it is inconvenient. Side-effects may include black tongue, black stools, nausea, constipation, and ringing in the ears (tinnitus). Bismuth subsalicylate should not be taken by those with aspirin allergy, kidney disease, or gout, and should not be taken for more than three weeks. Quinolone antibiotics may bind to metallic cations such as bismuth; they should not be taken concurrently.
The standard recommendation is for travelers at risk to 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: eitherciprofloxacin (Cipro)(PDF) 500 mg twice daily or levofloxacin (Levaquin)(PDF) 500 mg once daily for a total of three days. Quinolones 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. For children, the dosage of azithromycin is 10 mg/kg on day 1, up to 500 mg, and 5 mg/kg on days 2 and 3, up to 250 mg. Another option is trimethoprim/sulfamethoxazole (Bactrim), which is used less often today because of increasing bacterial resistance but may be appropriate for children or those unable to tolerate other antibiotics. The dosage is one double-strenth tablet twice daily for adults and 5 mg/kg trimethoprim/25 mg/kg sulfa twice daily for children. Trimethoprim-sulfamethoxazole should not be given to pregnant women or those with a history of sulfa allergy. 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. Oral rehydration solutions, which are rich in salt and sugar, are widely available and highly effective. If fluids that do not contain salt are used, plain salted foods, such as crackers, are recommended. Dairy products should be avoided until diarrhea has subsided, as these are often difficult to digest while the intestine is inflamed.
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 obtained, if possible.
The following are the recommended vaccinations for Thailand:
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, with the exception of short-term visitors who restrict their meals to major restaurants and hotels, such as business 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 transmitted by mosquitoes and occurs from May through October in Thailand. The disease is highly prevalent in the north and occurs sporadically in the south. Annual outbreaks have been reported in the Chiang Mai Valley. Sporadic cases have been described in the Bangkok suburbs.
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 Thailand, the chief risk is from dog bites, though cases from cat bites are also reported. 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.
Polio vaccine is not generally recommended for adult travelers who completed the recommended childhood immunizations, since polio has not been reported from Thailand for several years. A one-time booster of inactivated polio vaccine may be considered for extended travel to rural areas.
Cholera vaccine is not generally recommended, though cholera is reported, because most travelers are at low risk for infection. Two oral vaccines have recently been developed: Orochol (Mutacol), licensed in Canada and Australia, and Dukoral, 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.
Yellow fever vaccine is required for all travelers greater than one year of age arriving from a yellow-fever-infected country in Africa or the Americas and for travelers who have been in transit more than 12 hours in an airport located in a country with risk of yellow fever transmission, 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, immune-compromised, or allergic to eggs. It should also not be given to those with a history of thymus disease or thymectomy.
An outbreak of hand, foot, and mouth disease was reported from Thailand in early 2014, causing almost 14,000 cases by the end of May. A small outbreak was reported from Burirum province, in the northeastern part of the country, in July 2012. Between July and September 2010, a hand, foot, and mouth outbreak caused more than 10,000 cases nationwide, including a small outbreak in Phuket. An outbreak was also reported in 2006 (see ProMED-mail; September 7, 2006, September 28, 2010, July 14 and 15, 2012, and June 10, 2014).
Most cases of hand, foot and mouth disease occur in infants and young children, though adults may also be affected. 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). Most cases are caused by enteroviruses, which are transmitted by exposure to fecal material from infected individuals. The key to prevention is good personal hygiene and scrupulous hand-washing, especially after defecation and before handling food.
Two cases of leptospirosis were reported in Spanish travelers who had visited the Phi Phi islands in September 2013 (see Eurosurveillance). In June 2012, a leptospirosis outbreak was reported from the northeastern part of Surin province, causing 107 confirmed cases and seven deaths (see ProMED-mail, June 26, 2012).
Leptospirosis is acquired by exposure to water contaminated by the urine of infected animals. In Thailand, the animal reservoir includes rats and dogs. Outbreaks often occur in between August and November, which is the rainy season, and at times of flooding. Most cases occur in the north and northeast regions of the country (see Emerging Infectious Diseases). Symptoms may include fever, chills, headache, muscle aches, conjunctivitis (pink eye), photophobia (light sensitivity), and rash. Most cases resolve uneventfully, but a small number may be complicated by meningitis, kidney failure, liver failure, or hemorrhage. Those who may be exposed to contaminated fresh water, such as those on adventure trips, may consider taking a prophylactic 200 mg dose of doxycycline, either once weekly or as a one-time dose.
In September 2006, a leptospirosis outbreak was reported from Nan province in the northern part of the country, related to recent floods (see ProMED-mail; September 12, 2006). A previous outbreak occurred in September-October 1999 in the Khumuang subdistrict, Buriram province, in the northeastern part of the country.
An increased number of malaria cases was reported in April 2011 from Yala Province in the south. Three cases of malaria were reported in late 2005 and early 2006 among travelers to Koh Phangan in the southern part of the country, where malaria is thought to be highly uncommon. See ProMED-mail (May 20, 2006, and April 22, 2011) and Eurosurveillance for further information. In 2002, two cases were reported in German travelers who had visited Khao Sok national park, also in the southern part of the country (see Eurosurveillance). Because the risk appears to be low, malaria prophylaxis is not generally recommended for travel to the southern peninsula. However, travelers should be aware that the risk, though small, does exist, and should immediately seek medical attention if they develop fever or other symptoms suggestive of malaria.
An outbreak of melioidosis was reported from Thailand in August 2010, causing 1307 cases and six deaths, mostly among farmers in the northeastern part of the country. Three cases of melioidosis were reported in January 2005 among Finnish tourists who had survived the tsunami in December 2004. The tourists had been visiting Khao Lak on the southwest coast of Thailand when the tsunami struck. In October 2012, a case was reported in a Belgian traveler. Melioidosis is caused by a soil bacterium known as Burkholderia pseudomallei, which gains entrance to the body through cuts or other breaks in the skin, leading to pneumonia or wound infections. The infection may progress to septicemia and may be life-threatening, especially in those with compromised immune systems. In Thailand, most cases are reported from the northeastern part of the country, usually in rice farmers during the rainy season. To prevent melioidosis, travelers are advised to wear waterproof gloves and shoes or boots whenever coming into direct contact with soil, especially during the rainy season.
An outbreak of chikungunya fever, a mosquito-borne illness characterized by fever and incapacitating joint pains, was reported in early 2009 from southern Thailand, including Phuket. By late September, more than 42,000 suspected cases had been described and the outbreak had spread to all other regions of the country. The largest number of cases was reported from the southern province of Songkhla, followed by Narathiwat, Pattani, and Yala, also in the south. More than 2000 cases were reported from Phuket, including 31 cases in foreigners. None of the cases were fatal (see ProMED-mail, April 29 and May 15, 2009). Symptoms of chikungunya fever include fever, joint pains, muscle aches, headache, and rash. The disease is almost never fatal, but may be complicated by protracted fatigue and malaise. Rarely, the infection is complicated by meningoencephalitis, which is usually seen in newborns and those with pre-existing medical conditions. Insect protection measures are strongly recommended, as described below. Because of the risk of mother-to-child transmission, pregnant women need to take special care to protect themselves from mosquito bites. In October 2008, a chikungunya outbreak occurred in a village in Narathiwat province, in southern Thailand near the border with Malaysia.
Dengue fever, a flu-like illness sometimes complicated by hemorrhage or shock, is highly prevalent in Thailand. The number of cases usually peaks during the rainy season (ranging from May through November), when mosquitoes proliferate. A total of 26,000 cases and 33 deaths were reported nationwide for the first four months of 2013. A dengue outbreak was reported from Phuket in April 2013, causing more than 300 cases. Dengue is transmitted by Aedes mosquitoes, which bite primarily in the daytime and favor densely populated areas, though they also inhabit rural environments. No vaccine is available at this time. Insect protection measures are strongly advised, as outlined below.
More than 48,000 cases of dengue fever, 27 of them fatal, were reported from Thailand in the first nine months of 2011, chiefly in the central region. Provinces most affected included Krabi, Samut Sakhon, Satun, Songkhla, Ratchaburi, Nakhon Pathom, Nakhon Sawan, Chon Buri and Trat. An outbreak was reported from the island of Phi Phi in August 2011, causing 20 cases, some of them in tourists. In September 2011, an outbreak of a febrile illness, possibly dengue, was reported from the Karenni refugee camp in Mae Hong Song. More than 86,000 cases of dengue fever and at least 100 deaths were reported nationwide for the first nine months of 2010. Most of the cases were reported from the Northeastern provinces, followed by the Central, Southern and Northern regions. An outbreak was reported from the island of Phuket, causing almost 700 cases by November 2010.
Dengue outbreaks were reported from Buri Ram province and from the northeastern province of Surin in September 2010, from the northeastern province of Ubon Ratchathani in August 2010, from Nakhon Ratchasima province in July 2010, and from Pattani province in May 2010. In June 2009, a dengue outbreak was reported from the region of Mae Hong Son, causing 155 cases.
The dengue reports by province and region are available from the Thailand Ministry of Public Health dengue surveillance website at
http://188.8.131.52/surdata/disease.php?ds=66 for dengue fever,
http://184.108.40.206/surdata/disease.php?ds=26 for dengue hemorrhagic fever,
and http://220.127.116.11/surdata/disease.php?ds=27 for dengue shock syndrome. While the URL links go to webpages in the Thai language, if one goes to the central column of the page, there are links to the data files by years, with 2552 representing 2009. Clicking on the year will then provide a link to download the respective files for dengue fever reports by province and region, dengue hemorrhagic fever reports by province and region, and dengue shock syndrome reports by province and region).
For the year 2008, there were more than 91,000 cases of dengue fever nationwide, including 99 deaths. Koh Samet, Koh Mun, and Koh Kodi were particularly affected. A dengue outbreak was reported from Rayong Province in August 2008, causing almost 1400 cases and two deaths. For the first nine months of 2007, more than 40,000 dengue cases were reported nationwide, including 47 deaths. The number of dengue cases appeared to rise earlier than usual in 2007, due to early, heavy rains. A dengue outbreak was reported from Phuket in August 2007, resulting in 110 cases and at least two deaths by November.
In May 2007, an outbreak was reported from Trat province, 400 km southeast of Bangkok on the Cambodian border, and in the southernmost provinces along the Malaysian border. In August 2006, the provinces of Kamphaeng Phet, Nakhon Sawan, Phichit and Uthai Thani were declared dengue “alert zones” by the Ministry of Public Health because of a large number of cases (more than a thousand) being reported from these provinces (see Thailand Ministry of Public Health). A dengue outbreak was reported from Surin Province in July 2006 and from Ampur Mae Sareang in June 2006. Earlier in the year, a dengue outbreak was reported from Chaiyaphum Province. In April 2002, a unusually large number of cases was reported among travelers to southern Thailand, especially the island of Koh Pha Ngan.
An increased number of cholera cases has been reported from the northeastern part of Thailand, due to the consumption of raw cockles, poorly prepared som tam, and fast food. A cholera outbreak was reported from Pattani province in southern Thailand in November 2009 and was ongoing as of January 2010. An outbreak was reported in June 2007 among Burmese migrant workers and in a Burmese refugee camp in Tak province, which shares a long border with Burma (see ProMED-mail, August 4 and 10 and October 30, 2007; February 5, 2010). As above, cholera vaccine is not recommended for most travelers.
Four cases of Legionnaires’ disease were reported in December 2006 among guests who had stayed at a hotel in Patong Beach, Phuket, Thailand. See Eurosurveillancefor further information. Legionnaires’ disease is a bacterial infection which typically causes pneumonia but may also involve other organ systems. The disease is usually transmitted by airborne droplets from contaminated water sources, such as cooling towers, air conditioners, whirlpools, and showers. Legionnaires’ disease is not transmitted from person-to-person.
A total of 25 human cases of H5N1 avian influenza (“bird flu”), 17 of them fatal, have been reported from Thailand. The first twelve cases were reported in January-February 2004, at the time of the initial avian influenza outbreaks in Thailand and other Asian countries. New poultry outbreaks were reported in July 2004, followed by five additional human cases in September-October, 2004. Five more human cases were reported between October and December, 2005. No human or avian cases were reported in the first half of 2006, but fresh poultry outbreaks and three additional human cases were reported between July and September 2006. The most recent poultry outbreaks were reported from the northern province of Phichit in September 2007 and again in January 2008; from Nakhon Sawan province, also in January 2008; from Sukhothai province in October 2008; and from Uthai Thani province in November 2008.
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 Thailand, 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 Thailand should seek immediate medical attention, which may include testing for avian influenza. For further information, go to the World Health Organization, theCenters for Disease Control, and ProMED-mail.
An outbreak of botulism was reported in March 2006 among people who had eaten home-preserved bamboo shoots at a local village Buddhist festival in Baan Luang District, Nan Province. A total of 163 people were affected. Symptoms included dry mouth, dysphagia, dysarthria, ptosis, diplopia, abdominal discomfort, and muscle weakness. Forty people required intubation, but there were no fatalities. For further information, go to the World Health Organization and the Centers for Disease Control. Another botulism outbreak was reported in June 2006, affecting more than 50 people in the northern province of Phayao who had eaten raw deer meat. See Global Health for details.
Toxic jellyfish stings were reported to have killed two tourists swimming off the coast of Koh Phangan in August 2002. Three years before that, a fatal jellyfish sting was reported off Koh Samui in the Gulf of Siam. In general, the time of highest risk for jellyfish stings is the evening, when they come to the surface.
HIV disease has reached epidemic levels in Thailand. Most cases result from heterosexual transmission. HIV infection is common in prostitutes of both sexes.