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Medical Recommendations for Travel in Cambodia

Note: The article below was written in 1992. The infrastructure in Cambodia has improved greatly in recent years, and public health is also better. Most of the information, however, is still relevant. If you are planning to travel to Cambodia, you should consult your physician well in advance of your trip. Current medical recommendations for Southeast Asia travel are available in from the Center for Disaease Control.

Anyone travelling to a foreign country should be aware that being in an unfamiliar environment often increases the risk of illness. This is particularly true in a developing country, and for that reason persons planning to travel to Cambodia should take precautions to minimize that risk.

The first and most important step in preventing sickness is to consult a physician, preferably about one month before departure; an early visit will allow time for necessary vaccinations and medications to take effect. If the cost of a visit to the doctor seems prohibitively expensive, bear in mind that preventing an illness is much less expensive - not to mention less dangerous - than treating it after infection.

A number of infectious diseases are endemic in Southeast Asia, and the scarcity of medical facilities and trained personnel means that accidents and ailments which are relatively minor in the United States become more dangerous in Cambodia. Some of the conditions associated with international travel, such as motion sickness or jet lag, are merely an annoyance. Others, such as malaria, Japanese encephalitis, hepatitis B, or typhoid fever, can be fatal.

Persons using prescribed medication should be sure to carry enough to last the duration of the trip, and preferably longer, since flight schedules from Cambodia are not always reliable. It is also wise to pack medication for other common ailments, such as aspirin or Tylenol, or dramamine for motion sickness. Remember to keep all medicines in a carry-on bag while flying.

The most common problem encountered by visitors to foreign countries is traveler's diarrhea. Traveler's diarrhea is caused by consuming contaminated food or drink. Food purchased from street vendors, in particular, is often unsafe. However, diarrhea may also result from less obvious sources, such as brushing one's teeth with contaminated water, or eating with dirty utensils. Generally, bottled or canned carbonated drinks, or drinks made with boiled water, are safe, and cooked food is relatively safe if it is eaten while still hot. Fruits are less likely to cause diarrhea if they are peeled immediately before being eaten.

There are a number of medications which are usually effective for treating diarrhea, such as Pepto-Bismol, Imodium, or Lomotil. Affected persons should take lots of liquids, such as noncaffeinated bottled drinks or soup. Bloody diarrhea or diarrhea lasting more than three days should not be treated with Lomotil or Imodium; persons with these or other symptoms such as abdominal cramps or high fever should seek medical attention.

Persons living in Cambodia are usually immune to the bacteria which cause diarrhea in visitors, but refugees who have lived in the U.S. for long periods often lose their immunity; returning refugees should observe the same precautions as other travelers.

Several of the diseases common in Cambodia are transmitted by mosquitos. Some simple precautions can greatly decrease the risk of contracting these diseases. Wear long-sleeved shirts and long pants, and try to remain indoors as much as possible after sunset. Wear mosquito repellent, and sleep under a mosquito net. In areas of heavy infestation, the use of an aerosol insecticide within the sleeping quarters may be worthwhile.

Currently, the Center for Disease Control identifies eight diseases of particular concern to travelers in Southeast Asia:

1. Malaria
Malaria is transmitted by mosquitos; those carrying the disease are generally only active between dusk and dawn. The disease is characterized by alternating chills and fever, along with headache, muscle aches, and malaise. In its early stages, the symptoms often resemble flu. Symptoms may develop as early as eight days or as late as several months after departing infected areas. As the disease progresses it may cause nausea or delirium, and it may prove fatal. Chloroquine is often recommended to prevent malaria, but in Southeast Asia some strains of the disease are chloroquine resistant. Mefloquine, doxycycline, or a combination of Fansidar and Chloroquine are more effective. None of these medications are recommended for pregnant women, and, in any case, a physician should be consulted to insure that the medication is appropriate.

2. Hepatitis A
Hepatitis A is a viral disease spread by contaminated food and water, or by person to person contact. It is a danger primarily in rural areas and areas of poor sanitation; i.e., nearly all of Cambodia. Symptoms usually appear 4-6 weeks after ingesting contaminants, and may include weakness, loss of appetite, nausea, vomiting, and jaundice. Cases usually last from 2-6 weeks. There is no vaccine for hepatitis A, but a single dose of immune series globulin will protect against the disease for up to three months.

3. Hepatitis B
Hepatitis B is endemic throughout Southeast Asia, and there are carriers in all socioeconomic groups. The disease is transmitted through sex, blood transfusions, or by improperly sterilized medical instruments. The symptoms may be similar to hepatitis A, but usually appear 6-12 weeks after infection. Many patients do not know they have the disease until jaundice occurs. Persons who have had hepatitis B may carry the virus for years after recovery, and they can spread the disease. Pregnant women may pass the disease on to the fetus. About one percent of the cases of hepatitis B are fatal. Although there is a vaccine, it is not generally recommended for tourists.

4. Japanese encephalitis
A mosquito-borne viral disease, Japanese encephalitis is found in rural areas of Southeast Asia. The disease attacks the cerebrum and is often fatal; survivors are often left with neurological damage. Symptoms can include drowsiness, fever, headache, muscle weakness, confusion, paralysis, jerky movements, and difficulty in seeing, speaking, or swallowing. The vaccine is unavailable in the U.S., but it can be obtained in Asia. Since the vaccinations must be administered over the course of three weeks, it is not recommended for most visitors. However, persons staying in rural areas for extended periods should consider the vaccine.

5. Dengue fever
Dengue fever is found in both rural and urban areas, it is transmitted by mosquitos which are active during the day, and which are often present indoors. The disease is a flu-like illness characterized by fever, rash, joint and muscle pains, and severe headaches. As there is no vaccine for dengue fever, the disease can best be avoided by preventing mosquito bites. Persons experiencing fever should consult a physician.

6. Typhoid fever
Typhoid fever is prevalent in rural areas and small cities. An oral vaccine is available, and it is recommended for persons traveling to rural areas, or persons staying longer than six weeks; however, even vaccinated persons can contract the disease. Exercising caution in food and drink is the best way to prevent Typhoid, as the disease is spread through contaminated food and water. Typhoid fever begins with malaise, headache, body pains, and loss of appetite; high fever, an abdominal rash, and constipation are characteristic symptoms as the disease progresses.

7. Rabies
The risk of rabies is greatest in areas with a high concentration of dogs. The disease is transmitted through the saliva of an infected animal, and once symptoms appear, is inevitably fatal. Anyone bitten by an animal which might be rabid must seek medical attention immediately. A pre-exposure vaccine is available, and although it does not offer complete immunity, it does lessen the number of shots required if the disease is contracted. Generally, the pre- exposure vaccine is only recommended for veterinarians and animal handlers, or persons staying long-term.

8. Schistosomiasis
Schistosomiasis is caused by the larvae of a flatworm which is released into water by infected snails. The larvae are small enough to penetrate unbroken skin during bathing, wading, or swimming. Initial symptoms of schistosomiasis may include itching, hives, anorexia, diarrhea, and headache; as the disease progresses the victim may also suffer from high fever, chills, and bloody diarrhea. No preventative vaccine is available, but the disease can be treated with drugs. Limiting contact with untreated fresh water is the best way to prevent schistosomiasis. Persons bathing or swimming in rivers, ponds, or lakes should immediately dry off thoroughly afterward, and, if possible, rub the skin with rubbing alcohol. Bath water is safe when treated with chlorine or iodine, or if it is heated to at least 122 degrees Farenheit for 5 minutes.

In addition to the above diseases, there are a few other health risks which visitors should be aware of. Persons who may have sex in Cambodia should bear in mind the danger posed by AIDS and other sexually transmitted diseases. While Cambodia has not had a high incidence of AIDS in the past, an increase in prostitution, coupled with the influx of peacekeeping soldiers and tourists, may mean that the disease will begin to spread rapidly. Other diseases which could be contracted in Cambodia, while rarer than those previously mentioned, include cholera, filariasis, typhus, dysentery, mumps, chicken pox, and poliomyelitis.

Snakes, leeches, and centipedes may also pose a danger in rural areas. Perhaps the greatest danger in rural areas, however, is man-made: There are hundreds of thousands - if not millions - of anti-personnel mines in Cambodia, the majority of which are in areas close to the Thai border. In 1990 alone, more than 6,000 Cambodians suffered amputations due to mine injuries. For tourists, mines do not really pose a threat, but anyone who expects to stay in a rural area for a long period of time should avoid walking in unfamiliar areas without a knowledgeable guide.

Upon returning to the U.S., travelers experiencing discomfort should see a doctor immediately; symptoms of some diseases don't always become apparent immediately.

Further information can be obtained from your physician, or by contacting the Center for Disaease Control in Atlanta, Georgia, at (404) 332-4559.


References:

Center for Disease Control. Health Information for International Travel, 1990.

Center for Disease Control International Travelers' Hotline, (404) 332-4559.

Collier's Encyclopedia, Vols. 9, 15, 21. U.S.A. 1967.

Encyclopedia Americana, Vols. 10, 24. Danbury, CT 1991.

Stover, Eric. Land Mines in Cambodia, Asia Watch and Physicians for Human Rights, U.S.A. 1991.

UNICEF. Cambodia: The Situation of Children and Women, Phnom Penh, 1990.

Wurtz, Dr. Rebecca. "Infectious Diseases in the International Traveler," Clinical Microbiology Newsletter, Vol. 13, No. 6.

Wurtz, Dr. Rebecca. "Infectious Disease Prophylaxis For Travelers," 1986.

World Book Encyclopedia, Vols. 9, 16. U.S.A. 1990.


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