A144 Case Study Vaccinations For China

Check the vaccines and medicines list and visit your doctor (ideally, 4-6 weeks) before your trip to get vaccines or medicines you may need.

All travelers

You should be up to date on routine vaccinations while traveling to any destination. Some vaccines may also be required for travel.

Routine vaccines

Make sure you are up-to-date on routine vaccines before every trip. These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot.

Most travelers

Get travel vaccines and medicines because there is a risk of these diseases in the country you are visiting.

Hepatitis A

CDC recommends this vaccine because you can get hepatitis A through contaminated food or water in China, regardless of where you are eating or staying.

Typhoid

You can get typhoid through contaminated food or water in China. CDC recommends this vaccine for most travelers, especially if you are staying with friends or relatives, visiting smaller cities or rural areas, or if you are an adventurous eater.

Some travelers

Ask your doctor what vaccines and medicines you need based on where you are going, how long you are staying, what you will be doing, and if you are traveling from a country other than the US.

Hepatitis B

You can get hepatitis B through sexual contact, contaminated needles, and blood products, so CDC recommends this vaccine if you might have sex with a new partner, get a tattoo or piercing, or have any medical procedures.

Japanese Encephalitis

You may need this vaccine if your trip will last more than a month, depending on where you are going in China and what time of year you are traveling. You should also consider this vaccine if you plan to visit rural areas in China or will be spending a lot of time outdoors, even for trips shorter than a month. Your doctor can help you decide if this vaccine is right for you based on your travel plans. See more in-depth information on Japanese encephalitis in China.

Polio

You may need a polio vaccine before your trip to China if you are visiting the Xinjiang province, especially if you are working in a health care facility, refugee camp, or humanitarian aid setting. This kind of work might put you in contact with someone with polio.

  • If you were vaccinated against polio as a child but have never had a polio booster dose as an adult, you should get this booster dose. Adults need only one polio booster in their lives.
  • If you were not completely vaccinated as a child or do not know your vaccination status, talk to your doctor about getting vaccinated.
Rabies

Rabies can be found in dogs, bats, and other mammals in China, so CDC recommends this vaccine for the following groups:

  • Travelers involved in outdoor and other activities (such as camping, hiking, biking, adventure travel, and caving) that put them at risk for animal bites.
  • People who will be working with or around animals (such as veterinarians, wildlife professionals, and researchers).
  • People who are taking long trips or moving to China
  • Children, because they tend to play with animals, might not report bites, and are more likely to have animal bites on their head and neck.
Yellow Fever

There is no risk of yellow fever in China. The government of China requires proof of yellow fever vaccination only if you are arriving from a country with risk of yellow fever. This does not include the US. If you are traveling from a country other than the US, check this list to see if you may be required to get the yellow fever vaccine: Countries with risk of yellow fever virus (YFV) transmission.

For more information on recommendations and requirements, see yellow fever recommendations and requirements for China. Your doctor can help you decide if this vaccine is right for you based on your travel plans.

Note: Yellow fever vaccine availability in the United States is currently limited. If you need to be vaccinated before your trip, you may need to travel some distance and schedule your appointment well in advance. Find the clinic nearest you.

Malaria

When traveling in China, you should avoid mosquito bites to prevent malaria. You may need to take prescription medicine before, during, and after your trip to prevent malaria, depending on your travel plans, such as where you are going, when you are traveling, and if you are spending a lot of time outdoors or sleeping outside. Talk to your doctor about how you can prevent malaria while traveling. For more information on malaria in China, see malaria in China.

Key
  • Get vaccinated
  • Take antimalarial meds
  • Eat and drink safely
  • Prevent bug bites
  • Keep away from animals
  • Reduce your exposure to germs
  • Avoid sharing body fluids
  • Avoid non-sterile medical or cosmetic equipment

HEALTH ISSUES

Although China is now the world’s second-largest economy, per capita income is still below the world average, with wide disparity in wealth and development between rural and urban as well as east and west. Health risks vary accordingly.

Air Pollution

China’s rapid economic expansion has resulted in tremendous increases in emissions of air pollutants, particularly in the megacities. Although aggressive efforts are underway to control pollution, 16 of the 20 most polluted cities in the world are in China, and Beijing regularly tops the list. On peak pollution days, the levels of particulate matter in the air can exceed 40 times the limit considered safe by the World Health Organization. Short-term exposure to these levels of air pollution can irritate the eyes and throat, and those with underlying cardiorespiratory illness, including asthma, chronic obstructive pulmonary disease, or congestive heart failure, may find their condition exacerbated. In addition, exposure to high levels of air pollution significantly increases the risk of respiratory tract infections, including sinusitis, otitis, bronchitis, and pneumonia. Children and the elderly are the most vulnerable to these effects.

Although surgical-style face masks have become increasingly fashionable in the big cities of China, especially Beijing and Shanghai, they provide no protection from air pollution and are not recommended. Properly fitted N95 masks can filter out particulates but not gaseous pollutants and can sometimes actually compound breathing problems, so are not routinely recommended.

Vaccine-Preventable Diseases

Routine vaccinations should be up-to-date, including seasonal influenza. In addition, hepatitis A and B and typhoid vaccinations are usually recommended. Since the Xinjiang Uygur Autonomous Region borders Pakistan, a polio-endemic country, adults traveling to this region who will be working in health care settings, refugee camps, or humanitarian aid settings should be vaccinated against polio, including a single lifetime booster dose of polio vaccine (IPV). Measles and rubella immunity is particularly important, and although a massive vaccination campaign begun in September 2010 has decreased the number of reported measles cases, there were still more than 100,000 cases reported in 2014. A few travelers have made news headlines by triggering outbreaks in their home countries after returning from China. Although limited data exist on rubella in China, it was not part of the national immunization program until 2008, and incidence is believed to be high.

China is making considerable advances in vaccination, with the objective of developing their own locally made vaccines. There have, however, been many well-publicized issues with counterfeit and improperly stored vaccines. In addition, vaccine shortages are frequent; adult tetanus vaccines were out of stock from 2014 through the time of writing. Travelers are unlikely to be able to complete unfinished vaccination series once in China and may be unable to access tetanus vaccine if injured while there. All travelers should have an up-to-date tetanus-containing vaccine before going to China. Hong Kong functions under different rules, and international vaccines are in use there.

HEPATITIS B

Hepatitis B infection is endemic in China. Nearly one-third of the 350 million people worldwide infected with the hepatitis B virus (HBV) reside in China. Hepatitis B vaccination and other preventive measures should be discussed with non-immune travelers.

JAPANESE ENCEPHALITIS

Japanese encephalitis (JE) occurs in all regions except Qinghai, Xinjiang, and Xizang (Tibet) (see Map 3-08 and Table 3-07). China has greatly reduced the incidence of JE through vaccination and, as of 2008, included JE in its expanded national immunization program; however, the disease remains a threat to unimmunized travelers. Although the JE season varies by region, most cases in local residents are reported from June through October. The risk of JE for most travelers to China is low but varies based on season, destination, duration, and activities. Risk is highest among travelers to rural areas during the transmission season. JE vaccine is recommended for travelers who plan to spend ≥1 month in endemic areas during June through October. It should be considered for shorter-term travelers if they plan to travel to rural areas and will have an increased risk for JE virus exposure based on their activities or itineraries, such as spending substantial time outdoors or staying in accommodations without air conditioning, screens, or bed nets. However, rare sporadic cases have occurred on an unpredictable basis in short-term travelers, including in periurban Beijing and Shanghai.

RABIES

Rabies is a serious problem in China, as in much of Asia, with more than 3,000 reported human deaths per year. Mammal bites in any area of China, including urban areas, must be considered high risk for rabies. As rabies immune globulin is generally unavailable, animal bites are often trip-enders, requiring evacuation to Hong Kong, Bangkok, or home for postexposure prophylaxis. Bites are surprisingly common in tourists. For example, dog bites were the most common dermatologic problem seen after China travel in an analysis of data from the GeoSentinel Surveillance Network. Rabies risk and prevention should be discussed in pretravel consultations, and a strategy for dealing with a possible exposure should be developed. Long-term travelers and expatriates living in China should consider the preexposure vaccination series. Travel health insurance, including medical evacuation insurance, should be encouraged (see Chapter 2, Travel Insurance, Travel Health Insurance, & Medical Evacuation Insurance).

Vectorborne Diseases

MALARIA

Malaria risk is very low for travelers to China, with the exception of those visiting rural parts of southern Yunnan Province. For this area, chemoprophylaxis should be considered. Mefloquine resistance in southern Yunnan means that travelers should be given doxycycline or atovaquoneproguanil for travel in this area.

DENGUE

In 2014, southern China experienced its worst dengue outbreak in decades; Guangdong province reported more than 40,000 cases in just 2 months. Travelers should practice daytime mosquito precautions in the summer months.

Other Health Risks

FOODBORNE ILLNESSES

The risk for travelers’ diarrhea appears to be low in deluxe accommodations in China but moderate elsewhere. Usual food and water precautions should apply, and travelers should consider bringing an antibiotic for self-treatment of moderate to severe diarrhea. Since highly quinolone-resistant Campylobacter is a problem in China, azithromycin may be a good choice. Tap water is not safe to drink even in major cities. Most hotels provide bottled or boiled water, and bottled water is easily available. In addition, there have been several well-publicized episodes of contamination of food with pesticides and other substances. Travelers should strictly avoid undercooked fish and shellfish and unpasteurized milk.

SEXUALLY TRANSMITTED DISEASES

Sexually transmitted diseases, including syphilis, HIV, gonorrhea, and chlamydia, are a growing problem in China, particularly along the booming eastern seaboard. Travel is associated with loosened inhibitions and increased casual sexual liaisons. Travelers should be aware of STD risks and use condoms if they have sex with someone whose HIV or STD status is unknown. Hepatitis B vaccination before travel should be considered.

ROAD TRAFFIC INJURIES

Traffic in China is often chaotic, and the rate of traffic crashes, including fatal ones, is among the highest in the world. Driving is on the right side of the road in mainland China but on the left in Hong Kong and Macau. In practice, many people drive down the middle of the road. Child safety seats, rear seat belts, and bicycle or motorcycle helmets are rarely seen and not widely available. Electronic bicycles (E-bikes) are popular and do not have to be registered. They often travel in pedestrian and bicycle lanes as well as with traffic. Because E-bikes are quiet (no engine noise), they can be hard to avoid. Motor vehicles and E-bikes often drive with no lights, making night travel dangerous. Traffic crashes, even minor ones, can create major traffic jams and sometimes turn into violent altercations, particularly when foreigners are involved. China has not signed the convention that created the International Driving Permit, and travelers require a Chinese license to drive in China. For all of these reasons, it is often simpler and safer to hire a local driver than to drive oneself. It is also advisable to avoid driving at night or when weather conditions are bad, and not to assume that traffic rules or right-of-way will be respected. Travelers should fasten seat belts when riding in cars and wear a helmet when riding bicycles or motorbikes.

VITAMIN D DEFICIENCY

Vitamin D deficiency is a major issue in the northern provinces of China, where smog often blocks out sunlight, causing inadequate absorption of vitamin D through the skin even in the summer months. If the traveler will be spending more than 6 months in China, vitamin D supplementation is recommended.

Medical Care in China

Western-style medical facilities that meet international standards are available in Beijing, Shanghai, and Hong Kong. Some hospitals in other cities have “VIP wards” (gaogan bingfang), which may have English-speaking staff. The standard of care in such facilities is somewhat unpredictable, and cultural and regulatory differences can cause difficulties for travelers. In rural areas, only rudimentary medical care may be available. Hepatitis B virus transmission from poorly sterilized medical equipment remains a risk outside major centers.

Ambulances are not staffed with trained paramedics and often have little or no medical equipment. Therefore, injured travelers may need to take taxis or other immediately available vehicles to the nearest major hospital rather than waiting for ambulances to arrive.

Pharmacies often sell prescription medications over the counter. Such medications have sometimes been counterfeit, substandard, or even contaminated. Travelers should bring all their regular medications in sufficient quantity; if more or other medications are required, it is advisable to visit a reputable clinic or hospital.

Some travelers wish to try traditional Chinese medicine and acupuncture. Although most do so uneventfully, there is a risk of bloodborne and skin infections from acupuncture needles, and traditional medicine products may be contaminated with heavy metals or pharmaceutical agents. Acupressure may be preferable to acupuncture.

Travelers are strongly advised to purchase travel health and medical evacuation insurance before travel. Most hospitals will not directly accept foreign medical insurance, however, and patients will often be expected to pay a deposit before care to cover the expected cost of the treatment.

BIBLIOGRAPHY

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