China and Taiwan: Immunisations and malaria advice

You must discuss your own particular needs and contraindications to vaccines or tablets with your doctor or practice nurse. Advice can change so check again for future visits. 

Ensure you are fully insured for medical emergencies including repatriation. The 'T7' leaflet (from Post Offices) gives details of health care agreements between countries. The completed form must be submitted about 6 weeks before you plan to leave.

Immunisations

• Confirm primary courses and boosters are up to date as recommended for life in Britain - including vaccines given to special groups because of risk exposure or complications (e.g. hepatitis B for health care workers, influenza and pneumococcal vaccines for the elderly).

• Courses or boosters usually advised: tetanus; hepatitis A; typhoid; diphtheria.

• Vaccines sometimes advised : Japanese B encephalitis; rabies (China only);  tuberculosis; hepatitis B; cholera.

• Yellow fever certificate required if entering from an infected area.

Notes on the diseases mentioned above

• Tetanus is contracted through dirty cuts and scratches and poliomyelitis spread through contaminated food and water. They are serious infections of the nervous system.

• Typhoid and hepatitis A are spread through contaminated food and water. Typhoid causes septicaemia and hepatitis A causes liver inflammation and jaundice. In risk areas you should be immunised if good hygiene is impossible.

• Cholera is spread through contaminated water and food. More common during floods and rainy seasons. Those unable to take effective precautions, for example, during wars and when working in refugee camps or slums may consider vaccination when outbreaks are anticipated or being reported.

• Tuberculosis is most commonly transmitted via droplet infection. BCG vaccination is recommended for travellers under 16 years of age who will be living or working with local people for a prolonged period of time (three months or more). Following individual risk assessment, vaccination may also be considered for travellers under the age of 35 years who may be at high risk through their occupation abroad eg healthcare workers.

• Diphtheria is also spread by droplet infection through close personal contact. Vaccination is advised if close contact with locals in risk areas is likely.

• Hepatitis B is spread through infected blood, contaminated needles and sexual intercourse. It affects the liver, causes jaundice and occasionally liver failure. Vaccination is recommended for those at occupational risk (e.g. health care workers), for long stays or frequent travel to medium and high risk areas, for those more likely to be exposed such as children (from cuts and scratches) and those who may need surgical procedures.

• Japanese B encephalitis is spread by mosquitoes. It is a serious infection of the brain and vaccination is advised for those in risk areas unable to avoid mosquito bites, staying for long periods (e.g. more than 4 weeks) or visiting rural areas.

• Rabies is spread through bites or licks on broken skin from an infected animal. It is always fatal. Vaccination is advised for those going to risk areas that will be remote from a reliable source of vaccine. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite.

   

Malaria

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria.

Malaria precautions

Serious risk of malaria in China is now confined to a few areas not normally visited by package tourists or business travellers but may be visited by backpackers or voluntary workers. Urban and densely populated areas are normally malaria free.

Malignant P.falciparum is present only on Hainan island and Yunnan provinces and sporadically in Guangxi province. These areas are in the south-west of China and the risk is minimal in large cities.

Benign P.vivax malaria alone occurs in a few isolated areas in the 'flood' plains of the Yangtze (Chang Jiang) and Yellow (Huang He) rivers - specifically within the provinces of Fujian, Guangdong, Guangxi, Guizhou, Sichuan, and Xizang (along the valley of the Zangbo river). Isolated cases occasionally occur in other parts of the country (go to Malaria Map). 

Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.

Check with your doctor or nurse about suitable antimalarial tablets. (Mefloquine or doxycycline or Malarone is usually recommended for Hainan and Yunnan provinces, along the borders with Laos and Vietnam and Hainan Island. Chloroquine or proguanil is usually recommended for the other risk areas).

Prompt investigation of fever is essential. If travelling to remote areas, a course of emergency 'standby' treatment should be carried.

This map is only intended as a guide since mosquitoes do not respect boundaries and the risk areas shown may not be exact. Substantial malaria risk is shaded in dark red - becoming a lighter red where the risk is minimal.

The above advice is appropriate for the majority of travellers to this country. If you are at all unsure as to what measures are suitable for you, (eg if you are pregnant, or are suffering from a condition requiring special medication), it is recommended that you talk to your health advisor. This page is produced by the Scottish Centre for infection and Environmental Health.