China

Where to start in describing this vast country? The worlds most populous, with 18000 km of coast, huge geographic
and climactic variation from the cool far north to the tropical south and mountainous east, megacities, a huge rural
population, the worlds longest lasting continuous civilisation and until recently a rampant economy. Culturally there is
great diveristy as well, although the Chinese government attempts to keep a tight reign on dissent.
Most travellers have a fairly uneventful trip from a health point of view . Commonest destinations include the
Forbidden City in Beijing, Teracotta Warriers in Xian, Yangtze river cruises, the Great Wall, ultramodern Shianghai,
Guilin's verticle limestone and Tibet via railway to high altitude.
The following information provides some broad and general guidelines about health risks and recommendations for
these destinations. This should not be taken as a substitute for personal consultation with a doctor with experience in
travel health.

Most Common Health Issues

Travellers Diarrhoea
This is the one most travellers to developing countries experience sooner or later, with watery diarrhoea and sometimes
vomiting. It is caused by bacteria, such as E.coli, Campylobacter, Salmonella and Shigella. Careful food and drink choices (no tap
water), as well as hand hygiene, help in prevention. It is treated with rehydration if mild but if inconvenient, with a bowel
stopper such as loperamide (Gastrostop or Immodium) and if more severe or persistent, with an antibiotic or giardia
treatment. These are best obtained prior to travel as many medications sold over the counter are fake. We stock kits containing
all of these medications but as some are prescription items, you will need to make an appointment to see one of our doctors.

Accidents
Road accidents are extremely common due to the volume of traffic, lack of road rules and lack of rear seatbelts and helmets for
bikes. Leave driving to the locals (obtaining a licence is difficult anyway). Be sensible, make sure your friends look after you if
you are drinking, pack a first aid kit, make sure you take travel insurance and keep an eye on travel alerts.

STD's
Business travellers to China often put themselves at risk, where offers of massage may lead to something else, especially after
drinking. Unprotected encounters carry a high risk of STD's, including HIV, Chlamydia, Gonorrhoea and Syphilis and even using
condoms doesnt always prevent Herpes or genital warts. See a doctor on return if you have put yourself at risk and abstain
until you are given the all clear.

Animal Bites
Dog bites carry the highest risk for rabies, although any mammal wound that breaks the skin should be considered a risk monkeys included. Immediate and thorough irrigation and cleaning of animal wounds is essential, followed by a course of
shots, which may require evacuation to a country that carries safe immunoglobulin if not pre-vaccinated for rabies (see seeking
medical help below). A tetanus booster may be necessary if not up to date. Animal wounds are also prone to becoming infected
and appropriate antibiotics should be used at the first sign of spreading infection.

Malaria
This disease is very rare in travellers to China, except those travelling to rural parts of the far southwest Yunnan province or to
Hainan Island in the wet season. The mosquitoes bite from dusk onwards, so mosquito avoidance (DEET repellent, sleeping
nets) at this time in these areas is important. Seek advice from a travel health doctor as to whether malaria preventative
medication is necessary or advisable.

Japanese Encephalitis
This rare but serious mosquito born virus occurs mainly in rural areas around rice paddies in most regions, especially in the wet
season June to October. Highest risk is in Guizhou, Shaanxi, Sichuan and Yunnan provinces. Vaccination is often recommended
for longer trips or for those visiting an area with particularly high risk for shorter trips.

Bird Flu
Sporadic cases occur, nearly always in locals who have direct contact with sick poultry. As a precaution, avoid live bird markets
and farms and ensure bird products are well cooked (including eggs). Flu vaccine does not protect against this form of flu.

Pollution
This is a significant problem in the large cities, especially Beijing, where air pollution is often well above acceptable standards
and may lead to exacerbation of respiratory problems in tourists as well as chronic health issues in the local population.

Altitude Sickness
Only a problem if travelling to Tibet. See our fact sheet on altitude sickness.

Security, Safety Issues and Natural Disasters

Keep an eye on the Australian Governments smart traveller website for the latest advice. Watch your valuables. Keep a copy of
all travel documentation in a separate place from the originals. China is prone to massive earthquakes, typhoons, floods and
landslides.

Travel Insurance
Essential. Make sure it provides appropriate cover for your trip and activities.

Seeking Medical Help

The medical system in rural areas is basic. Although the main cities have clinics catering for western tourists, communication
problems and cultural differences mean complicated or serious medical issues are often best dealt with by evacuation to Hong
Kong, Bangkok or back to Australia. Blood or blood products (such as rabies immunoglobulin) may not be safe. Ambulances are
often unavailable so taxis are often used if immediate transport to hospital is required. Many over the counter medications are
fake or substandard, so carrying your own medical kit for treatment of common ailments is important.

Vaccinations
Routine Vaccinations for all travellers
All international travellers should be up to date or immune to the following as these are transmissable diseases which
may have serious complications:
Measles
Chickenpox
Influenza - especially for the elderly or those with underlying medical conditions
In addition a tetanus booster if more than 5- 10 years since last vaccinated is advisable to avoid having to get a booster
shot in China in the event of a tetanus prone wound.
Recommended Vaccinations for most travellers to China
Hepatitis A is a food and water borne virus that infects the liver and causes jaundice. Many people in the developing
world have natural immunity, but travellers generally do not. The vaccine is very safe and effective, a single injection
providing immediate protection for 6-12 months, after which a booster shot provides long-term immunity.
Hepatitis B is a blood borne virus, but may also be sexually transmitted. Accidents, injuries and sometimes even medical
treatment in the developing world can expose travellers to this disease. Hepatitis B is highly infectious and can lead to
chronic liver disease and liver cancer. All children and young adults born since 1990 in Australia have generally been
vaccinated
Other vaccinations to consider
Rabies is a virus spread from infected animals to humans through bites, scratches and exposure to saliva. If not properly
treated and rabies develops, the disease if fatal. Travellers should avoid close contact with either wild, stray or domestic
animals; in particular dogs, cats, monkeys and bats. For travel to these countries, vaccination against rabies is often
recommended for those at particularly high risk, for example working with animals or touring/biking through rural areas.
Typhoid fever is a bacterial infection which is caught through ingesting contaminated food and water. Resistance to
common antibiotics is also widespread so treatment has become more difficult.
Japanese Encephalitis, spread by the Culex mosquito, is a rare but very dangerous brain infection encountered in South
and South East Asia, extending as far north as Japan and Russia. There are now 2 very effective vaccines available. Risk is
mainly in rural areas, particularly in the wet season and near rice paddies. Vaccination should be considered for extended
travel, or short term travel to an area where there is a current outbreak.
Cholera- although this disease is very rare, because the vaccine provides some cross protection against common E Coli
diarrhoea, vaccination may be recommended for certain individuals.