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Post by Raoul Duke on Jul 3, 2004 16:57:23 GMT 7
The info below is from the US Centers for Disease Control (CDC). The full story can be found at www.cdc.gov/travel/eastasia.htm Please note that this info is for travelers. As expats, the rules are a little different....you aren't going to spend a year or more here without eating at a street vendor's, but the increased time will increase your exposure to diseases that are just exotic rarities for short-term travelers! Please note that Polio seems to have been dropped from the list of concerns in China by both the CDC and the WHO. Case in point for us long-term expats: this info does change over time and we should be sure and update ourselves periodically! Also note that these immunizations are on top of the standard protections you should have anyway. You should especially be sure that your Tetanus protection is up to date! If our dear friends who happen to be swarthy, foreign, less-sanitation-intensive Commonwealth types stubbornly insist on using your own pathetic, derivative health care info sources you can find them here: Canada- www.voyage.gc.ca/dest/index.aspUK- www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/enAustralia- www.smartraveller.gov.au/zw-cgi/view/Advice/ChinaNow for some real information... The CDC recommends the following vaccines (as appropriate for age):See your doctor at least 4–6 weeks before your trip to allow time for shots to take effect. * Hepatitis A or immune globulin (IG), except travelers to Japan. * Hepatitis B, if you might be exposed to blood (for example, health-care workers), have sexual contact with the local population, stay longer than 6 months, or be exposed through medical treatment. * Japanese encephalitis, only if you plan to visit rural areas for 4 weeks or more, except under special circumstances, such as a known outbreak of Japanese encephalitis. * Rabies, if you might be exposed to wild or domestic animals through your work or recreation. * Typhoid, particularly if you are visiting developing countries in this region. * As needed, booster doses for tetanus-diphtheria and measles. Hepatitis B vaccine is now recommended for all infants and for children ages 11–12 years who did not receive the series as infants. All travelers should take the following precautions, no matter the destination: * Wash hands often with soap and water. * Because motor vehicle crashes are a leading cause of injury among travelers, walk and drive defensively. Avoid travel at night if possible and always use seat belts. * Always use latex condoms to reduce the risk of HIV and other sexually transmitted diseases. * Don’t eat or drink dairy products unless you know they have been pasteurized. * Don’t share needles with anyone. * Eat only thoroughly cooked food or fruits and vegetables you have peeled yourself. Remember: boil it, cook it, peel it, or forget it. * Never eat undercooked ground beef and poultry, raw eggs, and unpasteurized dairy products. Raw shellfish is particularly dangerous to persons who have liver disease or compromised immune systems. Travelers visiting undeveloped areas should take the following precautions: To stay healthy, do... * Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, make water safer by BOTH filtering through an “absolute 1-micron or less” filter AND adding iodine tablets to the filtered water. “Absolute 1-micron filters” are found in camping/outdoor supply stores. * If you visit an area where there is risk for malaria, take your malaria prevention medication before, during, and after travel, as directed. (See your doctor for a prescription.) * Protect yourself from mosquito bites: o Pay special attention to mosquito protection between dusk and dawn. This is when the type of mosquito whose bite transmits malaria is active. o Wear long-sleeved shirts, long pants, and hats. o Use insect repellents that contain DEET (diethylmethyltoluamide). o Read and follow the directions and precautions on the product label. o Apply insect repellent to exposed skin. o Do not put repellent on wounds or broken skin. o Do not breathe in, swallow, or get into the eyes (DEET is toxic if swallowed). If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth. o Unless you are staying in air-conditioned or well-screened housing, purchase a bed net impregnated with the insecticide permethrin or deltamethrin. Or, spray the bed net with one of these insecticides if you are unable to find a pretreated bed net. o DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit. o Children under 10 years old should not apply insect repellent themselves. Do not apply to young children’s hands or around eyes and mouth. o For details on how to protect yourself from insects and how to use repellents, see Protection against Mosquitoes and Other Arthropods. * To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot.
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Post by Raoul Duke on Jul 3, 2004 17:03:02 GMT 7
Current Range of Japanese EncephalitisFrom the US Centers for Disease Control (CDC). Note that it says an effective cheaper vaccine is available in China. Also note that it's spreading and is expected in northern Oz soon... MORE INFO at www.cdc.gov/ncidod/dvbid/jencephalitis/Japanese Encephalitis Fact SheetCLINICAL FEATURES * Acute encephalitis; can progress to paralysis, seizures, coma and death * The majority of infections are subclinical ETIOLOGIC AGENT * Japanese encephalitis (JE) virus: flavivirus antigenically related to St. Louis encephalitis virus INCIDENCE * Leading cause of viral encephalitis in Asia with 30-50,000 cases reported annually * Fewer than 1 case/year in U.S. civilians and military personnel traveling to and living in Asia * Rare outbreaks in U.S. territories in Western Pacific SEQUELAE * Case-fatality ratio: 30% * Serious neurologic sequela: 30% COST * Domestic: < $1 million/year - largely cost of immunizing travelers and military personnel * International: no data, probably tens of millions of dollars TRANSMISSION * Mosquito-borne Culex tritaeniorhynchus group RISK GROUPS * Residents of rural areas in endemic locations * Active duty military deployed to endemic areas * Expatriates in rural areas * Disease risk extremely low in travelers SURVEILLANCE * Passive system based on domestic imported cases referred to CDC and other reference laboratories * Laboratory-based passive surveillance in endemic areas TRENDS * Expanding range of JE viral transmission to northern Australia * Inactivated JE vaccine CHALLENGES * Currently available killed vaccine expensive and occasionally reactogenic OPPORTUNITIES * Alternative cheaper, effective attenuated vaccine used in China, but not available elsewhere * Post marketing surveillance of adverse reactions to killed vaccine * Electronically available information for travelers and care providers RESEARCH PRIORITIES * Facilitate implementation of attenuated vaccine in unvaccinated populations in endemic areas * Develop improved vaccines * Identify risk factors for progression to symptomatic encephalitis and viral persistence * Describe clinical features of JE in AIDS and determine its potential as an opportunistic infection
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Post by Raoul Duke on Jul 3, 2004 17:07:21 GMT 7
Another, more readable and useful, fact sheet on JE from some nameless American health nobbling council to be found at www.astdhpphe.org/infect/jpenceph.htmlJapanese Encephalitis * Japanese encephalitis is a potentially severe viral disease that is spread by infected mosquitoes in the agricultural regions of Asia. * It is one of several mosquito-borne virus diseases that can affect the central nervous system and cause severe complications and death. * Japanese encephalitis can be a risk to travelers to rural areas where the disease is common. * There is no specific treatment for Japanese encephalitis. * A vaccine is licensed for use in travelers whose itineraries might put them at risk for Japanese encephalitis. All travelers should take precautions to avoid mosquito bites to prevent Japanese encephalitis and other mosquito-borne diseases. What is Japanese encephalitis? Japanese encephalitis is a disease that is spread to humans by infected mosquitoes in Asia. It is one of a group of mosquito-borne virus diseases that can affect the central nervous system and cause severe complications and even death. What is the infectious agent that causes Japanese encephalitis? Japanese encephalitis is caused by the Japanese encephalitis virus, an arbovirus. Arbovirus is short for arthropod-borne virus. Arboviruses are a large group of viruses that are spread by certain invertebrate animals (arthropods), most commonly blood-sucking insects. Like most arboviruses, Japanese encephalitis is spread by infected mosquitoes. Where is Japanese encephalitis found? Japanese encephalitis is found throughout rural areas in Asia. Transmission can also occur near urban areas in some developing Asian countries. Japanese encephalitis is a seasonal disease that usually occurs in the summer and fall in the temperate regions of China, Japan, and Korea. In other places, disease patterns vary with rainy seasons and irrigation practices. How do people get Japanese encephalitis? The Japanese encephalitis virus has a complex life cycle involving domestic pigs and a specific type of mosquito, Culex tritaeniorhynchus, that lives in rural rice-growing and pig-farming regions. The mosquito breeds in flooded rice fields, marshes, and standing water around planted fields. The virus can infect humans, most domestic animals, birds, bats, snakes, and frogs. After infection, the virus invades the central nervous system, including the brain and spinal cord. What are the signs and symptoms of Japanese encephalitis? Most infected persons develop mild symptoms or no symptoms at all. In people who develop a more severe disease, Japanese encephalitis usually starts as a flu-like illness, with fever, chills, tiredness, headache, nausea, and vomiting. Confusion and agitation can also occur in the early stage. The illness can progress to a serious infection of the brain (encephalitis) and can be fatal in 30% of cases. Among the survivors, another 30% will have serous brain damage, including paralysis. How soon after exposure do symptoms appear? Symptoms usually appear 6-8 days after the bite of an infected mosquito. How is Japanese encephalitis diagnosed? Diagnosis is based on tests of blood or spinal fluid. How common is Japanese encephalitis? Japanese encephalitis is the leading cause of viral encephalitis in Asia, where 30,000 to 50,000 cases are reported each year. The disease is very rare, however, in U.S. travelers to Asia. The chance that a traveler to Asia will get Japanese encephalitis is very small: 1) only certain mosquito species can spread Japanese encephalitis; 2) in areas infested with mosquitoes, only a small portion of the mosquitoes are usually infected with Japanese encephalitis virus; 3) among persons who are infected by a mosquito bite, only 1 in 50 to 1 in 1,000 will develop an illness. As a result, fewer than 1 case per year is reported in U.S. civilians and military personnel traveling to and living in Asia. Only 5 cases among Americans traveling or working in Asia have been reported since 1981. Who is at risk for Japanese encephalitis? Anyone can get Japanese encephalitis, but some people are at an increased risk: * People living in rural areas where the disease is common * Active-duty military deployed to areas where the disease is common * Travelers to rural areas where the disease is common (very small increased risk) What is the treatment for Japanese encephalitis? There is no specific treatment for Japanese encephalitis. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Care of patients centers on treatment of symptoms and complications. How can Japanese encephalitis be prevented? A vaccine is licensed for use in U.S. travelers to rural areas where the disease is common. The vaccine is recommended only for persons who plan to travel in these areas for 4 weeks or more, except in special circumstances such as an ongoing outbreak of disease. Because of the potential for other mosquito-borne diseases in Asia, all travelers should take steps to avoid mosquito bites. The mosquitoes that transmit Japanese encephalitis feed mainly outside during the cooler hours at dusk and dawn. Travelers should minimize outdoor activities at these times, use mosquito repellent on exposed skin, and stay in air-conditioned or well-screened rooms. Travelers to rural areas should use a bednet and aerosol room insecticides.
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Post by Nate M on Jul 20, 2004 0:21:10 GMT 7
Hey Raoul,
Any idea how much Malarial drugs run in China? I have a prescription for Doxycycline here in the U.S, but a year's supply will run me 160 bucks, (I had been under the impression that the cost would be significantly less than that). Would it be worth getting in China instead?
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Post by burlives on Jul 20, 2004 8:36:47 GMT 7
Doxycycline Hydrochloride is cheap but I forget exact prices and I wouldn't bet on being able to buy in bulk. I seem to remember it as less than 100 yuan for a box of 24 tabs. You can get it in "medicine supermarkets" without a prescription, but you never know if it's real.
Doxycycline -- not just for gonorrhea.
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Post by Raoul Duke on Apr 22, 2005 19:42:00 GMT 7
Note that only the far southern fringes of China- down near the borders with Myanmar, Thailand, Laos, and Vietnam- are in the malaria zone. The vast majority of us will not need anti-malarials in China unless we travel into this region. Ladies and gentlemen, I stand corrected. It seems that RURAL dwellers in a number of areas, especially the Yangzi River Valley should also take malaria precautions. Please read the following:
Malaria: Prophylaxis is recommended only for rural areas in the following provinces: Hainan, Yunnan, Fuijan, Guangdong, Guangxi, Guizhou, Sichuan, Tibet (Xizang) (in the Zangbo River valley only), Anhui, Hubei, Hunan, Jiangsu, Jiangxi, Shandong, Shanghai, and Zhejiang. In provinces with risk, transmission occurs only during warm weather: north of latitude 33° N, July-November; between latitude 25° N and 33° N, May-December; south of latitude 25° N, transmission occurs year-round. For the provinces of Hainin and Yunnan, prophylaxis with Lariam, Malarone, or doxycycline is recommended. For all other risk areas, chloroquine is the drug of choice.This comes from a great resource at www.mdtravelhealth.com/destinations/asia/china.html. Goes to show ya...those of us who live here, especially those living outside the cities, really need to stay on top of this stuff. We really ain't in Kansas anymore.
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Post by Mr Nobody on Apr 22, 2005 20:05:57 GMT 7
I am moderately sure that Guangdong was reported as a minor risk area also. And my doctor said that a good solid course of the antibiotic will give a slowly diminishing resistance for quite some time afterwards, or between doses of real and fake ones.
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Post by Raoul Duke on Apr 22, 2005 20:27:32 GMT 7
From what I gather, exactly where you live seems to be key. The cities are pretty safe...probably not worth taking the meds in most of them. But wet rural areas- jungle, rice paddy, riversides, warm rainy mountain areas, etc.- seem to be pretty high in risk. It's probably a good idea to think of it that way rather than in terms of an entire province.
By the way, the above link is now on our Links page for easy reference later.
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Post by Jollyjunklass on May 18, 2005 1:49:25 GMT 7
Hi guys,
Well I made my appointment today to get all my shots done, I go in June. Anyway, I was taken aback by the price of these vaccinations, I did not expect it to be so costly. These were the prices I was quoted, Canadian funds: Hepatitis, 3 shots at $60.00 each (one to take place in China, so unsure of price of third shot); Rubella, $40.00; Japanese Encephalitis, $100.00; Typhoid, $100.00; Rabies, 3 shots at $100.00 a pop and tetanus, may be free. This totals a whopping $720.00, yikes.
There will also be other costs with, just in case, prescriptions.
I would like to bring this figure down, quite a bit if I can. My thoughts are forgo the rabies and the Japanese Encephalitis. Any suggestions out there, what have you guys managed to get by on or did you receive them all. I mean, even if I could knock off the rabies, what do you think?
Did any of you receive any of these shots there, cheaper, perhaps?
Thanks
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Post by George61 on May 18, 2005 3:47:17 GMT 7
From memory, (which could be dangerous) I did the Tetanus, Hepatitis, and had a booster for Polio. I've got it writ down somewhere. It's been over three years since this was done. I might need a refresher course soon.
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Newbs
SuperDuperBarfly!
If you don't have your parents permission to be on this site, naughty, naughty. But Krusty forgives
Posts: 2,085
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Post by Newbs on May 18, 2005 6:31:46 GMT 7
I AM NOT A DOCTOR, THIS IS SECOND HAND.
George, from what I've been told Tetanus and Polio are good for 5 to 10 years. Hepatitis, depends on what letter follows.
With Malaria I've heard that the side effects can sometimes be nearly as unpleasant, and have long-term repercussions, as the disease. Anyone else heard this.
Millana I didn't have the innoculations for Rabies and Japanese encephalitis, and now I wish I did. I don't have the diseases, but it would be nice for the peace of mind thing.
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Post by Lotus Eater on May 18, 2005 7:21:29 GMT 7
AGAIN this is not medical advice - but my doctor said that the malaria stuff is almost useless as it only covers a couple of types of malaria.
I do not take any malaria stuff - but I have an inbuilt protection - I am thallasaemic and the only good side of that is that it does prevent malaria.
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Post by Mr Nobody on May 18, 2005 8:11:22 GMT 7
JE and Rabies - get Rabies in China only if you go to certain areas, cheaper there at 180 rmb for the whole course. I will get it there. I tend to pet animals.
JE, only get Chengdu Biological Institute, better to get in HK or China.
The other JE are no where near as effective. Somewhere is my post on this.
Polio needs a booster? How about TB?
Maybe i should get a test. I was told by the doc that I do not need boosters for these, they were for life. I will check.
No vaccine as yet for malaria, can get antimalarials in China. No script needed, see previous post by, I think, Burl.
Tetanus booster needs to be about 5 years in China, 2 years rural or if go barefoot. 10 years if civilized. Rabies is for 3 years only! Hep is for life, but only if you have the complete course, or otherwise it is useless - approx 20% protection for around 12 months.
Flu vaccine currently is in short supply in OZ I may not get any, only for elderly at this time. If not I will get it in China also.
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Post by Jollyjunklass on May 18, 2005 12:03:47 GMT 7
Bond, Are you real sure about that, the rabies I mean. I did a calculation and that is $27.00 as opposed to $300,00, major difference. Do you know how much the JE is there? And only having two places which administer it, could be a bit of a problem. First off, I may have to quickly grab some Chinese folk off the street, get them to make an appointment for me, hang around until the appointment date arrives, etc., could be tricky. My other option may be, if I am somewhere close to those areas, wait a while, until I am more familiar with the environment. And then get the shots somewhere down the road. I forgot about TB. I had to pry the info. out of them over the phone. It sounds like you tell them where you are going and for how long, and then they arrange some type of package deal for you. At first she only mentioned the price of hep and the rubella shots, so it didn't sound too bad, but then I thought, well what about the rest. So I called back and started asking about specific prices for each one, she told me most, but, she also told me I would find out what else I needed when I went to my appointment. The malaria pills were something like 8 bucks a day, I'm not quite sure how all that works. So I said to her, well this could cost me up around a thousand bucks, and she said it may. That's way too steep. I would like to go to a rural place, hopefully, Guilin or Kunming, however these are the highest disease infested areas, so I am now second guessing this choice. The other areas don't require as many shots and meds. Anyway Bond, I see you said, maybe I should get a test. Well I also went to my doctor, and she is sending me for a slew of tests and blood work. I think some tests are able to check your immune status, and if your immune status is okay, you can forgo certain inoculations, however, I am not absolutely positive on this one. She is going to test my immunity for hep A & B, and Rubella. A couple of other little tidbits are, try to get a filariasis treatment (DEC). This is for worms, and only may be needed if you plan to swim in any freshwater lakes, streams or rivers. They also have oral re-hydration packets, so you don't have to get that IV business. Water purification tablets are another thought. Anyway, I am going to hold off on a few, especially rabies. I'll try not to venture into happy monkey territory until I get the shots. Hey Newbs, can't you still look into getting these shots over there. Are you north or south, what are the mosquitos like? I also found out about this stuff called permathrin, sounds pretty decent if you have to go into rural territory. You put it on your mosquito net or clothing and it will last up 'til 5 washes. Well, it almost sounds insane, like going into some jungle from a different planet, and as usual I'm probably over cautious. Better safe than sorry, I guess. It seems like Yunnan is a lot worse than most provinces, which kinda sucks. BTW Bond, here is a site I came across with some jobs where your gurlies at, not sure if they are any good, but they are worth a try, www.abroadchina.org/person/all.asp?key=7Once again guys, thanks all for the responses, I don't know what I'd do without you, I honestly believe I would have given up along time ago. In a way I hope Raoul doesn't get too many joiners to the site, not like the other big ones, they are too impersonal and stand offish, I might add. Sorry Raoul, but it's so cozy here, lol. It would be sad to see it end up like the other sites. Oh yeah, one last question, pleeese tell me no. Are there cockroaches in apartments there, I know Asians sure like to bring one or two over here. Any other apartment dwellers? I can handle any bug, outdoors, that you throw at me, but I don't like the thought of them crawling around in my home.
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Post by Mr Nobody on May 18, 2005 14:00:53 GMT 7
sorry, millana, i have accidendtally mislead you. The Chengdu Biological institute is a brand name. It is the best vaccine for JE available. One shot, 99.7% effective, fewer symptoms etc. But only available in China or HK. There are several brands available in China, but the others are not as good as this one, and many are not as good as the ones yu can get at home.
Rabies cost is current price as by the gf at this moment in Nanning. yes, 180 rmb for the whole course. I intend to get it because pets get rabies too, and i pet animals, can't help it. I like animals. I forget they can bite or scratch.
If you go to guilin we will be neighbours - only about 5 hours apart by bus.
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Post by Lotus Eater on May 19, 2005 20:34:49 GMT 7
ROFL!! I wouldn't worry about the filariasis treatment - the freshwater rivers, stream and lakes here are generally not safe for swimming - they are usually way too polluted. I have only seen clean water in high mountain areas and ONE river in 'normal' living areas that you would even consider trying. Hebi has this river -the Qi He.
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Post by Jollyjunklass on May 20, 2005 0:18:50 GMT 7
Hey Lotus, In the vidoes I'm watching, kids are constantly jumping into brown waters, what's up here.
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Post by Lotus Eater on May 20, 2005 6:42:22 GMT 7
They might - but I can guarantee that you will take one look at the murky brown water, the grunge floating in it and consider what else WILL have been put in it and change your mind about that lovely cooling dip.
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Post by Dragonsaver on Aug 25, 2005 22:42:02 GMT 7
Can I get the immunization in China? I can get the 1st one for Hep A & B but not the rest. Can I get the other there. There is NO TIME for me to get them here. I am getting Typhoid here because the DR. said I needed it. I don't see it on the list but maybe I missed it. Anyhow, I really need to know if I can get the shots and/or boosters in China. It will take one worry off my mind. That will leave me with 4000+/- worries to deal with.
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Post by Raoul Duke on Aug 26, 2005 0:26:26 GMT 7
Yes, you can get the boosters in China. Be sure and bring over accurate records of what you've had so far. There are "Western" versions and "Chinese" versions of most of these shots. Once you've started one track you need to finish on the same track. However, the Western versions, while more expensive, are indeed obtainable in China.
Your possible destination raises a double caution for you. You (DS) were talking about a small, obscure city in a poor agricultural province. In general the closer you get to the countryside (poor sanitation, use of raw human sewage as fertilizer, etc.) the greater the risk. This doesn't mean you shouldn't go there, it just means you should take the risks more seriously. (It also doesn't mean people in the biggest cities don't need these precautions!)
At the same time, the smaller city may not have the vaccines you need available. You may have to go to a larger city to get them. It's worth the trip. Please get all the shots and keep them current.
Do take your doctor's warnings about typhoid seriously. Nasty, nasty stuff and they do have it here...again, especially in the less developed areas.
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Post by Jollyjunklass on Aug 26, 2005 1:47:59 GMT 7
Raoul,
Typhoid is the one shot I did not get. Do you think I will be able to get this shot in Hunan, maybe Changsa?
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Post by Raoul Duke on Aug 26, 2005 1:58:58 GMT 7
Yes, you should be able to get the typhoid shot in Changsha. Don't put it off!
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Post by Dragonsaver on Aug 26, 2005 2:11:10 GMT 7
Raoul
I know nothing about the city or province where I am going. I put a request in the "Request for City Info", but had no replies.
I have not signed the contract yet, waiting for medical. Please, if you know about the area etc. let me know as I don't want to mess-up by accepting something I shouldn't.
I have to e-mail them to-night and ask some more questions, so illuminate me dear leader of wisdom.
Thankx
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Post by Dragonsaver on Aug 26, 2005 9:39:23 GMT 7
Raoul sorry to hear you are super meggameggamegga busy. Thanks for the advice. I have asked for info on follow-up inoculations at the University Hospital.
I looked up the location through Google and it is a 'new' city with a lot of tourism etc.
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Post by Raoul Duke on Aug 26, 2005 11:52:20 GMT 7
Hey DS, commented on another thread. Seem to remember Hebei? If so, there is some high potential here for dirty, isolated, and backwards. Note that cities will not come out and say this on their web site... Afraid I don't know this town at all. But I figure that if this is the province where they made Hamish live, it must be pretty grim...
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