Travel Vaccinations & Health Advice for Cambodia

People travel to Cambodia for many reasons. Many visits are recreational – to historic places like Siem Reap, the major centre of Pnom Penh and for cruising on the Mekong. Some trips are for business, particularly for not-for-profit organisations. Many others are for reunions with family and friends. It is also increasingly common to see Australians involved in long term humanitarian work.

Cambodia is also popular destination for school trips. There is much to appreciate in Cambodia, particularly if you are in your teens. Business travel tends to be to major cities while individual and family travel can be anywhere.

It is impossible to provide advice on whether malaria prophylaxis is required or not in a generic way. It must be individual. You can never say there is no risk of malaria anywhere in Cambodia.

You can say the risk of malaria might be low in the major populated centres of Pnom Penh and Siem Reap but you can never say there is NO risk. CDC considers the risk to be minimal in the major centres and around Angor Wat.

Travel medicine providers must balance the risk of the disease against potential side effects and costs associated with medication. This isn’t always easy when itineraries may change. Certain aspects of the trip must be considered. These include time of year (higher risk during the wet warmer months), rural versus urban (malaria transmitting mosquitos prefer clean stagnant water rather than polluted urban water) and accommodation (higher end with air conditioning versus basic homestays plus or minus nets). All influence risk of exposure.

Mosquito avoidance measures are important irrespective of risk perception.

It is also unfortunate when advice is out of date with the current situation.

WHO provides regular updates on the malaria status of several countries in the Greater Mekong Subregion (Cambodia, Laos, Myanmar, Thailand, Vietnam and the Yunan province of China). There is a regional focus on malaria elimination by 2030.

The strategy has achieved a substantial reduction in malaria cases of 77% since 2012 including a reduction of the serious form, Falciparum malaria of 94%. Notifications were more than 10,000 per year in 2012 and there were less than 500 reported cases in 2022. This is a remarkable achievement.

Understanding malaria, the disease, and the mosquito, plus mosquito avoidance measures, is just as important as the advice on whether prophylaxis is required.

It is always particularly important to investigate a fever of unknown origin as soon as possible. This applies even if taking prophylaxis.

Eating and drinking safely is import in Cambodia. Traveller’s diarrhoea is a common health issue.

Most cases occur in the first week of travel and the illness can last for 3-5 days (not good if you are away for a week or travelling for business).

Traveller’s diarrhoea is more associated with contaminated food – quite different to the viral diarrhoea we see in a childcare setting where the disease is easily passed on by close contact or contaminated objects or hands.

The risk of traveler’s diarrhoea can be reduced by paying good attention to the rules of eating and drinking safely while overseas. In Cambodia you have the option of stir fry cuisine including piping hot rice, a variety of cooked vegetables and bottled water. Keeping your hands clean should be the gimme! Eating salads in a five-star restaurant is very different to salads in a street café. Shellfish are always risky in any setting, particularly in areas where water contamination is common.

Carrying medication in the event of illness is very important, particularly if heading to the airport or about to embark on an organised bus outing.

Cambodia does have a risk of exotic disease. Some vaccinations are recommended but you don’t need to go over the top.

Most travellers would be advised to have their routine immunisations current and strongly consider Hepatitis A. You might not consider a flu vaccine under normal circumstances but taking a break in the middle of winter and transiting airports does put you at risk. A true flu can last 5 to 7 days and make you a very undesirable travelling companion, particularly if it’s a special occasion.

The other “food and water vaccine”, typhoid, might be considered for the more adventurous eaters or if staying with friends and relatives in a more rural setting. Cases of typhoid do occur.

Accommodation in Cambodia can range from 5-star resorts to backpacker homestays. Water and sanitation issues are much more likely in those staying in basic accommodation. Cruising on the Mekong is also popular, and cruise boats come in all sizes. Time ashore needs to be considered.

There is no vaccination for traveller’s diarrhoea but attention to the rules of eating and drinking safely should help to keep you safe. Some people seem to be at a higher risk of travellers diarrhoea while others might be on medications which might increase their risk.

Other more exotic vaccines for the prevention of rabies, japanese encephalitis and cholera really depend on what you intend to do, time away and season of travel. Those offered to a long-term resident might be very different to a short-term visitor.