Aside from safety concerns, the issue that is most often on the minds of older people planning extended travel in Asia is their health. This is particularly so for travellers to the tropical countries and to areas outside of the big cities.

Asia is a relatively safe continent in which to travel from a personal safety perspective — and that’s been covered in a previous article here — but there are many tropical illnesses and diseases that can be contracted in Asia if the right precautions are not taken.

From a health perspective, Asia is a safer continent in which to travel than Africa and some other tropical regions of the world because of the generally higher standard of medical services available should treatment be required whilst travelling.  But proper trip preparations are important to reduce the chances of falling ill whilst on an extended trip.

Vaccinations

The first priority in trip preparations should be to ensure that vaccinations for serious illnesses and diseases are up to date, and you have all that are required for the countries you intend to visit.

Whilst you can check out what is required through various sources on the web, a more reliable way to ensure that you have all of the vaccinations that you will need is to visit a specialist travellers’ vaccination clinic, if you have one near where you live.

These clinics generally have more up-to-date information on what is required for each country. General practitioners who do not specialise in travel medicine may not have as much detailed information on every country, and you could end up receiving some vaccinations that are not necessary.

Take your proposed itinerary to the clinic with you because for some countries the vaccination recommendations may be different for urban and rural areas.

This aspect of the trip preparations needs to start several months before departure because some vaccinations require booster shots. And in any case, it’s best to ensure that you are over any discomfort from side effects of the vaccinations well before you leave.

There is no risk of yellow fever in Asia, so no yellow fever vaccination is required for travel only to Asia. However, most Asian countries require proof of yellow fever vaccination if travelling to Asia from many countries of Africa or South America.

Traveller’s diarrhoea

If you do experience illness whilst on extended travel in Asia, it’s more likely to be traveller’s diarrhoea — also known as the Bali belly, Delhi belly or Turkey trots — than anything more serious like malaria or dengue fever.

Unfortunately about a third of all first-time visitors to Asia will come down with traveller’s diarrhoea (TD) at some stage, but there are simple precautions that you can take to minimise the risk of this happening to you.

Contaminated water is one of the most common causes of TD, so avoiding salads and fruit that can’t be peeled is wise. Of course, if you are staying in five-star hotels or eating in upmarket restaurants where filtered water is used for washing fruit and vegetables, the risk is much less.

Another common cause of food poisoning is restaurant workers not washing their hands properly or using food ingredients that have not been properly refrigerated. The risk is much higher in smaller restaurants and those in rural areas.

Many travel guides recommend not eating at street stalls, but if you can see how the food is being stored and how it is being prepared, sometimes the risk of eating at a street stall is less than in a restaurant where you can’t see what goes on in the kitchen.

Places with open kitchens are a good choice because they are forced to adhere to high standards of food hygiene and preparation because everything is on view to patrons.

Many travel guides strongly recommend avoiding ice in drinks, but when you are in a tropical country, that can spoil the enjoyment of having an iced latte or a cocktail with ice.

It’s better to make a judgment call on whether to have ice in your drink based on what you see around you in whatever restaurant or bar that you are visiting. And don’t feel embarrassed to ask the waiter or proprietor whether they are using ice made from purified water.

What you should avoid is desserts using shaved ice. These are prepared using large blocks of ice that, although might be made from purified water, can be easily contaminated by handling during transport.

From time to time you may find yourself in locations where you have no choice but to eat in places about which you have doubts in terms of food quality or hygiene. In these cases it is advisable to take a TD preventative such as Travelan, which is a bovine colostrum powder capsule that contain E. coli antibodies.

These capsules will prevent or substantially reduce the effects of TD in about 90 percent of cases. They are a natural product so don’t have any bad side effects – the only known ones being some possible mild constipation when used for several days at a time, such as on remote area treks.

In the event that you are struck down with TD in situations where you haven’t taken a TD preventative, you will need to administer a medication to stop the diarrhoea and take oral rehydration salts to assist with the rehydration of the body.

These should be regarded as essential items in every traveller’s first aid kit because if you are struck down by TD, you may not always be in a location where medication and oral rehydration salts are readily available.

Malaria

The disease that most travellers worry about when in Asia is malaria, because there is no vaccination for malaria, only antimalarial prophylactics that will reduce the severity of the disease if contracted, and enable more time to get to a suitable location for treatment before it becomes life-threatening.

This map on the website of the International Association for Medical Assistance to Travellers shows that malaria is prevalent across a large swathe of tropical Asia, with the exception of the drier regions in the west. 

However, it is highly unlikely that you will contract malaria in any of the urban areas of Asia, and especially in the big cities. Expatriates living in Asia rarely give malaria a second thought, because most cases of malaria are contracted in rural areas where fewer expatriates live.

For those who do live outside of the cities, they know that preventing mosquito bites is the key to avoiding contracting malaria. Sleeping with a mosquito net if the bedroom is not well sealed with insect screens or air-conditioned, using an insect repellent containing DEET when outside in the hours around dawn and dusk, and wearing loose light clothing that covers as much of the body as possible will help to lessen the risk of contracting malaria.

If travelling to a rural area where you may be sleeping in rooms without mosquito nets, it is highly advisable to take your own. They are light and easy to pack and can usually be strung up to any sturdy light fitting without causing damage. The nets that are impregnated with permethrin are the best type to buy because they discourage mosquitos from trying to find a way in through a fold or small hole.

Permethrin is a chemical with very low toxicity, but DEET is not. Many travellers are reluctant to use repellents containing DEET, preferring instead to use natural products with ingredients like citronella, eucalyptus oil and lavender. Whilst these natural ingredients may help to keep a few mosquitos away, they are nowhere near as effective as DEET.

There are a lot of unsubstantiated claims about the effectiveness of natural oils and herbal repellents on the web because the sale of these products is big business.  The companies making those products know that most people would prefer to use an organic product on their skin than a chemical one.

I’m one of those people. I live in a rural area of the Philippines and I’ve tried them all. I can vouch for that the fact only the DEET based repellents are 100 percent effective against all types of mosquitoes.

However, you should avoid using the aerosol DEET repellents. You’ll risk getting the chemical in your eyes, in your hair and on your clothes. It is best to use the lotion type, which can be applied carefully to the face and to all other exposed areas of the body. And then once you are inside and unlikely to go out again, shower and change your clothes. That way you can minimise your exposure to the chemical.

Of course, many people don’t like smothering themselves in a DEET lotion twice a day, so it’s a personal choice as to whether to follow that regime to prevent mosquitos from biting you, or to take an antimalarial prophylactic.

There are four different antimalarial prophylactics available. The mosquitos in some areas of Asia are resistant to one or more of these so it’s important to consult with a doctor who has up to date information if you choose to take this option.

All are expensive and all can have nasty side effects, so for me the choice is usually to go with the DEET lotion. I only took an antimalarial once, and that was for a trip to the backwaters of Kerala. Fortunately I didn’t experience any side effects. But I didn’t experience any mosquitoes either. So maybe I wasted my money that time.

Dengue fever

Although I live in a rural area, I’m not far out of the city, so it’s not malaria that I am concerned about getting from mosquitos – it’s dengue fever. That’s the main reason I regularly use the DEET repellent when outside in the early morning or late afternoon. I’ve lived in Asia for more than 20 years and do not personally know of anyone who has contracted malaria, but I know of more than a dozen friends and work colleagues who have contracted dengue fever.

Dengue fever is prevalent over an even wider area of tropical Asia than malaria, extending up into southern China and down into northern Australia.

It is not as life threatening as malaria (although it can be if not properly treated) but it’s still a very unpleasant illness to have, usually requiring confinement in hospital in the early stages, and sometimes taking months to fully recover. Severe headaches and joint pains are the most common symptoms, often accompanied by a skin rash, nausea and vomiting.

Usually when it starts, people feel like a bad case of the flu is coming on, or even a stomach virus, but if it continues to get worse, and you think you may have been bitten by a mosquito, you need to have a blood test to determine whether it could be dengue fever.

The reason that it is important to get a proper diagnosis as soon as possible is that dengue can, on rare occasions, develop into dengue hemorrhagic fever, which is a potentially fatal complication. Older travellers, whose immune systems are not as strong as younger travellers, are more at risk of this happening.

There is a new vaccine for dengue fever, but when the first large scale vaccination programme was carried out on schoolchildren in the Philippines in 2016, three children died from complications that were suspected to have been caused by the vaccine. Another 11 deaths may have also been linked to the vaccine.

At the present time, the vaccine is only being recommended for patients who are known to have previously contracted one of the four dengue viruses, as trials have indicated that this minimises the risk of any complications occurring. Other dengue vaccines are still in their development or trial stages.

To avoid contracting dengue fever, follow the same advice as given above for malaria, and take precautions to prevent mosquitoes from biting you.

Japanese encephalitis

Another nasty disease that some travellers to Asia become fearful about is Japanese encephalitis. That’s because about a quarter of all people who develop the disease will die.  However, a very small proportion (less than one percent) of people who become infected by the encephalitis virus will actually develop the disease.

Japanese encephalitis is endemic across most of tropical Asia and large swathes of northern Asia too, as can be seen on this map. But it’s not a disease that is usually of much concern to locals because it’s not as common as malaria or dengue fever.

Preventing infection requires exactly the same precautions against being bitten by mosquitoes as outlined above for malaria and dengue fever. There is a vaccination available for Japanese encephalitis, but it is expensive (around $500 - $1,000). For that reason most travellers don’t get vaccinated unless they are going to spend lengthy periods of time in rural areas.

Unlike malaria and dengue fever, Japanese encephalitis cannot be transmitted from an infected person to another person - it can only be transmitted from pigs and water birds to people via a particular species of mosquito. That is why the risk of transmission is lower and primarily confined to rural areas.

Tuberculosis

This is a serious disease that is not always listed as a risk for travellers, but in parts of Asia where there is a high incidence of active TB, there is a small risk of contracting the disease when in crowded places such as shopping malls and markets.

TB is a bacterial infection of the chest that can only be spread by people coughing or sneezing in the vicinity of other people. It is not as easily caught as a cold or influenza, but nevertheless there is a small risk when you are in crowds.

The only prevention is to wear a surgical facemask in crowded places and many Japanese travellers do that as a matter of course.

Western travellers often feel self-conscious about wearing a facemask, but it is a sensible precaution for older travellers to consider because those with lower immune systems are most at risk of catching TB in public places.

The countries with the highest incidence of TB in Asia are Bangladesh, Cambodia, China, India, Indonesia, Myanmar, Pakistan, Philippines, Thailand and Vietnam.

Should you return from extended travel in any of those countries and develop a cough that doesn’t go away (or worse, cough up blood in the process), you should mention to your doctor that you have been travelling in Asia because in countries where there is a low incidence of TB, it may not occur to your doctor to initially test for TB if they do not know you have been travelling in a high risk country.

TB can be fairly easily treated these days once diagnosed, but requires the patient to take drugs three times a day for 6-9 months, so is not a disease to be taken lightly.

Deep vein thrombosis

Fortunately these days, most older regular travellers are well aware of the risk of deep vein thrombosis (DVT) – or more specifically venous thromboembolism – when travelling, and indeed most airlines contain warnings about the risk of blood clots in the legs in their inflight magazines.

But if travelling long distances on budget airlines where there is often no magazine or inflight video reminder, and seats are more cramped than on full service airlines, it’s more important to pay attention to the health warnings about DVT.

Getting up and walking around the plane is not easy to do on single-aisle aircraft because you are invariably bumping into flight attendants, especially at meal service times, so doing stretching exercises in the seat may often be the only option.

Wearing compression stockings for long flights is advisable for anyone over 60. It’s important to choose the correct size stockings. They should fit snugly but not overly tight.

Other ailments

Older persons who are travelling with any sort of chronic health condition should carry sufficient prescription medications with them for the entire trip because the same medications may not be available in all countries, and even where they may be, can only be purchased with a local doctor’s prescription.

Medications should always be carried in their original packing and with a copy of the prescribing doctor’s prescription.

In the event that any medications are lost -- or on rare occasions confiscated by customs – a local prescription can be obtained from a local doctor, but some doctors may not be willing to write new prescriptions without a medical examination or at least seeing the full medical history of the patient.

A good way to do that, without carrying paper files, is to store the medical history on a smartphone or tablet app or in cloud storage with a shareable link that can be provided to the medical practitioner.

For travellers who may be concerned about any health issues aside from those mentioned in this article, most countries in the developed world have well researched information websites that provide advice on travel health issues for travellers to almost every country in Asia.

The World Health Organisation’s website has links to the national websites for residents of the United States, Canada, Australia, New Zealand, the United Kingdom and seven other European countries, through which this information can be obtained.

Travel insurance

Many younger travellers spend months on the road with only the most basic travel insurance — or in some cases none at all — convinced that their young age will protect them from any serious illnesses.  Whilst that’s often the case, that’s not a risk that older travellers can take.

For any extended travel in Asia, older travellers should take out the best health insurance that they can afford.  This will not only give them piece of mind, but ensure that if they do succumb to any illnesses whilst on the road, they can seek treatment in an international hospital — of which there are many good ones in Asia.

It’s important to ensure that the coverage includes repatriation to their home countries in the case of serious illness (this doesn’t increase the premium much because this rarely happens and therefore insurers can spread the risk over many thousands of premiums) and also covers pre-existing conditions (which must be declared when taking out the policy).

Many policies only cover travellers up to age 65 or 70, so a special over-70s policy will be required for senior travellers. These generally cost more, but are worth the investment. The over-70s policies usually come with more restrictions, so read the fine print carefully when comparing policies.

Finally, do remember that as we age the stress of travel takes a greater toll on our bodies, so we need to take it much easier than we did on our younger days and take opportunities for rest whenever we can.

Remember too that for over-70s in particular, one of the most troublesome medical problems from travelling are broken bones or complications from falls.

In most Asian countries, health and safety regulations are less strict than in western countries, not properly enforced or even non-existent. Hazards like holes in footpaths, electric cables taped across shopping mall floors, open drains and the like, can present a range of perils that can result in serious injury for the older traveller.

So take things at a slow pace, watch where you walk, don’t forget to pack your medications, Travelan and DEET lotion, and you should be able to enjoy comfortable travelling in Asia with no health issues.

Header image: Nikolai Sorokin