World Country Guide

1
A yellow fever vaccination certificate is required from all travellers arriving within six days of leaving an infected area.

2
Following WHO guidelines issued in 1973, a cholera vaccination certificate is not a condition of entry to China. However, cholera is a slight risk in this country and precautions could be considered. Up-to-date advice should be sought before deciding whether these precautions should include vaccination as medical opinion is divided over its effectiveness. For more information, see the Health appendix. A strain of Bengal cholera has been reported in western areas.

3
Poliovirus transmission has been shown by reliable data to have been completely interrupted since 1994 through eradication programmes.

4
Malaria risk exists throughout the country below 1500m except in Beijing, Gansu, Heilongjiang, Inner Mongolia, Jilin, Ningxia, Qinghai, Shanxi, Tibet (Xizang, except in the Zangbo River Valley in the extreme southeast) and Xinjiang (except in the Yili River Valley). North of 33N, the risk lasts from July to November, between 33N and 25N from May to December, and south of 25N throughout the year. The disease occurs primarily in the benign vivax form but the malignant falciparum form is also present and has been reported to be multidrug-resistant. The recommended prophylaxis in risk areas is chloroquine, or mefloquine in Hainan and Yunnan.

Food & drink
Outside main centres, all water used for drinking, brushing teeth or freezing should have first been boiled or otherwise sterilised. Only eat well-cooked meat and fish, preferably served hot. Pork, salad and mayonnaise may carry increased risk. Vegetables should be cooked and fruit peeled.

Other risks
Bilharzia (schistosomiasis) is endemic in the central Yangtze river basin. Avoid swimming and paddling in fresh water; swimming pools that are well chlorinated and maintained are safe. There is some risk of plague. Hepatitis E is prevalent in northeastern and northwestern China and hepatitis A is common across the country. Hepatitis B is highly endemic. Tuberculosis is common in indigenous populations. Oriental liver fluke (clonorchiasis), oriental lung fluke (paragonimiasis) and giant intestinal fluke (fasciolopsiasis) are reported, and brucellosis also occurs. Bancroftian and brugian filariasis are still reported in southern China, visceral leishmaniasis is increasingly common throughout, and cutaneous leishmaniasis has been reported from Xinjiang. Haemorrhagic fever with renal syndrome is endemic. Precautions should be taken against Japanese encephalitis, particularly in rural areas. Mite-borne or scrub typhus may be found in scrub areas of southern China. Altitude sickness can be a problem in parts of Gansu, Qinghai, Sichuan, Tibet, Xinjiang and Yannan. There are still habitual occurrences of avian influenza (bird flu) and the SARS virus.
Rabies is present, although the Government policy that bans dogs and cats from main cities makes this less of a risk in these areas. For those at high risk, vaccination before arrival should be considered. If you are bitten, seek medical advice without delay. For more information, consult the Health appendix.

Health care
Medical costs are low. Many medicines common to Western countries are unavailable in China. Medical facilities in international hospitals are excellent. There are many traditional forms of medicine used in China, the most notable being acupuncture. Medical insurance is strongly advised.