Low standards of public hygiene, stress and overcrowded conditions are to blame for most of the health problems that beset travelers in China. It’s easy to become stressed and exhausted, leaving yourself vulnerable to infections. Travel at an easy pace, and treat yourself occasionally to upmarket accommodation. Take vitamins (buy them overseas before you arrive). Personal hygiene is one area it pays to be meticulous – wash hands often and don’t share drinks or cigarettes. When in the shower, always wear flip-flops or shower shoes, provided free at hotels. The smallest cuts can become infected, so clean them thoroughly and apply an antiseptic cream (buy it overseas before you arrive). With the majority of China’s water supply highly contaminated, water is the major cause of sickness. Don’t drink tap water, or use it to clean your teeth; avoid ice in drinks, be careful showering with water in your mouth or eye sockets, and never eat the ice lollies sold on the streets.
Chinese who live their life in China have built up immunities, but most foreigners will get sick at very basic things. Either pollution levels affecting dizziness and eyesight and throat, fake food and drink, or even more basic, brushing teeth or having a shower with your eyes open.
Bring medication and extra medication where ever possible. Obtaining foreign drugs, or even their equivalents is difficult, sometimes impossible, and sometimes highly questionable in China due to fakes. Keep copies of the prescriptions or details about the medicine with the medicine – English is OK. If bringing vitamins, keep them in the original containers.
It is very important to bring an anti diarrheal agent — (Imodium is great), and any other prescription drugs required. Further, if you easily get flu/colds or sick, I strongly recommend a supply of both Tylenol Day Time Non Drowsy FLU and wide spectrum Antibiotics.
To stay healthy is a challenge in China – you need to always be aware of your surroundings… Drink plenty of high end clean bottled water, avoid excessive drinking, get lots of sleep, avoid fake drinks & food wherever possible, anticipate colds, and be prepared with medicine to fight it.
90% of China’s urban groundwater is contaminated. Water quality is very poor and you may develop intestinal problems if you use tap water to brush your teeth, or if you eat vegetables which have not been cooked after having been rinsed in tap water. Bring Pepto Bismol help prevent intestinal troubles and Imodium for when it’s too late.
Be careful not to get any water in your mouth or eye sockets when you shower. It tastes normal, but could easily make you sick. Always brush your teeth with bottled water – the 4 and 5 star hotels catering to foreigners will supply bottled water for free for this purpose.
Cheap bottled water that was filtered with nylon filters is still commonly sold. Only buy name brand bottled water in big supermarkets.
Food & Drink
Food safety is one of the most serious and sensitive recurring issues in China.
Be aware of the dangers initially of eating street food and drinking water. It’s very, very, very common for foreigners to get very sick easily in China by not being careful and prudent in what they eat/drink.
- The street food smells great, looks interesting and is tempting, however, it is the most frequent reason foreigners get sick. Take some time to build up your immunities – at least 3 or 4 weeks, before you consider tasting.
- Similarly, NEVER ever eat runny eggs, watery salad, pink chicken or other semi cooked items until your bodies get adjusted — about 6 months).
- Be very wary of hard shelled fruits such as watermelon or cantaloupe, since these are sold to markets by weight and growers routinely inject river water into the fruit as it’s growing to make them heavier and plumper for sale.
- Also be wary of bottled water and soft drink bought on the streets – check the seals — most is counterfeit.
- Many (actually most) bars and KTV outlets sell fake common “well” liquor (vodka, scotch, gin, rum, tequila) – you have no idea what is in these.
China is a smoking country – it’s one of the few vices that is widespread and enjoyed. You will see ashtrays everywhere – people in China smoke nearly everywhere, and while the number of Chinese that do not smoke is growing, non-smokers have been forced to become accustomed to second hand smoke, particularly in 2nd tier cities, in taxis, offices, hotels, restaurants, elevators etc..
For the non-smokers coming to China, there is little that can be done about the 2nd hand smoke that will be in hotel rooms, offices, theatres, taxis, restaurants etc.. You will still smell smoke, breath smoke, and the Chinese around you are unlikely to put out there cigarettes easily. There is nothing that can be done about this.
Indeed, in China, smoking is considered a privilege by many, and as a result, even in government meetings and banquets, you may be offered expensive cigarettes reserved for use by the wealthy and powerful as a status symbol. It IS acceptable, as a foreigner, to politely decline – particularly singers, dancers and musicians.
Both Beijing (as of 2015) and Shanghai (as of March 2017) are taking measures to curb smoking in hotels, restaurants and bars.
Remember, the pollution is far worse.
There are no vaccinations that are required for a trip to China unless you are coming from a country that has a high risk of yellow fever. That said, it is a good idea to be up-to-date for your vaccination shots and immunizations before you arrive in China.
See your local doctor or physician to determine which of the following vaccinations is right for you. The CDC (Center for Disease Control) recommends that you be current on all your routine vaccinations. Check the CDC website for the latest recommendations. The following vaccinations are recommended for your consideration for China:
- Hepatitis A – available for all travelers to China older than 12 months. Hepatitis A is a viral infection spread by contaminated food and water which causes an inflammation of the liver. Symptoms are yellowing of the eyes and skin, preceded by fever and pains in the upper right abdomen. The traditional one-shot vaccine gives protection for about 3 months.
- Hepatitis B – available for anyone older than 5 years. According to the CDC, China has a high risk for this disease. Hepatitis B virus can be passed on through unprotected sexual contact, transfusions of unscreened blood and dirty needles. Though the disease occurs worldwide, it’s especially prevalent in parts of China, so it’s worth asking your doctor about the vaccine (typically 3 injections over 6 months), particularly if you intend to travel through Asia for 6 months or more.
- Typhoid – mostly for those who are traveling to rural areas or smaller cities (basically anywhere other than Shanghai, Beijing, Guangzhou). Also very good if you plan to try food that isn’t prepared in a 4/5 star restaurant due to the amount of tap water used in cooking. [see below for more detail]
- Cholera – most western health practitioners recommend it. [see below for more detail]
- Meningitis – a serious problem in Tibet and rural areas of China
- Rabies – recommended for those who might find themselves hiking in the China backwoods or visiting monkey (south of China), horses (north of China) or other animal parks.
- Tetanus – Remember also that a tetanus booster is required every ten years.
Certain areas of China involve a higher risk of disease, so if you will be traveling to one of the following locations, please consider asking your doctor for their recommendations on the following:
- Xinjiang – Bird Flu and Polio
- Rural China – Malaria, Typhoid, and Japanese encephalitis
Always refer to a qualified physician before making any decisions about vaccinations. Vaccinations can be costly, so make sure you have room in your travel budget – the cost to prevent these diseases is always cheaper than to cure them!
It’s also wise to get a dental check-up, and if you decide to take a course of anti-malarial tablets, start taking them before you go.
In ALL cases, get an International Certificate of Vaccination for each one you have, and make copies of it, and keep one copy with your passport at all times. You may need the certificate.
Diarrhea is the most common illness to affect travelers, usually in a mild form while your stomach gets used to unfamiliar food. The sudden onset of diarrhoea with stomach cramps and vomiting indicates food poisoning. Get plenty of rest, drink lots of bottled water. These are the primary forms:
- Dysentery is inflammation of the intestine, indicated by diarrhoea with blood or mucus and abdominal pain. There are two strains. Bacillary dysentery has acute discomfort, fever and vomiting, plus abdominal pains with bloody, watery diarrhoea requiring antibiotics.
- Amoebic dysentery is more serious as bouts last for several weeks and often recur. The gradually appearing symptoms include bloody faeces accompanied by abdominal cramps, but no vomiting or fever. Antibiotics are needed.
- Giardiasis is distinguished by smelly burps or farts, discoloured faeces without blood or pus, and fluctuating diarrhoea; treatable in hospital with an antibiotic.
Typhoid and cholera are spread by contaminated food or water, generally in areas outside of Shanghai and Beijing. The varied symptoms of typhoid include headaches, high fever and constipation, followed by diarrhoea in the later stages. The disease is infectious and requires immediate medical treatment but it’s also difficult to diagnose. The first indication of cholera is the sudden but painless onset of watery and unpredictable diarrhea, later combined with vomiting, nausea and muscle cramps. The rapid dehydration caused by the diarrhoea rather than the intestinal infection itself is the main danger.
Mosquitoes are widespread throughout southern China, particularly if you’re visiting tropical regions in southern China. Carried by the anopheles mosquito, malaria is caused by a parasite which infects the blood and liver. Symptoms are flu-like fever with hammering headaches, shivering, and severe joint pain. If you’re travelling in a high-risk area it is advisable to seek professional medical opinion well prior to arrival.
Aedes aegypti mosquitoes, identifiable by their black-and-white stripes, are responsible for transmitting dengue fever, a viral disease whose symptoms are similar to malaria, though there’s sometimes also a rash spreading from the torso over the limbs and face. There’s no cure, and though symptoms subside on their own after a week or so of rest, chronic fatigue can keep you in bed for months afterwards.
The key measure with both diseases is to avoid being bitten in the first place. Mosquitoes are most active at dawn and dusk, so at these times wear long sleeves and trousers and avoid dark colours, and use repellent on exposed skin. Repellent containing about forty percent DEFT (diethyl toluamlde) is effective, but the chemical is toxic and prolongued use can cause side-effects keep it away from eyes and open wounds. Air conditioning and ceiling fans at higher speed help keep mosquitoes away as do mosquito coils – but really only effective indoors.
After the water issues, the most common hazard to your health in China is the host of flu infections, mostly in the winter months. The problem is compounded by the overcrowded conditions, chain-smoking, intense pollution and the widespread habit of spitting, which rapidly spreads infection. Initial symptoms are sore throat, chills and a feeling of malaise, followed by prolongued bouts of bronchitis. Drink lots of fluids and get plenty of sleep.
More serious is tuberculosis, a respiratory disease transmitted by inhalation, and spread by coughing and spitting (which is why China has a high incidence). It strikes at the lungs and in a small number of cases can be fatal, There is no need for visitors to be overly worried about the disease – many people are immune thanks to previous, mild infections or through childhood vaccinations. If your trip will involve spending a lot of time on crowded subway, trains or buses, it’s worth consulting your for about your TB-immune status.
The Ministry of Public Health and the Ministry of Public Security requires that all foreign workers staying in the country for a certain period of time are required to undergo medical checkups within 30 days of arrival. These medical checkups are mandatory.
The health check must be done within 30 days of entry into China. A Mandarin speaking friend will be needed to help with paperwork. When you go for your health check you will need:
- Your original passport
- Color copies of your visa
- Color copies of the data page of your passport
- Several photos of the specified size and type (usually only one or two are needed).
- The fee (typically paid by WeChat, AliPay or cash)
Specific requirements may vary from city to city so check in advance if you’re not sure.
The medical checkup is very simple, you are taken to an approved foreigner medical facility, taken into a locker room, put on hospital robe and hospital shoes, then you move from room to room carrying your medical chart, the process is surprisingly efficient, and the facility clean. The examination nominally takes about 30 minutes. The medical examination includes:
- Height, Weight, Blood pressure, Body temperature, Internal medicine, EENT; B-ultrasound (liver, gallbladder, spleen and kidneys), EKG, Chest X-Ray, Laboratory tests: Blood Routine, Blood type, Urinalysis, HIV, TPPA, Hepatitis B surface antigen, Anti-HCV, ALT etc.
- Infectious diseases check including: Influenza, Poliomyelitis, Malaria, Dengue fever, Relapsing fever, Epidemic typhus, syphilis and AIDS (including HIV infection). This also includes Hepatitis B, Plague, Cholera, Yellow fever and other infectious disease which are confirmed by the State Council.
The main reasons your visa may be refused on health grounds are if you show signs of, or are diagnosed with, psychiatric illness, infectious Tuberculosis, or other infectious diseases which in the opinion of the supervising doctor can endanger public health or security. In 2010 there was a relaxation in immigration policy which previously prevented people with HIV and leprosy entering the country. Officials now have more leeway when deciding whether to issue a visa on health grounds.
Note: If you have a Cholera vaccination before you arrive, it will still be active in your system during the time of the medical exam, which could lead to serious complications! Speak to your doctor about this conundrum. Others have SOMETIMES found by having the western doctor issue a special letter plus certificate of Cholera vaccination on a specific date, it has allowed the local medical examiner to still approve your health examination, based on that.
In general, look for the largest hospital in the biggest city in the area. In Shanghai or Beijing, you’ll find international hospitals with English speaking doctors and staff. Some larger, upscale international hotels in China even have an English-speaking doctor or nurse on-site. See EMERGENCIES for details.